In this episode, I sit down with Virginia Tucker to talk about all things Health Insurance. For many of us, this may be a topic we don’t fully understand, and yet selecting the right insurance for our needs can be critical to our health and our wallets.
From insurance for the self-employed and small business owners to medicare gotchas and tips for travel, Virginia provides a masterclass of what we need to know to make sure we don’t get any unpleasant surprises should a health challenge or emergency occur.
Listen to My Interview with Virginia Tucker
Links and Images from My Interview with Virginia Tucker
You can find Brevard Health Advantage on the web at https://brevardhealthadvantage.com/
While Virginia works at one of the few brick and morter, open year round, health insurance agencies, she is definitely not all work and no play! She and her family are huge fans of Disney World and recently dressed up as characters from The Avengers for Disney Dapper Days.
Takeaways from My Interview with Virginia Tucker
- One of my biggest takeaways from this episode is the importance of sitting down with an agent 2 or more years before you file for medicare. Your premiums are set based on income from the previous years and smart financial planning might help you optimize your premiums.
- If you have an emergency while traveling in the United States, your insurance will cover you and be considered in-network.
- If traveling outside the US, consider purchasing travel insurance.
Complete Transcript of My Interview with Virginia Tucker
Kim: 00:01 You’re listening to Space Coast Stories, a podcast with interviews and stories from people and businesses on Florida’s Space Coast. I’m your host, Kim Shivler. Thanks for joining me.
Kim: 00:16 Hey everybody on the Space Coast. Welcome back to Space Coast Stories. I’m your host, Kim Shivler and today I am interviewing Virginia Tucker. She is an insurance agent and we’re going to talk about everything we need to know about health insurance, which you know at this time of year we’re not preparing to do our insurance. It’s not open enrollment, but if we solve some of this now, then maybe when we get there to open enrollment we will be prepared because I think sometimes insurance agents find people miss open enrollment and then they’re kind of stuck.
Virginia: 00:57 Yes. Welcome Virginia. Thank you so much for having me. I’m very excited to be sitting down and having a chat with you about insurance. I know it’s a a beast of its own and in a lot of people don’t understand it because they’ve never had to use it. Maybe they have a very healthy lifestyle and then all of a sudden here comes in event and now they are bombarded with questions that they have about their policy or they don’t understand what’s going on. They don’t understand the vocabulary that’s going on. So that’s why it’s really important to have an agent. So that way they can interpret that. Even take a look at your explanation of benefits your EOB. We really like to focus on the individual. They are a pretty important factor here, in Brevard county. We’re leading with small businesses and with the affordable care act coming out, it allowed people to become entrepreneurs and tackle that ah question of health insurance.
Virginia: 02:01 That was one of those factors that people looked at constantly. Can they come off their group plan and be able to cover their wife and kids and be able to distribute that risk. So the affordable care act allowed us to do that and it also allowed us to take care of that financially, as well. So the uh, individuals we like to talk to throughout the year and during open enrollment or course the open enrollment right now is happening November 1st through December 15th so do you have any other questions or anything like that? So that way I can, any specific questions regarding that?
Kim: 02:41 Oh, absolutely. First, let’s make sure everyone knows that you work at Brevard Health Advantage, right? Which is a very special agency in that you’re one of the few brick and morter insurance agencies that are one brick and mortar and are open year round.
Virginia: 02:57 That’s correct. We are open year round because everybody has questions and they don’t just happen during open enrollment. So we like to have that availability to our clients year round because what happens if you all of a sudden get a job and now you have group coverage or you lose your job and you don’t have group coverage anymore and you have that special enrollment period, which now you’re looking for individual health insurance or you’ve made more this year. You, you know, you’re a real estate agent or even insurance broker or something like that. You’ve come across and you’ve done a big deal, now you’ve made more money. We need to take a look at how that’s going to affect your income and potentially your tax credit or you’ve taken a larger distribution from your 401k’s. Things like that. We like to have a discussion, ongoing discussion with our clients throughout the year and be available to them throughout the year.
Kim: 03:55 And now when you mentioned tax credit, is that true of all types of insurance plans or is that just certain things where it could change depending on how much you make?
Virginia: 04:07 Yes, so with the affordable care act, specifically when you live in Brevard County, you do have access to three different carriers. Those would be with Florida Blue, Florida Healthcare Plans and Health First Health Plans. There aren’t any other carriers in Brevard County that are participating with the affordable care act. The affordable care act is required to cover 10 specific essential health benefits. There are some plans out there that don’t cover those specific health benefits and so they have underwriting and don’t comply with the affordable care act, but you also can’t get a tax credit for those. So when we’re talking about the tax credit, those three carriers are what we have to look at, so we do specifically do look at your income and you can be in within the range of 100% to 400% of the federal poverty guideline based on your household size. It’s a pretty large range of income. Some people meet it and some people don’t. If you don’t meet it, whether you don’t make enough or you make too much, we can talk about strategies on what my best fit your household and your needs.
Kim: 05:17 So that’s a nice, if you are an entrepreneur and maybe you’ve started and maybe you’re having a rocky year this year, there may be some options where it’s not just that the insurance itself might be more affordable, but that there’s some credits to help.
Virginia: 05:30 Exactly and within the credits to have to lower your premium. If you meet a within a certain range, they’ll also have a cost share reduction that will reduce your deductible and Max out of pocket and what may also work on your copayments as well. It’s a really great way for small business owners to kind of take a look at their income and see if that’s something that can work for them and their family.
Kim: 05:59 So aside from tax credit and changes like that during the year, you mentioned something that I think a lot of people get nervous about. If you lose a job, it particularly, that’s a scary thing for a lot of people. What happens to my insurance? What type of solutions do you have for them?
Virginia: 06:17 So we always discuss what the best option is for you. So we don’t like to call ourselves the insurance agents. We like to call ourselves people that were consultants. We’re insurance consultants because that doesn’t mean that you’re going to be coming into our office and purchasing a product. We like to be able to have a full on conversation on what are your Cobra options from your job? Have you utilized your deductible and Max out of pocket because you had a couple surgeries early on in the year and while your Cobra may be a little bit more expensive, if you come onto a brand new product, you’ve restarted deductible and Max out of pocket. Is that advantageous? Does your Cobra have a better prescription drug plan? Does itI have a PPO plan that works really well with your doctors, and we may not have that where it may be even more expensive when we’re comparing apples to apples.
Virginia: 07:13 So we want to be sure that our clients are making the best educated decision when it comes to um, continuing your coverage after you’ve lost your coverage, whatever the reason may be. Sometimes smaller groups, they can no longer afford it or they’ve lost the numbers to continue group coverage. It’s not just the or the or they’ve gone away, they’ve had to shut their doors, whatever the, the instance may be. If you’re losing group coverage, there’s always an option if you come to us. And talk about what you’re willing to take on as risk. Cause that’s another piece of the puzzle. You’re not, you’re no longer required to purchase health insurance in 2019 moving forward. That was a change made. So there’s no more penalty on your taxes if you don’t purchase ACA coverage. That’s great for the consumer because now they can take a look at a non ACA plan and not be penalized for it.
Virginia: 08:14 If they’re healthy, they can get a non ACA plan for half the cost, if you don’t qualify for a tax credit. Um, sometimes when you qualify for the tax credit though, it definitely is more advantageous for you to take a look at the ACA plans.
Kim: 08:29 Great. And you did throw out a few jargon pieces are there. So let’s cover those for people who are like me, who are not insurance people, first of all, maybe if you’ve never worked for a company or ever been laid off before anything, what is Cobra?
Virginia: 08:44 So Cobra, whether you fill it or not, when your job purchases your health insurance, they are participating in a portion of the cost. They’re required to. So when you get Cobra you have to pay the entire cost of that health insurance plan that your job has been purchasing for you, help helping you purchase, you’re coming up with the rest of the difference.
Virginia: 09:07 So Cobra is allowing you to extend that same coverage. Your keeping the same network, the same plans, everything just you’re covering the entire cost, whether it be for yourself, the employee, yourself and your spouse or your family. Sometimes with the family and of course with your spouse, it can get a little more costly. That’s what we want to also talk about as well. When you sit down in our office, you can also continue on your Cobra coverage for vision and dental separately. You know, you design your own package at your work. Um, you can keep that cover coverage usually up to 18 months. Those individuals that are getting up in their retirement years, they are planning on getting their social security or Medicare that might be better for them to sustain on their Cobra until they turn 65 and then they have a smooth transition into Medicare, which we can assist with as well.
Virginia: 10:02 But we also want to have a conversation, you know about income and things like that to insure that you are prepared for Medicare. Medicare, we do that right now and we usually meet with people about six months prior to them turning 65 for that in an initial meeting to go over the products. We are brokers so we can offer a multitude of product lines from advantage plans to medicare supplement plans and we need to have a conversation about what’s best for you, what network are you looking for? Do you have a home somewhere else in the United States that you have an established doctor? What are your prescriptions? Who’s your favorite pharmacy? All of those pieces make up an entire puzzle of the Medicare, which is a completely different beast from individual health insurance. That’s why we want to take a couple of meetings to discuss your needs and make sure nothing has changed from going into the aging up until the age of 65 also, if you’re past the age of 65 and you’re moving in the Brevard county area, because of that change in Zip code, you do need to have another conversation about what’s available and it can open up a special enrollment period for both individuals under the age of 65 and Medicare age.
Virginia: 11:22 Um, you know, if you’re moving from California to Florida to Brevard county, there are different advantage plans available to you that might be better for you have better coverage and cheaper. It’s just something that should be discussed because more information is always better than less.
Kim: 11:39 In other words, even though we have these enrollment periods, there are special circumstances where you’re not just left out in the cold. So coming in and having that conversation would be a really good idea.
Virginia: 11:50 Yes. So special enrollment periods do apply to both over and under the age of 65. Specifically if you are under the age of 65 getting married., having a child, losing coverage, being dropped off of a Medicaid situation, kid care situation. If they’re kicking you off of that because you’ve made too much money, come talk to us. There’s something that we could probably do for you. Getting divorced is a special enrollment period. Moving is a special enrollment period. If you’re not sure if that applies to you, it’s a five minute conversation that we more than happy to to have now. The special enrollment period doesn’t last forever. It only lasts for 60 days from the event. So if you’re any day past that, sorry, can’t help you. Well we can’t help you with an ACA plan. We’ll have to take a look at some non ACA products.
Kim: 12:47 Okay. So if you’re going to move, get married, have a baby, et cetera. Within that 60 days, come talk to Virginia. There’s a lot more here I think than people think encompasses insurance and just from this I can tell why it’s a good idea to talk to someone instead of just going on the Internet and buying now. And I think that’s particularly where you mentioned Medicare and I think most people think, oh well, you know, I’m turning 65, I just sign right up and, but I have heard you speak and there are few things that really make an important on why you need to talk to somebody because there are correct certain things where you’ll get penalized if it’s not done properly.
Virginia: 13:32 Correct. Yeah. If you don’t enroll in a particular product, uh, within the 60 days that you have, you can get penalized thereafter. For example, if you don’t enroll in a particular plan, like a part D plan, and then later on say 10 years down the road you decide, well I need this now because I’ve been diagnosed with x, y, z. Because you chose not to participate, you will have to pay a much higher rate and potentially go through underwriting or potentially have a holding period. There’s a lot of moving parts. So it’s always better to speak to an agent to make sure you’re making the best decision. Um, also even a couple of years prior to you turning 65 you might want to talk about if you’re high income earner, you might want to talk to an agent. If there’s any way that you can maneuver that because you are required to report your income to have a look back period of two years and if they would see that you’re a high income earner, they will up the cost of your Medicare.
Virginia: 14:40 Just something to take a look, look at, especially if you’re a business owner. Business owners have that malleable income where maybe they might be able to get some more expenses on their taxes, things like that, so it’s just warrants a conversation. Even if it’s a 30 minute conversation and you realize that you’re, you’re kind of stuck in the position that you’re in, that’s perfectly fine. At least you had the conversation because we’ve spoken to a lot of people where they said, well, I wish I known this two years ago that I could have made some changes. Why am I now playing $200 more? I say, well because of this, these decisions that were, that led up to this point and we didn’t see you. So we like to talk, we like to migrate our customers and hold their hand from under the agent 65 all the way through the process of turning 65 to make sure that they’re meeting all of their health needs.
Virginia: 15:37 They are distributing their risk cause that’s what health insurance is. They’re distributing their health costs by paying a premium every month. And then we’ll also talk about the networks of doctors and things like that.
Kim: 15:51 You mentioned part D Medicare Part D, what exactly is that again? Jargon again.
Virginia: 15:55 That is a Part D is D for drugs. So as your prescription drug plan now if you do get an advantage plan that will replace all of those and it has an integrated drug plan. A lot of that, I don’t want to get too far down into the rabbit hole so to speak, cause it’s a lot of, a lot of jargon and it does. Usually we meet for about an hour and a half to discuss all of that specifically for advantage versus supplement plans and how those drug plans can supplement that. So I know our time here is, is limited so I don’t want to get too far into it and everybody’s situation is different. We have a medicare specialist specialist here, so I specialize particularly to individuals under the age of 65. No, just enough to be dangerous.
Kim: 16:44 I think you know enough to let us know that there is more here than just going online and signing up.
Virginia: 16:52 Yes, yes. And when people turning 65, they will be inundated with mailers and phone calls and TV commercials that say like, Hey, are you turning 65 call us today? And they can’t. They only talk about their product. We’re brokers. We can talk about different products in one sitting. So we’re able to compare and contrast and make sure that you, we meet all of your needs.
Virginia: 17:20 People who call the one 800 number. They get sold. And this happened to my mother in law, you know, she, she saw this, uh, one particular plan. She says, oh, that sounds great. And she ended up getting signed up and then she didn’t know what she had because she had spoken to somebody over the phone and didn’t have a contact number, doesn’t have an office.
Virginia: 17:42 She didn’t know where to go, where it’s her network, who, what is her deductible? They sent her a booklet, a packet, and said have a nice day. There are sometimes the governmental allows special enrollments and things like that for Medicare they just had one. Um, because of uh, something that happened, I’m not fully aware of what, what happened because again, I’m under the eye. I specialize in under the age of 65. But they were allowing people to switch out of plans in the same carrier and which is can be great. It gives you a trial period to look, but that doesn’t happen all the time. It doesn’t happen every year. It only happened this year and is as long as I’ve been here. I’ve only seen it happen this year. So you want to be sure that you’re making the right decision. The cheapest is not always the best for you.
Virginia: 18:30 It might work out where you spend an extra 10 or $15 on, for example, the prescription drug plan, but now you only have $5 copays for all the drugs that you take versus having to pay a $500 deductible first and then have $50 copays for the prescriptions that you take. And we can analyze that for you and run the numbers and do spreadsheets if you like. I know we got a lot of engineers here in Brevard County, and we’re very familiar with spreadsheets and we’re very familiar with running the numbers and know what we do is take the premium and multiply times 12 and add the Max out of pocket. And that is your ultimate risk if something major happened. So a lot of times the cheapest is not always the best and a lot of times actually the most expensive is not the best. How much risk do you want to take on your family? And that’s how we amount that cause at the end of the day if you feel more comfortable about having a very expensive plan just so that way you know you have that coverage, then that’s what, that’s what’s best. If not, if you want to take that risk, have a high deductible plan, that’s fine too. It’s whatever you want to do. We just want to make sure you have the right network for it.
Kim: 19:44 That makes sense, and it depends how what your economic circumstances are. For some people, you know at $10,000 deductible that may make more economic sense than something that’s going to cost them more over the long run. Particularly if they are healthy and have some financial means. That makes a lot of sense and I think something you pointed out, and this is something that I tell my clients always, if you can work with someone who is a consultant status or as she said broker who could put you into whatever’s best for you, you’re usually going to get the best service because they can put you into other things. Whereas if you call the one 800 number, that person only has one thing to put you in, right? I highly recommend that you come and sit down with Virginia. We did and actually the plan that I had, she said that that’s, I can’t do any better than that.
Kim: 20:48 You’re in the right thing for what you need right now. So tell them then how can they, how can people get in touch with you
Virginia: 20:55 Sure. Again, we are located in Satellite Beach our address is 574 Highway A1A Satellite Beach, Florida. If you’re driving to us, we are off the Pineda Causeway one mile south of the Pineda Causeway. So go all the way to the beach and take a right.
Virginia: 21:14 Our telephone number is (321) 574-6440 and you can take a look at our website at BrevardHealthAdvantage.com and again, my name is Virginia in agency owner is Pat Schankle. We are a two woman team and we like to think ourselves again as consultants in a boutique. Um, because we do specialize in the individual, we can take a look at anything that’s available in Brevard County and, uh, compare and contrast for you and make sure that you’re getting in the network.
Virginia: 21:50 The network is the most, most important in my opinion. It, you know, we can come, we can analyze dollars in money all we want, but at the end of the day, are you getting access to the doctors that you want and need?
Kim: 22:03 And that’s the network. The network is which doctors, which hospitals, which facilities you get to use. This is your insurance, correct?
Virginia: 22:12 Correct, cause not all networks are the same. No, not definitely not. And, um, you know, some people want to pay a little bit more to have access to the specialty hospitals. The research hospitals the Shands, the Mayo clinics and things like that, or if their travel a lot, if they have a home up north, they want to have doctors there. But little tip for you though, a lot of people don’t know this if you’re traveling and an emergency happens. So if you’re skiing in Alaska, this is my favorite example, you’re skiing in Alaska and you break your leg and you’re taken to the hospital, that is an emergency.
Virginia: 22:52 They will fix that no matter what insurance you have, as long as you have insurance, that is going to be considered an in network event. Don’t need a referral. You went in through the emergency room, they set you up.
Virginia: 23:05 Now, don’t hang out in Alaska to have physical therapy. Okay? You need to come home, get situated and find your in network doctors. Now if you have a PPO or something like that, then you may have some in network doctors in Alaska and you can continue on your vacation and keep going. However, my recommendation would still be come home and, and get that physical therapy. Just as an instance, if you’re traveling and you have an accident and it’s an emergency situation, it is considered in network no matter what type of health insurance you have.
Kim: 23:40 That’s very valuable information. Now is that just within the US?
Virginia: 23:48 Some of those plans do have international networks. Um, I do have two plans for individuals under the age of 65 that do have international networks. They are very select. But if you are traveling internationally, I would recommend getting a travel insurance policy. They’re very, very affordable. I believe. Pat, she travels a lot. Pat The agency owner, she travels a lot. She goes to Costa Rica and she’s been to Ireland and Japan and things like that. You can purchase in a year long travel policy. I think she paid around $300 a year for it. It’s very inexpensive and it covers your evacuations and if you fall and break your leg or things like that. So it’s um, pretty comprehensive as great network and I, that’s what I would recommend is getting a separate travel policy for international travel. I wouldn’t rely on the health insurance in the US.
Kim: 24:45 That’s what I always did. I used to travel for a living and we always just got those separate policies, especially the evacuations were what I always thought about.
Virginia: 24:52 Yeah, the political evacuations,
Kim: 24:55 iEven like I want to get home. Yeah. You know, if you’re hurt, you want to be back home, you don’t want to be wherever in the world. And of course everybody that phone number, the links to the website, all that’s going to be in the show notes at SpaceCoastStories.com. And the other thing when you come to visit Virginia and talk about insurance, she has a favorite hobby. So all of you Disney fans out there, you guys can come and, and geek out on Disney is, I understand you’re a big Disney family, right?
Virginia: 25:30 We are. We have had, um, annual passes for the past three years. This past weekend was Dapper Day and we did, we went all out. Um, this was our third Dapper Day. And for people that don’t know what Dapper Day is, not sanctioned by Disney, but a lot of people, Disney fanatics, they will dress up dapper, um, like, uh, the Kentucky Derby or from the 1950s and sixties, and it’ll be themed with some of their favorite Disney movies. So this year, because Disney has acquired Marvel, we did, um, the Avengers, I was Thanos, so I had the 1950s, a fit and flare, bright yellow dress with a purple apron and a, and one of those bright yellow rubber gloves. And I had glued on gemstones on the knuckles to be my gauntlet, um, that was hanging out of my pocket. And then I wore a bright purple wig with a, with a yellow, a hair tie off on it.
Virginia: 26:36 So it was, uh, my daughter who’s four is adorable. She was, um, spider and my husband was Captain America. And when we also went with another family, but we had a lot of fun taking pictures around Epcot, um, having battle scenes and whatnot. So we go, we go a lot. We don’t go in the summer because it’s too crowded and too hot, but we are really looking forward to the, um, the Star Wars opening up in August and we actually do the Disney runs and things like that. So we’re really involved with the culture of Disney and what they have to offer for, for just the family. It’s a wonderful experience that we’ve been there for three years and it’s different every single time you find something different every single time. So um, it’s a lot of fun.
Kim: 27:28 Yeah, it sounds like fun. Thank you so much for spending this time with me today and sharing really some valuable information about insurance.
Virginia: 27:40 Yeah, it’s been very exciting and thank you so much for allowing me to come on this show. And you know, again, our telephone number is (321) 574-6440 I’m the first person that you’ll speak to and get all your questions answered to thank you so much Kim.
Kim: 27:58 You’re welcome. And my Space Coast friends, come see Virginia, talk about insurance, talk about Disney, you Disney fans and join me next time as I interview another interesting person here on Florida’s Space Coast bye.
Kim: 28:16 Join us next time for another episode of Space Coast Stories. You can find the show notes and other information at SpaceCoastStories.com. The views of the guests on this show are their own and don’t necessarily represent the views of the show owners, host or company. Thanks for listening to Space Coast Stories.