I could afford and have had plan n for 2 years now. This year I am switching to an advantage plan because of the part d coverage. After paying plan b premium and plan n and part d premiums my drug cost was 732.00 in January, 325 the next month, and on and on. There is no way this was sustainable and I could not find a part d plan with better coverage. This year I will pay 47.00 for the same medicine until I reach the donut hole and then it will be 120.00. Leave it to the US government to make such a mess out of healthcare.
The cost of the supplement arrangement is the biggest downside. Unfortunately, that cost becomes problematic foe many, especially as the premiums increase.
It's still better than being bankrupted because of a cancer diagnosis. I consider my $300/mo supplemental plan premium a bargain (my gross income is $25,000/annual). I will never be bankrupted becaue of cancer treatment. Already been through a 15 month life-threatening cancer diagosis/treatment and my out of pocket was $30. THIRTY DOLLARS (after $225 annual medicare deductible)@@Theretirementnerds
Congratulations!!!! Yours is BY FAR the most balanced and honest information I have yet heard on TH-cam! I am 68, and I made my decisions based on my own research. This was because I came to the conclusion that most of the info was coming people with vested interests (i.e. insurance agents). You are a VERY REFRSHING exception to the rule!
The thing is a lot of the anti-medicare advantage viewpoints tend to compare the coverage to traditional medicare with a (good) supplement, but that's really not what the program was intended for. To be apples to apples, you have to compare it to traditional medicare without a supplement.
@@Tim85-y2qI think if you take the incremental premiums of supplement plan into consideration while comparing with Medicare Advantage, it is absolutely an Apples to Apples comparison.
also worth considering is ----- do private practice Docs participate in these advantage plans? 1: Problem with the provider list My own experience (20years as a medical provider)is that often the list published by advantage plans a VERY out of date. My patients often complained that when they signed up for the Advantage plan they were shown a long list of providers. But, when it became time to use the providers many have left the Advantage plan as the insurers payment to the Docs was too low that the practice was losing money, leading to the provider leaving the plans. 2: Some medical groups do not participate (usually, Anesthesia, Emergency, Pathology and others) so if you need to have your appendix removed you WILL get a bill from these providers $$$$$$ 3; Traveling with an advantage plan?--- forget it , you may be in a situation that NONE are in network (hospital Docs etc..) $$$$$ 4; Danial of services; a very common issue, Need a cancer specialist at the University? Sorry, out of network, Try to appeal the decision ALMOST NEVER WORKS!!! 5: Quality of the providers; the cream rises to the top---The very best MDs may not want the super low reimbursement rate from the Advantage Plan. Conversely, New and inexperienced Docs will always accept these plans (They need the work, and get the experience on the unsuspecting patient) I would love to see an honest discussion on these 5 points
Hi Max, thanks for watching and we'll do our best :) 1. Agreed. Goes both ways. Often times providers are in-network, but do not show up on the carrier's provider search and vice versa. This is highly dependent on the insurance company. As with most things... some are better than others. 2. Some (not all) providers and groups mentioned do not participate, you are correct. It is not this way everywhere, but in our area, we have 4 major hospital systems. Some Advantage plans have 2 of the systems in-network. Some have 3. Some have all 4 hospital systems in-network. Looking at private practice doctors is where the provider search comes in (Question #1). 3. This will depend on the plan. Emergency services must be covered as in-network by advantage plans. So, if you are traveling and have an emergency (hospital codes it as such), it will be covered as in-network. PPO plans will have more flexibility while traveling. There are some major PPO plans that have 97% of all non-pediatric physicians nationwide in-network. This is by no means all or even a majority of PPO plans, but they do exist. HMO plans - yeah, not a lot of help traveling (except the emergency situation). We don't see a lot of people scheduling visits while traveling though... but it leads to #4 4. Say you want to travel (not for fun, but for a provider) because you want Mayo or certain University hospital care, yes, there is a chance it is out of network. Groups like Mayo said they won't take Advantage. In the same breath, groups like Kaiser won't take supplement plans. Many university hospital systems have their own Advantage plans (not all). Also, with Advantage plans, you can appeal to have services or providers covered and we have seen those approved. If there is only one cancer treatment center in your and no other viable options, they can be approved. More hoops to jump through for sure. 5. In private practice, yes. In hospitals, not as much. But yes, Advantage plans USUALLY lose to supplement plans in the network conversation for sure. Honest enough?
I've been retired for 9 years now & I'm poor, under the 100% FPL. I haven't been sick with anything for 15 years now & that was a cold. So an Advantage plan was the only thing that made sense for me. As I understand it, I have dual care coverage, what Medicare doesn't pay, Medicaid picks up the rest. The extras I get from the Advantage plan have made a big difference in my life.
Glad your health has been good and hope it remains that way. Advantage plans can work very well for a lot of people. Definitely not for everyone, but they can work well. Thank you for watching and adding your perspective!
That is correct as long as you don't fall into a financial situation where Medicaid expects you to "spend down" resources, but that's functionally like a deductible anyway, so it's not really much different than any other insurance situation.
That was a great presentation, thank you. My wife started Medicare this year and had both of her knees replaced (about 3 months apart) and we paid very. very little with her Advantage plan. We live in North Central Florida and had no problem with physican or facility participation. I don't understand how the system actually works because we never even came close to her out-of-pocket maximum that was quoted by her Advantage underwriting, despite the claims totaling in excess of 300K. If nothing significant changes I anticipate signing up for the same program when I"m eligible for Medicare in another year.
Thank you for watching and for adding your perspective. There are stories of both good and bad with many of these. We're glad to hear yours was a good experience. Appreciate you!
@@JoeDoe2 Typical Advantage Plan, be it HMO or PPO, will not have a deductible, but instead a fixed dollar amount copay for most services. For example, Hospital copay may be $290 per day for the first 5, then covered 100% after that. Specialist copay may be $35, Outpatient copay maybe $50, etc. So you have a pretty good idea up front what it will cost you out of pocket. Out of network on a PPO is more likely to get you into percentage copays on services. At those rates, not very likely to get anywhere close to your annual deductible in-network, unless you have some very serious problems that require ongoing treatment, like multiple hospital admissions in a year, extended stay in rehab or skilled nursing facility, need costly durable medical equipment, etc.
I talk to doctors all day long as part of my job... they love Medicare Advantage plans the same way that cats love dogs. I talked to more and more doctors everyday that are just dropping them. Refusing to see people that have their plans. That being said if you're 65 don't have a lot of money and are healthy it could be a great option for you. I haven't gone to the doctor in 15 years I don't plan on going in the next 15. If I get cancer I would choose to walk off a cliff rather than go through chemo. Everybody gets to make their own choices in this life
I'm convinced that the commissions for Advantage plans, and/or the renewal money amounts and durations must be higher than supplement plans. There are agents in my local area who will lie by telling you that NO ONE is buying supplement plans in hopes that you'll 'follow the herd' and choose Advantage just cause they've brainwashed you into thinking that's what everyone else is buying these days. (the peer pressure sales pitch). When I told an agent I wanted a supplement plan, he started asking me if I had any chronic health conditions as if I needed to defend my choice. When I defended my choice, in part due to it having a nationwide network and how people who retire and travel the country in a RV may get sick and don't want to worry about whether the provider will code their treatment as an 'emergency', or they may want to hang out in Florida as a snowbird, visiting someone for 6 months at a time, he asked me, "but are YOU going to do that?" He then said "just worry about 2023" (my first year of enrollment) but that could be suicidal if I later needed to switch to a supplement plan and couldn't meet underwriting guidelines due to a health condition. (The government made that rule, not me). He went on a rant about how much more premiums would be for a supplement plan if they unconditionally covered pre-existing conditions. But yet, Obamacare and M.A. plans cover pre-existing conditions! The govt has CHOSEN not to extend the same coverage to supplement plans if you start out with M.A. So why can the govt pay for pre-existing conditions for Obamacare and M.A. plans but not supplemental plans after initial enrollment? No one can answer that question. It's blatant discrimination against supplement plans that aren't bought initially. I can switch to M.A. anytime and have pre-existing conditions covered. The agent CLEARLY had better commission terms with the insurance company if I chose a M.A. plan, and I have no idea how much commissions are or when he gets paid or for how long. It was just OBVIOUS that M.A. plans MUST pay better than supplement plans, or they pay SOONER, or LONGER, or some other factor I don't even know about that benefits the agent. There's no other logical reason for his obvious bias. In another instance, where an agent sent out flyers to come to his free 'informational meeting' where he buys everyone's meal, and based on Medicare rules is only suppose to talk about Medicare IN GENERAL, NOT specific plans, he pushed AARP's HMO ONLY and claimed that no one is even buying supplement plans anymore, which is not true. The stats are out there. It was obvious these agents only want to sell M.A. plans, so if there's any 'hate' out there for M.A. plans, it's not coming from the agents who sell them. It's obvious they don't care about the customer's needs. They care about the commissions they're getting. They act as if supplement plans are going to pay them diddly squat by comparison, at least in the long run, if not initially. He acted like supplement plans are barely worth writing up, and was not even sure sure how to do it at first. I had to wait a day while he went and found out. Agents can also steer you to certain companies for their own selfish monetary reasons. They must be getting some type of bonus commission that the poor customer doesn't even know about, and that agents are under no obligation to disclose. They only reason I used him to sign me up was because I didn't want to sign up directly with the company cause their own agents gave out conflicting information during multiple phone calls I made with questions about WHEN I could sign up. (i.e. "Do you have to have the Medicare number before I can sign up?") One agent said yes, another said no. I was going through a living hell just getting a Medicare number from the govt. And one of their agents deceived me over the phone in order to get my email and home address and then flood me with emails and ads in the mail. He initiated an application on my behalf without my permission, or even telling me he was going to. 5 minutes later, I get an email from AARP wanting me to "FINISH" the application! It's like he was wanting to tie his name to the commission before anyone else could, once I decided what I wanted to do. The agent who signed me up said it would take up to 10 business days to get approval, and the application itself said it would take up to 15 business days. It took less than 48 hours. Any agent who had signed people up for my plan before should have known how long it really takes, regardless of what the application says. This is another reason why it's obvious he only wanted to sell M.A. plans, cause that's all he's ever done and he's been licensed and practicing for several years and I'm sure does very well financially cause he can afford to buy 25 dinners at a high scale restaurant meeting, at $20+ each (or more) per dinner. Do the math. Another agent left a non-discript sticker on my front door, saying to call the number on the slip to claim an undeliverable package, which was a lie. It's illegal for agents to even come to your house uninvited, whether they knock on the door or not. He must have thought that calling him back was an invitation, at which time he could drop off his literature and save the cost of a stamp. I'm convinced the industry includes unethical crooked agents. People need to verify EVERYTHING they are told by ANYONE, using multiple sources. Answers will vary, and you have to decide who's right. And don't give out your information too soon. Watch out! You have been warned!
The future is MA plans. period. You're stuck in the past with your view on supp plans . You can travel with MAPD PPO's But if you want to pay $300 a month with no included rx, dental, vision or hearing coverage as apossoed to a $0 premium MA. to see 2 doctors twice a year, well... that's upto you 🤷♂️.
@@paulleonard7038 He does a side by side cost comparison video of Advantage vs. Supplement and the Advantage is almost half as much as the supplement plan....$1978.80 vs. 4678.80/yr. A decent Advantage is not $0 premium. The $0 premium plans are HMO's, not PPO, requiring a middle man to schedule you, get you in weeks or months later, just to get a referral to a specialty Dr that you already know you need, and already have the Dr. picked out. It's a stupid, time consuming formality. Plus, you wait weeks or months to see the specialty Dr., then weeks or months to get scheduled for surgery or other procedure to be done. You could die waiting all that time. Plus, you are limited to a geographic area and network only doctors. If you travel out of the area, like people who RV around the country in retirement, or for life, it's good for emergencies only. The better deal depends on how much medical care you need in a given year, where, and from who. There are people with conditions that they've been waiting years to fix, such as putting off needed surgery, not just '2 doctors twice a year' so that is an assumption. There are people with ongoing medical conditions that need things like therapy, and I know people whose agent recommended supplement for that reason. If that's not enough, it's a flawed regulation to tell people that they can ONLY sign up for supplement plans ONCE without medical underwriting, and if they ever switch to Advantage for more than a year, they can't go back without underwriting. Their conditions could be such that they don't want to risk not being able to go back. So they're between a rock and a hard place due to that regulation. An agent told me that if everyone could switch to supplement anytime they wanted, like after getting cancer, everyone would just wait until then and switch to supplement. But the same can be said for Obamacare. It's a double standard, and the regulation should be changed. A person can't just change policies whenever they want, either way. They have to wait for enrollment period. It's a huge 'we got cha' incentive to sign up for supplement from the beginning, and it works. Add to that the travel, network, and referral limitations, and to some people, it's worth it. As for the other stuff like dental, I'm tired of dental plans with networks, which is what it would be with advantage. The dentist I want to go to are in such demand due to skill and popularity, they don't mess with taking ANY insurance. Their schedules are booked and they don't need to. So I have to buy my own plan that lets you go to any dentist, anyway. Not everyone needs hearing and vision. Glasses can be purchased out of pocket for far less than all the premiums you would pay, and hearing loss is gradual, and if you need an expensive hearing aid, you have time to switch to advantage then if you want without it killing you.
Any agent lying, most likely works for a call center. I would never mislead my clients, for that reason, they are my clients and I am in contact with them regularly. 9f course I offer Supplements and MA plans, and recommend on am individual basis.
I think it all boils down to the plan itself. When I retired before Medicare age they pushed my wife out of my plan and into a MA PPO that matches my plan. It includes the same RX coverage. It has a 400 dollar deductible / 2,000 dollar total out of pocket max. Per person.
ln traditional Medicare your doctor makes the decisions about your healthcare needs ln Disadvantage plan the insurance company makes the decision about your healthcare needs.
The 2nd opinion is only based on profit/loss, though - not whether something is medically necessary. Some insurers are getting heat for using algorithms to baselessly deny claims.
I've just recently stumbled upon your videos and by far, they are the most comprehensive, clear and balanced presentations that I have encountered. My spouse and I sincerely appreciate the work that you are doing. We will be in contact with your organization this week for an initial consultation.
I have an advantage plan. I am lucky to also have Medicaid and have the United Health Duel advantage plan. A few years I had prostate cancer, my insurance refused to treat me saying I would die before cancer killed me. I appealed because my health was good and prostate cancer was my only problem. With appeal they cover me. Am now prostate cancer free.
Very interesting the discussions about how some are very happy with their Advantage Plans and for others it has been a nightmare. Clearly it varies from company to company, plan to plan and state to state. Which is the biggest arguement in favor of Supplement Plans. It's like eating out while on a road trip. You see two places next to each other. One is a little local cafe, call it "Joe's ", the other a Denny's. You know Denny's is far from perfect, but whether you are in California or New Hampshire, Washington or Florida, you know what you are going to get. Joe's is a crap shoot. Supplement "G" (for example) is Supplement "G" no matter what state you are in or what company you are dealing with (of course you want a reliable company that isn't going belly up any time soon!) But the coverage is the same. If it's covered by Medicare, it's covered by your Supplement Plan. You pay your Part B deductible and you are done, as long as Medicare covers it. You can go to any doctor that takes Medicare. Any hospital. No worries about in network, out of network, deductibles, copays, whatever. You don't want to be thinking about all that when you are sick. Advantage is too much of a gamble.
Isn't there a fifth situation in which one can switch from Medicare Advantage to Supplement Plan: Suppose one has Medicare Advantage and moves their primary residence to a location that is outside of the service area of their Medicare Advantage plan. Can't one then switch to a supplement plan in that case without underwriting?
Thing is , you never know what kind of health problems you will have in the future.Do you want to take that kind of risk with MA plans? I turn 67 this May.I enrolled in Traditional Medicare with a supplement, "G",before my 65th B-day.At 66, it was found out ,unbeknownst to me, that I had 70% blockage in a major artery and just recently I i started having problems in my leg.Thank God for Medicare! I didn't have to fill out any forms or worry that i didn't have total coverage.My deductible for the year was about $220.That's all I had to pay.No surprises.I pay $115 for my supplement/Medigap policy.I also pay very little for all the medications I now have to take.. BTW, before I was 66, I was walking a lot, especially up and down hills and the only thing I took was vitamin D.Yes, you never know what life will throw at you.
That is the crux of the insurance conversation, right? How comfortable is someone with risk? Are they willing to spend more money now, so they may not have to spend more later? Or, save more money now with the risk of having to spend more later? The unfortunate reality is that supplement plans are too expensive for some people. Yours sounds like a reasonable amount. There are some states where it starts at $300/month for a 65 year old and plans go up from there (sometimes twice a year). Love supplement plans. If people can afford them, they are amazing. If people can't, Advantage plans in many areas of the country are actually quite good. Thank you for watching and commenting!
I don’t know why there’s so much bashing on advantage plans! A lot of retired senior citizens cannot afford the extra supplemental plan premiums! It’s hard enough plan B already take more money from your social security! Supplemental plans are good if you can afford the added extra high premiums every month! Otherwise medicare advantage plans works !
There are areas and plans that don't make a lot of sense. Also, there are a lot of people who are or were tricked into an Advantage plan not knowing what they are or how they work - mostly through call centers.
Outragepus to me this is so complicated. Pay into your whole life but still have a 165.00 monthly preminuim but need a 200.00 monthly supplement plan and a drug plan that has deductible or Advantage with limited medical choices and network that you have annual out of pocket maxs up to 5,000 and not allowed a supplement plan l mean wtf cant l just keep the ACA l hate this.
Unfortunately, can't just keep the ACA. Well, you can, but once you reach 65, you lose all subsidies, and the plan gets much more expensive, more so than the advantage or supplement options.
Nothing in life is free. At least with Medicare you are getting a service in retirement even though it costs money. The worst is with Social Security. I had a friend who passed at age 58. He was single and worked all his life paying into the SSA. All of the money that he paid in (and his employers paid in) to SSA is just gone. Not he or any of his beneficiaries will ever be able to benefit from the thousands of dollars he put into the system.
@tomm7505 oh be quiet l paid into for decades. Lm self employed so pay double l will continue to work so will continue to pay double while l now have to pay for medicare So save the nothing is for free lecture.
@@tomm7505 If he had a wife she can get survivor's benefits. My own dad died in his fifties and my mom remarried at age 50 (she was 8 years younger than my dad) so my own mother is now collecting survivors benefits from her second husband who lived into his mid 80s and made a lot more money than my dad did since he worked for a longer period of time. She also got a good supplemental plan from her NYC job and she has a lot of health problems now and they cover EVERYTHING. They also covered her second husband till he passed. She has excellent coverage through medicare plus supplement plan. NYC wanted to change to a Medicare Advantage plan and the retirees sued the city and the judge threw out the Medicare Advantage plan the mayor wanted to switch to.
Advantage plans have cost taxpayers quite a bit more than original Medicare (something like 17 or 19 BILLION dollars up to a few years ago) and studies have shown that medical outcomes are essentially the same. With original Medicare, you have the patient, the provider and the government involved in payment. With Advantage plans, you have the same 3 (patient, provider and government) and then you are adding the insurance company and all the complicated (and expensive) hurdles and layers of bureaucracy. With everyone crying about running out of money for Medicare, I don’t understand why the government is pushing these. The only way this would make sense is if the government has an end goal of increased (or complete) privatization. Recently the center for Medicare services caught flack for funding studies that transferred Medicare recipients (without their permission) to private equity firms (called direct contracting entities). These entities were allowed profits of up to 40%. The governments solution to public pressure was to make some small changes and rename the program ACO REACH. I’ll leave it to posterity to confirm but Advantage plans may be the beginning of the end for Medicare.
Part (not all) of the reason is because Advantage plans take away the 80% risk. The monthly payments to Advantage plans are perceived as less risky to the government than the 80% Medicare is responsible for (Part B) or other risks for Part A. Again, not the whole reason, but one of them as to why the government incentivizes Advantage plans.
Thank you for not being bias.. i feel better that i am in advantage plan and that you did not favor 1 than the other plans. With ever getting expensive, i can not afford the premiums on supplemental plans. Besides I see are in network. Good job on this very educational vlog. Thank you
My friend ranted and raved about her Advantage Plan. The only issue she had was she couldn't get dental care because she needed an oral surgeon. No good. NO one takes the plan. Fast forward to Labor Day weekend and off she goes on vacation a few states away. Reaches her destination and... can't move out of the vehicle. Had a stroke. So now she is hundreds of miles away, way out of network, and was told earlier they will not let her return until she is done with the 21 day rehab. It will be VERY interesting to see what bills come in from this horror. She has no money. She had carotid blockage surgery scheduled this month, but that went away along with the vacation from Hades. Ugh!
She went on vacation even though she was scheduled to have carotid artery surgery...bad idea. Her doctors sound like they're awful. A blocked carotid artery should not be scheduled for weeks and weeks away.
I live in Ca. I started out with supplement F. As I aged into the policy the premiums started to be cost prohibitive. I switched to a G supplemental plan. In Ca., I'm glad they have the "Birthday Rule." regarding supplement plans. Sign-up for medicare can be confusing. Thank you for your informative videos.
Thank you for watching! We have that happen all the time. Plan F is amazing, but it gets to be cost prohibitive. Plan G is amazing, it is making its way that direction as well. Appreciate your feedback and insights!
I have a friend that had a bad bad experience with his medicare Advantage Plan. He was 70 or 71 and had a wreck on his Harley Davidson motorcycle. He doesn't remember for sure what happened other than he was riding down a 2 lane asphalt road between 2 towns following his son-in-law who was on his own motorcycle. My friend must have hit a pile of gravel in the middle of the road where a smaller gravel road intersected the road he was on. His son-in-law noticed that he was not behind him and turned around and went back. He found "G" off the side of the road. he had slid and hit his head on a metal culvert (yes he was wearing a helmet). When "J" found him he was unconscious so he called 911 and 2 paramedics showed up. "G's" son-in-law told them that "G" (who was unconscious) had a pacemaker and they called an air ambulance that flew him to a trauma hospital about 42 miles away. He came to later that day and the hospital kept him over night and released him the next day. His hospital bill was over $120,000.00 and his air ambulance bill was over $80,000.00. Total was over $200,000.00. I saw him a few weeks later and he said "Medicare" denied all his claims because he went to a hospital that was not in network. He said "Medicare" said he had medical coverage on his motorcycle so they were responsible (the motorcycle insurance company). I was new to Medicare and I called my agent and he said "NO WAY"! "G" appealed their decision twice and they denied it twice. Here in Texas the most medical coverage you can have on yourself on a car, truck, or motorcycle is $5,000.00, I had just $2,500.00 on my Harley. "G" kept complaining about this and finally I asked to see his "Medicare coverage card". He showed me a Medicare Advantage Plan Card. He made an agreement to pay $600 a month on this $200,000.00+ debt but told me he was unable to pay his utility bills because he only received Railroad Retirement Benefits and his wife received Social Security as their only income. "G" ended up filing bankruptcy to get out from under that $200,000.00 + debt. I checked my insurance and I only had $2,500.00 medical coverage on me on my motorcycle policy. I had $100,000.00 on any one I were to hurt in an accident but only $2,500.00 on me. My wife and I have Original Medicare Parts A&B, a Supplement Plan G and a part D drug plan. So I called my motorcycle insurance agent and he said $5,000.00 was the most coverage I could get for myself on all my vehicles. I called my Medicare Part G agent and he said that with the coverage I had (A,B,D, & G) Medicare would pay and any medical coverage I had or another vehicle driver had would reimburse Medicare. He then said your friend must a Medicare Advantage Plan, which it turns out he did. That's why I will never change to an Advantage Plan. My agent recently was quoted as saying if he writes a new to medicare person in New Jersey or California (as an example) he would get $750.00 commission and if he wrote the same person in those 2 states a Supplement Plan G or N he would only receive about $300.00 commission. That's why so much Advantage plan advertising is on TV, radio, Internet, etc.
So sorry to hear such a sad story. Our knee-jerk reaction is the same as the 1st person where that doesn't sound right. How long ago was this? Advantage plans are required to cover out-of-network emergency care as in-network. There are some plans that have limits on that. Super unfortunate situation and can totally understand any apprehension around Advantage plans.
I like my supplement N plan $76 a month and i see any doctor . can’t imagine having a $6700 yearly out of pocket, Can’t imagine having an insurance company and the government making all the decisions
Plan N is great! Thank you for watching! The biggest point we try to make is that the decision is not one size fits all. Everyone is different, and geography matters. In some states, Plan N starts at almost $300 per month for a 65 year old. Many people can't afford that. In some areas, an Advantage plan has a $1000 out of pocket max and even less and no premium. Other situations and areas it would be silly to recommend an Advantage plan because of circumstances. So much variation both with humans and geography. Makes us happy that you are happy with your plan!
I am on an advantage plan here in Florida. I recently checked to see what a supplement would cost in my area after watching the scary Advantage plan videos here on TH-cam. It looks to be about $300 a month for the plans. That is $3600 a year out of pocket just for the premiums that they never mention. I am an RN and would still rely on my doctor for medical recommendations. Maybe If I get sick and have to be hospitalized I'll see the disadvantage but so far I love my Advantage plan, no premiums, covers my meds, hearing aid help, over-the-counter meds, etc.
So glad you are happy with it! Hopefully our video showed that Advantage plans work REALLY well for a lot of people. The problems arise when people are sold an Advantage plan but were not explained how they work. And yes, Florida has some of the highest Supplement plan costs in the country 😬
I've been trying to decide for the last 2 months what I should do regarding my current advantage plan. I called several health insurance providers, who were absolutely clueless. Today I compared the different plans, and honestly while the maximum amount of pocket might be a little bit high, the advantage plan honestly seems to be a better fit for me. The other thing that I've had issues with is that I'm only 59 and on SSDI with Medicare, and the health insurance providers don't seem to offer supplement plans if your ages less than 65. I still don't know what to do and I've got 7 days to figure it out. It's far too complicated. Unfortunately if you try to search the internet for help, every single link is somebody trying to sell you something. Thanks for your video.
Hi Robbie, thank you for watching and yes, it is a very complicated process. I got your email. Just replied to it. We're happy to help in any way we can.
You'd better never get seriously ill, or you're in for a rude surprise. If you get cancer you are 150% more likely to die with an "Advantage" plan. Good luck with that!
@@leftykeys6944 not like I have a lot of choice. I'm on SSDI as stated at 59 I can't get a supplement plan. According to United healthcare and Humana, they both stated that I am not eligible for a supplement plan due to being at an age less than 65. Thank you so much for making me feel worse and even more afraid than I already am. I'm waiting on a person that Erik put me in touch with to get a hold of me to see if I might be able to change.
@@Theretirementnerds Medicare Advantage patients are 30% more likely to die from gastrectomy, pancreatectomy,and hepatectomy. th-cam.com/video/6FKFsxRs-Rw/w-d-xo.html “Your chances of surviving cancer could depend on the type of Medicare plan you have, a new study reports. Americans enrolled in a privatized, cost-saving Medicare Advantage plan are more likely to die within a month of undergoing complex cancer surgery, compared to those in traditional Medicare, the researchers found.” “Those covered by Medicare Advantage were 1.5 times more likely to die within a month after having their stomach or liver removed, and twice as likely if they had cancer surgery of the pancreas, according to findings published recently in the Journal of Clinical Oncology.” www.upi.com/Health_News/2022/11/28/cancer-outcomes-Medicare/8401669644047/ This next article repeats the points covered in the previous listed articles. It also states: “…the investigators found that people with traditional Medicare are more likely to be treated by a hospital more experienced in dealing with cancer…” including teaching hospitals, National Cancer IQ Institute-designated cancer centers, and hospitals accredited by the Commission on Cancer. www.medicinenet.com/script/main/art.asp?articlekey=284208 There’s plenty more where this came from. All it took was a quick online search. It is reprehensible that anyone is allowed to make a profit off of healthcare in this country. I am outraged that the final decision on anyone's treatment comes not from a doctor, but from some insurance hack who never went to medical school or set foot in a lab, let alone an operating room in a hospital. These pirates are now trying to privatize the British national health system, where NOBODY has ever been denied the care they need or bankrupted by medical debt. British doctors don’t have to hire a whole staff of people just for billing, and no one has to see a damn medical bill. How ‘bout THAT. But the privatizers are hellbent on hijacking their system like they did ours. And people will suffer and die over there from treatable conditions, just like they do here.
Based on my MIL's experience here in Denver I would say that as you increase in age, you need to reevaluate your plan. She was healthy (controlled type II diabetes, HBP) until approximately 7 years before things headed south at 85 yrs of age and she needed more care. When she fell and hospital needed a rehab/LTC discharge, the supplement company had the worst choices (I'm an RN, worked in LTC...they were bad). BIL, an actual insurance company lawyer of all things, spent 45 minutes debating on the phone with the supplement person regarding the goverment's and Google ratings of the choices. (People, please look up the infractions/violoations/ratings when comparing LTCs). Without his knowledge of medicine, insurance, and skills in court, my MIL would have ended up in an absolute nasty place.
Long Term Care is an important discussion and one we are making videos to clarify. LTC can financially destroy wealth and family inheritances. Medicare does not cover LTC. Advantage plans do not cover LTC. Supplement plans do not cover LTC. Definitely and important conversation. Sorry your family had to go through that.
@@Theretirementnerds I'm surprised that I've never heard of people being wiped out financially when original medicare was first passed and everyone had to pay 20%, like back in the 1960s and 70s before the gap plans were developed. What a coincidence it is that health care costs skyrocketed as providers were able to increase the odds of getting paid thanks to insurance. College tuition is the same way. It skyrocketed under Obama after Obama decided everyone with no money should get free college.....someone other than the student was paying for it. The world gravitates to where the money is, and things become less efficient as a result. Obamacare is a disaster that makes the insurance companies rich via subsidies, even when your network is so poor, it only amounts to your public county hospital, and the waiting list for treatment is a year, if they even agree to treat your condition. Want a reputable surgeon? It won't happen. They don't take Obamacare.
@@JoeDoe2 No no no. Lies. President Obama had no say in college tuitions. Move along. The ACA only pays the premium. Your tales of no surgeons taking them is a lie. I should know, for I used the ACA for surgery a few years ago and it was in excess of a quarter million dollars. Take your hate elsewhere.
Erik, I had a company health plan where I had my primary care doctor and when I needed something that he did not do, xrays or whatever, he would search for the applicable in network provider and then refer me to them. I did not have to do anything as far as calling the insurance company to locate an in network specialist and get approval. Everything revolved around the primary care doctor - had to see him first before seeing anybody else. Is it that way when on an Advantage plan? Or does the patient have to contact the insurance company to get approval and arrange visits to various specialists, etc? Thanks.
Hi Frank! Both can take place. Many HMO Advantage plans still go through the primary care provider. Others may not require referrals, in which case, you can either call the insurance company, use their online search, or call the provider directly. Thank you for watching and reaching out!
I'm in NY city on a PPO advantage plan with one of the big insurance companies. I have a few health issues yet things have worked out well for me with them. But every year they change the plan features and in network providers. They even change the name of the plan and advise me that if I don't do anything, I will be be moved to the new plan. So I have to go through comparing to see if it's still worth staying with them. I think I could benefit by seeing an independent agent if they are trustworthy. Any advice on how to find one in Manhattan?
We understand the sentiments against Advantage plans. We can tell you they are not all the same. We try to be as open as possible and put things in context. United Healthcare did have 17.3B in profits in 2021. That is across all business lines, including the entities they own, not just Medicare Advantage. That was not made from just denying people. They do have denials. Absolutely. But their operating profits are not made from just denying everything. As a whole, the company in 2021 operated on a 6% margin. From a business perspective, a 6% margin is very low. When dealing with a company as big as United, that has massive revenue streams, that 6% turns into 17.3B. We share your frustration when Advantage plans deny care that should not have been denied, causing appeals and headache and many other negative consequences.
Thank you. MA was a joke made up by republican lawmakers who hated the fact that Medicare was an amazing government program and were hell bent on a way to privatize it. And so now we have half of senior Americans stuck on these for profit plans - making insurance companies rich and sick elderly Americans die. It’s truly disgusting.
Ira, this is the 2nd time you've mentioned this on our channel. It is not correct. Part C was signed into law by Bill Clinton in 1997 and it began in 1999. It is a bipartisan concept. We are politically neutral and it is very clear as you look into this that both sides of the government incentivize and promote Advantage plans for the point we made in a separate comment response you made. Out of curiosity, are you an insurance agent? Your points here and in your other comment sound very similar to agents who only offer supplement plans, which is fine, just curious.
6% seems low. I would like to check out their annual report to see this broken out by business unit. I live near UHC headquarters and have a friend who is an actuary there. If I get additional info, I'll try to share it with this channel. Bottom line, 6% is still 3x the 2% overhead Medicare supposedly runs. You need to go back to 1970s and Nixon administration which was when HMOs came into existence. The whole business model, which has morphed into what it is today, was founded on the premise that doctors were overprescribing services because they were reimbursed based on fee-for-service rather than outcomes. The thought was that these plan administrators could cut the fat, and still make a profit. The result, unfortunately, is what we see in the comments I read on all videos on this topic....some happy, some mad, but mainly frustration and confusion. And it's all unnecessary, for the most part. I have traveled the world in my 65 years, and lived in places with single payer. It's not perfect, but I can say first hand, that most people are content, and certainly they don't have to spend countless hours trying to discern fact from fiction. Oi
The more I research this I look at Medicare Advantage plans as very similar to the employer provided insurance I had when I was working. Working with a PPO network, pre-approvals and co-pays weren't a hardship. The Medicare Advantage plans have the benefit of added dental coverage and possibly hearing and vision. The big issue is how healthy are you and how many good years versus bad years you will have. If you are healthy, don't use the healthcare system very much you may be ahead overall on an advantage plan. If you are unhealthy and use the healthcare system frequently you may be ahead with a supplement plan.
With all due respect… It is not how healthy you are at the time, but what happens when you are not healthy in the future… ($$$) that needs to be contemplated… A MAJOR factorial.
It's also about how you plan on using the healthcare system. If at 85 years of age you are going to be treating cancer, having organ transplants or open-heart surgery then you need a different plan than those who will not. It's all a cost/benefit analysis.
@@danielrussell9416 AND WHEN YOU NEED A MEDIGAP, IT IS TOO LATE. You can NOT get it when you need it most. You commit to MA though annually, if healthy you can change. But healthy and not using MA make people complacent. UNTIL they can't get it when needed. Remember insurance is there to protect you. The objective isn't to break even.
@@Michael-si9ci That is true, however many people do make that decision based on their current health status. People feel why should they pay for high supplement premiums when they see a doctor maybe once or twice a year at most, are in excellent health, and are not on any medications. For many it is a gamble that pays off. For others it doesn't work out as they'd hoped. In New York, where I live, supplement plans are extremely expensive. I'm taking the risk that my health will last for a number of years, perhaps a decade, and the money that I save on an advantage plan will help if I feel the need to switch to a supplement plan in later. It's a matter of paying high supplement premiums for years when you don't use it, or paying $0 with added benefits of dental, vision, hearing, and gym membership ($600 annual) during those healthy years. When I do need health care if and when my health status changes, I'll look into Supplement plans.
I have been a Kaiser North (California) patient for over 30 years. I like them and will probably stay with them. While working I had to pay about $400 a month for my wife's healthcare. Now that I am retired, with Covered California (ACA) we pay almost $500 a month for the two of us. We have always had copays. Kaiser Advantage will cost $0 a month which sounds like a good deal. It will cost a maximum of $12K a year out of pocket for the two of us.
You bring up a great point. For many, either Medicare option is as strong or stronger than the company plans we've been used to our whole lives. Thank you for watching and sharing your experience!
This is the second video of yours that I have watched and they have both been very informative. I will be turning 65 this coming February so I am getting as much information as possible so I can make the proper choice for me. I think my next step will be to ask friends and relatives what plan they have and what they like / dislike about them.
I'm glad the videos have been helpful. We try to educate so you are better equipped with the information you need to make these decisions. I am making a video about looking to friends and family for these plans so keep an eye out for that in the coming days :) Friends and family are great to learn if their plan has good customer service. Outside of that though, friends and family can be tricky. I won't bore you with a TH-cam comment, but I'll send the video to you once we have it done :)
I'm noticing that there is more and more competition between Medicare Advantage Plans. I think this works to our advantage because the plans will be more likely to be on the up and up and approve treatment in a timely manner. I've never had problems with Advantage Plans myself, but understand some people have.
How long does a person traveling the USA in a RV have to declare a change of residence so that they can take on a new network in a new location and be covered? What if they move in the middle of the year, and their company doesn't operate in that area? Doesn't coverage available and prices vary a lot based on zip code? There issues are not being covered by agents in their 'information' videos and meetings.
If someone moves in the middle of the year and their company doesn't operate in that area, they can switch to either a different Advantage plan or a Supplement plan. Coverage availability, access to plans, plan benefits, and costs are all highly depending on zip code.
What's the sayin, don't hate the player, hate the system(?). If you took all the salaries of the sales people and all the TV and mail ads and costs of phone calls, then the profits made off of selling an unnecessary product and put it into Medicare for all.
I'm in New York and I currently have a Medicare Advantage plan; I would like to switch back to original Medicare with a Medigap High G plan. How would I go about doing that, if it is even possible? Thank you!
In New York, you always have guaranteed issue for switching back. We would recommend working with an agent who can help through that whole process. If you have an agent, use him or her. If you don't, we can help. Send me an email to erik@90daysfromretirement.com
Would need to know quite a bit more about the individual and where you live before we could recommend any particular plan. Happy to look into it after we get to know a little more about you if you want to send me an email to Erik@90daysfromretirement.com
Only purchase a PPO Advantage Plan with a company like UHC. You can see any doctor or specialist without pre-approval. You'll be hard pressed to find a doctor or hospital that does NOT accept UHC. If you started with a supplement you can try an Advantage Plan without risk. Change back to your supplement within 12 months with zero underwriting. I've had an advantage plan for 10 years and have saved many thousands of dollars in premiums. But it's always based on your risk tolerance. That's the basis of all insurance.
Very well said. There are other carriers outside of just UHC that also have solid PPO plans as well, but yes, always important to check providers before this decision. Thank you for watching!
@@motherearthhelpers3112 UHC is ONE of the best for coverage choices. That's what I said in my comments. Before someone buys a plan. They should look at the coverage choices. But always a PPO.
You mentioned that some treatment centers do not take regular Medicare and some do not take Medicare Advantage. I looked up MD Anderson, Cleveland Clinic, and Mayo Clinic. MD Anderson takes regular Medicare and works with a limited number of Medicare Advantage plans. Cleveland Clinic take regular Medicare and works with quite a few Medicare Advantage plans, and Mayo Clinc takes regular Medicare(with restrictions) and does not take Medcare Advantage.
Could you do a video on the strategy of initially (At 65) choosing a low cost supplement plan and at some point say in 10 years when the premiums rise switch to a 0 premium advantage plan...
I am very impressed by a comprehensive facts. I have looked at at least 50 videos and this is by far the most thorough and unbiased. I even learned a few things. Thanks 😊
Tough to answer that without a bit more detail (don't share over TH-cam 🙂). Things like where you live and where you go during the winter. Some Advantage plans have large, nationwide networks or they have passports of sort. Larger entities have plans you can easily switch to and from. The providers and facilities you prefer to use will influence that. Several facilities and hospital networks won't accept Advantage plans (Mayo Clinic). Others (much fewer in number) don't participate with Medicare (supplements) In general, a supplement has less you need to think about in that regard because supplement plans do not have a network. If a provider participates with Medicare, and the procedure is Medicare-approved, you are covered, regardless of your state.
After watching this video. If you want the insurance company to dictate your life chose advantage if not chose supplement plan. In my area out of pocket cost is $5,950 for the cheapest advantage plan.
Where you live definitely matters. Hard to ignore the $500 - $1000 out of pocket max plans in certain areas, but yes, if your out of pocket max is in the $6,000 range, a little easier to ignore. We get what you're saying with the dictating your life part. That is a bit strong in our experience. Most procedures and services don't have any hoops or dictation happening other than make sure you visit in-network providers. But yes, prior authorizations and denials do happen so we get where you're coming from. Thank you for watching!
I have an advantage plan that is the only 5 star rated advantage plan in the state and uses the largest hospital system in my area. My primary physician was already in this system. The total out of pocket is $4,500. I am 69 years old. Should I consider going back to a supplement plan?
Tough to answer without a bit more information. Where you live matters. Your health situation now and for the past few years matters. Your satisfaction with the plan matters. The big takeaway is that Advantage plans aren't inherently bad. But, they are different than Original Medicare with a Supplement plan. If you have an agent, highly recommend reaching out to him or her to look at your situation. Your agent should know you personally and be familiar with your goals. If you don't have an agent, we're more than happy to take a look for you. My email is erik@90daysfromretirement.com If you could include where you live, that would be helpful. Thank you for watching!
@@Theretirementnerds I am in Mobile Alabama and the plan is Viva and is tied to the Mobile Infirmary System which is the largest in South Alabama. My health at present is good. I did have a recent scare but it turned out to be not as serious as I thought but it did cause me to think ahead a little. I am going to look at adding a cancer policy and see if a hospitalization rider is available. I also am looking into the cost of going back to a supplement.
@@frankfowlkes7872 I'd recommend working with your agent around what you just mentioned and they will have insight and advice around next steps for you. Sounds like your thoughts is in the right place of what to consider.
If an agent died in a car wreck tomorrow, can they will all future renewal commissions to an heir of their choice? If they don't have a will, or have a will but don't mention future commissions specifically, can the next-of-kin in order of succession make a claim to all the insurance companies their relative was due future commissions from, assuming they know about it, and get the money that way after showing proof they're entitled to it under state law, and informing the executor if the executor didn't already know about all those stats and future income streams?
Hi Joe, it'll depend on the contracts that agent has. From everything we've seen, commissions will either go to the upline or go away upon death. Not willed to family or next-of-kin.
@@Theretirementnerds I don't know how a dead agent's commissions could be split amongst multiple other agents in an upline. And I'm wondering how common it is for older people to even bother becoming licensed when they know they may not live long enough to reap all the renewal money they earned. How many years are agents entitled to renewal money on contracts, assuming they live long enough, both supplement plans, and M.A. plans? With as many websites and youtube channels as there are which discuss Medicare and agent sales careers, no one has made a video on this, yet it's an important factor in deciding whether to even get licensed or not. It seems to me that if you don't 'start young' in order to get everything that's coming to you, it may not be worth it. I'm also wondering if insurance agents typically and deliberately quit selling new plans at a certain age cause they don't want to risk not getting paid their full due if they should die in the next 5 years, or however many years it takes for renewal money to roll off. And how does an agent keep the same customer and keep getting renewals once the initial policy renewal money ends? Do they have to call up all those customers and try to get them to switch to another plan so that the commission clock can start over again with that customer? That doesn't seem right. As for 'upline' and 'FMO" stuff I keep hearing about, and cooperating with other agencies in other states and locals like you mentioned, I think youtube videos on those subjects would get lots of views from people thinking about getting into the business. FMO websites lead you to believe you MUST be affiliated with a FMO in order to contract with each company and plan. But other sources say that's not true, that all you need is an agent's license. And people keep using the word 'broker' to distinguish between a 'captive' agent when there are no 'broker' licenses to be had, only agent licenses. It's not like real estate agents and their brokers who 'carry' their license. I don't know where to go to get educated on all these things, and people should know all this before they even bother to study for any tests to get licensed. 'FMO' and 'broker' and 'upline' and 'call centers' are all vague terms that someone should delve into on their youtube channels, unless they think not enough people care enough to watch such videos.
@@JoeDoe2 Interesting story about commissions. An agent sold my husband a term life insurance policy about 15 years ago. A few months later he and his wife were walking to temple on the Sabbath when a car jumped the curb and killed both of them. I guess he lost all of his commissions...I bet he had a decent life insurance policy on him and his wife for their kids.
I’m recently retired and didn’t really understand what choices were available. As a result I made a disastrous choice and ended up filing paperwork over and over trying to get the company to pay my doctors. Even though they were part of the network the company refused to pay the doctors.
I am early in my research but my understanding is that an Advantage Plan is buying into a large insurance provider. If that is true then my wife and I have had an Advantage Plan our entire lives. It has been horrible. Having said this I expect they are going to be all we can afford. We're not rich so I expect we will only get second rate care.
So much of this depends on where you live and the plans available to you. From an Advantage plan only perspective, I think this video will help: th-cam.com/video/5Tl0Ut1tTEs/w-d-xo.html From both and Advantage and Supplement perspective, this video will help: th-cam.com/video/eOP76hMPiDs/w-d-xo.html
16:32 When you say that insurance companies pay $15-20 more in first year commissions for dental, vision, etc plans if the customer is going with a M.A. plan, when those perks are always included with M.A. plans anyway, and don't require you to sell them separately? It should only be supplement plans where you have a chance to sell those extra plans for a commission, right?
Correct. Agents do not get separate dental and vision commissions with MA plans. Only standalone dental and vision plans when someone gets a supplement plan.
Rural areas are typically where you will find Advantage plans missing. Hospital access and rates and numbers of people to offset risk just don't make sense for a lot of companies to take on.
If you can afford G or N pay for G or N and if you can't afford it grab the Advantage, as its better than just Medicare A and B only. Advantage plan feels like a hope and pray you don't get really sick......
Advantage plan denied approval for necessary heart surgery. After waiting 2 months for the first denial, I suffered an emergency after which they finally agreed to pay (their minimal share). Regular medicare is better overall, both physically and financially.
I am not planning to retire at 65, but am self-employed and without insurance. I have been assuming all along that I can get on Medicare when I turn 65. Your website title of 90 days before retirement, makes me wonder? Can you please answer this one question? Thank you.
You can go on Medicare at 65 and continue working. In fact, in your case, based on what you shared, you will want to go on Medicare at 65 to avoid penalties.
My mother in Florida has Optimum and she told me for 2023 they will pick up a&b premium cost they cover (140) this year plus its a no charge premium and has decent drug coverage at tier 1&2. With out of pocket of 1900.00 So sometimes people can't afford A+B + N or G + D premiums year after year
I've been overseas for decades and am now 66 years old...I'm retired military for 23+ years after 25 years of active duty (retired as a Sergeant Major, E-9 and have a monthly pension)...I received an email from the military coverage we have before turning 65 (Tricare) that I would have to switch to Medicare...Since I'm still overseas I haven't made any move to apply...I'll be going back to the USA next year for a visit (30days max) but will remain overseas. As I understand it, no US plan will cover me while overseas so I have to have International insurance coverage from somewhere that I pay for or take the risk of paying everything out of pocket...What's your recommended path in regards to Medicare and either supplemental or advantage coverage since in reality I'll likely never use any of it as an expat? I also will be applying for Social Security while back in the USA (I reach FRA in January 2023 - 66 years 4 months)...Thanks in advance... Great video BTW...👍😎👍
You are correct in regards to Medicare not doing anything for you really outside the US. If you are only going to be here for 30 days max, no real reason to have US-based options. If you are ever in the US for longer than 30 days, it is a conversation to have. A lot of people with Tricare will keep that and get a no-cost advantage plan just for the perks - again - if you are staying in the US for longer. Thank you for watching!
I still am waiting for someone who recommends supplement plans who will compare an Advantage plan that includes Part D vs. Supplement plans which require a separate part D. No one I have heard who recommends supplements will acknowledge that many Advantage plans include part D. Nor do they acknowledge that drug plans for seniors is just as costly as doctor visits and no supplement plans pay for drugs.
This is such an insightful comment Duwayne. Prescription drugs are often the biggest single expense that seniors have and the Part D conversation is just as important as the rest of this. We cover this in a few other videos, but this one goes into more depth around how Part D works that you may find useful: th-cam.com/video/17F6LUcujDE/w-d-xo.html Thank you!
Prescriptions can be denied with advantage plans, it happens very often. Plus you can only use certain pharmacies. I have seen part D plans from as little to $0 to $20
@@evanscott729 thank you for watching. Prescriptions being denied is not unique to Advantage plans, and it isn't that they are denied, it's that they are not covered, meaning not on formulary. This same thing can and does happen with standalone Part D plans. Drugs are handled similarly between standalone Part D plans and Advantage Part D coverage with the exception of with a standalone plan, you can shop around and find a plan that covers your mix of medications and pharmacies. With an Advantage plan, you are tied with that carrier's drug plan, but you can still shop Advantage plans and make sure you find one that covers your medications.
15:33 How could someone say that an agent is, or isn't, worth the ZERO dollars that they pay for it? If there's no charge, then they didn't pay. What am I missing here? It makes no sense, unless they got screwed by the agent and wish they had done it themselves or with a different agent. And can a customer change agents during open enrollment without changing plans? Does the new agent get an origination commission, or a renewal commission? Does the customer have to notify the agent that they want to change, or does the new agent tell them, or the insurance company?
Don't fully understand the first question. Some people feel using an agent is worth it. Others don't. You can change agents whenever you want, but the new agent does not get paid on a plan they didn't help you get on. So if you stay on the same plan, but go to another agent for help, the agent helping you is not receiving the commission on the plan you are on.
@@Theretirementnerds Click on the 15:33 that I posted and listen to it. I put it there for your convenience. It doesn't make sense. A person doesn't pay zero dollars to buy a plan. You must have meant something besides the words you used, or the words that are heard in the video.
Hi Joe, clicked and listened. We're referring to the cost of an agent being zero. It won't cost people money to use an agent. Unrelated to the plan cost. We get questions all the time of, "How much do I have to pay to use an agent." or... "Is an agent worth the amount I have to pay the agent?" The point is that the answer is people don't pay to use an agent. It is illegal for agents to charge money for their services to the Medicare Beneficiary. And to the question of "is an agent worth the amount I have to pay the agent?" The amount to pay an agent will be zero, and some people feel the no-cost service is worth having. Others don't.
@@Theretirementnerds Does the new agent begin getting renewal commissions the next time the plan you're staying on renews, like after open enrollment when it's apparent that the customer isn't changing plans? Does the new agent get paid full a full commission at such time that you finally change plans, followed by renewals as long as you keep it? What keeps a customer from changing M.A. plans each year, generating a full commission for their friend or relative who stays as their agent year after year? Do agents not get paid to switch plans for an existing customer that they've signed up once? Where do agents go to learn the answers to all these 'what if' questions without having to ask someone else?
@joe doe the "full" commission is just year 1 when the Medicare beneficiary first goes on Medicare. So, let's say you go on Medicare and use an agent to get an MA plan. It'll depend on the state, but let's assume it is the $601. That's year 1. Year 2 is $300. Let's say you switch to a different agent and a different MA plan during Year 2. The new agent does not get the $601, agent gets $300. The reality is that many agents see less than both numbers if they have an agency they work under or share commissions with
I only recommend advantage plans to those who cannot afford the monthly premium. The pre-authorizations alone are enough for me to steer a client clear of Part C. I worked in physical therapy prior to becoming an agent and had multiple patients who I was seeing because their advantage plan required they go through physical therapy before authorizing a knee or hip replacement. Worst case story was a client who’s health deteriorated in the time she was going through therapy to the point the doctor would no longer perform her knee replacement surgery. She now has to live with chronic knee pain because the delay of surgery. MOOP where I’m at is around 3,500.
The good news is CMS updated rules for 2024 is to reduce carriers from denying services.. they're looking to require carriers to offer the same service rates as original medicare.
Correct. Not the same way OM does, meaning there could be prior authorizations or denials based on medical necessity, but yes, they must cover everything OM covers.
Thank you so much of your videos. I am learning more and more about original medicare, supplement and advantage plan. There’s always a disadvantage and advantage of the three plans. It depends to us the situation of ourselves if we have more or less health problems. And most of all the cost of the insurance premium. Very helpful to me.
One additional thing about Advantage plans is that there is no guarantee you will get the same benefits from year to year. I turn 65 in March and live in Florida so there are some great options with Advantage plans but I hesitate because who knows 5 years down the road if those plans will still be great. I'm leaning towards a HDG plan.
@@pamelaholden2701 High Deductible Plan G. It is different than regular Plan G. Much lower premiums, but has a $2,700 deductible in 2023 people would pay before any benefits kick in. Once the deductible is met, all Medicare-approved hospital and medicare charges are covered.
@@Theretirementnerds Outside of cataract surgery, which I've already had, I've never spent anything like $2,700 total in one year on medical expenses, and never in 6 years have had a deductible, as my HMO Medicare Advantage has no deductibles. And my entire OOP can only be a maximum of $3,650, anyway. But I have a 5 star CMS rated plan, and those are few and far between. I believe Kaiser is another one. If people would only choose 4 or 5 star Advantage plans, they would probably be happy with them, too.
@@commonsense6967 agreed, there are fantastic plans out there. Not all areas have 4 and 5 star plans, but yes, selecting plans with higher star ratings is helpful. Sounds like you have a stellar plan! 👌
Talk about the indemnity plans you can get to cover high cost deductibles tha you can get if admitted in the hospital or 1 day inpatient or physical therapy cost.
my mom has secure horizons plan 1 from aarp..she pays 170 dollars a month out of SS and it COVERS 100% ofEVERYTHING shes ever had for over 20 years.. i dont think i can get this plan.. but i dont know whats best.. advantage is best for her
A big problem with HMOs and out-of-network ERs: You cannot diagnose your situation to determine if it's an emergency. You are also unqualified to make that diagnosis. Once that diagnosis is made, it is too late to make an intelligent financial decision about your care. Therefore, you are at risk of incurring expenses you might otherwise forego if you had the information to make an intelligent decision. Let's say it's a stomach virus but you think it's a hernia, appendicitus or food poisoning or something else. The hospital knows the stomach virus is going around, but you don't know that. So you pay dearly for your insufficient information. It's a scam. You don't present yourself to the ER with a list of codes, but with symptoms to be diagnosed.
Exactly, my husband suddenly couldn't lift his arm up and felt dizzy, he happened to be at home and was in our yard checking the pool filter controls when it the dizziness hit him along with the weak arm. I thought it was a pinched nerve in his neck and shoulder. We went to the ER and they called a stroke code. (his speech was not slurred, he could smile and his mouth did not droop, he could stick out his tongue, his eyes appeared normal and in alignment, he could follow my finger with his eyes, he could walk normally, etc). I thought it was a pinched nerve in his shoulder that he'd just had a recent MRI a few weeks prior for but the doctors in the hospital were smart enough to put him in a CT scanner and give him an MRI and many many other tests. He had had a stroke and was lucky that the clot broke up without needing the clot busting drug and he hasn't had any residual side effects other than some headaches afterwards. What if we had waited till the next day or had been out of our coverage area?!? People die while on vacation all the time. The bills came to about $70,000, we paid about $250. Our insurance company paid for most of that bill, they negotiated it down. My husband is not on medicare yet, he is supposed to go on it next year.
@@jdenino6022 Per CMS rules, Advantage plans are required to cover urgent and emergency care nationwide, without imposing additional costs or coverage rules. As for non-emergency or non-urgent medical away from home, it depends on the particular plan. Some provide coverage, some don't.
You may not know for sure whether your condition is potentially serious or not. Neither will the intake person at the front desk at the ER. Not until a physician is able to examine you and diagnose, will it be known for sure. If it turns out not to be something that needs more than some rest and over the counter remedies, then they'll just release you at that point. Turning someone away who presents themselves at an ER with what could be a potentially serious or life-threatening condition, would expose the hospital or clinic to a lawsuit, if that person suffers complications or later dies as a result of refusal of treatment.
@@g0989 my husband went to the ER with dizzyness and weakness in one arm. They immediately called a stroke code before a doctor even looked at him and put him in a ct scanner immediately. He was able to speak perfectly fine and answer questions. You don’t know if it’s an emergency till the experts in the ER look at you and run some tests. He was in hospital for 3 days.
In my Medicare Advantage Plan, you could seek medical advice at the HMO's urgentcare facility, or if you prefer, the hospiral ER. Urgent care co-pay is $20; ER co-pay is $135, which is waived if you are admitted to hospital.
My oncologist would miss me 😎, so I went with a Supplement Plan I’m paying nearly $800/mo for Part A, B, D ($597.60 due to IRMAA), $128.60 for a Plan G Supplement from AARP/United Healthcare, $9.50 for a WellCare Prescription plan and $49.60 for a vision/dental plan In 2024, the IRMAA should drop off, as my 2022 income was much less, and the prescription plan is going to $0.50 - I am concerned about an increase in the Plan G - I’ll find out in July
Yeah, this sounds good but why is it that when you call, they usually try to steer you toward Advantage plans? could it be because they get a higher commission? Just call ANY OF THEM and you will see!
@@Theretirementnerds Maybe in your area but overall, agents get a higher commission with Advantage Plans. I know because in my area., I originally signed up for Original Medicare A & B, got a supplemental and drug coverage in separate plans about 10 years ago and have been very pleased with my decision. This year THE SAME AGENT THAT ORIGINALLY SIGNED WITH, called me about joining a Medicare Advantage Plan; I told him that I was pleased with my present pleased with my present plans and NOT TO CALL ME AGAIN. So, your claim regarding independent agents may work for your area but not mine.
@@rich9890 I'm sorry that happened to you. Just so you are aware, Advantage plan 1st year commissions are higher, as in when you first go on Medicare. Switching you at this point from Supplement to Advantage would not get that agent the higher commission - unless there is something else going on with that agent we arent privvy to. As we state in the video, it is a bad business model to put people on something that is bad for them, especially if our business model is service oriented where we will help people for the rest of their lives. For call centers that have zero service models, and are funded by venture capital, and are hoping to sell as quickly as possibly, they absolutely push Advantage plans. Or agents who are short sided and haven't figured out that client referrals are the best way to grow their business. We are with you 100% that pushing Advantage plans for the commissions is wrong. We also believe that for some people (not all and not even most) Advantage plans are a very good option.
I think that people that can afford it choose regular medicare with a medigap plan. People that can't afford it, choose medicare advantage, and probably most regret it when they become sick.
You'd be surprised how many truly wealthy people we see choose Advantage instead because they aren't worried about hitting the out of pocket max. With these being so different based on zip code, a lot of people love them, a lot of people don't.
I have quite a few customers who could absolutely afford a supplement plan and all the other "stand alones" that would be necessary to be compliant with federal regulations and complete their coverage. As successful business people, they decided to enroll in an advantage plan after assessing their own healthcare, financial and risk tolerance needs and doing the math. As an agent, it's my role to research the various plans, present the information and use my tools to enroll them correctly, NOT to parent them.
@@SuRFerretti we see it a lot. Many of these wealthy people got there by having a different risk tolerance and betting on themselves or paying as little as possible for what they don't use now, investing the savings for potential use in the future. Everyone approaches these decisions differently for sure.
Those contracts are kept pretty confidential. From what we've been able to determine, it will depend on the service provided. Medicare pays low. Insurance companies try to negotiate as well.
10:25 How can you refer to a hospital system that doesn't participate at all in Medicare, and only accepts their advantage plan? If advantage plans ARE medicare, then they're taking Medicare, right? Is there such a thing as a non-medicare related advantage plan?
Advantage plans replace Original Medicare. They are not Original Medicare. You need to sign up for Medicare to get an Advantage plan, but the two are very different. Hospitals and providers can decide to participate with Medicare and not an Advantage plan. They can decide to participate with Medicare and accept an Advantage plan. They can decide to not participate with Medicare and accept an Advantage plan. Or they can decide not to participate with any.
I recently had this very conversation with a PCP billing manager. Their recommendation to patients transitioning onto Medicare is to "just get a supplement", without understanding anything about advantage plans or the federal regulations that require a prescription drug plan also, and nothing about the ancillary benefits the advantage plan bundles in, OR the financials of the patient. That is why it is important to work with a licensed agent. Do you have a video on what it takes to become a licensed agent? We go through extensive vetting with the state department of financial services just to obtain our license, are required to complete hours of fraud, abuse, ethics and other license specific continuing education to maintain that license with the state AND ongoing training with every carrier with whom we are appointed, who ALSO completes an extensive vetting before granting that appointment. Then, as part of every annual AHIP training and individual carrier certification, we are reminded of the consequences of NOT doing our job ethically which could involve not only being terminated but losing our license and hefty fines. We also have to carry E&O insurance.
100% agree with you. There are a lot of people that give advice on this topic that only know one side of the conversation, but there are so many moving parts. We don't have that video, but not a bad idea. I've written out what I'd want to say around a video like that, but every time I go through it, it feels like I'm trying to be defensive, but I agree, I don't know that people know what it takes to be an agent and the significant penalties for unethical practices.
@@JohnJohn-wr1jo There are many factors that affect choosing the right plan for each customer. I don't recommend ANY plan until I do a thorough needs analysis, including medical and financial health.
I'm having problems with the insurance advantage . I got covid have been unable to walk and have tried to get rehab and it's been denied it's not right . I never was told there was a difference and I'm in a very big problem the insurance won't pay for me to go for Rehab for few months
Send me an email to erik@90daysfromretirement.com with your zip code. If I'm licensed in your area, happy to help. If I am not, I have partners that cover all 50 states. Thank you!
I really like your content, I work with advantage plans but fully understnad they are not a one size fits all. All of the negative things I get told by client who have talked to other agents who don't sell advantage make me laugh.
I appreciate your kind words! 100% agree with you. Interesting how if someone can only sell Fords, there are no other good car makers out there. Now, Advantage plans have their weaknesses and are not perfect for everyone, and we love supplements as well, but some of the myths and blatant lies being spread about Advantage plans are unfortunate.
Hi Julie, there are plans called DSNP plans made specifically for Dual Eligibles, meaning you are eligible for both Medicare and Medicaid. Something to look into in your area.
@@Theretirementnerds I’ve been checking on it and I think in the long run I’ll probably be better off with the original Medicare and the supplement Medigap
Medicare Advantage in not universal in it's benefits. It depends on the State where you live, and who your provider is. The best option for someone in California, may be different for someone in Indiana.
I could afford and have had plan n for 2 years now. This year I am switching to an advantage plan because of the part d coverage. After paying plan b premium and plan n and part d premiums my drug cost was 732.00 in January, 325 the next month, and on and on. There is no way this was sustainable and I could not find a part d plan with better coverage. This year I will pay 47.00 for the same medicine until I reach the donut hole and then it will be 120.00. Leave it to the US government to make such a mess out of healthcare.
The cost of the supplement arrangement is the biggest downside. Unfortunately, that cost becomes problematic foe many, especially as the premiums increase.
It's still better than being bankrupted because of a cancer diagnosis. I consider my $300/mo supplemental plan premium a bargain (my gross income is $25,000/annual). I will never be bankrupted becaue of cancer treatment. Already been through a 15 month life-threatening cancer diagosis/treatment and my out of pocket was $30. THIRTY DOLLARS (after $225 annual medicare deductible)@@Theretirementnerds
Congratulations!!!! Yours is BY FAR the most balanced and honest information I have yet heard on TH-cam! I am 68, and I made my decisions based on my own research. This was because I came to the conclusion that most of the info was coming people with vested interests (i.e. insurance agents). You are a VERY REFRSHING exception to the rule!
Appreciate you saying that! Thank you so much for watching!
But an informative, clear and thoughtful one.
The thing is a lot of the anti-medicare advantage viewpoints tend to compare the coverage to traditional medicare with a (good) supplement, but that's really not what the program was intended for. To be apples to apples, you have to compare it to traditional medicare without a supplement.
@@MyCarolp I know him and he is actually not an agent.
@@Tim85-y2qI think if you take the incremental premiums of supplement plan into consideration while comparing with Medicare Advantage, it is absolutely an Apples to Apples comparison.
also worth considering is ----- do private practice Docs participate in these advantage plans?
1: Problem with the provider list My own experience (20years as a medical provider)is that often the list published by advantage plans a VERY out of date. My patients often complained that when they signed up for the Advantage plan they were shown a long list of providers. But, when it became time to use the providers many have left the Advantage plan as the insurers payment to the Docs was too low that the practice was losing money, leading to the provider leaving the plans.
2: Some medical groups do not participate (usually, Anesthesia, Emergency, Pathology and others) so if you need to have your appendix removed you WILL get a bill from these providers $$$$$$
3; Traveling with an advantage plan?--- forget it , you may be in a situation that NONE are in network (hospital Docs etc..) $$$$$
4; Danial of services; a very common issue, Need a cancer specialist at the University? Sorry, out of network, Try to appeal the decision ALMOST NEVER WORKS!!!
5: Quality of the providers; the cream rises to the top---The very best MDs may not want the super low reimbursement rate from the Advantage Plan. Conversely, New and inexperienced Docs will always accept these plans (They need the work, and get the experience on the unsuspecting patient)
I would love to see an honest discussion on these 5 points
Hi Max, thanks for watching and we'll do our best :)
1. Agreed. Goes both ways. Often times providers are in-network, but do not show up on the carrier's provider search and vice versa. This is highly dependent on the insurance company. As with most things... some are better than others.
2. Some (not all) providers and groups mentioned do not participate, you are correct. It is not this way everywhere, but in our area, we have 4 major hospital systems. Some Advantage plans have 2 of the systems in-network. Some have 3. Some have all 4 hospital systems in-network. Looking at private practice doctors is where the provider search comes in (Question #1).
3. This will depend on the plan. Emergency services must be covered as in-network by advantage plans. So, if you are traveling and have an emergency (hospital codes it as such), it will be covered as in-network. PPO plans will have more flexibility while traveling. There are some major PPO plans that have 97% of all non-pediatric physicians nationwide in-network. This is by no means all or even a majority of PPO plans, but they do exist. HMO plans - yeah, not a lot of help traveling (except the emergency situation).
We don't see a lot of people scheduling visits while traveling though... but it leads to #4
4. Say you want to travel (not for fun, but for a provider) because you want Mayo or certain University hospital care, yes, there is a chance it is out of network. Groups like Mayo said they won't take Advantage. In the same breath, groups like Kaiser won't take supplement plans. Many university hospital systems have their own Advantage plans (not all). Also, with Advantage plans, you can appeal to have services or providers covered and we have seen those approved. If there is only one cancer treatment center in your and no other viable options, they can be approved. More hoops to jump through for sure.
5. In private practice, yes. In hospitals, not as much. But yes, Advantage plans USUALLY lose to supplement plans in the network conversation for sure.
Honest enough?
if you have the money of course you want the most expensive plan. you could be paying $1000 a month in premium
I've been retired for 9 years now & I'm poor, under the 100% FPL. I haven't been sick with anything for 15 years now & that was a cold. So an Advantage plan was the only thing that made sense for me. As I understand it, I have dual care coverage, what Medicare doesn't pay, Medicaid picks up the rest. The extras I get from the Advantage plan have made a big difference in my life.
Glad your health has been good and hope it remains that way.
Advantage plans can work very well for a lot of people. Definitely not for everyone, but they can work well.
Thank you for watching and adding your perspective!
I in the same ship works great for me.
That is correct as long as you don't fall into a financial situation where Medicaid expects you to "spend down" resources, but that's functionally like a deductible anyway, so it's not really much different than any other insurance situation.
Thank you. I have low cash flow and I cannot afford Supplement Plans. You point this out. It is REALITY.
How do you afford your co-pays.
That was a great presentation, thank you. My wife started Medicare this year and had both of her knees replaced (about 3 months apart) and we paid very. very little with her Advantage plan. We live in North Central Florida and had no problem with physican or facility participation. I don't understand how the system actually works because we never even came close to her out-of-pocket maximum that was quoted by her Advantage underwriting, despite the claims totaling in excess of 300K. If nothing significant changes I anticipate signing up for the same program when I"m eligible for Medicare in another year.
Thank you for watching and for adding your perspective. There are stories of both good and bad with many of these. We're glad to hear yours was a good experience. Appreciate you!
So how much was her out of pocket? How did she know in advance? After surgery is a little late to be finding out what its going to cost
Florida is one of, if not THE best state for MAPD plans
@@JoeDoe2 Typical Advantage Plan, be it HMO or PPO, will not have a deductible, but instead a fixed dollar amount copay for most services. For example, Hospital copay may be $290 per day for the first 5, then covered 100% after that. Specialist copay may be $35, Outpatient copay maybe $50, etc. So you have a pretty good idea up front what it will cost you out of pocket. Out of network on a PPO is more likely to get you into percentage copays on services. At those rates, not very likely to get anywhere close to your annual deductible in-network, unless you have some very serious problems that require ongoing treatment, like multiple hospital admissions in a year, extended stay in rehab or skilled nursing facility, need costly durable medical equipment, etc.
I talk to doctors all day long as part of my job... they love Medicare Advantage plans the same way that cats love dogs. I talked to more and more doctors everyday that are just dropping them. Refusing to see people that have their plans. That being said if you're 65 don't have a lot of money and are healthy it could be a great option for you. I haven't gone to the doctor in 15 years I don't plan on going in the next 15. If I get cancer I would choose to walk off a cliff rather than go through chemo. Everybody gets to make their own choices in this life
Thank you for watching and sharing your perspective
I’m with you I CHOOSE NOT TO GO TO any DOCTORS….have not gone since 2012 NEVER take ANY PRESCRIPTIONS I’m 71 years old and I’m very healthy …
I'm convinced that the commissions for Advantage plans, and/or the renewal money amounts and durations must be higher than supplement plans. There are agents in my local area who will lie by telling you that NO ONE is buying supplement plans in hopes that you'll 'follow the herd' and choose Advantage just cause they've brainwashed you into thinking that's what everyone else is buying these days. (the peer pressure sales pitch). When I told an agent I wanted a supplement plan, he started asking me if I had any chronic health conditions as if I needed to defend my choice. When I defended my choice, in part due to it having a nationwide network and how people who retire and travel the country in a RV may get sick and don't want to worry about whether the provider will code their treatment as an 'emergency', or they may want to hang out in Florida as a snowbird, visiting someone for 6 months at a time, he asked me, "but are YOU going to do that?" He then said "just worry about 2023" (my first year of enrollment) but that could be suicidal if I later needed to switch to a supplement plan and couldn't meet underwriting guidelines due to a health condition. (The government made that rule, not me). He went on a rant about how much more premiums would be for a supplement plan if they unconditionally covered pre-existing conditions. But yet, Obamacare and M.A. plans cover pre-existing conditions! The govt has CHOSEN not to extend the same coverage to supplement plans if you start out with M.A. So why can the govt pay for pre-existing conditions for Obamacare and M.A. plans but not supplemental plans after initial enrollment? No one can answer that question. It's blatant discrimination against supplement plans that aren't bought initially. I can switch to M.A. anytime and have pre-existing conditions covered. The agent CLEARLY had better commission terms with the insurance company if I chose a M.A. plan, and I have no idea how much commissions are or when he gets paid or for how long. It was just OBVIOUS that M.A. plans MUST pay better than supplement plans, or they pay SOONER, or LONGER, or some other factor I don't even know about that benefits the agent. There's no other logical reason for his obvious bias.
In another instance, where an agent sent out flyers to come to his free 'informational meeting' where he buys everyone's meal, and based on Medicare rules is only suppose to talk about Medicare IN GENERAL, NOT specific plans, he pushed AARP's HMO ONLY and claimed that no one is even buying supplement plans anymore, which is not true. The stats are out there. It was obvious these agents only want to sell M.A. plans, so if there's any 'hate' out there for M.A. plans, it's not coming from the agents who sell them. It's obvious they don't care about the customer's needs. They care about the commissions they're getting. They act as if supplement plans are going to pay them diddly squat by comparison, at least in the long run, if not initially. He acted like supplement plans are barely worth writing up, and was not even sure sure how to do it at first. I had to wait a day while he went and found out.
Agents can also steer you to certain companies for their own selfish monetary reasons. They must be getting some type of bonus commission that the poor customer doesn't even know about, and that agents are under no obligation to disclose. They only reason I used him to sign me up was because I didn't want to sign up directly with the company cause their own agents gave out conflicting information during multiple phone calls I made with questions about WHEN I could sign up. (i.e. "Do you have to have the Medicare number before I can sign up?") One agent said yes, another said no. I was going through a living hell just getting a Medicare number from the govt. And one of their agents deceived me over the phone in order to get my email and home address and then flood me with emails and ads in the mail. He initiated an application on my behalf without my permission, or even telling me he was going to. 5 minutes later, I get an email from AARP wanting me to "FINISH" the application! It's like he was wanting to tie his name to the commission before anyone else could, once I decided what I wanted to do.
The agent who signed me up said it would take up to 10 business days to get approval, and the application itself said it would take up to 15 business days. It took less than 48 hours. Any agent who had signed people up for my plan before should have known how long it really takes, regardless of what the application says. This is another reason why it's obvious he only wanted to sell M.A. plans, cause that's all he's ever done and he's been licensed and practicing for several years and I'm sure does very well financially cause he can afford to buy 25 dinners at a high scale restaurant meeting, at $20+ each (or more) per dinner. Do the math.
Another agent left a non-discript sticker on my front door, saying to call the number on the slip to claim an undeliverable package, which was a lie. It's illegal for agents to even come to your house uninvited, whether they knock on the door or not. He must have thought that calling him back was an invitation, at which time he could drop off his literature and save the cost of a stamp.
I'm convinced the industry includes unethical crooked agents. People need to verify EVERYTHING they are told by ANYONE, using multiple sources. Answers will vary, and you have to decide who's right. And don't give out your information too soon.
Watch out! You have been warned!
The future is MA plans. period.
You're stuck in the past with your view on supp plans .
You can travel with MAPD PPO's
But if you want to pay $300 a month with no included rx, dental, vision or hearing coverage as apossoed to a $0 premium MA. to see 2 doctors twice a year, well... that's upto you 🤷♂️.
@@paulleonard7038 He does a side by side cost comparison video of Advantage vs. Supplement and the Advantage is almost half as much as the supplement plan....$1978.80 vs. 4678.80/yr. A decent Advantage is not $0 premium. The $0 premium plans are HMO's, not PPO, requiring a middle man to schedule you, get you in weeks or months later, just to get a referral to a specialty Dr that you already know you need, and already have the Dr. picked out. It's a stupid, time consuming formality. Plus, you wait weeks or months to see the specialty Dr., then weeks or months to get scheduled for surgery or other procedure to be done. You could die waiting all that time. Plus, you are limited to a geographic area and network only doctors. If you travel out of the area, like people who RV around the country in retirement, or for life, it's good for emergencies only. The better deal depends on how much medical care you need in a given year, where, and from who. There are people with conditions that they've been waiting years to fix, such as putting off needed surgery, not just '2 doctors twice a year' so that is an assumption. There are people with ongoing medical conditions that need things like therapy, and I know people whose agent recommended supplement for that reason. If that's not enough, it's a flawed regulation to tell people that they can ONLY sign up for supplement plans ONCE without medical underwriting, and if they ever switch to Advantage for more than a year, they can't go back without underwriting. Their conditions could be such that they don't want to risk not being able to go back. So they're between a rock and a hard place due to that regulation. An agent told me that if everyone could switch to supplement anytime they wanted, like after getting cancer, everyone would just wait until then and switch to supplement. But the same can be said for Obamacare. It's a double standard, and the regulation should be changed. A person can't just change policies whenever they want, either way. They have to wait for enrollment period. It's a huge 'we got cha' incentive to sign up for supplement from the beginning, and it works. Add to that the travel, network, and referral limitations, and to some people, it's worth it. As for the other stuff like dental, I'm tired of dental plans with networks, which is what it would be with advantage. The dentist I want to go to are in such demand due to skill and popularity, they don't mess with taking ANY insurance. Their schedules are booked and they don't need to. So I have to buy my own plan that lets you go to any dentist, anyway. Not everyone needs hearing and vision. Glasses can be purchased out of pocket for far less than all the premiums you would pay, and hearing loss is gradual, and if you need an expensive hearing aid, you have time to switch to advantage then if you want without it killing you.
Any agent lying, most likely works for a call center. I would never mislead my clients, for that reason, they are my clients and I am in contact with them regularly. 9f course I offer Supplements and MA plans, and recommend on am individual basis.
@@JoeDoe2 I stopped reading after "premium mapd are not $0, $0 are hmo not ppo"
You have no idea wtf you're talking about...
I think it all boils down to the plan itself. When I retired before Medicare age they pushed my wife out of my plan and into a MA PPO that matches my plan. It includes the same RX coverage. It has a 400 dollar deductible / 2,000 dollar total out of pocket max. Per person.
ln traditional Medicare your doctor makes the decisions about your healthcare needs
ln Disadvantage plan the insurance company makes the decision about your healthcare needs.
Another way to look at it is that you get a second opinion from your Medicare Advantage plan medical reviewers.
The 2nd opinion is only based on profit/loss, though - not whether something is medically necessary. Some insurers are getting heat for using algorithms to baselessly deny claims.
@@mospheric👍
In traditional Medicare, doesn’t Medicare make the final decision? Not the doctor.
I've just recently stumbled upon your videos and by far, they are the most comprehensive, clear and balanced presentations that I have encountered. My spouse and I sincerely appreciate the work that you are doing. We will be in contact with your organization this week for an initial consultation.
This is very kind of you to say! So happy these are helping people and we'd be honored to help you and your spouse in any way we can.
You're kidding right? Tell me, what did he say?
I have an advantage plan. I am lucky to also have Medicaid and have the United Health Duel advantage plan.
A few years I had prostate cancer, my insurance refused to treat me saying I would die before cancer killed me. I appealed because my health was good and prostate cancer was my only problem. With appeal they cover me. Am now prostate cancer free.
So glad to hear it worked out and even more happy to hear you are cancer free!
Very interesting the discussions about how some are very happy with their Advantage Plans and for others it has been a nightmare. Clearly it varies from company to company, plan to plan and state to state. Which is the biggest arguement in favor of Supplement Plans.
It's like eating out while on a road trip. You see two places next to each other. One is a little local cafe, call it "Joe's ", the other a Denny's. You know Denny's is far from perfect, but whether you are in California or New Hampshire, Washington or Florida, you know what you are going to get. Joe's is a crap shoot.
Supplement "G" (for example) is Supplement "G" no matter what state you are in or what company you are dealing with (of course you want a reliable company that isn't going belly up any time soon!) But the coverage is the same. If it's covered by Medicare, it's covered by your Supplement Plan. You pay your Part B deductible and you are done, as long as Medicare covers it. You can go to any doctor that takes Medicare. Any hospital. No worries about in network, out of network, deductibles, copays, whatever. You don't want to be thinking about all that when you are sick. Advantage is too much of a gamble.
Thank you for watching Alan!
You may like this video on that subject:
th-cam.com/video/Gq5s6exibfE/w-d-xo.html
Isn't there a fifth situation in which one can switch from Medicare Advantage to Supplement Plan: Suppose one has Medicare Advantage and moves their primary residence to a location that is outside of the service area of their Medicare Advantage plan. Can't one then switch to a supplement plan in that case without underwriting?
Yes! Thank you for adding that!
Thing is , you never know what kind of health problems you will have in the future.Do you want to take that kind of risk with MA plans?
I turn 67 this May.I enrolled in Traditional Medicare with a supplement, "G",before my 65th B-day.At 66, it was found out ,unbeknownst to me, that I had 70% blockage in a major artery and just recently I i started having problems in my leg.Thank God for Medicare! I didn't have to fill out any forms or worry that i didn't have total coverage.My deductible for the year was about $220.That's all I had to pay.No surprises.I pay $115 for my supplement/Medigap policy.I also pay very little for all the medications I now have to take..
BTW, before I was 66, I was walking a lot, especially up and down hills and the only thing I took was vitamin D.Yes, you never know what life will throw at you.
That is the crux of the insurance conversation, right? How comfortable is someone with risk? Are they willing to spend more money now, so they may not have to spend more later? Or, save more money now with the risk of having to spend more later?
The unfortunate reality is that supplement plans are too expensive for some people. Yours sounds like a reasonable amount. There are some states where it starts at $300/month for a 65 year old and plans go up from there (sometimes twice a year).
Love supplement plans. If people can afford them, they are amazing. If people can't, Advantage plans in many areas of the country are actually quite good.
Thank you for watching and commenting!
I don’t know why there’s so much bashing on advantage plans! A lot of retired senior citizens cannot afford the extra supplemental plan premiums! It’s hard enough plan B already take more money from your social security! Supplemental plans are good if you can afford the added extra high premiums every month! Otherwise medicare advantage plans works !
There are areas and plans that don't make a lot of sense. Also, there are a lot of people who are or were tricked into an Advantage plan not knowing what they are or how they work - mostly through call centers.
Sometimes, all depending, your state might pay it for you if you’re under a certain income amount
Outragepus to me this is so complicated. Pay into your whole life but still have a 165.00 monthly preminuim but need a 200.00 monthly supplement plan and a drug plan that has deductible or Advantage with limited medical choices and network that you have annual out of pocket maxs up to 5,000 and not allowed a supplement plan l mean wtf cant l just keep the ACA l hate this.
Unfortunately, can't just keep the ACA. Well, you can, but once you reach 65, you lose all subsidies, and the plan gets much more expensive, more so than the advantage or supplement options.
Nothing in life is free. At least with Medicare you are getting a service in retirement even though it costs money. The worst is with Social Security. I had a friend who passed at age 58. He was single and worked all his life paying into the SSA. All of the money that he paid in (and his employers paid in) to SSA is just gone. Not he or any of his beneficiaries will ever be able to benefit from the thousands of dollars he put into the system.
@tomm7505 oh be quiet l paid into for decades. Lm self employed so pay double l will continue to work so will continue to pay double while l now have to pay for medicare So save the nothing is for free lecture.
@@judiashley5818 Boo Hoo
@@tomm7505 If he had a wife she can get survivor's benefits. My own dad died in his fifties and my mom remarried at age 50 (she was 8 years younger than my dad) so my own mother is now collecting survivors benefits from her second husband who lived into his mid 80s and made a lot more money than my dad did since he worked for a longer period of time. She also got a good supplemental plan from her NYC job and she has a lot of health problems now and they cover EVERYTHING. They also covered her second husband till he passed. She has excellent coverage through medicare plus supplement plan. NYC wanted to change to a Medicare Advantage plan and the retirees sued the city and the judge threw out the Medicare Advantage plan the mayor wanted to switch to.
Advantage plans have cost taxpayers quite a bit more than original Medicare (something like 17 or 19 BILLION dollars up to a few years ago) and studies have shown that medical outcomes are essentially the same. With original Medicare, you have the patient, the provider and the government involved in payment. With Advantage plans, you have the same 3 (patient, provider and government) and then you are adding the insurance company and all the complicated (and expensive) hurdles and layers of bureaucracy. With everyone crying about running out of money for Medicare, I don’t understand why the government is pushing these. The only way this would make sense is if the government has an end goal of increased (or complete) privatization. Recently the center for Medicare services caught flack for funding studies that transferred Medicare recipients (without their permission) to private equity firms (called direct contracting entities). These entities were allowed profits of up to 40%. The governments solution to public pressure was to make some small changes and rename the program ACO REACH. I’ll leave it to posterity to confirm but Advantage plans may be the beginning of the end for Medicare.
Part (not all) of the reason is because Advantage plans take away the 80% risk. The monthly payments to Advantage plans are perceived as less risky to the government than the 80% Medicare is responsible for (Part B) or other risks for Part A. Again, not the whole reason, but one of them as to why the government incentivizes Advantage plans.
Thank you for not being bias.. i feel better that i am in advantage plan and that you did not favor 1 than the other plans. With ever getting expensive, i can not afford the premiums on supplemental plans. Besides I see are in network. Good job on this very educational vlog. Thank you
My doctors and hospitals are in network
So glad it was helpful! We have a few deep dive videos like this coming soon!
My friend ranted and raved about her Advantage Plan. The only issue she had was she couldn't get dental care because she needed an oral surgeon. No good. NO one takes the plan. Fast forward to Labor Day weekend and off she goes on vacation a few states away. Reaches her destination and... can't move out of the vehicle. Had a stroke. So now she is hundreds of miles away, way out of network, and was told earlier they will not let her return until she is done with the 21 day rehab. It will be VERY interesting to see what bills come in from this horror. She has no money. She had carotid blockage surgery scheduled this month, but that went away along with the vacation from Hades. Ugh!
Thank you for watching and sharing.
Remember, Advantage plans are required to cover emergency care as in-network.
She went on vacation even though she was scheduled to have carotid artery surgery...bad idea. Her doctors sound like they're awful. A blocked carotid artery should not be scheduled for weeks and weeks away.
Thank you. You are a great presenter of such a confusing healthcare system.
You are too kind Cheryl. Thank you so much for watching!!
I live in Ca. I started out with supplement F. As I aged into the policy the premiums started to be cost prohibitive. I switched to a G supplemental plan. In Ca., I'm glad they have the "Birthday Rule." regarding supplement plans. Sign-up for medicare can be confusing. Thank you for your informative videos.
Thank you for watching! We have that happen all the time. Plan F is amazing, but it gets to be cost prohibitive. Plan G is amazing, it is making its way that direction as well. Appreciate your feedback and insights!
I have a friend that had a bad bad experience with his medicare Advantage Plan. He was 70 or 71 and had a wreck on his Harley Davidson motorcycle. He doesn't remember for sure what happened other than he was riding down a 2 lane asphalt road between 2 towns following his son-in-law who was on his own motorcycle. My friend must have hit a pile of gravel in the middle of the road where a smaller gravel road intersected the road he was on. His son-in-law noticed that he was not behind him and turned around and went back. He found "G" off the side of the road. he had slid and hit his head on a metal culvert (yes he was wearing a helmet). When "J" found him he was unconscious so he called 911 and 2 paramedics showed up. "G's" son-in-law told them that "G" (who was unconscious) had a pacemaker and they called an air ambulance that flew him to a trauma hospital about 42 miles away. He came to later that day and the hospital kept him over night and released him the next day. His hospital bill was over $120,000.00 and his air ambulance bill was over $80,000.00. Total was over $200,000.00. I saw him a few weeks later and he said "Medicare" denied all his claims because he went to a hospital that was not in network. He said "Medicare" said he had medical coverage on his motorcycle so they were responsible (the motorcycle insurance company). I was new to Medicare and I called my agent and he said "NO WAY"! "G" appealed their decision twice and they denied it twice. Here in Texas the most medical coverage you can have on yourself on a car, truck, or motorcycle is $5,000.00, I had just $2,500.00 on my Harley. "G" kept complaining about this and finally I asked to see his "Medicare coverage card". He showed me a Medicare Advantage Plan Card. He made an agreement to pay $600 a month on this $200,000.00+ debt but told me he was unable to pay his utility bills because he only received Railroad Retirement Benefits and his wife received Social Security as their only income. "G" ended up filing bankruptcy to get out from under that $200,000.00 + debt. I checked my insurance and I only had $2,500.00 medical coverage on me on my motorcycle policy. I had $100,000.00 on any one I were to hurt in an accident but only $2,500.00 on me. My wife and I have Original Medicare Parts A&B, a Supplement Plan G and a part D drug plan. So I called my motorcycle insurance agent and he said $5,000.00 was the most coverage I could get for myself on all my vehicles. I called my Medicare Part G agent and he said that with the coverage I had (A,B,D, & G) Medicare would pay and any medical coverage I had or another vehicle driver had would reimburse Medicare. He then said your friend must a Medicare Advantage Plan, which it turns out he did. That's why I will never change to an Advantage Plan. My agent recently was quoted as saying if he writes a new to medicare person in New Jersey or California (as an example) he would get $750.00 commission and if he wrote the same person in those 2 states a Supplement Plan G or N he would only receive about $300.00 commission. That's why so much Advantage plan advertising is on TV, radio, Internet, etc.
So sorry to hear such a sad story. Our knee-jerk reaction is the same as the 1st person where that doesn't sound right. How long ago was this? Advantage plans are required to cover out-of-network emergency care as in-network. There are some plans that have limits on that. Super unfortunate situation and can totally understand any apprehension around Advantage plans.
I have had a Advantage. Plan for years. And have never had a problem with it.. I don’t have to have. A referal, have never had any problems
Thank you for watching and sharing your experience Janet!
I like my supplement N plan $76 a month and i see any doctor . can’t imagine having a $6700 yearly out of pocket,
Can’t imagine having an insurance company and the government making all the decisions
Plan N is great! Thank you for watching!
The biggest point we try to make is that the decision is not one size fits all. Everyone is different, and geography matters. In some states, Plan N starts at almost $300 per month for a 65 year old. Many people can't afford that. In some areas, an Advantage plan has a $1000 out of pocket max and even less and no premium.
Other situations and areas it would be silly to recommend an Advantage plan because of circumstances.
So much variation both with humans and geography.
Makes us happy that you are happy with your plan!
Refreshingly honest and useful presentation. Thank you!
Thank you so much!!
I am on an advantage plan here in Florida. I recently checked to see what a supplement would cost in my area after watching the scary Advantage plan videos here on TH-cam. It looks to be about $300 a month for the plans. That is $3600 a year out of pocket just for the premiums that they never mention. I am an RN and would still rely on my doctor for medical recommendations. Maybe If I get sick and have to be hospitalized I'll see the disadvantage but so far I love my Advantage plan, no premiums, covers my meds, hearing aid help, over-the-counter meds, etc.
So glad you are happy with it! Hopefully our video showed that Advantage plans work REALLY well for a lot of people. The problems arise when people are sold an Advantage plan but were not explained how they work.
And yes, Florida has some of the highest Supplement plan costs in the country 😬
I've been trying to decide for the last 2 months what I should do regarding my current advantage plan. I called several health insurance providers, who were absolutely clueless. Today I compared the different plans, and honestly while the maximum amount of pocket might be a little bit high, the advantage plan honestly seems to be a better fit for me. The other thing that I've had issues with is that I'm only 59 and on SSDI with Medicare, and the health insurance providers don't seem to offer supplement plans if your ages less than 65. I still don't know what to do and I've got 7 days to figure it out. It's far too complicated. Unfortunately if you try to search the internet for help, every single link is somebody trying to sell you something. Thanks for your video.
Hi Robbie, thank you for watching and yes, it is a very complicated process.
I got your email. Just replied to it. We're happy to help in any way we can.
You'd better never get seriously ill, or you're in for a rude surprise. If you get cancer you are 150% more likely to die with an "Advantage" plan. Good luck with that!
@@leftykeys6944 will you send the source for the 150% number? Would be interested in seeing this study.
@@leftykeys6944 not like I have a lot of choice. I'm on SSDI as stated at 59 I can't get a supplement plan. According to United healthcare and Humana, they both stated that I am not eligible for a supplement plan due to being at an age less than 65. Thank you so much for making me feel worse and even more afraid than I already am. I'm waiting on a person that Erik put me in touch with to get a hold of me to see if I might be able to change.
@@Theretirementnerds Medicare Advantage patients are 30% more likely to die from gastrectomy, pancreatectomy,and hepatectomy.
th-cam.com/video/6FKFsxRs-Rw/w-d-xo.html
“Your chances of surviving cancer could depend on the type of Medicare plan you have, a new study reports. Americans enrolled in a privatized, cost-saving Medicare Advantage plan are more likely to die within a month of undergoing complex cancer surgery, compared to those in traditional Medicare, the researchers found.”
“Those covered by Medicare Advantage were 1.5 times more likely to die within a month after having their stomach or liver removed, and twice as likely if they had cancer surgery of the pancreas, according to findings published recently in the Journal of Clinical Oncology.”
www.upi.com/Health_News/2022/11/28/cancer-outcomes-Medicare/8401669644047/
This next article repeats the points covered in the previous listed articles. It also states: “…the investigators found that people with traditional Medicare are more likely to be treated by a hospital more experienced in dealing with cancer…” including teaching hospitals, National Cancer IQ Institute-designated cancer centers, and hospitals accredited by the Commission on Cancer.
www.medicinenet.com/script/main/art.asp?articlekey=284208
There’s plenty more where this came from. All it took was a quick online search.
It is reprehensible that anyone is allowed to make a profit off of healthcare in this country. I am outraged that the final decision on anyone's treatment comes not from a doctor, but from some insurance hack who never went to medical school or set foot in a lab, let alone an operating room in a hospital. These pirates are now trying to privatize the British national health system, where NOBODY has ever been denied the care they need or bankrupted by medical debt. British doctors don’t have to hire a whole staff of people just for billing, and no one has to see a damn medical bill. How ‘bout THAT. But the privatizers are hellbent on hijacking their system like they did ours. And people will suffer and die over there from treatable conditions, just like they do here.
Based on my MIL's experience here in Denver I would say that as you increase in age, you need to reevaluate your plan. She was healthy (controlled type II diabetes, HBP) until approximately 7 years before things headed south at 85 yrs of age and she needed more care. When she fell and hospital needed a rehab/LTC discharge, the supplement company had the worst choices (I'm an RN, worked in LTC...they were bad). BIL, an actual insurance company lawyer of all things, spent 45 minutes debating on the phone with the supplement person regarding the goverment's and Google ratings of the choices. (People, please look up the infractions/violoations/ratings when comparing LTCs). Without his knowledge of medicine, insurance, and skills in court, my MIL would have ended up in an absolute nasty place.
Long Term Care is an important discussion and one we are making videos to clarify. LTC can financially destroy wealth and family inheritances.
Medicare does not cover LTC. Advantage plans do not cover LTC. Supplement plans do not cover LTC. Definitely and important conversation. Sorry your family had to go through that.
Look at attained age vs issue age on med sup
@@Theretirementnerds I'm surprised that I've never heard of people being wiped out financially when original medicare was first passed and everyone had to pay 20%, like back in the 1960s and 70s before the gap plans were developed. What a coincidence it is that health care costs skyrocketed as providers were able to increase the odds of getting paid thanks to insurance. College tuition is the same way. It skyrocketed under Obama after Obama decided everyone with no money should get free college.....someone other than the student was paying for it. The world gravitates to where the money is, and things become less efficient as a result. Obamacare is a disaster that makes the insurance companies rich via subsidies, even when your network is so poor, it only amounts to your public county hospital, and the waiting list for treatment is a year, if they even agree to treat your condition. Want a reputable surgeon? It won't happen. They don't take Obamacare.
@@JoeDoe2 No no no. Lies. President Obama had no say in college tuitions. Move along. The ACA only pays the premium. Your tales of no surgeons taking them is a lie. I should know, for I used the ACA for surgery a few years ago and it was in excess of a quarter million dollars. Take your hate elsewhere.
I don’t want to deal with Pre-approvals, or Pre-authorizations. So, no Advantage plans for me. I also don’t want to have to Appeal for Denials.
They all work well until you get sick MA is really a Terrible path that is hard to get out of
Erik, I had a company health plan where I had my primary care doctor and when I needed something that he did not do, xrays or whatever, he would search for the applicable in network provider and then refer me to them. I did not have to do anything as far as calling the insurance company to locate an in network specialist and get approval. Everything revolved around the primary care doctor - had to see him first before seeing anybody else. Is it that way when on an Advantage plan? Or does the patient have to contact the insurance company to get approval and arrange visits to various specialists, etc? Thanks.
Hi Frank!
Both can take place. Many HMO Advantage plans still go through the primary care provider. Others may not require referrals, in which case, you can either call the insurance company, use their online search, or call the provider directly.
Thank you for watching and reaching out!
I'm in NY city on a PPO advantage plan with one of the big insurance companies. I have a few health issues yet things have worked out well for me with them. But every year they change the plan features and in network providers. They even change the name of the plan and advise me that if I don't do anything, I will be be moved to the new plan. So I have to go through comparing to see if it's still worth staying with them. I think I could benefit by seeing an independent agent if they are trustworthy. Any advice on how to find one in Manhattan?
Happy to introduce you to our person there. Send me an email to erik@90daysfromretirement.com with your zip code and I'll get you connected.
I will follow up. Thanks! @@Theretirementnerds
As a hospital case manager I would say they aren't hated enough. FYI united health care made 17+ billion last year denying people.
We understand the sentiments against Advantage plans. We can tell you they are not all the same. We try to be as open as possible and put things in context. United Healthcare did have 17.3B in profits in 2021. That is across all business lines, including the entities they own, not just Medicare Advantage. That was not made from just denying people. They do have denials. Absolutely. But their operating profits are not made from just denying everything. As a whole, the company in 2021 operated on a 6% margin. From a business perspective, a 6% margin is very low. When dealing with a company as big as United, that has massive revenue streams, that 6% turns into 17.3B.
We share your frustration when Advantage plans deny care that should not have been denied, causing appeals and headache and many other negative consequences.
Thank you. MA was a joke made up by republican lawmakers who hated the fact that Medicare was an amazing government program and were hell bent on a way to privatize it. And so now we have half of senior Americans stuck on these for profit plans - making insurance companies rich and sick elderly Americans die. It’s truly disgusting.
Ira, this is the 2nd time you've mentioned this on our channel. It is not correct. Part C was signed into law by Bill Clinton in 1997 and it began in 1999. It is a bipartisan concept. We are politically neutral and it is very clear as you look into this that both sides of the government incentivize and promote Advantage plans for the point we made in a separate comment response you made. Out of curiosity, are you an insurance agent? Your points here and in your other comment sound very similar to agents who only offer supplement plans, which is fine, just curious.
@@Theretirementnerds -- Negative consequences like preventable deaths, perhaps? You guys are hilarious.
6% seems low. I would like to check out their annual report to see this broken out by business unit. I live near UHC headquarters and have a friend who is an actuary there. If I get additional info, I'll try to share it with this channel. Bottom line, 6% is still 3x the 2% overhead Medicare supposedly runs. You need to go back to 1970s and Nixon administration which was when HMOs came into existence. The whole business model, which has morphed into what it is today, was founded on the premise that doctors were overprescribing services because they were reimbursed based on fee-for-service rather than outcomes. The thought was that these plan administrators could cut the fat, and still make a profit. The result, unfortunately, is what we see in the comments I read on all videos on this topic....some happy, some mad, but mainly frustration and confusion. And it's all unnecessary, for the most part.
I have traveled the world in my 65 years, and lived in places with single payer. It's not perfect, but I can say first hand, that most people are content, and certainly they don't have to spend countless hours trying to discern fact from fiction. Oi
The more I research this I look at Medicare Advantage plans as very similar to the employer provided insurance I had when I was working. Working with a PPO network, pre-approvals and co-pays weren't a hardship. The Medicare Advantage plans have the benefit of added dental coverage and possibly hearing and vision. The big issue is how healthy are you and how many good years versus bad years you will have. If you are healthy, don't use the healthcare system very much you may be ahead overall on an advantage plan. If you are unhealthy and use the healthcare system frequently you may be ahead with a supplement plan.
Very well stated.
With all due respect… It is not how healthy you are at the time, but what happens when you are not healthy in the future… ($$$) that needs to be contemplated… A MAJOR factorial.
It's also about how you plan on using the healthcare system. If at 85 years of age you are going to be treating cancer, having organ transplants or open-heart surgery then you need a different plan than those who will not. It's all a cost/benefit analysis.
@@danielrussell9416
AND WHEN YOU NEED A MEDIGAP, IT IS TOO LATE. You can NOT get it when you need it most. You commit to MA though annually, if healthy you can change. But healthy and not using MA make people complacent. UNTIL they can't get it when needed. Remember insurance is there to protect you. The objective isn't to break even.
@@Michael-si9ci That is true, however many people do make that decision based on their current health status. People feel why should they pay for high supplement premiums when they see a doctor maybe once or twice a year at most, are in excellent health, and are not on any medications. For many it is a gamble that pays off. For others it doesn't work out as they'd hoped. In New York, where I live, supplement plans are extremely expensive. I'm taking the risk that my health will last for a number of years, perhaps a decade, and the money that I save on an advantage plan will help if I feel the need to switch to a supplement plan in later. It's a matter of paying high supplement premiums for years when you don't use it, or paying $0 with added benefits of dental, vision, hearing, and gym membership ($600 annual) during those healthy years. When I do need health care if and when my health status changes, I'll look into Supplement plans.
I have been a Kaiser North (California) patient for over 30 years. I like them and will probably stay with them. While working I had to pay about $400 a month for my wife's healthcare. Now that I am retired, with Covered California (ACA) we pay almost $500 a month for the two of us. We have always had copays. Kaiser Advantage will cost $0 a month which sounds like a good deal. It will cost a maximum of $12K a year out of pocket for the two of us.
You bring up a great point. For many, either Medicare option is as strong or stronger than the company plans we've been used to our whole lives. Thank you for watching and sharing your experience!
Great presentation.
Thank you!
Advantage Plan PPO - you can see any doctors you want without any prior approvals ❤
This is the second video of yours that I have watched and they have both been very informative. I will be turning 65 this coming February so I am getting as much information as possible so I can make the proper choice for me. I think my next step will be to ask friends and relatives what plan they have and what they like / dislike about them.
I'm glad the videos have been helpful. We try to educate so you are better equipped with the information you need to make these decisions. I am making a video about looking to friends and family for these plans so keep an eye out for that in the coming days :)
Friends and family are great to learn if their plan has good customer service. Outside of that though, friends and family can be tricky. I won't bore you with a TH-cam comment, but I'll send the video to you once we have it done :)
I'm noticing that there is more and more competition between Medicare Advantage Plans. I think this works to our advantage because the plans will be more likely to be on the up and up and approve treatment in a timely manner. I've never had problems with Advantage Plans myself, but understand some people have.
How long does a person traveling the USA in a RV have to declare a change of residence so that they can take on a new network in a new location and be covered? What if they move in the middle of the year, and their company doesn't operate in that area? Doesn't coverage available and prices vary a lot based on zip code? There issues are not being covered by agents in their 'information' videos and meetings.
If someone moves in the middle of the year and their company doesn't operate in that area, they can switch to either a different Advantage plan or a Supplement plan.
Coverage availability, access to plans, plan benefits, and costs are all highly depending on zip code.
What's the sayin, don't hate the player, hate the system(?). If you took all the salaries of the sales people and all the TV and mail ads and costs of phone calls, then the profits made off of selling an unnecessary product and put it into Medicare for all.
I'm in New York and I currently have a Medicare Advantage plan; I would like to switch back to original Medicare with a Medigap High G plan. How would I go about doing that, if it is even possible? Thank you!
In New York, you always have guaranteed issue for switching back. We would recommend working with an agent who can help through that whole process. If you have an agent, use him or her. If you don't, we can help. Send me an email to erik@90daysfromretirement.com
How do you think about the Blue Medicare Advantage PPO plan? Is it OK plan for retired seniors?
Would need to know quite a bit more about the individual and where you live before we could recommend any particular plan. Happy to look into it after we get to know a little more about you if you want to send me an email to Erik@90daysfromretirement.com
We live in Troy Michigan
Only purchase a PPO Advantage Plan with a company like UHC. You can see any doctor or specialist without pre-approval. You'll be hard pressed to find a doctor or hospital that does NOT accept UHC. If you started with a supplement you can try an Advantage Plan without risk. Change back to your supplement within 12 months with zero underwriting. I've had an advantage plan for 10 years and have saved many thousands of dollars in premiums. But it's always based on your risk tolerance. That's the basis of all insurance.
Very well said. There are other carriers outside of just UHC that also have solid PPO plans as well, but yes, always important to check providers before this decision.
Thank you for watching!
No, UHC doesn't cover Moffitt, which is our choice for cancer. So, I would disagree with this.
@@motherearthhelpers3112 UHC is ONE of the best for coverage choices. That's what I said in my comments. Before someone buys a plan. They should look at the coverage choices. But always a PPO.
You mentioned that some treatment centers do not take regular Medicare and some do not take Medicare Advantage. I looked up MD Anderson, Cleveland Clinic, and Mayo Clinic. MD Anderson takes regular Medicare and works with a limited number of Medicare Advantage plans. Cleveland Clinic take regular Medicare and works with quite a few Medicare Advantage plans, and Mayo Clinc takes regular Medicare(with restrictions) and does not take Medcare Advantage.
Could you do a video on the strategy of initially (At 65) choosing a low cost supplement plan and at some point say in 10 years when the premiums rise switch to a 0 premium advantage plan...
I'm on a advantage plan and it's been working for me now for many years I'm 66years old, but I've been in good health health
Thank you for sharing! They can work really well for people, despite what news stories say. Not perfect for everyone, but many do work well.
@@TheretirementnerdsI am in Puerto Rico 🇵🇷 🇺🇸 I was on medicaid as well
As usual you are thorough and do an excellent presentation of making sense of a very complicated process. Thanks l look forward to your videos
Thank you Tony!
I am very impressed by a comprehensive facts. I have looked at at least 50 videos and this is by far the most thorough and unbiased. I even learned a few things. Thanks 😊
Thank you so much Tony!
Which is best plan for snow birds and people who travel a lot in the US advantage or supplement?
Tough to answer that without a bit more detail (don't share over TH-cam 🙂). Things like where you live and where you go during the winter. Some Advantage plans have large, nationwide networks or they have passports of sort. Larger entities have plans you can easily switch to and from.
The providers and facilities you prefer to use will influence that. Several facilities and hospital networks won't accept Advantage plans (Mayo Clinic). Others (much fewer in number) don't participate with Medicare (supplements)
In general, a supplement has less you need to think about in that regard because supplement plans do not have a network. If a provider participates with Medicare, and the procedure is Medicare-approved, you are covered, regardless of your state.
@@Theretirementnerds thank you.
After watching this video. If you want the insurance company to dictate your life chose advantage if not chose supplement plan. In my area out of pocket cost is $5,950 for the cheapest advantage plan.
Where you live definitely matters. Hard to ignore the $500 - $1000 out of pocket max plans in certain areas, but yes, if your out of pocket max is in the $6,000 range, a little easier to ignore.
We get what you're saying with the dictating your life part. That is a bit strong in our experience. Most procedures and services don't have any hoops or dictation happening other than make sure you visit in-network providers. But yes, prior authorizations and denials do happen so we get where you're coming from.
Thank you for watching!
I have an advantage plan that is the only 5 star rated advantage plan in the state and uses the largest hospital system in my area. My primary physician was already in this system. The total out of pocket is $4,500. I am 69 years old. Should I consider going back to a supplement plan?
Tough to answer without a bit more information. Where you live matters. Your health situation now and for the past few years matters. Your satisfaction with the plan matters.
The big takeaway is that Advantage plans aren't inherently bad. But, they are different than Original Medicare with a Supplement plan.
If you have an agent, highly recommend reaching out to him or her to look at your situation. Your agent should know you personally and be familiar with your goals.
If you don't have an agent, we're more than happy to take a look for you.
My email is erik@90daysfromretirement.com
If you could include where you live, that would be helpful.
Thank you for watching!
@@Theretirementnerds I am in Mobile Alabama and the plan is Viva and is tied to the Mobile Infirmary System which is the largest in South Alabama. My health at present is good. I did have a recent scare but it turned out to be not as serious as I thought but it did cause me to think ahead a little. I am going to look at adding a cancer policy and see if a hospitalization rider is available. I also am looking into the cost of going back to a supplement.
@@frankfowlkes7872 I'd recommend working with your agent around what you just mentioned and they will have insight and advice around next steps for you. Sounds like your thoughts is in the right place of what to consider.
If an agent died in a car wreck tomorrow, can they will all future renewal commissions to an heir of their choice? If they don't have a will, or have a will but don't mention future commissions specifically, can the next-of-kin in order of succession make a claim to all the insurance companies their relative was due future commissions from, assuming they know about it, and get the money that way after showing proof they're entitled to it under state law, and informing the executor if the executor didn't already know about all those stats and future income streams?
Hi Joe, it'll depend on the contracts that agent has. From everything we've seen, commissions will either go to the upline or go away upon death. Not willed to family or next-of-kin.
@@Theretirementnerds I don't know how a dead agent's commissions could be split amongst multiple other agents in an upline. And I'm wondering how common it is for older people to even bother becoming licensed when they know they may not live long enough to reap all the renewal money they earned. How many years are agents entitled to renewal money on contracts, assuming they live long enough, both supplement plans, and M.A. plans? With as many websites and youtube channels as there are which discuss Medicare and agent sales careers, no one has made a video on this, yet it's an important factor in deciding whether to even get licensed or not. It seems to me that if you don't 'start young' in order to get everything that's coming to you, it may not be worth it. I'm also wondering if insurance agents typically and deliberately quit selling new plans at a certain age cause they don't want to risk not getting paid their full due if they should die in the next 5 years, or however many years it takes for renewal money to roll off. And how does an agent keep the same customer and keep getting renewals once the initial policy renewal money ends? Do they have to call up all those customers and try to get them to switch to another plan so that the commission clock can start over again with that customer? That doesn't seem right. As for 'upline' and 'FMO" stuff I keep hearing about, and cooperating with other agencies in other states and locals like you mentioned, I think youtube videos on those subjects would get lots of views from people thinking about getting into the business. FMO websites lead you to believe you MUST be affiliated with a FMO in order to contract with each company and plan. But other sources say that's not true, that all you need is an agent's license. And people keep using the word 'broker' to distinguish between a 'captive' agent when there are no 'broker' licenses to be had, only agent licenses. It's not like real estate agents and their brokers who 'carry' their license. I don't know where to go to get educated on all these things, and people should know all this before they even bother to study for any tests to get licensed. 'FMO' and 'broker' and 'upline' and 'call centers' are all vague terms that someone should delve into on their youtube channels, unless they think not enough people care enough to watch such videos.
Give it a break. You are just droning on and on and on.
@@DianeScotts Lemme guess, you've been married five times and your kids act like you're dead.
@@JoeDoe2 Interesting story about commissions. An agent sold my husband a term life insurance policy about 15 years ago. A few months later he and his wife were walking to temple on the Sabbath when a car jumped the curb and killed both of them. I guess he lost all of his commissions...I bet he had a decent life insurance policy on him and his wife for their kids.
I’m recently retired and didn’t really understand what choices were available. As a result I made a disastrous choice and ended up filing paperwork over and over trying to get the company to pay my doctors. Even though they were part of the network the company refused to pay the doctors.
So sorry to hear this! Thank you for sharing!
I am early in my research but my understanding is that an Advantage Plan is buying into a large insurance provider. If that is true then my wife and I have had an Advantage Plan our entire lives. It has been horrible. Having said this I expect they are going to be all we can afford. We're not rich so I expect we will only get second rate care.
So much of this depends on where you live and the plans available to you.
From an Advantage plan only perspective, I think this video will help:
th-cam.com/video/5Tl0Ut1tTEs/w-d-xo.html
From both and Advantage and Supplement perspective, this video will help:
th-cam.com/video/eOP76hMPiDs/w-d-xo.html
16:32 When you say that insurance companies pay $15-20 more in first year commissions for dental, vision, etc plans if the customer is going with a M.A. plan, when those perks are always included with M.A. plans anyway, and don't require you to sell them separately? It should only be supplement plans where you have a chance to sell those extra plans for a commission, right?
Correct. Agents do not get separate dental and vision commissions with MA plans. Only standalone dental and vision plans when someone gets a supplement plan.
Advantage plans should be offered everywhere.
Rural areas are typically where you will find Advantage plans missing. Hospital access and rates and numbers of people to offset risk just don't make sense for a lot of companies to take on.
@@Theretirementnerds ahhhhh that’s why. Thanks
If you can afford G or N pay for G or N and if you can't afford it grab the Advantage, as its better than just Medicare A and B only. Advantage plan feels like a hope and pray you don't get really sick......
Advantage plan denied approval for necessary heart surgery. After waiting 2 months for the first denial, I suffered an emergency after which they finally agreed to pay (their minimal share). Regular medicare is better overall, both physically and financially.
I am not planning to retire at 65, but am self-employed and without insurance. I have been assuming all along that I can get on Medicare when I turn 65. Your website title of 90 days before retirement, makes me wonder? Can you please answer this one question? Thank you.
You can go on Medicare at 65 and continue working. In fact, in your case, based on what you shared, you will want to go on Medicare at 65 to avoid penalties.
My mother in Florida has Optimum and she told me for 2023 they will pick up a&b premium cost they cover (140) this year plus its a no charge premium and has decent drug coverage at tier 1&2. With out of pocket of 1900.00 So sometimes people can't afford A+B + N or G + D premiums year after year
Excellent point! Thank you for sharing that perspective
I've been overseas for decades and am now 66 years old...I'm retired military for 23+ years after 25 years of active duty (retired as a Sergeant Major, E-9 and have a monthly pension)...I received an email from the military coverage we have before turning 65 (Tricare) that I would have to switch to Medicare...Since I'm still overseas I haven't made any move to apply...I'll be going back to the USA next year for a visit (30days max) but will remain overseas. As I understand it, no US plan will cover me while overseas so I have to have International insurance coverage from somewhere that I pay for or take the risk of paying everything out of pocket...What's your recommended path in regards to Medicare and either supplemental or advantage coverage since in reality I'll likely never use any of it as an expat? I also will be applying for Social Security while back in the USA (I reach FRA in January 2023 - 66 years 4 months)...Thanks in advance... Great video BTW...👍😎👍
You are correct in regards to Medicare not doing anything for you really outside the US. If you are only going to be here for 30 days max, no real reason to have US-based options. If you are ever in the US for longer than 30 days, it is a conversation to have.
A lot of people with Tricare will keep that and get a no-cost advantage plan just for the perks - again - if you are staying in the US for longer.
Thank you for watching!
@@Theretirementnerds Thanks for your reply...I've sub'd, you've earned it! Cheers from Dave in Dubai...
👍😎👍
🙏🙏🙏
Thank you Dave! Appreciate you!
We have the Blue Cross Blue Shield (Blue) Medicare Advantage Plan PPO and happy with it. Please share your opinions. Thanks
I still am waiting for someone who recommends supplement plans who will compare an Advantage plan that includes Part D vs. Supplement plans which require a separate part D. No one I have heard who recommends supplements will acknowledge that many Advantage plans include part D. Nor do they acknowledge that drug plans for seniors is just as costly as doctor visits and no supplement plans pay for drugs.
This is such an insightful comment Duwayne. Prescription drugs are often the biggest single expense that seniors have and the Part D conversation is just as important as the rest of this. We cover this in a few other videos, but this one goes into more depth around how Part D works that you may find useful:
th-cam.com/video/17F6LUcujDE/w-d-xo.html
Thank you!
Prescriptions can be denied with advantage plans, it happens very often. Plus you can only use certain pharmacies. I have seen part D plans from as little to $0 to $20
@@evanscott729 thank you for watching. Prescriptions being denied is not unique to Advantage plans, and it isn't that they are denied, it's that they are not covered, meaning not on formulary. This same thing can and does happen with standalone Part D plans.
Drugs are handled similarly between standalone Part D plans and Advantage Part D coverage with the exception of with a standalone plan, you can shop around and find a plan that covers your mix of medications and pharmacies. With an Advantage plan, you are tied with that carrier's drug plan, but you can still shop Advantage plans and make sure you find one that covers your medications.
15:33 How could someone say that an agent is, or isn't, worth the ZERO dollars that they pay for it? If there's no charge, then they didn't pay. What am I missing here? It makes no sense, unless they got screwed by the agent and wish they had done it themselves or with a different agent. And can a customer change agents during open enrollment without changing plans? Does the new agent get an origination commission, or a renewal commission? Does the customer have to notify the agent that they want to change, or does the new agent tell them, or the insurance company?
Don't fully understand the first question. Some people feel using an agent is worth it. Others don't.
You can change agents whenever you want, but the new agent does not get paid on a plan they didn't help you get on. So if you stay on the same plan, but go to another agent for help, the agent helping you is not receiving the commission on the plan you are on.
@@Theretirementnerds Click on the 15:33 that I posted and listen to it. I put it there for your convenience. It doesn't make sense. A person doesn't pay zero dollars to buy a plan. You must have meant something besides the words you used, or the words that are heard in the video.
Hi Joe, clicked and listened. We're referring to the cost of an agent being zero. It won't cost people money to use an agent. Unrelated to the plan cost. We get questions all the time of, "How much do I have to pay to use an agent." or... "Is an agent worth the amount I have to pay the agent?"
The point is that the answer is people don't pay to use an agent. It is illegal for agents to charge money for their services to the Medicare Beneficiary. And to the question of "is an agent worth the amount I have to pay the agent?" The amount to pay an agent will be zero, and some people feel the no-cost service is worth having. Others don't.
@@Theretirementnerds Does the new agent begin getting renewal commissions the next time the plan you're staying on renews, like after open enrollment when it's apparent that the customer isn't changing plans? Does the new agent get paid full a full commission at such time that you finally change plans, followed by renewals as long as you keep it? What keeps a customer from changing M.A. plans each year, generating a full commission for their friend or relative who stays as their agent year after year? Do agents not get paid to switch plans for an existing customer that they've signed up once? Where do agents go to learn the answers to all these 'what if' questions without having to ask someone else?
@joe doe the "full" commission is just year 1 when the Medicare beneficiary first goes on Medicare.
So, let's say you go on Medicare and use an agent to get an MA plan. It'll depend on the state, but let's assume it is the $601. That's year 1. Year 2 is $300.
Let's say you switch to a different agent and a different MA plan during Year 2. The new agent does not get the $601, agent gets $300.
The reality is that many agents see less than both numbers if they have an agency they work under or share commissions with
Wow! Finely some real information! Thank you for your honest assessment. Next time I am in the market I will call your office.
Thank you for watching!!
I only recommend advantage plans to those who cannot afford the monthly premium. The pre-authorizations alone are enough for me to steer a client clear of Part C. I worked in physical therapy prior to becoming an agent and had multiple patients who I was seeing because their advantage plan required they go through physical therapy before authorizing a knee or hip replacement. Worst case story was a client who’s health deteriorated in the time she was going through therapy to the point the doctor would no longer perform her knee replacement surgery. She now has to live with chronic knee pain because the delay of surgery.
MOOP where I’m at is around 3,500.
The good news is CMS updated rules for 2024 is to reduce carriers from denying services.. they're looking to require carriers to offer the same service rates as original medicare.
Advantage plans must cover anything original Medicare would cover. I believe this is Federal law.
Correct. Not the same way OM does, meaning there could be prior authorizations or denials based on medical necessity, but yes, they must cover everything OM covers.
If they can deny treatment that OM would have covered, how are they covering everything OM does? It seems like a contradiction.
Thank you so much of your videos. I am learning more and more about original medicare, supplement and advantage plan. There’s always a disadvantage and advantage of the three plans. It depends to us the situation of ourselves if we have more or less health problems. And most of all the cost of the insurance premium. Very helpful to me.
I am so glad this is helpful for you and thank you for watching and commenting on these videos. Always love seeing your name pop up as a comment 🙂
One additional thing about Advantage plans is that there is no guarantee you will get the same benefits from year to year. I turn 65 in March and live in Florida so there are some great options with Advantage plans but I hesitate because who knows 5 years down the road if those plans will still be great. I'm leaning towards a HDG plan.
HDG is a great option there in Florida. In certain parts if Florida, Regular G rates can be high so HDG is very popular
What is HDG?
@@pamelaholden2701 High Deductible Plan G. It is different than regular Plan G. Much lower premiums, but has a $2,700 deductible in 2023 people would pay before any benefits kick in. Once the deductible is met, all Medicare-approved hospital and medicare charges are covered.
@@Theretirementnerds Outside of cataract surgery, which I've already had, I've never spent anything like $2,700 total in one year on medical expenses, and never in 6 years have had a deductible, as my HMO Medicare Advantage has no deductibles. And my entire OOP can only be a maximum of $3,650, anyway. But I have a 5 star CMS rated plan, and those are few and far between. I believe Kaiser is another one. If people would only choose 4 or 5 star Advantage plans, they would probably be happy with them, too.
@@commonsense6967 agreed, there are fantastic plans out there. Not all areas have 4 and 5 star plans, but yes, selecting plans with higher star ratings is helpful. Sounds like you have a stellar plan! 👌
Thank you!
Talk about the indemnity plans you can get to cover high cost deductibles tha you can get if admitted in the hospital or 1 day inpatient or physical therapy cost.
It is in our list of videos to shoot 🙂
my mom has secure horizons plan 1 from aarp..she pays 170 dollars a month out of SS and it COVERS 100% ofEVERYTHING shes ever had for over 20 years..
i dont think i can get this plan.. but i dont know whats best.. advantage is best for her
Thank you for sharing!
A big problem with HMOs and out-of-network ERs: You cannot diagnose your situation to determine if it's an emergency. You are also unqualified to make that diagnosis. Once that diagnosis is made, it is too late to make an intelligent financial decision about your care. Therefore, you are at risk of incurring expenses you might otherwise forego if you had the information to make an intelligent decision. Let's say it's a stomach virus but you think it's a hernia, appendicitus or food poisoning or something else. The hospital knows the stomach virus is going around, but you don't know that. So you pay dearly for your insufficient information. It's a scam. You don't present yourself to the ER with a list of codes, but with symptoms to be diagnosed.
Exactly, my husband suddenly couldn't lift his arm up and felt dizzy, he happened to be at home and was in our yard checking the pool filter controls when it the dizziness hit him along with the weak arm. I thought it was a pinched nerve in his neck and shoulder. We went to the ER and they called a stroke code. (his speech was not slurred, he could smile and his mouth did not droop, he could stick out his tongue, his eyes appeared normal and in alignment, he could follow my finger with his eyes, he could walk normally, etc). I thought it was a pinched nerve in his shoulder that he'd just had a recent MRI a few weeks prior for but the doctors in the hospital were smart enough to put him in a CT scanner and give him an MRI and many many other tests. He had had a stroke and was lucky that the clot broke up without needing the clot busting drug and he hasn't had any residual side effects other than some headaches afterwards. What if we had waited till the next day or had been out of our coverage area?!? People die while on vacation all the time. The bills came to about $70,000, we paid about $250. Our insurance company paid for most of that bill, they negotiated it down. My husband is not on medicare yet, he is supposed to go on it next year.
@@jdenino6022 Per CMS rules, Advantage plans are required to cover urgent and emergency care nationwide, without imposing additional costs or coverage rules. As for non-emergency or non-urgent medical away from home, it depends on the particular plan. Some provide coverage, some don't.
You may not know for sure whether your condition is potentially serious or not. Neither will the intake person at the front desk at the ER. Not until a physician is able to examine you and diagnose, will it be known for sure. If it turns out not to be something that needs more than some rest and over the counter remedies, then they'll just release you at that point.
Turning someone away who presents themselves at an ER with what could be a potentially serious or life-threatening condition, would expose the hospital or clinic to a lawsuit, if that person suffers complications or later dies as a result of refusal of treatment.
@@g0989 my husband went to the ER with dizzyness and weakness in one arm. They immediately called a stroke code before a doctor even looked at him and put him in a ct scanner immediately. He was able to speak perfectly fine and answer questions. You don’t know if it’s an emergency till the experts in the ER look at you and run some tests. He was in hospital for 3 days.
In my Medicare Advantage Plan, you could seek medical advice at the HMO's urgentcare facility, or if you prefer, the hospiral ER. Urgent care co-pay is $20; ER co-pay is $135, which is waived if you are admitted to hospital.
My oncologist would miss me 😎, so I went with a Supplement Plan
I’m paying nearly $800/mo for Part A, B, D ($597.60 due to IRMAA), $128.60 for a Plan G Supplement from AARP/United Healthcare, $9.50 for a WellCare Prescription plan and $49.60 for a vision/dental plan
In 2024, the IRMAA should drop off, as my 2022 income was much less, and the prescription plan is going to $0.50 - I am concerned about an increase in the Plan G - I’ll find out in July
Thank you so much for sharing your experience with your setup! I'm sure that IRMAA drop off will be happily welcomed.
Love my ppo advantage plan!!
Thank you Dotty! So glad it is working for you!
Yeah, this sounds good but why is it that when you call, they usually try to steer you toward Advantage plans? could it be because they get a higher commission? Just call ANY OF THEM and you will see!
Who is "they?"
Call centers? Absolutely.
Local, independent agents, not the case.
@@Theretirementnerds Maybe in your area but overall, agents get a higher commission with Advantage Plans.
I know because in my area., I originally signed up for Original Medicare A & B, got a supplemental and drug coverage in separate plans about 10 years ago and have been very pleased with my decision.
This year THE SAME AGENT THAT ORIGINALLY SIGNED WITH, called me about joining a Medicare Advantage Plan; I told him that I was pleased with my present pleased with my present plans and NOT TO CALL ME AGAIN.
So, your claim regarding independent agents may work for your area but not mine.
@@rich9890 I'm sorry that happened to you. Just so you are aware, Advantage plan 1st year commissions are higher, as in when you first go on Medicare. Switching you at this point from Supplement to Advantage would not get that agent the higher commission - unless there is something else going on with that agent we arent privvy to. As we state in the video, it is a bad business model to put people on something that is bad for them, especially if our business model is service oriented where we will help people for the rest of their lives.
For call centers that have zero service models, and are funded by venture capital, and are hoping to sell as quickly as possibly, they absolutely push Advantage plans. Or agents who are short sided and haven't figured out that client referrals are the best way to grow their business.
We are with you 100% that pushing Advantage plans for the commissions is wrong.
We also believe that for some people (not all and not even most) Advantage plans are a very good option.
I think that people that can afford it choose regular medicare with a medigap plan. People that can't afford it, choose medicare advantage, and probably most regret it when they become sick.
You'd be surprised how many truly wealthy people we see choose Advantage instead because they aren't worried about hitting the out of pocket max. With these being so different based on zip code, a lot of people love them, a lot of people don't.
I have quite a few customers who could absolutely afford a supplement plan and all the other "stand alones" that would be necessary to be compliant with federal regulations and complete their coverage. As successful business people, they decided to enroll in an advantage plan after assessing their own healthcare, financial and risk tolerance needs and doing the math. As an agent, it's my role to research the various plans, present the information and use my tools to enroll them correctly, NOT to parent them.
@@SuRFerretti we see it a lot. Many of these wealthy people got there by having a different risk tolerance and betting on themselves or paying as little as possible for what they don't use now, investing the savings for potential use in the future. Everyone approaches these decisions differently for sure.
No bashing…. Well said, thank you! Very helpful ❤️
Thank you so much!
some drs u cant see be careful
Do doctors get less money for doctor visits when you have an Advantage Plan than if you have a Medigap Plan ?
Those contracts are kept pretty confidential. From what we've been able to determine, it will depend on the service provided. Medicare pays low. Insurance companies try to negotiate as well.
10:25 How can you refer to a hospital system that doesn't participate at all in Medicare, and only accepts their advantage plan? If advantage plans ARE medicare, then they're taking Medicare, right? Is there such a thing as a non-medicare related advantage plan?
Advantage plans replace Original Medicare. They are not Original Medicare. You need to sign up for Medicare to get an Advantage plan, but the two are very different.
Hospitals and providers can decide to participate with Medicare and not an Advantage plan. They can decide to participate with Medicare and accept an Advantage plan. They can decide to not participate with Medicare and accept an Advantage plan. Or they can decide not to participate with any.
Thank you
Thank you for watching!
I recently had this very conversation with a PCP billing manager. Their recommendation to patients transitioning onto Medicare is to "just get a supplement", without understanding anything about advantage plans or the federal regulations that require a prescription drug plan also, and nothing about the ancillary benefits the advantage plan bundles in, OR the financials of the patient. That is why it is important to work with a licensed agent.
Do you have a video on what it takes to become a licensed agent? We go through extensive vetting with the state department of financial services just to obtain our license, are required to complete hours of fraud, abuse, ethics and other license specific continuing education to maintain that license with the state AND ongoing training with every carrier with whom we are appointed, who ALSO completes an extensive vetting before granting that appointment. Then, as part of every annual AHIP training and individual carrier certification, we are reminded of the consequences of NOT doing our job ethically which could involve not only being terminated but losing our license and hefty fines. We also have to carry E&O insurance.
100% agree with you. There are a lot of people that give advice on this topic that only know one side of the conversation, but there are so many moving parts.
We don't have that video, but not a bad idea. I've written out what I'd want to say around a video like that, but every time I go through it, it feels like I'm trying to be defensive, but I agree, I don't know that people know what it takes to be an agent and the significant penalties for unethical practices.
Surfetti, would you reccomend an Advantage Plan to a family member if the could afford a supplement?
@@JohnJohn-wr1jo There are many factors that affect choosing the right plan for each customer. I don't recommend ANY plan until I do a thorough needs analysis, including medical and financial health.
Excellent video... Totally worth watching.
Appreciate you watching and saying that!
I'm having problems with the insurance advantage . I got covid have been unable to walk and have tried to get rehab and it's been denied it's not right . I never was told there was a difference and I'm in a very big problem the insurance won't pay for me to go for Rehab for few months
I really enjoyed your video you have so much knowledge and you presented in a good manners and understanding . Thank you so much
Thank you! That means more than you know. Thank you for watching!
I would like to get your advice for choosing a Medicare plan. How can I contact you?
Send me an email to erik@90daysfromretirement.com with your zip code.
If I'm licensed in your area, happy to help. If I am not, I have partners that cover all 50 states.
Thank you!
@@Theretirementnerds
Thank you for your prompt reply. The zip code for my area is 95482.
Excellent video, thanks
Thank you!!
I really like your content, I work with advantage plans but fully understnad they are not a one size fits all. All of the negative things I get told by client who have talked to other agents who don't sell advantage make me laugh.
I appreciate your kind words! 100% agree with you. Interesting how if someone can only sell Fords, there are no other good car makers out there.
Now, Advantage plans have their weaknesses and are not perfect for everyone, and we love supplements as well, but some of the myths and blatant lies being spread about Advantage plans are unfortunate.
I have a question if you have Medicare and Medicaid which would be better at supplement or an advantage
Hi Julie, there are plans called DSNP plans made specifically for Dual Eligibles, meaning you are eligible for both Medicare and Medicaid. Something to look into in your area.
@@Theretirementnerds I’ve been checking on it and I think in the long run I’ll probably be better off with the original Medicare and the supplement Medigap
Excellent!
Get rid of advantage plans and have supplement plans get subsidies through U. S. government.
Thank you again, Erik! I am getting so much more out of your videos than any other channel.
So glad they are helpful! Let us know if there are topics you're looking for that we haven't covered
@@Theretirementnerds I will let you know if I come up with something. I need to get through the rest of your videos.
Thanks for being truthful. Thete's so much fear porn put out by most of the other youtube Medicare Supplement hawkers.
Thank you for watching!
Great job!
Thank you so much!
The advantage plan is a scam correct ?
No. Definitely not a scam. Also, Definitely not the same as Original Medicare.
Medicare Advantage in not universal in it's benefits. It depends on the State where you live, and who your provider is. The best option for someone in California, may be different for someone in Indiana.
100% correct
I. Have heart failure i medicare and my doctor for a portable breathing machine i get short of breath. They refuse to give me one or pay for it