Mention ski season to me, and my eyes glaze over. Not in the way they would if I was a sixth grader watching a documentary in history class with the lights dimmed, nearly into waking sleep; like I can hear the shush of powder between my skis on a run through the glades with no one around for what feels like miles. That said, for a skier, it would take a passion bigger than powder to get them off the slopes during ski season, and into an office.
For Stephanie Frisch, that passion has become helping individuals and families find their way in the incredibly confusing world of health insurance. Hard to believe? After all, who would give up a season of perfect days on the mountain for conversations about Medicare and the oft topsy-turvy world of Social Security, monthly adjustments, and aging in (or out) of the myriad plans on the market? Hear it straight from the source: “I’ve been a skier for 45 years now, but the Medicare enrollment period falls at the same time of year, so I’m turning my focus going forward.” Having her ability to check out and go skiing isn’t as much of a sacrifice as she thought though, when looking at the big picture. “I started as an agent in 2006, and established my business, Insurance 101 Services, in 2008. There is an epidemic of unawareness around the Medicare system. I’m dedicated to finding a cure for my clients.”
An ailing medical system can be just as detrimental to its population as the actual health issues. With Medicare, those that turn 65 and are eligible are as at risk of confusion as those who delay enrollment because they or their spouse have continued to work for a large company and receive benefits from it. “Another common situation I’ve been remedying is helping families whose loved ones have moved into an assisted living or board and care facility: and now they need to change the way they have access to benefits.” Stephanie has an incredible wealth of knowledge about the system, a high degree of experience with the plans available on the market, and has focused her attention - and intention - on becoming a trail guide to those stuck on the bunny hill, as it were.
Stephanie stays abreast of all things Medicare, not just the plans offered by the companies that she is contracted with. There are steps to activating Part B for the first time, steps to paying the Part D premiums. “People that make incomes higher than the benchmark set by Social Security also tend to pay more - I can explain how that all works, what the amounts are, and how they can avoid responsibility for that extra amount if there are certain life events, such as retirement.” Only about 10% of clients Stephanie assists, she estimates, know about the level adjustments on premium pricing (or Income Related Monthly Adjustment Amounts). “We can lay down an estimate for how much my client can expect, and a detailed trail map as to avoiding the penalties entirely.”
Stephanie serves over a thousand clients, and her list keeps growing every year. Keeping her notes on conversations saved for each one on the latest software and phone syncing technology helps.
“When a client calls, I greet them by name, even if I haven’t seen or spoken to them in years,” says Stephanie. “I completely personalize my service by keeping your records up to date, including current plan, doctors, medications, and so much more. I might have stepped off the slopes (and recently, onto the green), but I’m not slowing down when it comes to the level of commitment and dedication I show each person that I come into contact with.”
In the following interview with South County Magazine, Stephanie addresses some frequently asked questions and recent trends in the industry.
South County Magazine: I’ve heard that there is a longer enrollment window for Medicare starting this year, is that true?
Stephanie Frisch: Well, yes and no, and I fear there will be a LOT of confusion regarding this at least for the first few years. The “Annual Enrollment” period (also referred to as the Open Enrollment period in past years) runs October 15 to December 7th. The 2019 plan details for Medicare Advantage and Medicare drug plans are released to the public October 1st, but applications can’t be accepted and/or submitted until 10/15.
CMS (Centers for Medicare & Medicaid Services) is bringing back an enrollment period that they have utilized off and on in the past to help those Medicare beneficiaries who may have made the wrong choice in picking their Medicare plan(s) during the Annual Enrollment period. This enrollment period will formally be called, “Open Enrollment”. It will run from January 1st to March 31st, and during this time period, Medicare Advantage enrollees will be allowed to dis-enroll from their current plan and move to a different Medicare Advantage plan. Or, they can move back over to Original Medicare (Medicare Part A and B) essentially dropping their MAPD plan. OEP isn’t an extension of AEP. It doesn’t provide the same flexibility as the AEP where you can make any changes you want. To clarify: During the 2019 OEP, you’re able to make “like plan” changes (The same plan change you made during AEP). So that would be: MAPD to MAPD; MAPD to Original Medicare and a Part D; Original Medicare and a Part D to MAPD.
SCM: I’m always hearing about the so-called “Donut Hole” for Medicare drug plans, what can you tell me about that?
SF: Drug coverage for Medicare beneficiaries didn’t become mandatory until 2006. At that time, the Federal government and drug manufacturers began subsidizing the cost of medications. Four different stages were established; Deductible, Initial Coverage, Coverage Gap (Donut Hole) and Catastrophic. For several years it has been publicized that the “donut hole” was going away in 2020. But recently the Bipartisan Budget Act of 2018 moved up the date for closing the so-called “donut hole” for brand name drugs to 2019.
So, in 2019 the standard benefit requires the beneficiary to pay 25% of their prescription drug costs between $415 (the RX deductible in 2019 if the drug plan has one) and $3,820. This amounts to about $850.00 annually. Then, for 2019 and every year after, the beneficiary cost sharing for brand name drugs after the initial coverage limit has been met, is 25% -- Same as in the initial coverage stage, so hence, there goes the “donut hole”! How did the government make this “magic” happen? Well, part of the drug costs in the “Coverage Gap-donut hole” – are absorbed by the drug manufacturers providing a 70% discount on brand name drugs. Future drug plan premiums may show another way the “donut hole” was eliminated, but that is my personal speculation, not fact.
There is still the “Catastrophic stage” however. In this stage the Medicare beneficiary has nominal costs. Once beneficiary expenditures (which include those big drug manufacturer discounts) reach a total of $5,000, the beneficiary is through the coverage gap and reaches catastrophic coverage. On any future prescriptions the beneficiary pays either a co-pay of $3.35 for generic drugs or $8.35 for brand name drugs or a co-insurance of 5%, whichever is greater.
SCM: Last year you brought on Carlos Aguilar as an associate of Insurance 101 Services, what is his role in your company currently?
SF: Carlos is a very valuable asset to my business. There are no longer enough hours in the day for me to help everyone that contacts me, so I rely on Carlos to help those individuals and families so that they get the timely assistance and personalized service that I pride my company with providing. His focus in assisting me is helping individuals and families under age 60, and those more comfortable in learning about their Medicare and insurance options in Spanish.
SCM: I know you’ve had your office in San Juan Capistrano now for four years, but do you still make house calls?
SF: Sure, but most of my house calls now are a result of assisted living facilities such as Atria San Juan and “board and cares” learning of my free services from Dr. Haga and Dr. Yang.
Over the last several years we’ve started helping each other to get Medicare beneficiaries settled in and comfortable in their new homes. It’s a difficult process moving a loved one into one of these facilities for many reasons and eliminating as much stress as possible is crucial. I help guide the families down that path, letting them know the steps to take with Social Security. We also look at making changes to their loved ones current Medicare plan(s) so they are able to receive care in their new home. If the individual is moving from another county or state and on a Medicare Advantage plan, they will lose that coverage within a few months, and we need to put them on an Orange County based plan that best suits their needs, re-evaluating their drug plan coverage is also very important.