002: Demystifying Medicare – Dawn McFarland

Marty Stevens-Heebner: (00:02)
Moving your mom or your dad, or yourself, isn't just about moving things from one place to another. It is much more complicated than that, as are so many things having to do with later life. How to move your mom, and still be on speaking terms afterward, provides in-depth conversations with professionals, older adults and their family members, who share their stories with warmth, understanding, and humor. I'm your host, Marty Stevens-Heebner, and here you'll find answers to many of your questions, as well as different perspectives that I hope will inform and inspire you.

Marty Stevens-Heebner: (00:41)
Today, I get to talk to Dawn McFarland, who is the founder and president of M&M Benefit Solutions Insurance Services. She really has a passion for helping people navigate the often confusing path to how they receive their healthcare. And especially she works with people who are eligible for Medicare, because I know that's a big mystery for a lot of people.

Marty Stevens-Heebner: (01:02)
Dawn currently serves as the vice-president of legislation for the State of California Association, on the Medicare Advisory Council for the National Association of Health Underwriters, and because she's not busy enough already, she's also a certified community educator for the Alzheimer's Association. Welcome, Dawn, and thank you so much for joining me. And I don't know how you made time to sit down with me given that crazy schedule you must have.

Dawn McFarland: (01:28)
I appreciate you so much, Marty, and I'm grateful to be able to have a conversation with you and hopefully get more information out there. You know I like to educate people.

Marty Stevens-Heebner: (01:39)
And you are superb at it. You even organized that conference during COVID last year. That was amazing. You were so great.

Dawn McFarland: (01:47)
Thank you.

Marty Stevens-Heebner: (01:48)
You're welcome. And I was honored to be a part of it, thank you. So let's start by having you talk about your favorite memory of your grandparents.

Dawn McFarland: (01:56)
I love that question. I lost both my closest grandpa and grandma, who are my mom's parents, I think we're going on three years now, ago. And I tell my husband all the time I miss my grandpa like nothing else. He was the best male figure I had throughout my life. So I would say when I look back on all the memories... And there were a lot, they were super involved in my life... I think the best memories were they used to house sit for a couple in Evergreen, Colorado. I grew up in Colorado.

Dawn McFarland: (02:38)
They used to house sit for this couple in Evergreen, and when I was in my younger years... I don't know, I think I was pre-seven, eight-years-old, the Higgins... We called them the Higgins, that they had a house that was... It almost felt like a fairy tale, because there was a big hill behind it and there was a creek down below. It was always fun when we went to see grandma and grandpa up at the house. It was like a vacation.

Marty Stevens-Heebner: (03:04)
It's magical.

Dawn McFarland: (03:05)
It was magical.

Marty Stevens-Heebner: (03:07)
Yeah, especially when you're a little kid. How beautiful. That's wonderful. You have such a specific field in insurance, and it is so vital because people are completely mystified by Medicare. What do you love about what you get to do?

Dawn McFarland: (03:22)
The first thing that I like, and I feel like it's the most important thing, is that I love working with gratitude. I've worked with customer service pretty much my entire career. It's been something customer service related. But there's something special about working with the senior market, especially when you help them. They are so grateful. And when you are living day in and day out helping people and they feel grateful, then that's my favorite thing. I love working in gratitude. And the second thing is I like to problem solve. I'm a total geek.

Marty Stevens-Heebner: (03:55)
I love that about you. Yes, it's so great.

Dawn McFarland: (03:59)
So obviously, that's a big problem-solving game. And every situation's unique, so it's never boring.

Marty Stevens-Heebner: (04:05)
I can only imagine. And you were talking about working with gratitude. You yourself exude that. You are very generous and so helpful with all kinds of information. I know you've been very helpful to me.

Dawn McFarland: (04:19)
Ah, thank you.

Marty Stevens-Heebner: (04:20)
Yeah, so it's no wonder you get a lot of gratitude back. No wonder. And tell me about a great client story, especially one that was a little bit complicated, so people can understand the process. That would be wonderful.

Dawn McFarland: (04:34)
A client who was referred to me by another client, and this woman is someone who... This happened during last year at COVID, and she didn't feel technology savvy particularly, but she was brave enough to hear instruction and work through it. She didn't have anything outside of her original Medicare, and she's starting to have more serious heart problems. And what I was able to do was not only walk her through that... And she's nervous, right, because all of these. And it's COVID and nothing felt stable.

Dawn McFarland: (05:18)
I feel like we were able to navigate her into a plan, work through all of the issues with guaranteed issue, get her into a plan that she's satisfied with that is really ultimately helping her save a lot of money. Because if you don't have anything outside of original Medicare, you're paying 20% of the bill, so not having something in place, and then also prescriptions on top of that. So that's what comes top of mind for my favorite story right now.

Marty Stevens-Heebner: (05:46)
I love that. What makes the whole Medicare route so complicated?

Dawn McFarland: (05:52)
Part of it's a good thing. It's choice. So it's good that there's so many choices. That's not the bad part. I think the hard part is how many deadlines that there are that definitely make a difference. If you don't enroll in Part B in the proper amount of time, you could face a penalty for the rest of your life as long as you're on Medicare. Same thing with Part D. So it's avoiding the pitfalls of the deadlines, making sure you're covered properly, not having lapse in coverage so you don't face those kinds of penalties. And again, it works a bit differently than how we... Usually up until we hit that age, we have employer health insurance or the individual insurance, and the market doesn't work quite the same.

Marty Stevens-Heebner: (06:40)
Very interesting. Is there an explanation of why it doesn't work similarly, or it's just bureaucracy?

Dawn McFarland: (06:48)
So part of the way in which it's different is because it is partially through the government. We pay taxes to receive our Medicare, so there's a lot of regulation from the government as well. And elder fraud abuse, the potential for people to get in trouble, it's always out there. So I understand why there's so many strict rules. I think just making sure that you have someone to guide you through it, it becomes not so complicated. Someone just has to understand all those little bits, and then once you get it, it's not that complicated.

Marty Stevens-Heebner: (07:27)
Oh, that's wonderful. That's wonderful. What pitfalls... Okay, so let's talk about the deadlines. So is it in regard to one's age? Is it a time of the year? What [crosstalk 00:07:39]?

Dawn McFarland: (07:39)
A lot of people are working past age 65 now.

Marty Stevens-Heebner: (07:44)
I will be, and I look forward to it.

Dawn McFarland: (07:46)
Yeah, me too, actually. So turning 65 is a trigger. And if you don't have health insurance in your employer and you turn 65, you need to get Medicare because you're not going to be covered. Individual plans will no longer cover you. So turning 65 is a trigger.

Dawn McFarland: (08:08)
And you have three months before your 65th birthday, the month of your 65th birthday, and three months after your 65th birthday to be in what they call that initial enrollment period, which you're not going to pass any deadlines, create penalties, or miss opportunities for guaranteed issue. Because that's also a difference between your current medical world and the Medicare world. There's underwriting when it comes to supplements. Not the Medicare Advantage plans, but the supplements. So I would say that's probably the biggest deadline.

Dawn McFarland: (08:44)
And then if you're employed and you have employer coverage, there's some rules. So if your employer has less than 20 employees, you have to... Usually Medicare will pay first, so you need to figure that out. And you're not always advised by your employer that you need Medicare. You think you're going along fine with the health insurance plan through your employer. If something happens, that's when you find out that you should have had Medicare, because Medicare pays first. So that's a scenario.

Dawn McFarland: (09:13)
And then if you work for an employer that has more than 20 employees, your employer coverage is likely going to be credible coverage, so you don't need Medicare until you retire from that employment.

Marty Stevens-Heebner: (09:22)
So in other words, if it's a bigger company and you're covered by your employer, it's okay if you miss that deadline around 65?

Dawn McFarland: (09:31)
Yep, you can waive Medicare until... And oftentimes I'll recommend that you do that, because why pay a Part B premium when you're getting covered by your employer?

Marty Stevens-Heebner: (09:42)
Yeah, yeah. And everybody thinks oh, Medicare will cover everything. No, it doesn't. I especially know this hanging out with you.

Dawn McFarland: (09:49)
That's true, it does not. No long-term care, no assisted living facilities. Those are the kinds of things that you need to prepare for financially outside of Medicare, and don't count on them to be covered by your Medicare.

Marty Stevens-Heebner: (10:05)
Yeah, long-term care insurance, I mean, we can't push it enough. I mean, seriously, get a policy. You will thank yourself later. You really, really will. Makes such a huge difference. Now, there are Medicare supplements that you can also get. What kinds of things do those cover?

Dawn McFarland: (10:21)
Medicare supplement covers anything that Medicare covers, and that's part of the difference and part of the routes. You have three basic routes when you have Medicare. You have original Medicare that we've talked about. It covers 80%, you're responsible for 20% plus your prescriptions. Your next option would be original Medicare plus a supplement and a prescription drug plan. And a supplement in that way, they cost more than the Medicare Advantage plans, which is the third route. They cost more upfront and premium than the Medicare Advantage plans, but they cover the full 20%. You might be responsible for a deductible. That's where all these things, you know, the [crosstalk 00:11:03].

Marty Stevens-Heebner: (11:02)
You need a guide like you.

Dawn McFarland: (11:04)
Yeah. But a Medigap Medicare supplement covers the rest of the 20% as long as it's a service covered by Medicare. If you move into a Medicare Advantage plan... And you don't pay a copay with a supplement when you go get services.

Marty Stevens-Heebner: (11:17)
No.

Dawn McFarland: (11:19)
Medicare Advantage plans not so much. You do pay a copay when you go in to get your services. It operates very similar to how you experience healthcare prior to Medicare, because you do have to stay in network. You pay the copays when you go in. The difference is you have to stay in network. So if you choose a Medicare Advantage plan, you don't have the freedom to travel across the country and see any doctor that takes Medicare.

Marty Stevens-Heebner: (11:43)
Got it. Oh, that's interesting. That's important. Again, why we need you to hold the torch and guide us through the tunnel of Medicare and those kind of benefits.

Dawn McFarland: (11:51)
I like that. I like the hold the torch analogy.

Marty Stevens-Heebner: (11:54)
Yeah, and in a way, shepherding. I mean, that's what we do, too, in terms of clients and their treasures and things like that. But yeah, I mean, really it helps so much, and there are so many different kinds of guides out there. There's what you do, there's what I do. There are care managers who are different from caregivers, and we'll be examining that, of course, on later episodes. I also wanted to ask you... I asked you what you love about what you do. I have got to ask you, what don't you love about what you do? That's always fun to talk about. What don't you love? [crosstalk 00:12:23]?

Dawn McFarland: (12:22)
You know what I don't love? I don't love that I'm nervous. I feel like it's so important to not put somebody in a situation. So I think if there's anything I don't love, it's that part of it. And I always want to make sure the person that I'm taking care of is truly taken care of. And there's some whammies that can come out of nowhere that you couldn't necessarily foresee. So I think that's what I don't love about it, is if something changes from a current situation that we advise on, because of the deadlines and the time periods and the special enrollment periods required to do so, sometimes our hands are tied and that's hard.

Marty Stevens-Heebner: (13:06)
Not mentioning that you're dealing with people's health, especially in later life. There's so much at stake frequently. I mean, it's amazing how much longer people are living and living in a healthy way.

Dawn McFarland: (13:17)
It's true.

Marty Stevens-Heebner: (13:18)
But when something hits you or your family, you got to know what's going on and that you're covered. Can you talk about a scenario or a client where something went wrong or they missed something? Because I'm trying to really... I want to alert people to the things they really have to pay attention to. And if they don't do these things or pay attention, it could really hurt them in the long run. You already talked about the time frame, but what else can happen?

Dawn McFarland: (13:50)
That's the biggest one, time frame, because it affects so many things. It affects penalties and it affects guaranteed issue. I'll give you another scenario. I had a client who reached out to me. They turned 65 in December. They reached out to me... I think it was the first week in April, which we just missed the deadline to be able to get the Part D without having a special enrollment period. So now this individual has to wait until AEP, which is October 15th to December 7th, to enroll in a drug plan that will start covering him January 1st. And there's going to be a penalty of 1% of the national standard average, which it's 33 cents per month. It's not a huge penalty, until you miss a lot of months because it's added on for every month you didn't have it.

Marty Stevens-Heebner: (14:50)
Wow.

Dawn McFarland: (14:51)
Then it lasts for the rest of your life. So, I know.

Marty Stevens-Heebner: (14:56)
That just does not make sense to me.

Dawn McFarland: (14:57)
I know.

Marty Stevens-Heebner: (14:58)
It is what it is, right? Now, you mentioned an acronym in there. Waiting for the... Was it AEP? ADP?

Dawn McFarland: (15:06)
AEP. Thank you, yes. Annual enrollment period.

Marty Stevens-Heebner: (15:09)
Oh. There you go.

Dawn McFarland: (15:12)
That's what it is, yep.

Marty Stevens-Heebner: (15:13)
And when is that specifically? What dates are those?

Dawn McFarland: (15:15)
October 15th to December 7th every year.

Marty Stevens-Heebner: (15:18)
Okay, that's good to know. Thank you for going through all this wonky stuff, because people don't know the ins and outs and it's good at least, because people can also listen to this again to take notes and that kind of thing to make sure they're on top of stuff.

Dawn McFarland: (15:33)
Yeah, I appreciate being able to talk about it, because a lot of times you forget what to bring up. You're asking great questions.

Marty Stevens-Heebner: (15:39)
Oh, well, that's very kind of you. Well, you're giving great answers. And I know that about you. You're very thorough, you're a very good communicator. That's another thing that's key about somebody who's going to guide you through this, is you want somebody who can articulate it in understandable phrases, as opposed to super technical or something like that, where they assume that you know their vernacular already, you know the business, and we don't know one another's businesses. And also, if you're a consumer or a client coming, that's why they come to you, because you have the expertise.

Dawn McFarland: (16:12)
Same with you. I've already decided that I want you to come in and help us when we need it for our parents' house.

Marty Stevens-Heebner: (16:19)
Ah, thank you. I'm honored by that. That's always fun. Yeah, thank you. What kind of questions should people be asking professionals like you when they're interviewing them and thinking about working with them?

Dawn McFarland: (16:35)
I think that one of the most important is are they appointed with multiple carriers? Someone who's only pushing one carrier... And not pushing necessarily, but if they're captive to one carrier and only educating you about that one carrier, I feel like that's just... Again, the Medicare scope is so wide and it's such a rainbow of options, I feel like only hearing about one carrier is not... Even one or two carriers... is not a really good picture of what your options are. So that's probably number one.

Dawn McFarland: (17:12)
Number two, because Medicare has so many parts, I feel like it's also... There's a lot of agents that only do Medicare supplements and they don't do Medicare Advantage plans, which also means they don't certify and are able to talk about the Medicare Advantage plans. And it just, again, doesn't give you the full picture, and I really feel like that's important if you're working with a... To be fully guided, you should be with someone who can talk to you about the whole market.

Marty Stevens-Heebner: (17:41)
They're not limited.

Dawn McFarland: (17:42)
Right. And that's my personal opinion. There are agents out there... Not that they're bad agents, but I just feel like it's such an important thing to know all of your options.

Marty Stevens-Heebner: (17:52)
Yeah, that's vital. Anything else they should consider? Certain licenses, things like that?

Dawn McFarland: (17:59)
To be able to sell, you have to be licensed by the State of California, so they should have a Department of Insurance license. I will always promote that they should be a member of the National Association of Health Underwriters, where I volunteer, is an organization for our industry. And what we do is advocate for our clients, for agents and our clients, when pieces of legislation... As you know, that's a huge political topic right now. When pieces of legislation come out, what we do is look at it from our perspective. Because we are the ones on the street working with clients, we know what they're experiencing, and we try to advocate for making sure these pieces of legislation are not causing unintended consequences. So I feel like agents that are involved in our association... And you can look up... There's a Find an Agent tool on NAHU, nahu.org.

Marty Stevens-Heebner: (18:56)
And that's the National Association of Health Underwriters.

Dawn McFarland: (19:00)
That's correct. Yeah, and there's a Find an Agent tool to find agents all across the country. If you wanted to find someone who knows your area, that's a place you can go to look.

Marty Stevens-Heebner: (19:09)
That's fantastic. That's so important. What do you wish people knew about what you do?

Dawn McFarland: (19:17)
I think what I wish is I wish they knew that that agent... I wish everyone understood that agents, at least in California, help people at no additional charge.

Marty Stevens-Heebner: (19:29)
Which is great.

Dawn McFarland: (19:30)
Why wouldn't they use someone who understands? So that's the one thing I wish everybody knew.

Marty Stevens-Heebner: (19:38)
Why wouldn't you hire a guide to get through a dark tunnel?

Dawn McFarland: (19:40)
Right?

Marty Stevens-Heebner: (19:41)
Or even get around a museum. Yeah, exactly, exactly. What drew you to this?

Dawn McFarland: (19:48)
It's funny. When I first got licensed in 2012, right before Covered California opened up, there was Medicare stuff on the test, and it seemed so complicated. I was like, "I don't want any part of this. I don't want to understand it. I'm not going to try to understand it." So I had an aversion for sure when I was first licensed. But then in my experience, when I was the president for the Los Angeles chapter of the association, there was kind of a pool for Medicare agents as members, and we didn't really have any content for Medicare agents.

Dawn McFarland: (20:30)
And I was asked to help lead a Medicare summit for Los Angeles, and I didn't know anything about Medicare. I was in a group space consulting for brokers and doing other things. But I understood the need. And so the first Medicare summit that I did was live in Woodland Hills at the country club. And at that I heard so much about how much need there will be as Boomers begin to retire. The statistic last year... I don't know what it is this year, I haven't looked it up, but 10,000 people turning 65 across the country every day.

Marty Stevens-Heebner: (21:08)
Every day starting in 2012. It'll go until 2032.

Dawn McFarland: (21:12)
Isn't that crazy?

Marty Stevens-Heebner: (21:13)
It is 10,000 per day. Yeah. And the percentage... And I don't have them in front of me or you know I'd recite them, the percentages. But it's going to grow so much, until basically older adults will be a full quarter of the population.

Dawn McFarland: (21:32)
The more I thought about it... So that first one I think was probably five years ago now that I knew that, and I still wasn't going to jump on it. It kept coming back in my head that what an opportunity and what a way to help a population that I actually really like working with. That's another thing with my grandpa, he was an Eastern Star in the Masons and we would go visit the old folks homes. And I really enjoy spending time with senior citizens. So it kept tugging at me. Finally, I gave in. I said, "Okay, I'm going to do this." I spent a full year, because I did not feel comfortable. I would shadow people to understand how they would advise their clients because I didn't feel comfortable. Again, I don't ever want to put somebody in a situation that's going to hurt them.

Marty Stevens-Heebner: (22:22)
There's so much at stake. There really is. That's why you want somebody experienced like you. By the way, how many years have you been doing this, this specialization?

Dawn McFarland: (22:30)
Medicare specifically, this is going on my fourth AEP. If you're taking care of your parents, or a lot of people have also been laid off or all of the things that have happened, there is help available. So they've increased the subsidies for individuals going through Covered California. They've made a SEP, another SEP for the individual market.

Marty Stevens-Heebner: (22:56)
What's SEP?

Dawn McFarland: (22:57)
Special enrollment period.

Marty Stevens-Heebner: (22:58)
Oh, sorry. So there's AEP, which is annual enrollment period, and S... Thank you.

Dawn McFarland: (23:04)
Yep. No, thank you, because again, acronyms and being in your industry, I know. So I just want to put that out there, that no, if you are looking at health insurance options, right now is a really good time for you to check into the ability to get subsidies, because I'm seeing a huge increase in the amount of subsidies that people are getting.

Marty Stevens-Heebner: (23:26)
That's wonderful. And what do subsidies cover specifically when it comes to Medicare and such?

Dawn McFarland: (23:32)
It's interesting that I don't think to explain that. So a subsidy is technically a tax credit. But what the government said... President Biden signed in March. He signed the American Rescue Plan Act.

Marty Stevens-Heebner: (23:44)
Right.

Dawn McFarland: (23:45)
In that act, they increased subsidy for... Excuse me. Health insurance can only be received through Covered California because they need assistance. So a subsidy is a tax credit that is applied to your health insurance premium. And in that ARPA that the president signed, he made it so that no individual paid more than 8.5% of their income for health insurance.

Marty Stevens-Heebner: (24:12)
Wow.

Dawn McFarland: (24:13)
Before, it used to be if you were over 400% of the federal poverty level... And there's a chart for that... You wouldn't get a subsidy, but now I'm seeing quite a few people are getting it.

Marty Stevens-Heebner: (24:24)
Oh, well, that's good. That's helpful. I mean, little revisions to our healthcare system are not a bad thing, especially for older adults and their families. You know, they've been working so hard all those years, they deserve it. Okay, one more question. I want you to imagine yourself at 90. What do you think you'd be telling yourself now if you could?

Dawn McFarland: (24:50)
Quit working so much.

Marty Stevens-Heebner: (24:54)
Yeah. Yeah, you and me both. Right? We'll see. We'll get bored. And it is such rewarding work to work with older adults.

Dawn McFarland: (25:03)
It is. Which is why we continue and work longer hours, because it matters. But I really think that that is probably what I would... I would tell myself to prioritize a little bit differently.

Marty Stevens-Heebner: (25:23)
Just know, your 90-year-old self is talking to you now. And my 90-year-old self-

Dawn McFarland: (25:29)
What would you tell yours?

Marty Stevens-Heebner: (25:30)
I'm sorry, what?

Dawn McFarland: (25:31)
What would you tell yourself?

Marty Stevens-Heebner: (25:33)
You know, I was just thinking about that, and I would probably suggest the same thing. And maybe get a haircut. I don't know.

Dawn McFarland: (25:43)
No, you have pretty hair, don't do it.

Marty Stevens-Heebner: (25:45)
Well, thank you. Thank you. It was amazing how long it got during COVID, but enough about dead protein. This has been so much fun. Thank you for hanging out with me and really going into the detail and answering all my questions, because it's just the answers aren't easily accessible out there.

Dawn McFarland: (26:00)
And putting the pieces together. Thank you. Thanks for giving me the opportunity.

Marty Stevens-Heebner: (26:05)
Oh, you bet. And where can people reach you? We're going to include your information on our website howtomoveyourmom.com. But what's the best way? Is it email? Is it...

Dawn McFarland: (26:16)
Email is the best way, because that also, if you email me at Dawn, D-A-W-N, at M as in Mary, N as in Nancy, M as in Mary, benefitsolutions.com... That's benefit singular, solutions plural. The reason that's the best is because I'll always have my immediate responder that gives you access to my calendar, and that is the best way for us to start a conversation because it gives you time on my calendar.

Marty Stevens-Heebner: (26:43)
Yeah, that's perfect. That's very efficient. I like that very much. So thank you, Dawn McFarland, for being with me. I really appreciate it. Thank you.

Marty Stevens-Heebner: (26:55)
Thank you so much for listening to How to Move your Mom and Still Be on Speaking Terms Afterward. Please visit howtomoveyourmom.com for more information about this episode and for additional podcast episodes featuring other extraordinary guests and conversations. Until next time, this is your very grateful host, Marty Stevens-Heebner.