E1: Introduction to Medicare Alex: So you just kinda turned 65 and you get free healthcare, right? Amy: Ah, you walked right into that one, didn't ya? Welcome to the Mastering Medicare podcast where we demystify healthcare and Medicare for senior serving professionals and providers with your cohost, dr Alex Mohseni and dr Amy Schiffman. Visit masteringmedicare.net for show notes, additional episodes and valuable resources. I would like to welcome all the listeners to our first episode of mastering Medicare, where we are going to take a super dry and boring topic like government run health insurance and try to make it slightly palatable. My name is dr Amy Schiffman and I'm here with my cohost, dr Alex Mohseni, and we want to welcome you to our brand new podcast. Alex and I are both huge podcast fans and I'm honestly so giddy about the fact that we are making a podcast. So let's introduce ourselves. Alex, you first. Alex: I'm Alex masania. I'm an ER doctor, or I used to be an ER doctor, I Amy: would say. Alex: Uh, but these days I'm obsessed with elder care and how the back office and all the systems work for, for healthcare, especially with revenue cycle management and automation and, uh, business side of all of that. And I, and I love doing deep dives with folks and understanding. How they really operate, what their issues are, and what gets them excited. And the only other things I guess I would share are that I'm a complete nerd. I love math and chess, and I'm the former captain of both the math team and the chess team in my high school. So that's just so you get a sense as to the type of person you're dealing with here. Amy: Now I get it Alex: now. It all makes sense. Amy: It makes sense. Wow. That is a resume. Wow. That's pretty incredible. Okay. Let me introduce myself. My name is Amy Schiffman. I am also an emergency physician by training, and I did work as an emergency physician for a while, but at some point I got the entrepreneurial bug and I decided to go a new direction outside of what I was trained to do. And about 10 years ago or so, I started a house calls practice for frail and homebound folks. And if you know me, you will realize that when I decided I was going to start a house calls practice and was met with scarfs and sniffling remarks, it only fueled me more to figure it out. But medicine is kind of crazy, right? Like you spend years learning how to do one thing, and if you want to change directions, you really have to kind of like reach deep. I had to actually cross train myself. Not only. Clinically, but also from a systems perspective, I like had to figure out how the world outside of the emergency department worked. I mean, what was outpatient medicine like? Like what are the resources and how do you maneuver through how home based care. I had to understand Medicare backwards and forwards to make sure that I knew how to bill and code as well as I could provide the services for my patients. And that's what I think brought me to become really interested in Medicare. And part of the reason you're sitting here with me, Alex, is because we cross paths where Alex: it was May, 2014 and I still remember the first instance of the connection point. I guess one of my bosses took the Bethesda magazine where Amy was, I guess on Amy's practice, was being highlighted in some article about doing some amazing stuff. And. In the elder care market. And one of my bosses took that magazine and kind of threw it on my desk and said something to the effect of, you know, go connect with her. We need to talk to her. And through a mutual connection of a Michelle DeVito, a doctor whom we both love, I reached out to you and we ended up buying your practice. Amy: And here we sit today. Alex: Here we are today. Amy: So a couple of shout outs to Alex. He's not just an ER doctor who's become an expert in the field of telemedicine. I, I do have to tell you, Alex, I, you are a bit of a standout because you are one of only about 15 or 16 doctors that has medical licenses in every state in the United States. So Bravo, Alex: quite painful experience, I'm sure. Amy: Oh my goodness. Yeah. Just having the three that are around here is a. It's hard enough to manage. So Alex, who should be listening to us on this amazing new podcast, I mean, who actually is our target audience? It's kind of like anybody, right? Like, well, sort of. We're really focusing on demystifying the core concepts of Medicare because we both have recognized that a failure to understand these core concepts is a source of profound system dysfunction. And frankly, I also wanted to add that Alex probably has some visceral pain when there's a tremendous amount of system, a logic. So I guess that our target audience should be medical folks, hospital, outpatient, but also case managers, senior serving professionals. Those are the folks that we're probably going to get the most out of this podcast. But we welcome anybody with open arms, and this could include anybody who knows somebody or has Medicare, or you're just plain interested. So we're going to welcome everybody. So you might be saying to yourself, why do these folks even need to be educated? And I will tell you that there is a huge chasm between what senior serving folks know and what they need to know about Medicare. And I've been in the senior industry for about a decade, and it's been interesting to me that folks don't always understand the big picture. So because of that, there can't always like recommend or provide services and benefits that a lot of Medicare recipients are do and they, they just, they just don't understand the whole big picture. So it's hard. It's complicated. Medicare is just really freaking complicated, Alex. Alex: Yeah. The reason I'm doing this is it is what you are saying, but I would like to add that in my career, I've often gotten myself into trouble by voicing my opinion. Right? And what I'm talking about is when I see something that doesn't make sense or it's not working the right way, it's really difficult for me to keep my mouth shut and I'll raise my hand and say, that doesn't make sense to me, or that's Amy: not working. Right. I'm always the quiet meek one in the room. Alex: And my brother told me once, he said, you know, I think it causes you great. . Pain when things don't make sense and they're not done efficiently or, or coherently, and he's right. It's, it's, it's some form of pain inside of me when something doesn't make sense and I don't think there's any industry out there where the end user experience is more discordant with what's possible. Then healthcare, there is more stuff that doesn't make sense in healthcare than in any other industry. I would say. And that gives me great pain. So, and, and through my kind of interactions with you and the healthcare system, I've come to learn a lot and we continue to learn and we want to help reduce some of that pain that I and others feel by sharing what we've learned and trying to make some sense out of it. Amy: That is so true. And actually, as I started doing house calls, Alex, what you speak to is absolutely the truth. I could not believe how complicated it was. I mean, here I was, I'd been an emergency physician sitting in a box, you know, for a while, went through med school and residency and out in clinical practice, and I decided I wanted to start. Something new. I had to really actually learn how the healthcare system work because when you practice either in a clinic or you know, as I jokingly say in a box in the emergency department or even in a hospital, sometimes we're all very blind to how the money moves, how the system works, how. People get paid, how people don't get paid, resources that are available. It's just so complicated. So I had to dig in and, and interestingly, I got all of this information, not just from reading the Medicare regs, although strangely, I actually really enjoy that. And I took a little piece from every single interaction that I had, and I tried to make a cohesive. System approached way of thinking about all of this, and I then began educating both myself as well as anybody and everybody who would listen to me. I essentially became like a Medicare evangelists. Not like I want to spread Medicare, but I really wanted to be an educator in the Medicare field and I can. Attest to the fact that every single person who I've ever sort of given my top to bottom what I call Amy's Medicare lecture too, has literally said, you taught me five things I didn't even know before. And those were people that you would be shocked to know, people who are actually healthcare professionals, people who are senior serving professionals. So I welcome everybody to this podcast because I think there's something to learn and we continue to learn every single day, Alex: and we'll be speaking with domain experts. Absolutely. Amy: I'm so excited about that. All of our amazing. Speakers that are coming up. Woo. A little bit of housekeeping. I just want to make sure that everybody understands that as we go through this talk, despite the fact that we are people who basically absorb a tremendous amount of information, we are taking all of the things that we talk about right off of either the Medicare website or Medicare affiliated websites, right. Alex Alex: and our personal discussions with experts. Correct. But always consult your healthcare attorney. Amy: Yeah. We're not lawyers. Thank God. So the way that I see this podcast going is that I really want to see that we need to get all of our wiggles out. You know, like when you have kids and you're like, Oh, they can take him to the park and let's just let them get their wiggles out. Yeah. For me, I think getting our wiggles out for this particular podcast, um, as a way of educating the listeners is, I think we really just need to get out. All of the basics and we're going to do that in the first few podcasts. And then after that it's, we're going to be able to iterate on that and we're gonna be able to have re that's when the interesting speakers are going to start, other than just us, because we're really interesting people too. But the other outside of Amy and Alex, interesting speakers are going to start after we can get all of our Medicare wiggles out. Right. Alex: I'm excited. I mean, I count myself as one of the beneficiaries of your talk. It completely blew me away. So I'm really excited to bring this to the public. Amy: Okay. So the other thing is, is that of course, as we go through this, we're going to be talking in a few broad strokes, because we kind got have to get the information out there, but we're going to be talking about it in such a way that, of course, there's gonna be exceptions. It's not like I'm going to be lying to you, but some of the times it's just going to be 87.6% true. There's going to be exceptions to everything that we talk about. We will be doing deep dives on a lot of these exceptions as we go through each different week in each different podcast, but for today's purposes, we are going to be going through very broad strokes of what the basics of Medicare is. Alex: Perfect. As ER doctors, we hate BS, so let's get going. Amy: That sounds great. Okay, so Alex, why don't you ask me what Medicare is. Alex: Okay. Amy, what is Medicare? Amy: All right, so Medicare. Medicare is a government run health insurance that primarily focuses on older people. Over the age of 65 Alex: and I hear this term Medicaid sometimes w how is that different? Amy: Okay, so Medicaid is not what we're going to talk about today, but thanks for bringing it up. Medicaid is actually a state based health insurance program for low income sick people. Alex: Right. Got Amy: it. So what we're going to be talking about is Medicare, which is federal meaning national. It is a federally run health insurance program. It is basically the same everywhere in America. So if you're in Hawaii, if you are in Rhode Island, if you are in Virginia or in Florida. And you have Medicare, and we're talking about original Medicare, not Medicare advantage, which we will talk about. But if you are in America and you have original Medicare, the laws and the rules are pretty much the same everywhere you are. Alex: Right? So you just kind of turned 65 and you get free healthcare, right? Amy: Ah, you walked right into that one, didn't you? So, no. But why don't we just sort of break it down a little bit. So Medicare is comprised of three main parts. Part a, part B, and part D as in dog original. Medicare is part a, part B, and part D. basically, Medicare offers access to the full kit and caboodle of patient interactions with the healthcare system. So, so what exactly is Medicare overall? Alec. Alex: Well, Medicare, as we know, is health insurance mostly for those 65 and older. And there are some exceptions that we're going to go into, but as a health insurance, it, it has to pay the different people and the entities that provide care or some component of that care. And at some point, the higher ups decided that we need to organize this system into different. Chunks because the way that we're going to measure and pay for different services is going to be different. And let's organize it in a way so that we can make some sense out of it. And so they created these different parts. And in each part there are different sort of people and costs and qualifications. And so when we're talking about part a and part B and part D and even part C, Medicare advantage. Oh w w it's just an organization system, just like folders, right? So we're going to open up each of these folders and talk to you about what's inside of each. Amy: All right? So I'm going to be the one that's going to sort of take a little brief deep dive into each of these different sections. So as Alex said, Medicare's is basically a way of organizing how the government is going to pay each of the stakeholders, the doctors, the hospitals, the people who supply medications, anybody who's providing healthcare. So let's start with part a. Part a is essentially the payment system for what falls under the acute care spectrum. So let me explain what that means, right? The acute care spectrum is essentially the spectrum of care when you're sick. So that would be a hospital part, a pays for your hospitalization. It then pays along that same continuum. If you get discharged from the hospital and end up in. Post acute care rehab and then part a follows you into the home for home health, which is Medicare skilled home health, Alex: which is not the same as home care and get Amy: correct. We're going to get into that. Thank you. And it also pays for hospice. So let me repeat. Part a is the acute care spectrum from hospital to rehab Alex: to home. Right? I love mnemonics. And they all have H. and. M. I don't know if you'd pick that up. Hospital rehab, home and hospice. Amy: Okay. Take your meds. so anyways, yeah, so basically hospital rehab and home and hospice, hospital rehab home, but in the home you can be receiving home health or hospice. And. Part a is unique in the different Medicare's that we're going to be talking about because it is essentially a free entitlement on a monthly basis. There is no monthly cost for receiving part a Medicare. You basically turn 65 and if you have paid 40. Quarters into the social security system, you're going to get that for free on a monthly basis. Now, there are costs if you do end up in the hospital or in rehab, but on a monthly basis, there is no monthly premium for party Medicare. It is. Free. Alex: Okay. So let me try to maybe clarify what you're saying or help clarify. So throughout health insurance, there are different ways where the patient has to share in the costs of, of, of the care that they receive, right? Amy: Either in the form of premiums, deductibles, copays. Alex: Yeah, right? Yeah. So sometimes it's a premium, which means you're just paying for, I guess, the right to have a service. Right? And sometimes there's actual cost sharing where once the service is provided, then you need to pay a portion of it, either as a, a co-insurance or some other form of cost sharing. So copay, copay. Right, right. So here you're saying part a does not have a premium, but there are. Portions of part a that have co-insurance or cost sharing. Amy: So not co-insurance, but they have cost sharing. So yeah. So let me just review. So part a is the acute care spectrum and at every part of the acute care spectrum, except for home health and hospice, there is cost sharing. Alex: And in a later episode, we're going to do a deep dive into all of Amy: that. Absolutely. Part a is fascinating and it does have a lot of nuance to it. So just because something is sort of free at face value, it doesn't mean it's free if you use it. So if you use part a, you will have costs, Alex: you will have costs Amy: correct as the premium that's premium is free. Right. Okay. Alex: So to recap, part a is mostly hospital and after hospital Amy: stuff, it's for when you're sick. Yeah, exactly. Alex: We're going to define all of those in more detail later. Amy: Right. So let's move on to part B. So part B is an optin product also available to the same group of people that have part a available to them. So you're turning 65 the government will make part B insurance available to you. And that pays for professional services within Medicare. It pays for the interactions you have with a doctor, a nurse practitioner, a PA, or any number of others that are considered to be qualified health professionals. Part B also pays for labs, x-rays, medical equipment, and some respiratory meds, but I'm not going to do that in a deep dive here. Part B is an optin product that has a sliding scale, monthly deductible that is based on your income. At the lowest. It's like 140 bucks at the highest. It can be as high as 450 bucks, and it is a very important part of Medicare because it's what we all think about when we go see a doctor in a clinic. That doctor in the clinic is getting paid part B Medicare. Interestingly, if you end up in the hospital, Alex and we were talking about how part a covers the acute care spectrum and you end up in the hospital. It turns out that if you have pneumonia and you end up in the hospital. Part a pays for the room, the board, the food, the antibiotics, the care from the nurses, any equipment that's needed, all the tests that are done, any medications that are done in the hospital. But if you see a doctor, a nurse practitioner, or a PA in that hospital, they are actually billing part B for the services that were in that hospitalization. Alex: So to recap, just to make sure we understand here. Part a is paying for pretty much all of the hospital costs, except for the doctors. Slash NP. Slash, PA, which is part Amy: B. Correct. Alex: And a part B is those sort of professional services, you know, doctors slash NP, slash, PA, regardless of whether inpatient or outpatient. Amy: Absolutely, absolutely. Alex: And to recap, on the high level cost side, part a, there's no premium, but there is cost sharing potentially, depending on which part of part eight and we'll get into that later. And part B does have a premium. Amy: It does have a premium and it is dependent upon your income. And it's actually, so it's depending on your income. It's actually a two year look back on your income. So whatever you pay in 2019. They're looking back two years to how much you earned in 2017 to decide how much your premium for part B in 2019 is going to be. Alex: That's fascinating. I had no idea that there was an income component to determining your premium. Amy: Asked me if Medicare just pays for whatever the doctor asks for. Alex: Okay. Amy, does Medicare pay whatever the doctor asked for Amy: Medicare part B does not pay. Whatever the doctor asks Medicare to pay. For example, if you go into a doctor's office and you say, Hey, listen, I would like to see you because I don't feel so good, and the doctor says, I'm going to send Medicare bill for like a thousand dollars they're not going to get that thousand dollars because Medicare has actually set the rates that physicians can collect for any services done under part B. They're called Medicare allowable costs. And interestingly, even if the doctor accepts Medicare part B. When Medicare pays for that part B service, they only pay 80% of the Medicare allowable cost. It's not as if they say, okay, the Medicare allowable costs is $100 here, doctor, here's your $100 they get, they say, Hey doctor, here's $80 and so that other $20 that is left from that hundred dollar Medicare visit. It falls upon the patient unless they have what is called Medigap insurance, and there is a lot of information out there. People know that it exists, but it is the insurance that people have to buy to pay that other 20% Alex: called Amy: also called supplemental co-insurance, Medigap. They all kind of mean the exact same thing. It is the insurance that is responsible for paying for the other 20%. Of the Medicare allowable costs, that Medicare itself does not pay. Alex: Got it. So just to recap again, part a is like non physician hospital and post-hospital costs with no premium, but some cost sharing, which we'll get into later. And part B is a professional fees like physician fees, inpatient or outpatient, but only 80% covered by Medicare. And you got to pay, you do need to pay a premium. To get the other 20% covered. Otherwise you're responsible for that. Amy: Correct. And none of these are particularly inexpensive, and we're going to talk a little bit about cost, but if you think of part B as being just, Oh, it's $140 a month, you haven't really thought of the fact that you probably also have to get a Medigap policy, which could easily be 300 300 $5,400 on top of it just to cover that other 20% Alex: got it. Amy: Okay. Part D. Part D as in dog part D. Alex: what happened to see. Amy: We're not going to talk about C right now. Alex, we're not going in alphabetical order. That would make too much sense. Too much sense, because that makes sense. Now, part C, we're going to skip for now that is what is called Medicare advantage, and we are going to talk about it briefly in this, in this first episode, but I don't want to talk about it right now. I think it sort of distracts us from what we're really trying to get at, which is original. Medicare original Medicare is part a, part B, and part D. and so let's dive into part D. Alex: so ABD, ABD, ABD pad, Amy: like an ABD abdominal pad or a big giant poofy pad. Alex: Tell our audience what an ABD pad is used for. Most of many of them maybe don't know Amy: exactly. Donating from a gunshot wound would be one thing. Bring me an ABD pad Alex: stack. Amy: It's basically a giant sponge. Okay, so part D, part D is also like part B, an opt in insurance with a monthly premium, and that is for medication insurance. Medication insurance is part D. Alex: hold on. My medications in the hospital stay aren't covered by part a Amy: no, those are covered by part a, but if you are an outpatient, you need to have part D as in dog insurance because all of the medications that you get while you're at home, your, your beta blockers and your, all your medications that you get while you're at home. Those need, unless you plan on paying for them out of pocket completely. The insurance that you need to help for that is part D. Alex: okay, so hold on. Amy: And that's by the way, different companies from part B, Alex: right? So part a is inpatient hospital and post-hospital care, non-physician stuff. Part B is physician and other professional fees, inpatient or outpatient. And part D is just outpatient medication. Amy: It is outpatient medications. Alex: Correct. Maybe some of our audience doesn't know what inpatient and outpatient means. Can you briefly explain that? Amy: Okay, so great question. I'm sure a lot of people think that as soon as that ambulance pulls up in front of the emergency department, you are an inpatient at that hospital because you're at a hospital in an emergency room. But strangely enough, the emergency department. Is actually considered outpatient medicine. You are not considered to be an inpatient until some delegated official within a hospital has called you an inpatient because it's really a status, not a place, but it's basically you have moved from outpatient status to inpatient status and that is not until after your emergency department visit is finished. So somebody says, we are going to admit you to the hospital. You actually don't even know if you're going to be an inpatient there because you could be going to something called observation. Also outpatient, part B. The emergency room is part B. It is. It's outpatient. Alex: This is observation Amy: as his observation. Those are both part B. You are not an inpatient until someone says you have met the qualifications under Medicare to be an inpatient and you can actually, you can actually be in the same room and be in an observation status. And then someone just flips a switch in the computer and suddenly you're an inpatient status in the same hospital bed. Alex: Boom. Got it. So once that switch to inpatient is made, that's when the part a kicks in, Amy: that's when part AA kicks in. Correct. But all the medications that are prescribed in the emergency department or observations could in fact be charged under your part D as in dog insurance. Some of, some of them are in fact. Because you're still an outpatient status. Alex: Right. And that's kind of tricky. And we'll get into the, we'll get into the details of that episode in and of itself. Exactly. Amy: But overall, part D is for outpatient medications. It's what the pharmacies that we interact with on a regular basis, that's the insurance company that they will send the bill for your medications. Okay. So there are many options for part D and part D does not necessarily pay for all the costs of the medications, but provide significant discounts. Depending on how much the patient wants to buy in terms of part D insurance. Additionally, you might choose different part D plans if you have different health conditions, like if you have diabetes or COPD, you can actually buy part D plans that are specific for those types of health conditions. Alex: Awesome. Okay, so to recap, yet again, because that's the only way I learned part a is inpatient, that we've got the H's inpatient hospital rehab, home health, and hospice. There's no premium, but there's all sorts of cost sharing, which we'll get into later. Part B is inpatient and outpatient professional fees, and there's additional stuff to that. We're, we're going to go into detail later. Part D is outpatient medications and part C, which is Medicare advantage. Amy: We're going to talk about that now. Okay, so all right, so let's, let's talk a little bit about. The lonely letter C. Right. We left off Medicare C we went a, we went B. We went D, but we left off Medicare C got it. So part C is what we now call Medicare advantage. Medicare advantage is essentially private health insurance because Medicare has contracted with private health insurance companies to squish together. Part a, part B and part D. it's like a all in one solution and it's an alternative as an alternative to original part a, part B, and part D Medicare separately as original Medicare. It's really important to understand, this is actually not Medicare through the government. This is Medicare through a private insurer. They have companies that are available in different States, in different regions that provide this type of thing. And it is not always common. In fact, where we're sitting right now, Alex, not a lot of people have Medicare advantage. I mean, original Medicare is kind of like the choice Alex: in Maryland Amy: and Maryland where we sit, but in places like Florida and Texas and New York in New Jersey, far more common. Alex: But just, just to paraphrase it again, Medicare advantage plans are essentially. At a minimum, they have pretty much the same benefits, the same minimal benefits of part a, B and D combined package together. Plus sometimes some additional benefits. And Medicare is basically paying private insurance companies, you know, the big names, you know, at now United, Humana, et cetera, and saying for each. Medicare advantage patient, I'm going to pay you X amount of dollars per month and you must provide at a minimum, the same services that are covered by regular, original Medicare. And if you want to provide additional services beyond that in order to attract customers. That's up to you. Amy: Correct. Right. Plus, the premium that the patients pay, which from a patient's perspective might actually be cheaper than if they bought part a, which is actually already free, plus part B plus D. so it's the money that the company gets from Medicare plus the premium that the patients pay, Alex: and if you're able to keep costs down below the amount that I pay you per month for each of those patients. That's your money, Amy: right? So it's how they make the money. Alex: Right? So that that is really what it is. It is. It is private insurance companies providing you Medicare plus some additional services. And they're getting paid by the government to do that, and they're trying to do it in an efficient way. Amy: It's managed care. It is a managed care product Alex: in an efficient way, and they're competing against each other, which is why, which is, which is good. It's good for the consumer that they're competing against other providers of Medicare advantage to provide higher quality services at lower cost. Amy: Yep. And I want to add two extra things to that. The first of which is that the kinds of services that they throw in. Original Medicare might not cover are things that seem like amazing, right? Like hearing AIDS or dental care or vision things, glasses, a lot of stuff that is not necessarily covered under original Medicare. A Medicare advantage plan may in fact pay for throw in there. They have social workers that often can get people to get meals on wheels or. Other different types of social determinants of health can be addressed by their large case management staffs. On the other hand, depending upon where you are, if a patient chooses to opt into one of these Medicare advantage plans, not every doctor that takes original Medicare takes that Medicare advantage plan because you're talking about a private insurance policy and suddenly not every doctor might take that insurance. So you have to be careful when you're switching from original to a Medicare advantage that your physician can stay your physician and will accept your Alex: insurance. And there's, I believe there's a few other potential negatives of one might need to consider as well. And we'll, we'll do a deeper dive into that topic on a separate episode. Amy: Absolutely. So let's just summarize where we're at. So Alex. I'm going to summarize my way. Then you summarize your way. Cause I love how we both come at this same problem in two different directions. I think of Medicare as basically a tripod of care that can bring a lot of stuff to a patient who is over the age of 65 with exceptions. And that part a is essentially free. You get it. When you turn 65 you do have costs associated. If you end up getting admitted to the hospital and going to rehab, it is part of the acute care spectrum. Part B is the professional fees, either inpatient or outpatient. It pays 80% of the Medicare allowable fee, and a lot of times people have to get a Medigap policy that goes along with it. And then there's part D, which is medication insurance, outpatient, outpatient medication insurance. Correct. Now, altogether. This could be pricey, Alex: right? Yeah. And we're going to get into the prices separately cause there's actually a lot of different elements and nuance to it. Amy: Absolutely. I mean, I kind of want to like give them a little hint, right? Should we give them a little hint of how much it costs to get old. Alex: It's just too much, man. Amy: Okay, fine. No problem. We won't scare, let's not scare them. Don't scare him yet. Don't scare the muggles. Don't scare the muggles. Alright. Alex: I think that's a great summary. Amy: Okay, good. So you don't want to summarize it more. I love them. I love the Alex, the Alex summaries. They're often more straight and narrow as opposed to the add Amy version of summaries. Alex: Can I tell you something? We can include this in the talk if you want or not so. You know, obviously I went to college, right? But I had a studying technique that I'm not, I don't see it in my kids and I, and, and I don't, I don't really see it in a bunch of other people either. But it really worked well for me, which was I would when I would. Take a course. I would try to take all of the information from that course and put it onto one page Amy: and I would do the same thing except for, I would put it on a one big giant whiteboard because I couldn't write small enough. Alex: Where was your whiteboard? Amy: Wherever I could find a classroom that was empty, I would go into a classroom and I would basically just like lock the door and be like, this is my classroom, and I would write all the information on one Blackboard. Alex: Interesting. Amy: And I would write it over and over again so that it was, I would just commit that to memory, but it's just, it could have been one piece of paper, but I felt like the need to write in big letters with chalk, Alex: but then how you can't take that home with you and you can't review it later. Amy: No, but then I would just say, okay, fine. Interesting. Alex: So for me, once I had it all on one page, then. Whenever I needed to study, I would just look at that page. Right. Every and a lot of the font would be super tiny, but by looking at that page Amy: over there, handwriting's not that neat. You have neat handwriting. Alex: It used to be, yeah, it used to be before med school, but then I could visualize at the test time. I could visualize when the question came up exactly where on the page it was, and I could just picture it. So that's how I learn. And in order to. Kind of help people who are similar to me. We've created a little cheat sheet about all the different parts of Medicare and the key elements, and we've put it on a, on a one pager that you're going to be able to access from our website and we're excited to share that with you. Amy: Great. So basically what you're saying is everything that we just talked about is available on one small piece of paper, Alex: plus more Amy: plus more plus extra, plus some QR codes, which are really cool. Alex: Plus a Vegomatic Amy: and it can keep cutting even after, even after it's sauce through a tin can. Oh my goodness. So where do we find the information about this awesome one pager, Alex: masteringmedicare.net Amy: masteringmedicare.net. Alex: Well, thank you for joining us for this introductory episode. We promise the future ones will be Amy: better. Absolutely.