My anecdote story is that I don't want to ask anyone's permission to receive medical care or be told where to get it. I'm happy with Medicare, and my supplemental plan G.
Anecdotally that's great and it works for you. But be advised that this decision is costing you thousands of dollars a year. Maybe you can afford that, and you think this is a small price to pay not to have to get preapprovals for elective procedures (as emergencies don't need prior approvals). If so, I'm happy for you, and it's obviously the best choice for your situation However, we are living off of meager SS income and any extra money we spent to avoid this pre-approval system (which may also help us avoid any unwarranted and unnecessary surgeries that only serve to line the pockets of unethical physicians) will mean less food we get to eat - impacting our health up front. We have a Medicare giveback in our Advantage plan that pays us $130 a month that Medicare overcharges us, in addition to our Advantage plan having no monthly premium. There are other advantages of our advantage plan as well, such as a $400 a year allowance for drug store items, such as OTC medications, vitamins, feminine products, etc. We also get Teledoc and free health club memberships as well as other things we don't use, but others might. We do like the included drug coverage. Most of my wife's meds are free, (I don't take any) but I think she paid $5 for antibiotics once. We realize that if we had to go into the hospital for a major medical event, it will probably cost us a little more, than Medicare with a plan G supplement will, but for all the years we have the plan and are healthy (like we have been so far) this puts us far ahead financially, saving us over $6,000 a year, every year, compared to basic Medicare with a plan G supplement in our home state. Of course, this varies by plan and state. There are some poor Advantage plans out there, which should be avoided, but there some good ones too. If considering an Advantage plan, I suggest you shop wisely or get an advisor who can recommend a good plan for you. But if you're in decent health like we are (I'm 68, haven't seen a doctor in 6 years and am on no meds) I'm sure you will find one that will save you money. This is why most people choose them. If, however, you are in poor health and see a doctor often for chronic medical conditions, you will probably be better served by Medicare with a Part G supplement and good drug coverage. But we're all like snowflakes, everyone unique...
@@les0101s But you do for non-emergency care from Advantage plans. Surgeries need to be pre-approved and performed in their plan facilities. More and more hospitals are leaving theses plans. Facts.
@@morrismonet3554 Fortunately, I live in a city with good plans. My plan covers all the hospitals and all my doctors, as well as my specialists. My diagnostics, like MRI's have no co-pay as long as I go to their specified providers. You have to do your research on these plans at this time of the year.
It's absurd that the hospital system will accept these extraordinary negotiated rates from Medicare, but will absolutely not assist people without insurance and high medical bills. How shameful is our Healthcare system.
It’s the insurance companies contact to the hospitals that they will only pay a low percentage of the bill. So hospitals are forced to bill high rates to just cover their real cost. Also in the contacts they have to charge those high rates to all their patients or insurance won’t pay.
well, insurance spread the risk among the people that pays in, if you decided not to participate, then you took the risk and have to pay. What you are saying is the same as geting social security without paying in.
The excessively high rates charged to the uninsured are a kind of tax scam. Companies are able to get a small tax break when they write off bad debt. Therefore it might as well be a large number that gets written off. The patient was never going to be able to pay regardless of the amount, so for the most part they aren't harmed either. It's the government and it's tax payers that suffer a loss.
Prior to retiring recently I was an RN case manager and utilization reviewer for a hospital change. The attempts for prior auth for MAP was staggering to arrange out patient follow up treatment for our patients, to the point we didn't have staffing nor time to follow through for the best out patient care for the patients. The SNF availability for the MAP patients was limited to care facilities not always noted for quality, but the traditional Medicare A/B patients could go where they wanted. It was night and day difference providing needed follow up treatment for the traditional Medicare vs MAP.
I'm a current RN case manager and the dis-advantage plans have ramped up their worst... Almost like they know people are on to them and going to try to sucker the last bit of blood out of their victims.
I had a heart attack in 2015 and subsquent stroke , two weeks in hospital, 2 months in nursing home, 2 months home rehabilitation and my total I had to pay on my Blue Cross, Blue Shield Advantage plan was 300.00...
OK that was the BEST run down of Advantage vs Supplemental plans ever. Even though this MI is only an anecdote (and your mom's cancer youtube you also covered) it really helps one to get their brain around the worst case scenarios. I feel like being not risk adverse and in an urban area with great in-network options the advantage plan works pretty well for us, plus we're active, healthy and we take care of ourselves. We were paying nearly $20k a year for health insurance before retirement - because of our income - for incredibly basic coverage. Your other video comparing Advantage to Supplemental is also a must watch.
I enjoyed your presentation and it is very accurate. I worked for Health insurance companies for a couple of decades back when HMO's started. The Advantage plans remind me a lot of how the HMO plans work and if your provider is within their network, you are good, but you must check every year to verify your provider is still in that network. I have been on Medicare for a couple of years and have Plan G with the High Deductible. I have my HSA since I am healthy at 70, except for my accident. Glad you are presenting options since many seniors may not understand the consequences of their decisions.
Anecdote: I switched from my employer insurance plan to medicare advantage plen fron the same insurer when I turned 65 15 years ago. My bills have been small until this year. My primary detected that I had a heart murmur. The results is an echo to verify the murmur, and angiogram to tell if I could have a TAVR. Followed by a TAVR procedure. I was in the 30% of patients that needed a pacemker. 2 more echos and 2 CT scans. 9 days in the hospital, 5 for the TAVR mostly because my platelets "crashed". After release, my pulse rate dropped so it was to the ER with what turned out to be a Heart Block neccessitating the pacemaker. 4 more days in the hospital with an accompanying ambulance from the ER to the Cardiac unit. I still have 11 days of zero cost in the hospital this year. After 20 days, it will be $100 / day for an additional 80 days. I have zero copays for doctors and specialists. Also zero for labs and x-rays. I just got my August statement for the year. The hospital billed approx $300,000 and the insurer agreed to a little more than $100,000. My costs were $30 copay for the 2 CT scans. I did have to pay for parking for my wife. My meds accounting will come in a few days but most of my meds are zero copay with a few $5 copays. In addition to the medicare premium, I pay zero premium for the advantaage plan. I guess my non-profit HMO is a bargain. I must emphasize that it's a NON-PROFIT.
It is criminal that medical bills in the US are so incredible. The whole system is outrageously complicated and the big medical care corporations and insurance companies are laughing all of the way to the bank.
@@blackpowder4016Then how come healthcare costs half as much in the UK compared to the US? Outcomes are better as well and so is life expectancy. When the government pays, and has the ability to negotiate, things get better, at least in the case of healthcare.
@@blackpowder4016 -- Is that why a billed amount of over $523,000 is reduced to $22,000? Because the government can't use their large scale buying power to negotiate prices?
Unbelievable Eric, how do you find the energy to make all these extraordinary videos, and so specific at that. No one else has come remotely close to your content. I just had to commend you on helping all of us understand some of these costs associated with these two medicare systems.
I have an anecdote to share. I was watching a video about Medicare and my favorite part was when another video was referenced with this description: The presenter seems pretty neat.
Anecdote. Thank you for your breakdown. After 2 years of being on a supplement plan N I still go back and forth if I should switch to a g. So far all is good
Brilliant! You picked up a 70 year old (and still healthy knock on wood) subscriber. I ALWAYS advise folks shy of Medicare age to get original Medicare and just pay the premiums for Medicare and the supplemental
It really is not that hard to pick the best plan. Unfortunately, this video like most points people in the worst direction. 1. If you have a doctor connected with a major medical center, you should be asking the business office which is the best plan, gives the quickest and easiest approvals, etc. Most national providers offer advantage pros that treat all Medicare providers as in network. Your physician and hospital network have no interest in pointing you towards a plan that gives them problems. Happy anecdote.
GREAT INSIGHT! Thank you for the disclaimers at the end. Yes, an anecdote with no effort to sell. Thank you Thank you for the effort to teach. My family and I are in advantage plans, and simply READING the bills from a hospital stay has been impossible. Thank you!
I love this type of video and you did a great job as usual. As an anecdote, this year (2024) I switched from a supplemental plan F to a MA plan and I couldn't be happier. I retired in 2015. Now, gone is my $240 per month premium for supplement plan F, gone is my $110 per month part d plan where the drugs also cost twice as much and present is my $0 premium health plan, $0 premium drug plan, and I still see the same doctors and hospitals that I was anyway. I now save enough in one year, that if I ever reach my maximum out of pocket ($4100) I am still way ahead financially. Love my Advantage plan. Plus, I am 74 this year. I hate to think how much that supplemental will cost by the time I'm 80. ($450 - $500 per month?) I don't have to worry about it.
Anecdote ... 75 years old here. I wound up in the ER a week ago with severe abominable pain. Lots of tests and and a ERCP to clear gall stones from the gall bladder duct on the emergency day. They scheduled me for gall bladder removal surgery the next day. I called my medicare advantage and was told the surgery would need prior approval or they would NOT pay for the surgery. I told the nurse this and then the surgeon and I wound up signing an AMA ( Against Medical Advice) and came home, the surgery never happened. The bills haven't arrived yet so it will be interesting to see how it all goes. I still have my gall bladder and I feel great.
All You needed was a prior auth…the doctor handles this all. Why would you take it upon yourself to call? They would have approved this if it was necessary.
When you sign up for an Advantage Plan, you are giving permission of the insurance company (or software program they are running) to control the treatment decisions your doctor and you have agreed on. Advantage plans are in the business to make money, your treatment is interfering with their bottom line. It is an adversarial relationship that you signed up for. Probably tricked into it by the agent who sold you the plan. They get much higher commissions than sell Original Medicare supplement plans which require no approval.
I don’t think the advantage program is worth anything if Medicare will pay for your gallbladder surgery you just have to worry about the deductible. You’d never be denied and you get the treatment.
@@banon7853 You can’t have Medicare Advantage unless you give up original Medicare A and B. If you leave your Medicare Advantage plan and have just Original Medicare A and B then there will be no preauthorization, but you would be on the hook for copays, and deductibles. Which might be overwhelming if you had a very serious health event. They would have done the surgery if you agreed to bare the responsibility of your share.
Makes me glad I have Kaiser. I had two surgeries back to back with 4 days in the hospital all together and included many tests. The total cost was close to 100,000. Of that I paid $100.00 when I went into the emergency rm.
with medicare advantage , you would have the daily copay again if you were to be hospitalized each time in the same year, with a supplement you pay the deductible and copay only once for the whole year.
Anecdote included: The thing that never seems to get discussed about healthcare billing is that amount billed versus what-insurance-will-pay difference. The hospital shrugs their shoulders and eats the $485,000 difference....and we sort of ignore that fact. But if you had no insurance, then you would quite literally be looking at a $507,000 bill. I worked in IT for a health insurance administrator for 30+ years. I remember hiring a struggling single mom who had taken the bills for her young son's appendectomy as "legit", and unquestioningly was trying to pay those bills down...she was stunned to learn that the hospital probably would have only collected 1/10th that amount if there had been insurance involved. And she had already all but put herself out on the streets paying down those bills. THIS is healthcare in America...now rated dead last in every category of healthcare, *including outcomes!*, in the top 10 developed countries: Most expensive, worst general care, worst outcomes.
When you tell people from other countries about healthcare in the US, they are shocked to find out that Americans can go broke from a hospital bill. Most of the time, they don't even believe me.
I’m in Florida too and in my early years I didn’t have health insurance. I had to go to the hospital for surgery and the bill came to nearly 100k. When I was being discharged, they were wheeling me towards the front door and suddenly veered off and went to the business office. They were demanding some sort of payment and also wanted me to sign papers saying I would pay the entire bill. I told them that I was still medicated and under doctors orders so I couldn’t legally sign anything. My wife came in , very pissed off, and took me out of there. When they called a few days later I told them that I wanted an itemized bill. They argued with me and I told them that I knew that hospital bills are works of fiction and that I wanted the same discount that the insurance companies get. They knocked the bill down to $6,000 and I told them I would send $100 a month. After paying for 6 months I called them back and asked what it would take to pay it off. They agreed on $1,500 and I sent them a check and they marked it paid in full. Of course now I’m on Medicare and have a supplement plan but anyone who’s younger should remember that you can always negotiate.
Another thing that person should have done was to speak with a financial advisor at the hospital. Most that I have encountered will give you an application for assistance and determine if you are eligible for a reduction in your bill. That is WITH AND WITHOUT INSURANCE. I had a sizeable outpatient cancer surgery and radiation treatments. I had insurance. I applied for financial assistance. I was awarded a percentage of help and they applied that to my bill AFTER insurance paid it's portion. It made my medical bills that year much more manageable.
I just wanted to thank you for your very insightful videos. I’m still a decade away from Medicare but you turn 50 you start getting inundated. Friends and family are talking about it. So I wanted to figure out what the deal was. And now I get it. I can talk intelligently about it and understand what others are saying. I am in California and a member of Kaiser and that’s probably what I will keep. But who knows what the landscapes gonna look like in a decade. Thanks so much. Anecdote.
Thank you for this easily understandable comparison. I've had my MA for 8 years now, and will likely keep it, unless something drastically changes. Other insurance agents are giving us fear-porn anecdotes about possible changes to MA plans. I appreciate your truthful presentations!
Appreciate you watching! Changes are coming to many plans. They aren't released and we can't talk publicly about them until October 1st. Some plans are experiencing big changes, others small or none, so make sure you check out your Annual Notice of Change that should have arrived or will soon :)
Just getting started and appreciate this detailed walk through of a specific scenario with nods to the bigger picture. And especially appreciate that you recognize the plural of 'anecdote' is not 'data'...
Anecdote...I'm in FL. In early summer I went to the ER and was admitted in the hospital. I spent 5 days in the hospital and was discharged. The total I was responsible for was $120. I don't remember what the hospital bill was but probably well over 100K. My plan was care plus advantage plan and paying the $174 per month premium. I didn't have any therapy afterward. I was able to change my plan about a month after the hospital visit. My Dr office recommended that I go on a chronic advantage plan and I switched to freedom health and like it even more. Yes, I was allowed to change my plan at that time because I have several chronic conditions and Medicare allows you to change your plan outside of the normal enrollment period.
@@wallacesantana9190 plan G pays for EVERYTHING after the yearly deductible is met. Plan N, while cheaper, you will be responsible for up to $20 copays to Dr and $50 for emergency rooms. I don't know for sure but there may be copays for diagnostic tests. Some Drs charge excess fees that you will be responsible for. If you are fairly healthy and don't see the Dr often plan N may be best for you, but call and find out what options you have for your situation.
@@wallacesantana9190 I believe their is a lower cost plan G with higher deductibles. I'm new to this... I bought Plan N for about $93 just a few days ago!
It's always good to remember when listening to your very thorough explanation regarding the 2 different plans that its based on an "anecdote ". 1 persons example, 1 size does not fit all.
I always watch the entire video and then struggle to figure out a way to use the secret word in my comments. Do you have an anecdotal story for that? In any case, I have been on an advantage plan for about 10 years, mostly because I am not able to pay for a supplement and drug plan. I know I am gambling that I will stay healthy in my retirement years and that the money I saved with zero cost premiums and prescriptions over the years will outweigh what the cost would have been if I had stayed on traditional Medicare with a supplemental plan and a drug plan. Thanks for your very straightforward and informative videos.
Thank you for watching and sharing your thoughts! Saving a little in "pretend" premiums for yourself can help build a safety net to cover more expensive years.
This type of case study with all the numbers is extremely helpful. Seeing it side by side for this one example gives a great template for our future decision making.
Erik, what a wonderful video again! I am so happy that you came down hard on the shady brokers here who scream about anecdotal (some probably even fictitious) cases. I have even caught some of these guys lying, not just deceiving. Strangely, they all insist everyone should get a supplement plan. I called a broker here in Massachusetts to get his opinions about insurance companies that offer Advantage plans, and he said that he deals with only supplement plan companies!
Erik, Thanks for sharing this extremely clear and specific anecdote! I always learn something valuable by watching your videos! Keep up the great work! Glad to hear your relative is doing okay after her heart attack! We'll keep her in our prayers!
Anecdote. Nice presentation. I am especially impressed with your ability to write legibly with a marker on a white board. I was even able to make out the smallest print.
My husband and I have an advantage plan that we've been happy with. We found out that the insurance company we have is pulling out of the State of Washington at the end of this year. We're waiting to discuss our options with our insurance agent. I realize your video is an antidote, however it is giving me something to think about. I'll share this with my husband in the morning. Thank you for your time and consideration. L
As an anecdote, I had a 100 percent proximal blockage (clot not a plaque) of my proximal circumflex on Easter Sunday 2024, no prior angina or any cardiac symptoms. On Kaiser souther California, the hospital bill for ER, placement of 2 stents and 2 day hospital was around 150,000, adjusted amount 25k-30k my total out of pocket was < 800. And no monthly premiums for Kaiser except for the supplement, which actual pays my LA fitness membership which cost more than the supplement premium. So far very happy with Kaiser.
I had a heart attack and subsequent stroke in 2015 and my advantage plan payed for everything. 2 weeks in the hospital, Stent placement, ❤2 weeks in the hospital, 6 weeks in the nursing home and home psychical therapy for weeks. All I paid was 300 dollars..
Thanks Erik. It's amazing that if someone had no insurance that the total bill for this incident would be over $500K yet with insurance it's less than $35K. Thanks again, anecdotally.
Thank you for tuning in, Tom! The sticker price is pretty nuts. Hopefully the uninsured know they can negotiate that down and shouldn't be paying that sticker price.
Disadvantages of the advantage plans in my case: some providers will not take advantage plans and extra time, headache needing approvals before doctor or specialist visit. Anedote
While the costs of Medicare Supplement and Medicare Advantage are close in this video, I also realized the variable costs are a lot different. The variable costs are $ 240 for Medicare Supplement (the Part B Deductible) and $ 2,396 for Medicare Advantage. So for Medicare Advantage, you are paying a lot more out-of-pocket for your medical costs when the medical need arises but can save money when the medical need doesn't arise. For Medicare Supplement, on the other hand, your out-of-pocket costs are essentially limited and are going to be a lot more stable from year-to-year. The video also exemplifies the complete farce that exists today with U.S. hospital bills, because a $ 506,922.28 hospital bill gets magically "negotiated" to only $ 22,000.00 (or a whopping 95.66% discount). I simply don't understand why our politicians don't make this type of unreasonable hospital billing illegal. I simply don't understand why our politicians let our drug companies spend so much on unnecessary advertising (and then charge you $ 20 per daily pill for Jardiance). In closing, my wife and I went with a Medicare Supplement in part because I never liked the insurance "approval process", in part because we don't want to be restricted to a specific medical network. It's still a bargain because my wife and I only pay $ 7,309 annually for our Medicare medical+Supplement+prescription drug coverage. Anecdote ...
Pretty much true. With original Medicare and a supplement, your costs are predictable. They may be more expensive than MA would have been some years, but much less other years. How would the costs of the above example have been if the person in his family required more medical care after the heart attack(same year). Then original Medcare and Supplement would essentially cost $0(he already included the premium cost of the supplement plan in his example). MA would not cost $0 in any case. As to US health care costs-everything you say is very true. The US pays the most and gets the least due to greed.
Hospital are forced to charge high rates because of the insurance pay by percentage, which is low like 10% of the bill. It is designed to scare people in to having insurance.
@@tomb5552 Looks like the companies are starting to pay to low and to slow(another tactic they use) for some providers in the case of Medicare Advantage. A growing number of providers only take original Medicare. My opinion is that Insurance companies are just leeches on the health care system. Taking money for themselves that should be used for health care(and is used for health care in other countries).
I just had a TURP. The total costs that were sent to my Medicare Advantage plan were $83,000. The plan paid $8,500. My co-pay was $850.00. All my drugs are free and they pay $50.00 towards the fee medicare charges me. I will stick with the advantage plan.
Thank you for this video. Using real numbers from an actual Heart Attack case goes beyond the anecdote level data that is so common online. I definitely want to visit your companion video on drug costs given the way a separate Part D plan handles vs a MAP.
Anecdotal. Eric, awesome content! I have been in the Medicare space since 1997. This video is absolutely accurate concerning this set of circumstances. Real life claims and payment really help people understand what their out of pocket responsibility looks like. To those who watch this video: Do not get distracted by hospital bills. Everything is based on what Medicare will reimburse!
Really good video. My wife and I are about 2-3 years away from retirement and this info really helps. Anecdotally, I thought the Advantage plans were like $15/month or something. That's kind of what I remember my now deceased mom paying for Humana Gold.
These videos are so helpful. I'll be applying for Medicare next year, and will definitely be using your resources for my search. You make it so much less intimidating!
Would love you to provide our Medicare Advantage ANECDOTE from the Coachella Valley specifically just to show folks how location is everything for MA plans. With a powerful high senior population, big medical groups, three participating award-winning hospitals, and nearly all specialty groups participating in MA plans, it would be enlightening to see a top MA area just one time for people's edification. Our MOOPs this year were $699 and $800!! We have no copays except $25 for MRIs and $250 for ambulance. The hospital copays were minor as well. The significant benefits over the past 15+ years often made us feel as if we were making money on our MA plans, and that is WITH significant comorbidities such as heart disease, surgeries, autoimmune diseases, chronic illnesses, etc. We have never faced a denial of referral or service or medication even when off formulary with easy appeal. So, for THIS location, an MA plan can't be beat!
I've taken a screenshot 🙂 Thank you for sharing! Everyone reading this should understand that advantage plans are highly dependent on location and company. Yours sound amazing! Appreciate you!
Anecdote. I'm 11 months shy of 65, working full time in a large company with Anthem Blue Cross Shield PPO. At this point my goal is to work until I pass, and stay on company provided healthcare. I think in one of your videos you refer to Medicare as a maze. It's pretty complicated, likely changing from year to year, and expensive! Just trying to get a clear understanding of what my options are and a realistic understanding of which is best for me. Thanks for these videos.
Anecdote: ❤. Thankfully your relative is safe. Love the way you break things down with Medicare choices. I am on advantage plan for about 5 years now. My choice was before I saw your or any online advice. My calculations are exactly how you summarized and decided the maximum out of pocket cost will be my cost if I have really big expense. So far I have not had any problems even with prior authorization (no emergencies yet). As you say, permutations and combinations are different for each individual and each year. 👍keep up the good work
Great video. My anecdote would be about how federal retirees have different options. How postal retirees used to have federal coverage as an option, but next year have something different. At our monthly get together, I learned that my retired postal cohorts are just as confused as I am.... even the ones in NARFE
Anectode , my small town hospital in Tennessee is not accepting BCBS Advantage next year. Also any doctor owned by tthe hospital will not take it. This will leave many seniors here trying to decide what to do for the enrollment period.
Anedote, I made it to the end😊. What is not mentioned is the piece of mind when not having to deal with all the co pays and deductibles. Being on an F plan I have none. Had my droopy eyes fixed, never saw a bill. Peace of mind. I am 71 and pay 208 a month.
My anecdote is a worry: that premiums for original Medicare plus supplement plan G will rise so much that I’ll be forced to switch to an advantage plan. Scary.
My bill for 3 stents and 2 days in hospital CCU was $700 - nothing more. Love my Medicare advantage plan. I paid an additional $30 for each follow up rehab session to a total of about $600
I have a call coming up with you guys on October 25th. I think I need an antidote for all of the challenges I've faced with the Advantage programs. Great video.
Anecdote. I am getting ready to go onto Medicare between 6-18 months depending on my wife's employment. We are leaning heavily toward Plan G with drug coverage when I and my wife go onto Medicare. But, it is scary to navigate thru all the BS that is out there. However, I am going to start following you as you have one of the best that I have seen...so far. 🙂
I switched from a Plan G to a Plan N after two years. My plan G monthly premium was going up significantly every year and was going to go up to $168/month. Fortunately, I was able to switch to a Plan N with a monthly premium of $78/month. Thus, that represents a savings of over $1,000 per year. Now, with Plan N, after you meet your Medicare deductible, you can be charged a $20 co-pay per doctor visit, but I only go the doctor two or three times a year, so that is $40 to $60 dollars. Thus, I am saving a bunch of money with Plan N.
The anecdotal stories we hear about Advantage plans should be enough to scare people into a Plan G. The ability to seek medical care from professionals of your choice that you want treating your illness without permission from an insurance company can't be overstated.
It depends on where you live. My Medicare Advantage plan covers all the hospitals in my city. All the doctors I see and many more participate in my Advantage plan.
Just my anecdotal experience: When I was retiring a couple of years ago, I asked my doctors what the better option would be. Several of them said up front that they did not accept Medicare Advantage. While I enjoyed your cost analysis, if you can't see your current doctors (who were happy to work with my former employer's PPO insurance), then it is all for naught. The other issue is the costs with IRMAA. Since I was fortunate enough to work a professional job, my Medicare part B and D premiums are a wee bit higher than what you quoted, which might distort your figures somewhat.
I chose an Advantage plan for the no-cost additional coverage of drugs, dental, vision, fitness and OTC. My root canal and crown this year was paid 100% by my Advantage plan -- $2500.
Another great informative video. I like hearing anecdote stories when they come from reliable sources. I wish it was easier to chose a supplemental plan though. I also wish traditional Medicare offered a fitness membership. Keep up the good work. You are going to get super busy in the days ahead so be sure to eat right and rest when you can.
Thank you so much for watching! :) There are some supplement plans in certain states that will offer a gym membership. Not standard by any means, but there are a handful out there :)
The problem is not the insurance or Medicare. The problem is our healthcare system charging > $500,000 to treat a heart attack. When you get sick or need help - it's a feeding frenzy. How much actual time, in hours, all doctors included, generated these enormous charges? It's just ridiculous.
When my son had to go to the ER by ambulance for anaphylactic shock the first person we met in the “receiving room” was a woman from the Billing office to collect our insurance info. To be fair he had already gotten an EPI shot before getting to hospital so no longer on verge of death.
This is why I am moving to New Hampshire with an option of Plan G. The anecdote is that with an issue-age plan G or N this will be covered. You need to think about where to live when you are a senior citizen. It is important. Look at each state when it comes to Medicare. It matters. If you take care of yourself, I would recommend an issue-aged state to retire. If you can start Medicare age 65. and are issue-aged, that matters. You can receive the benefits of a supplement plan with the minimum cost. It all depends on where you work and what the healthcare benefit structure is. Out of Pocket matters. Know that. Don't think short-term. I plan to move to Supplement Plan G or N. They are the best if you can afford them. If you are getting close to age 60, think it through Medicare is great when used with knowledge. I support the site because they show they know what they are talking about.
I have a anecdote story. Nothing to do with the Medicare vs Advantage debate. Back in 1977 my father had triple bypass surgery. He wasn't Medicare eligible yet, and had no health insurance, no Medicaid. The total hospital bill was under $2,000. I know this because I was reviewing his bills and helped pay it. 47 years of healthcare inflation.
Old school here. Medicare A and B with a supplemental insurance and pay for prescription plan. I don't like the fact that there's so many rules with Advantage. Medicare is complicated enough. That's my anecdote and I'm stickin' to it. 😉
Love this video! Certainly impressed by the density and diameter of your 🏀s. What a weedy concept to get out to people. I really enjoyed watching the hospital billing vs medicare approved amounts. I learned something for sure! As a mathy guy, I am always impressed by your breakdowns. Anyway.... always impressed! and ya Anecdote!
When I was 58 I Had two stents placed in two arteries, the hospital billed me $240,000. My insurance paid them $18,000 and I had to pay $1,600, and the hospital was happy with that. The $19,600 was the real cost for the procedure. The $240,000 bill was for the insurance companies benefit to scare you in having insurance, and making them look like the good guys to public.
I’ve done medical billing for 40+ years. What do I have for coverage? Medicare and supplement plan G. I see who I choose for my medical care, have nightly dialysis, and never see a bill.
I just carried my healthcare plan over into retirement. That's what the woman from OPM said her husband did--everything is covered, and I only pay about $215.00 a month.
I take care of my elderly mom full time. She's got limited mobility with severe arthritis and we live off of her social security. I have no income, therefore no insurance. I've told her repeatedly that if I ever have a medical emergency, not to call an ambulance, to just let me go. A $5000 cremation fee is more doable than a single ambulance/ER visit for someone uninsured. See you all on the other side.
There are programs that pay you for looking after a disabled family member. I don't know if they exist in all states. But try looking for such programs.
In 2022, my 98 year old mother was in a suburban NY hospital for 10 or 12 nights, largely fighting an infection. She had no major tests except for 1 CT scan. Medicare was billed $96,000 for this stay, all but roughly $200 was covered by them and her Blue Cross supplement. She then transferred to a rehab facility for roughly 20 days, which was 100% covered. The hospital didn't even bother sending us a bill for the $200 or so that wasn't covered.
Been practicing medicine for almost 20 years in Washington, Up until last year I had no personal experience with paying for hospitalization. Forced me to reconcile what I had heard with actual dollars of my own money. Thank you for walking through a real example. We had one hospitalization where the charges were about 300,000. After watching your videos it seems that medicare with a supplement covers better than my healthcare supplied insurance. Due to coinsurance and in network and out of network maximums we paid around $20,000 for the years healthcare, not even counting premiums which are around $2,000 per month.
$6000 in network, $12,000 out of network. there were two hospitals involved. This is an employee plan. Not medicare. Just making the point that you think it just going to be your $5000 deductible until reality sets in@@Theretirementnerds
This country is so messed up. We can't even provide our Seniors, free health care. Never mind our whole country, like other countries do. Supposed to be the most powerful and richest country in the world, but somehow we can't do what other countries can. Health is the most important issue there is, nothing beats our health for importance. But we have plenty of money for war etc..
If you believe our healthcare system is messed up now (thanks to Obamacare, thanks to John Roberts), imagine how screwed up it would be if the government ran the healthcare system - with the efficiency of the post office and the compassion of the IRS. No thanks. Let’s fix the current system and keep the government out of it. The issue is that politics and the government get in the way, so the probability of any fix is remote. But just know that in Canada, it often takes nine months to get an appointment to see a PCP. I can see a PCP today anywhere in Texas if I want to.
Anecdotally, this is why I object to "Medicare for all." Remember, just like seniors are now forced to pay monthly Medicare premiums, everyone in the country will similarly be forced to pay them too, only at a much higher rate than seniors, who paid into the system for 45+ years and are still forced to pay for their Medicare insurance after retirement. Nothing is free, especially when the government is involved. It's just an opportunity for corrupt politicians to skim more money off for their own pockets. Why do you think some are pushing for it so badly? It's not because they love us, it's so they can better enrich themselves at our expense.
Other countries are much smaller than the U.S. Can you imagine the cost to provide healthcare for 350 million people. By the way, there is no such thing as "free" healthcare anywhere, someone is paying for it.
@@billmM3605 We have a lot of more money than other countries. The problem is, you shouldn't have neglected seeing te Dr, because you can't afford to go. Nothing is more important than health. We seem to find a trillion dollars in for miliary, which we will never use.
@@micker9830 Just what we need to do. Give the government another three trillion dollars a year to waste on things that it's not supposed to be used for. Your faith in our government doing the right thing is a nice thought, but very misguided.
@@GearMaven State and county if everything. Mich Colorado not good, Florida All major systems take Advantage, except Mayo, who is not taking new old people.
Recently I traveled to Italy and had a heart problem. The hospital put in one stint and I spent 3 days there. They released me and I had what I thought was a relapse the next morning. I went back in, did more tests, and spent the next 10 days in the hospital including a pacemaker installation. I got the bill about 3 months later. The total: $33,000 USD. I paid this out of pocket. I have plan G. I will submit this to try to get some of it back. However the care I received was excellent and the cost incredibly cheap. I expected much more. In addition a follow up here with a Dr in the USA went over everything they did and was shocked they di it so quickly. I really don't understand why its so much more expensive in the USA.
(ANECDOTE) Forgot to mention that Advantage plans have provider networks. So unlike original Medicare, you're restricted to using only providers that are in the network. This doesn't matter too much if you're lucky enough to live in an area that has excellent and abundant medical care, usually the larger urban areas. But it matters a lot if you're in a suburban / rural area, and the better-rated providers that are a good distance from you aren't even in the network.
I'm a Physical Therapist, and 36 visits after a heart attack, absent a significant event accompanying it, is probably excessive care, and probably occurred because the provider knew they were dealing with straight Medicare. Keep in mind that sometimes, services are denied because they aren't warranted, just as the Advantage Plan may decide...
Anecdote. My husband and I have a MAP that so far has worked very well for us. We are concerned however about the limitation of choices people have described regarding rehab facilities. We have excellent Long Term Care Plans. Would we be able to activate those if needed after a hospital stay? Thanks for your great videos... just subscribed
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My anecdote story is that I don't want to ask anyone's permission to receive medical care or be told where to get it. I'm happy with Medicare, and my supplemental plan G.
With that in mind, Supplement Plan G is perfect!
Anecdotally that's great and it works for you. But be advised that this decision is costing you thousands of dollars a year. Maybe you can afford that, and you think this is a small price to pay not to have to get preapprovals for elective procedures (as emergencies don't need prior approvals). If so, I'm happy for you, and it's obviously the best choice for your situation However, we are living off of meager SS income and any extra money we spent to avoid this pre-approval system (which may also help us avoid any unwarranted and unnecessary surgeries that only serve to line the pockets of unethical physicians) will mean less food we get to eat - impacting our health up front. We have a Medicare giveback in our Advantage plan that pays us $130 a month that Medicare overcharges us, in addition to our Advantage plan having no monthly premium. There are other advantages of our advantage plan as well, such as a $400 a year allowance for drug store items, such as OTC medications, vitamins, feminine products, etc. We also get Teledoc and free health club memberships as well as other things we don't use, but others might. We do like the included drug coverage. Most of my wife's meds are free, (I don't take any) but I think she paid $5 for antibiotics once.
We realize that if we had to go into the hospital for a major medical event, it will probably cost us a little more, than Medicare with a plan G supplement will, but for all the years we have the plan and are healthy (like we have been so far) this puts us far ahead financially, saving us over $6,000 a year, every year, compared to basic Medicare with a plan G supplement in our home state. Of course, this varies by plan and state. There are some poor Advantage plans out there, which should be avoided, but there some good ones too. If considering an Advantage plan, I suggest you shop wisely or get an advisor who can recommend a good plan for you. But if you're in decent health like we are (I'm 68, haven't seen a doctor in 6 years and am on no meds) I'm sure you will find one that will save you money. This is why most people choose them. If, however, you are in poor health and see a doctor often for chronic medical conditions, you will probably be better served by Medicare with a Part G supplement and good drug coverage. But we're all like snowflakes, everyone unique...
You don't have to ask for permission to get treatment for a heart attack from any insurance plan.
@@les0101s But you do for non-emergency care from Advantage plans. Surgeries need to be pre-approved and performed in their plan facilities. More and more hospitals are leaving theses plans. Facts.
@@morrismonet3554 Fortunately, I live in a city with good plans. My plan covers all the hospitals and all my doctors, as well as my specialists. My diagnostics, like MRI's have no co-pay as long as I go to their specified providers. You have to do your research on these plans at this time of the year.
It's absurd that the hospital system will accept these extraordinary negotiated rates from Medicare, but will absolutely not assist people without insurance and high medical bills. How shameful is our Healthcare system.
@@miguelberrios19 YES!!!
It’s the insurance companies contact to the hospitals that they will only pay a low percentage of the bill. So hospitals are forced to bill high rates to just cover their real cost. Also in the contacts they have to charge those high rates to all their patients or insurance won’t pay.
well, insurance spread the risk among the people that pays in, if you decided not to participate, then you took the risk and have to pay. What you are saying is the same as geting social security without paying in.
The excessively high rates charged to the uninsured are a kind of tax scam. Companies are able to get a small tax break when they write off bad debt. Therefore it might as well be a large number that gets written off. The patient was never going to be able to pay regardless of the amount, so for the most part they aren't harmed either. It's the government and it's tax payers that suffer a loss.
The sticker price is absurd. If anyone is uninsured, they should definitely negotiate that down.
Prior to retiring recently I was an RN case manager and utilization reviewer for a hospital change. The attempts for prior auth for MAP was staggering to arrange out patient follow up treatment for our patients, to the point we didn't have staffing nor time to follow through for the best out patient care for the patients. The SNF availability for the MAP patients was limited to care facilities not always noted for quality, but the traditional Medicare A/B patients could go where they wanted. It was night and day difference providing needed follow up treatment for the traditional Medicare vs MAP.
I'm a current RN case manager and the dis-advantage plans have ramped up their worst... Almost like they know people are on to them and going to try to sucker the last bit of blood out of their victims.
I had a heart attack in 2015 and subsquent stroke , two weeks in hospital, 2 months in nursing home, 2 months home rehabilitation and my total I had to pay on my Blue Cross, Blue Shield Advantage plan was 300.00...
OK that was the BEST run down of Advantage vs Supplemental plans ever. Even though this MI is only an anecdote (and your mom's cancer youtube you also covered) it really helps one to get their brain around the worst case scenarios. I feel like being not risk adverse and in an urban area with great in-network options the advantage plan works pretty well for us, plus we're active, healthy and we take care of ourselves. We were paying nearly $20k a year for health insurance before retirement - because of our income - for incredibly basic coverage. Your other video comparing Advantage to Supplemental is also a must watch.
You are too kind! Thank you so much for taking the time to watch a few of these. Makes me glad to know they are helpful :)
Anecdote. Thank you. As a retired 78 year old cpa, the only common factor very few know what we are talking about. Thank you.
Thank you for watching!
I enjoyed your presentation and it is very accurate. I worked for Health insurance companies for a couple of decades back when HMO's started. The Advantage plans remind me a lot of how the HMO plans work and if your provider is within their network, you are good, but you must check every year to verify your provider is still in that network. I have been on Medicare for a couple of years and have Plan G with the High Deductible. I have my HSA since I am healthy at 70, except for my accident. Glad you are presenting options since many seniors may not understand the consequences of their decisions.
Thank you so much for watching and sharing what you are on!
Anecdote: I switched from my employer insurance plan to medicare advantage plen fron the same insurer when I turned 65 15 years ago. My bills have been small until this year.
My primary detected that I had a heart murmur. The results is an echo to verify the murmur, and angiogram to tell if I could have a TAVR. Followed by a TAVR procedure. I was in the 30% of patients that needed a pacemker. 2 more echos and 2 CT scans. 9 days in the hospital, 5 for the TAVR mostly because my platelets "crashed". After release, my pulse rate dropped so it was to the ER with what turned out to be a Heart Block neccessitating the pacemaker. 4 more days in the hospital with an accompanying ambulance from the ER to the Cardiac unit. I still have 11 days of zero cost in the hospital this year. After 20 days, it will be $100 / day for an additional 80 days. I have zero copays for doctors and specialists. Also zero for labs and x-rays.
I just got my August statement for the year. The hospital billed approx $300,000 and the insurer agreed to a little more than $100,000. My costs were $30 copay for the 2 CT scans. I did have to pay for parking for my wife. My meds accounting will come in a few days but most of my meds are zero copay with a few $5 copays.
In addition to the medicare premium, I pay zero premium for the advantaage plan.
I guess my non-profit HMO is a bargain. I must emphasize that it's a NON-PROFIT.
Thank you so much for sharing this! Would love to do a similar video on your experience if you're willing
It is criminal that medical bills in the US are so incredible. The whole system is outrageously complicated and the big medical care corporations and insurance companies are laughing all of the way to the bank.
Any time the government pays the bills the prices skyrocket.
@@blackpowder4016Then how come healthcare costs half as much in the UK compared to the US? Outcomes are better as well and so is life expectancy. When the government pays, and has the ability to negotiate, things get better, at least in the case of healthcare.
Yes, CRAPitalism at its worst!
@@blackpowder4016 -- Is that why a billed amount of over $523,000 is reduced to $22,000? Because the government can't use their large scale buying power to negotiate prices?
@@shenmisheshou7002 crazy health care system in USA.
Unbelievable Eric, how do you find the energy to make all these extraordinary videos, and so specific at that. No one else has come remotely close to your content. I just had to commend you on helping all of us understand some of these costs associated with these two medicare systems.
Thank you so much my friend! Appreciate your support over the years. Trying our best to make sense of this system for everyone :)
I have an anecdote to share. I was watching a video about Medicare and my favorite part was when another video was referenced with this description: The presenter seems pretty neat.
Haha! Sounds like quite the clever video :)
Anecdote. Thank you for your breakdown. After 2 years of being on a supplement plan N I still go back and forth if I should switch to a g. So far all is good
Plan N is great! Your state is important and the doctors you choose to visit, but Plan N can save people good money. Thank you for watching ;)
@@rosebonner7091 your going to get sick
If your on advantage move back to Medicare if they’ll take you
Brilliant! You picked up a 70 year old (and still healthy knock on wood) subscriber. I ALWAYS advise folks shy of Medicare age to get original Medicare and just pay the premiums for Medicare and the supplemental
Thank you so much for finding us and subscribing :)
It really is not that hard to pick the best plan. Unfortunately, this video like most points people in the worst direction.
1. If you have a doctor connected with a major medical center, you should be asking the business office which is the best plan, gives the quickest and easiest approvals, etc. Most national providers offer advantage pros that treat all Medicare providers as in network. Your physician and hospital network have no interest in pointing you towards a plan that gives them problems. Happy anecdote.
@@peterkiviat9969 🖖
GREAT INSIGHT! Thank you for the disclaimers at the end. Yes, an anecdote with no effort to sell. Thank you Thank you for the effort to teach. My family and I are in advantage plans, and simply READING the bills from a hospital stay has been impossible. Thank you!
Thank you so much for taking the time to watch!
I love this type of video and you did a great job as usual. As an anecdote, this year (2024) I switched from a supplemental plan F to a MA plan and I couldn't be happier. I retired in 2015. Now, gone is my $240 per month premium for supplement plan F, gone is my $110 per month part d plan where the drugs also cost twice as much and present is my $0 premium health plan, $0 premium drug plan, and I still see the same doctors and hospitals that I was anyway. I now save enough in one year, that if I ever reach my maximum out of pocket ($4100) I am still way ahead financially. Love my Advantage plan. Plus, I am 74 this year. I hate to think how much that supplemental will cost by the time I'm 80. ($450 - $500 per month?) I don't have to worry about it.
Thank you so much for watching! So glad to hear you are happy with your choice :)
Anecdote ... 75 years old here. I wound up in the ER a week ago with severe abominable pain. Lots of tests and and a ERCP to clear gall stones from the gall bladder duct on the emergency day. They scheduled me for gall bladder removal surgery the next day. I called my medicare advantage and was told the surgery would need prior approval or they would NOT pay for the surgery. I told the nurse this and then the surgeon and I wound up signing an AMA ( Against Medical Advice) and came home, the surgery never happened. The bills haven't arrived yet so it will be interesting to see how it all goes. I still have my gall bladder and I feel great.
All
You needed was a prior auth…the doctor handles this all. Why would you take it upon yourself to call? They would have approved this if it was necessary.
When you sign up for an Advantage Plan, you are giving permission of the insurance company (or software program they are running) to control the treatment decisions your doctor and you have agreed on. Advantage plans are in the business to make money, your treatment is interfering with their bottom line. It is an adversarial relationship that you signed up for. Probably tricked into it by the agent who sold you the plan. They get much higher commissions than sell Original Medicare supplement plans which require no approval.
So if you didn’t have Medicare advantage and just had Medicare, would they have done the surgery?
I don’t think the advantage program is worth anything if Medicare will pay for your gallbladder surgery you just have to worry about the deductible. You’d never be denied and you get the treatment.
@@banon7853 You can’t have Medicare Advantage unless you give up original Medicare A and B. If you leave your Medicare Advantage plan and have just Original Medicare A and B then there will be no preauthorization, but you would be on the hook for copays, and deductibles. Which might be overwhelming if you had a very serious health event. They would have done the surgery if you agreed to bare the responsibility of your share.
Makes me glad I have Kaiser. I had two surgeries back to back with 4 days in the hospital all together and included many tests. The total cost was close to 100,000. Of that I paid $100.00 when I went into the emergency rm.
Sounds like great coverage! Thank you for sharing!
with medicare advantage , you would have the daily copay again if you were to be hospitalized each time in the same year, with a supplement you pay the deductible and copay only once for the whole
year.
With Plan G, you pay those same premiums month after month every year.
Anecdote included: The thing that never seems to get discussed about healthcare billing is that amount billed versus what-insurance-will-pay difference. The hospital shrugs their shoulders and eats the $485,000 difference....and we sort of ignore that fact. But if you had no insurance, then you would quite literally be looking at a $507,000 bill.
I worked in IT for a health insurance administrator for 30+ years. I remember hiring a struggling single mom who had taken the bills for her young son's appendectomy as "legit", and unquestioningly was trying to pay those bills down...she was stunned to learn that the hospital probably would have only collected 1/10th that amount if there had been insurance involved. And she had already all but put herself out on the streets paying down those bills.
THIS is healthcare in America...now rated dead last in every category of healthcare, *including outcomes!*, in the top 10 developed countries: Most expensive, worst general care, worst outcomes.
When you tell people from other countries about healthcare in the US, they are shocked to find out that Americans can go broke from a hospital bill. Most of the time, they don't even believe me.
I’m in Florida too and in my early years I didn’t have health insurance. I had to go to the hospital for surgery and the bill came to nearly 100k. When I was being discharged, they were wheeling me towards the front door and suddenly veered off and went to the business office. They were demanding some sort of payment and also wanted me to sign papers saying I would pay the entire bill. I told them that I was still medicated and under doctors orders so I couldn’t legally sign anything. My wife came in , very pissed off, and took me out of there. When they called a few days later I told them that I wanted an itemized bill. They argued with me and I told them that I knew that hospital bills are works of fiction and that I wanted the same discount that the insurance companies get. They knocked the bill down to $6,000 and I told them I would send $100 a month. After paying for 6 months I called them back and asked what it would take to pay it off. They agreed on $1,500 and I sent them a check and they marked it paid in full. Of course now I’m on Medicare and have a supplement plan but anyone who’s younger should remember that you can always negotiate.
But the Affordable Care Act took care of this problem.
@@freecycling6687 Hahaha I hope this was a sarcastic comment.
Another thing that person should have done was to speak with a financial advisor at the hospital. Most that I have encountered will give you an application for assistance and determine if you are eligible for a reduction in your bill. That is WITH AND WITHOUT INSURANCE. I had a sizeable outpatient cancer surgery and radiation treatments. I had insurance. I applied for financial assistance. I was awarded a percentage of help and they applied that to my bill AFTER insurance paid it's portion. It made my medical bills that year much more manageable.
I just wanted to thank you for your very insightful videos. I’m still a decade away from Medicare but you turn 50 you start getting inundated. Friends and family are talking about it. So I wanted to figure out what the deal was. And now I get it. I can talk intelligently about it and understand what others are saying. I am in California and a member of Kaiser and that’s probably what I will keep. But who knows what the landscapes gonna look like in a decade. Thanks so much. Anecdote.
Thank you so much for tuning in (to the end) and your kind words! Means a lot!
Yes, I suspect the landscape will look MUCH different in 10 years...
Thank you for this easily understandable comparison. I've had my MA for 8 years now, and will likely keep it, unless something drastically changes. Other insurance agents are giving us fear-porn anecdotes about possible changes to MA plans. I appreciate your truthful presentations!
Appreciate you watching!
Changes are coming to many plans. They aren't released and we can't talk publicly about them until October 1st. Some plans are experiencing big changes, others small or none, so make sure you check out your Annual Notice of Change that should have arrived or will soon :)
Just getting started and appreciate this detailed walk through of a specific scenario with nods to the bigger picture. And especially appreciate that you recognize the plural of 'anecdote' is not 'data'...
Thank you so much for watching!!
Anecdote...I'm in FL. In early summer I went to the ER and was admitted in the hospital. I spent 5 days in the hospital and was discharged. The total I was responsible for was $120. I don't remember what the hospital bill was but probably well over 100K. My plan was care plus advantage plan and paying the $174 per month premium. I didn't have any therapy afterward.
I was able to change my plan about a month after the hospital visit. My Dr office recommended that I go on a chronic advantage plan and I switched to freedom health and like it even more. Yes, I was allowed to change my plan at that time because I have several chronic conditions and Medicare allows you to change your plan outside of the normal enrollment period.
Thank you for watching and sharing your experience!
Anecdote I'm in NY state and plan G is expensive. Is plan N a good substitute?
@@wallacesantana9190 plan G pays for EVERYTHING after the yearly deductible is met. Plan N, while cheaper, you will be responsible for up to $20 copays to Dr and $50 for emergency rooms. I don't know for sure but there may be copays for diagnostic tests. Some Drs charge excess fees that you will be responsible for. If you are fairly healthy and don't see the Dr often plan N may be best for you, but call and find out what options you have for your situation.
@@wallacesantana9190 I believe their is a lower cost plan G with higher deductibles. I'm new to this... I bought Plan N for about $93 just a few days ago!
It's always good to remember when listening to your very thorough explanation regarding the 2 different plans that its based on an "anecdote ". 1 persons example, 1 size does not fit all.
Very important! Thank you so much!
I always watch the entire video and then struggle to figure out a way to use the secret word in my comments. Do you have an anecdotal story for that? In any case, I have been on an advantage plan for about 10 years, mostly because I am not able to pay for a supplement and drug plan. I know I am gambling that I will stay healthy in my retirement years and that the money I saved with zero cost premiums and prescriptions over the years will outweigh what the cost would have been if I had stayed on traditional Medicare with a supplemental plan and a drug plan. Thanks for your very straightforward and informative videos.
Thank you for watching and sharing your thoughts! Saving a little in "pretend" premiums for yourself can help build a safety net to cover more expensive years.
This type of case study with all the numbers is extremely helpful. Seeing it side by side for this one example gives a great template for our future decision making.
So glad it was helpful! Thank you for tuning in!
Erik, what a wonderful video again! I am so happy that you came down hard on the shady brokers here who scream about anecdotal (some probably even fictitious) cases. I have even caught some of these guys lying, not just deceiving. Strangely, they all insist everyone should get a supplement plan. I called a broker here in Massachusetts to get his opinions about insurance companies that offer Advantage plans, and he said that he deals with only supplement plan companies!
It certainly is an antidote that it is this hard to figure things out.
I'm on part G and I'm certainly glad that I am.
Plan G is great! Thank you so much for watching to the end :)
@@Theretirementnerds how about part N? Hubby got G... I never go to the doctor's if I can help it.
@@noeldeal8087 Plan N is great! Especially in MOM states. This video goes over one of the MOM states: th-cam.com/video/_sYQuQwXLXE/w-d-xo.html
Erik,
Thanks for sharing this extremely clear and specific anecdote! I always learn something valuable by watching your videos! Keep up the great work! Glad to hear your relative is doing okay after her heart attack! We'll keep her in our prayers!
Thank you so much, Mike! Appreciate your support and always enjoy seeing your comments :) Helps that you are always so nice!
Anecdote. Nice presentation. I am especially impressed with your ability to write legibly with a marker on a white board. I was even able to make out the smallest print.
Haha! Thank you! The upper left corner was tough because I couldn't stabilize with my hand for fear of smearing everything. Glad it was legible 🙂
I was thinking the same thing!
My husband and I have an advantage plan that we've been happy with. We found out that the insurance company we have is pulling out of the State of Washington at the end of this year. We're waiting to discuss our options with our insurance agent. I realize your video is an antidote, however it is giving me something to think about. I'll share this with my husband in the morning. Thank you for your time and consideration. L
Thank you for watching! Here is a video on options if your plan is eliminated like that:
th-cam.com/video/lS1LJS9tues/w-d-xo.html
At age 65 I had an eve. heart attack, had 2 stints, stayed one whole day, and out the following morning. Total was $450 on my free Advantage plan..
Thank you so much for sharing your experience! Glad to know you are okay!
As an anecdote, I had a 100 percent proximal blockage (clot not a plaque) of my proximal circumflex on Easter Sunday 2024, no prior angina or any cardiac symptoms. On Kaiser souther California, the hospital bill for ER, placement of 2 stents and 2 day hospital was around 150,000, adjusted amount 25k-30k my total out of pocket was < 800. And no monthly premiums for Kaiser except for the supplement, which actual pays my LA fitness membership which cost more than the supplement premium. So far very happy with Kaiser.
Thank you for watching and sharing your experience!
I had a heart attack and subsequent stroke in 2015 and my advantage plan payed for everything. 2 weeks in the hospital, Stent placement, ❤2 weeks in the hospital, 6 weeks in the nursing home and home psychical therapy for weeks. All I paid was 300 dollars..
Thanks Erik. It's amazing that if someone had no insurance that the total bill for this incident would be over $500K yet with insurance it's less than $35K. Thanks again, anecdotally.
@@tomm7505 good ole’ amercia
Thank you for tuning in, Tom! The sticker price is pretty nuts. Hopefully the uninsured know they can negotiate that down and shouldn't be paying that sticker price.
I really appreciate your clear detailed and concise explanation of this. No questions from me and a big thumbs up👍
Thank you so much for taking the time to watch!
Disadvantages of the advantage plans in my case: some providers will not take advantage plans and extra time, headache needing approvals before doctor or specialist visit. Anedote
Thank you for watching!
While the costs of Medicare Supplement and Medicare Advantage are close in this video, I also realized the variable costs are a lot different. The variable costs are $ 240 for Medicare Supplement (the Part B Deductible) and $ 2,396 for Medicare Advantage. So for Medicare Advantage, you are paying a lot more out-of-pocket for your medical costs when the medical need arises but can save money when the medical need doesn't arise. For Medicare Supplement, on the other hand, your out-of-pocket costs are essentially limited and are going to be a lot more stable from year-to-year.
The video also exemplifies the complete farce that exists today with U.S. hospital bills, because a $ 506,922.28 hospital bill gets magically "negotiated" to only $ 22,000.00 (or a whopping 95.66% discount). I simply don't understand why our politicians don't make this type of unreasonable hospital billing illegal. I simply don't understand why our politicians let our drug companies spend so much on unnecessary advertising (and then charge you $ 20 per daily pill for Jardiance).
In closing, my wife and I went with a Medicare Supplement in part because I never liked the insurance "approval process", in part because we don't want to be restricted to a specific medical network. It's still a bargain because my wife and I only pay $ 7,309 annually for our Medicare medical+Supplement+prescription drug coverage.
Anecdote ...
Pretty much true. With original Medicare and a supplement, your costs are predictable. They may be more expensive than MA would have been some years, but much less other years. How would the costs of the above example have been if the person in his family required more medical care after the heart attack(same year). Then original Medcare and Supplement would essentially cost $0(he already included the premium cost of the supplement plan in his example). MA would not cost $0 in any case. As to US health care costs-everything you say is very true. The US pays the most and gets the least due to greed.
Great insights! Thank you for sharing your thoughts so clearly and making it to the end ;)
Hospital are forced to charge high rates because of the insurance pay by percentage, which is low like 10% of the bill. It is designed to scare people in to having insurance.
@@tomb5552 Looks like the companies are starting to pay to low and to slow(another tactic they use) for some providers in the case of Medicare Advantage. A growing number of providers only take original Medicare. My opinion is that Insurance companies are just leeches on the health care system. Taking money for themselves that should be used for health care(and is used for health care in other countries).
Politicians have been in bed with the insurance carriers for decades. That's how Advantage came into play
I do not have an anecdote but I have found your presentations very informative. Thanks.
Appreciate you watching! And to the end!
I appreciate the anecdote video! I like how you break down all the costs including premiums etc.
Thank you so much! So glad it is helpful ☺
I just had a TURP. The total costs that were sent to my Medicare Advantage plan were $83,000. The plan paid $8,500. My co-pay was $850.00. All my drugs are free and they pay $50.00 towards the fee medicare charges me. I will stick with the advantage plan.
Thank you for watching and sharing your experience
Anecdote! So appreciate the side by side comparison, and clear explanations. Keep up the excellent content!
Thank you so much! :)
Thank you for this video. Using real numbers from an actual Heart Attack case goes beyond the anecdote level data that is so common online. I definitely want to visit your companion video on drug costs given the way a separate Part D plan handles vs a MAP.
Thank you so much for taking the time to watch!
Anecdotal. Eric, awesome content! I have been in the Medicare space since 1997. This video is absolutely accurate concerning this set of circumstances. Real life claims and payment really help people understand what their out of pocket responsibility looks like. To those who watch this video: Do not get distracted by hospital bills. Everything is based on what Medicare will reimburse!
Thank you so much for watching! :)
Thank you for such fabulous videos, (including anecdotal). Educational, practical, thorough, down to earth, understandable, great. Thanks.
You are too kind! Thank you for taking the time to watch!
You are a rock star!! Thank you. Anecdote! I love the disclaimer about anecdotes.
Thank you so much for watching!
Really good video. My wife and I are about 2-3 years away from retirement and this info really helps. Anecdotally, I thought the Advantage plans were like $15/month or something. That's kind of what I remember my now deceased mom paying for Humana Gold.
There are advantage plans with small premiums like that. Some up around $100. But the vast majority (75% in 2024) are $0 :)
These videos are so helpful. I'll be applying for Medicare next year, and will definitely be using your resources for my search. You make it so much less intimidating!
So glad these are helpful! Appreciate you taking the time to watch!
I'll stick w the supplement plan....😊
Would love you to provide our Medicare Advantage ANECDOTE from the Coachella Valley specifically just to show folks how location is everything for MA plans. With a powerful high senior population, big medical groups, three participating award-winning hospitals, and nearly all specialty groups participating in MA plans, it would be enlightening to see a top MA area just one time for people's edification. Our MOOPs this year were $699 and $800!! We have no copays except $25 for MRIs and $250 for ambulance. The hospital copays were minor as well. The significant benefits over the past 15+ years often made us feel as if we were making money on our MA plans, and that is WITH significant comorbidities such as heart disease, surgeries, autoimmune diseases, chronic illnesses, etc. We have never faced a denial of referral or service or medication even when off formulary with easy appeal. So, for THIS location, an MA plan can't be beat!
I've taken a screenshot 🙂
Thank you for sharing!
Everyone reading this should understand that advantage plans are highly dependent on location and company. Yours sound amazing! Appreciate you!
Anecdote. I'm 11 months shy of 65, working full time in a large company with Anthem Blue Cross Shield PPO. At this point my goal is to work until I pass, and stay on company provided healthcare. I think in one of your videos you refer to Medicare as a maze. It's pretty complicated, likely changing from year to year, and expensive! Just trying to get a clear understanding of what my options are and a realistic understanding of which is best for me. Thanks for these videos.
Thank you so much for watching! A lot to consider for sure!
If your employer plan is solid and a low cost, stay on as long as you are employed :)
@@TheretirementnerdsYour channel is awesome! Thank you!
Anecdote: ❤. Thankfully your relative is safe. Love the way you break things down with Medicare choices. I am on advantage plan for about 5 years now. My choice was before I saw your or any online advice. My calculations are exactly how you summarized and decided the maximum out of pocket cost will be my cost if I have really big expense. So far I have not had any problems even with prior authorization (no emergencies yet). As you say, permutations and combinations are different for each individual and each year. 👍keep up the good work
Thank you so much for tuning in and sharing your thought process! 🙂🙏
Sharing anecdotes about one's experiences is a way to interact with others. I am still patiently waiting for your video on Medicare in Ohio. 😊
@@margaretd7037 it's the next one up 😀
Great video. My anecdote would be about how federal retirees have different options. How postal retirees used to have federal coverage as an option, but next year have something different. At our monthly get together, I learned that my retired postal cohorts are just as confused as I am.... even the ones in NARFE
Anecdote. I am so thankful that you make this videos! Keep up the good work!!!
Will do! If you ever come across actual bills, those are my favorite so people can't say I'm misleading, haha!
Anectode , my small town hospital in Tennessee is not accepting BCBS Advantage next year. Also any doctor owned by tthe hospital will not take it. This will leave many seniors here trying to decide what to do for the enrollment period.
Anedote, I made it to the end😊. What is not mentioned is the piece of mind when not having to deal with all the co pays and deductibles. Being on an F plan I have none. Had my droopy eyes fixed, never saw a bill. Peace of mind. I am 71 and pay 208 a month.
My anecdote is a worry: that premiums for original Medicare plus supplement plan G will rise so much that I’ll be forced to switch to an advantage plan. Scary.
This does happen for people. Premiums can get pricey.
My bill for 3 stents and 2 days in hospital CCU was $700 - nothing more. Love my Medicare advantage plan. I paid an additional $30 for each follow up rehab session to a total of about $600
Thank you so much for sharing!
I have a call coming up with you guys on October 25th. I think I need an antidote for all of the challenges I've faced with the Advantage programs. Great video.
Thank you for watching! Excited for the 25th!
Anecdote. I am getting ready to go onto Medicare between 6-18 months depending on my wife's employment. We are leaning heavily toward Plan G with drug coverage when I and my wife go onto Medicare. But, it is scary to navigate thru all the BS that is out there. However, I am going to start following you as you have one of the best that I have seen...so far. 🙂
I switched from a Plan G to a Plan N after two years. My plan G monthly premium was going up significantly every year and was going to go up to $168/month. Fortunately, I was able to switch to a Plan N with a monthly premium of $78/month. Thus, that represents a savings of over $1,000 per year. Now, with Plan N, after you meet your Medicare deductible, you can be charged a $20 co-pay per doctor visit, but I only go the doctor two or three times a year, so that is $40 to $60 dollars. Thus, I am saving a bunch of money with Plan N.
Appreciate you watching and saying that! Happy to help however we can. It is a lot of junk to wade through :(
The anecdotal stories we hear about Advantage plans should be enough to scare people into a Plan G. The ability to seek medical care from professionals of your choice that you want treating your illness without permission from an insurance company can't be overstated.
It depends on where you live. My Medicare Advantage plan covers all the hospitals in my city. All the doctors I see and many more participate in my Advantage plan.
@@les0101s, cool just dont move or go on vacation
@@dogpatch8266 I can get emergency care while on vacation. If I move, I'll get a different plan.
@@dogpatch8266 You can get emergency care if needed while on vacation. You can also change plans when you move.
You can buy any care you want. We take nice vacations with the premium savings
Just my anecdotal experience: When I was retiring a couple of years ago, I asked my doctors what the better option would be. Several of them said up front that they did not accept Medicare Advantage. While I enjoyed your cost analysis, if you can't see your current doctors (who were happy to work with my former employer's PPO insurance), then it is all for naught.
The other issue is the costs with IRMAA. Since I was fortunate enough to work a professional job, my Medicare part B and D premiums are a wee bit higher than what you quoted, which might distort your figures somewhat.
Anecdote. Good info. I'm 60, starting to try to figure this all out before it's time to pick.
Thank you for watching! A lot could change in the next 5 years. We'll keep you updated 🙂
I chose an Advantage plan for the no-cost additional coverage of drugs, dental, vision, fitness and OTC. My root canal and crown this year was paid 100% by my Advantage plan -- $2500.
Same here. I noticed that my Advantage plan will be decreasing the $ amount of these extras next year.
Thank you for sharing your experience!
Another great informative video. I like hearing anecdote stories when they come from reliable sources. I wish it was easier to chose a supplemental plan though. I also wish traditional Medicare offered a fitness membership. Keep up the good work. You are going to get super busy in the days ahead so be sure to eat right and rest when you can.
Thank you so much for watching! :)
There are some supplement plans in certain states that will offer a gym membership. Not standard by any means, but there are a handful out there :)
The problem is not the insurance or Medicare. The problem is our healthcare system charging > $500,000 to treat a heart attack. When you get sick or need help - it's a feeding frenzy. How much actual time, in hours, all doctors included, generated these enormous charges? It's just ridiculous.
Anecdote- Great video! Your attention to detail is impressive. Thanks for sharing such helpful information.
Thank you, Katrina!🙂🙏
Hope your family member has a long healthy outcome. Thanks for the education!
Thank you so much!
When my son had to go to the ER by ambulance for anaphylactic shock the first person we met in the “receiving room” was a woman from the Billing office to collect our insurance info. To be fair he had already gotten an EPI shot before getting to hospital so no longer on verge of death.
I had a stent for my Circumflex Artery in 2022. Cost 162,500. I only had to pay $275. Anthem Advantage Medicare HMO plan.
Thank you for sharing!
This is why I am moving to New Hampshire with an option of Plan G. The anecdote is that with an issue-age plan G or N this will be covered. You need to think about where to live when you are a senior citizen. It is important. Look at each state when it comes to Medicare. It matters. If you take care of yourself, I would recommend an issue-aged state to retire. If you can start Medicare age 65. and are issue-aged, that matters. You can receive the benefits of a supplement plan with the minimum cost.
It all depends on where you work and what the healthcare benefit structure is. Out of Pocket matters. Know that. Don't think short-term. I plan to move to Supplement Plan G or N. They are the best if you can afford them. If you are getting close to age 60, think it through Medicare is great when used with knowledge. I support the site because they show they know what they are talking about.
Appreciate you watching and sharing your thoughts! Means a lot! And for making it to the end :)
I have a anecdote story. Nothing to do with the Medicare vs Advantage debate. Back in 1977 my father had triple bypass surgery. He wasn't Medicare eligible yet, and had no health insurance, no Medicaid. The total hospital bill was under $2,000. I know this because I was reviewing his bills and helped pay it. 47 years of healthcare inflation.
If only our salaries had inflated at that same rate since then!
Wow! That's interesting. Looked up a quick calculator and it said that $2,000 in 1977 is the equivalent of $10,381 today 😮
@@Theretirementnerds Triple bypass surgery for $10K, can you imagine?
Loved your video and the anecdotes! Subscribed to the channel. I'm also a long time nerd (now 71) and really appreciate real data. Thank you!
Thank you so much for watching and subscribing! :)
Old school here. Medicare A and B with a supplemental insurance and pay for prescription plan. I don't like the fact that there's so many rules with Advantage. Medicare is complicated enough. That's my anecdote and I'm stickin' to it. 😉
Thank you so much for watching and sharing your thoughts! :)
Anectdote,65 and plan g for me. Thanks for all the videos!!
Thank you so much for watching! Plan G is Ggggreat! Not sure if the cereal has that trademarked :)
I had to pick what was available in my area. ie Advantage vs Supplemental.
Anecdote: You forgot to show what cost to patient would be with JUST Medicare.
Here's a video that does that :)
th-cam.com/video/77YF-TL0n-8/w-d-xo.html
@@abspasadena He says what it would be without Plan G get a calculator out.
@@JCcreates927 grrrr….
While they seem more expensive they are not as reliable and they can change your coverage at anytime.
Anecdote, TY for an interesting presentation, but wow! Medicare ect. is very confusing. I guess I need to get up to speed with some education.
Love this video! Certainly impressed by the density and diameter of your 🏀s. What a weedy concept to get out to people. I really enjoyed watching the hospital billing vs medicare approved amounts. I learned something for sure! As a mathy guy, I am always impressed by your breakdowns. Anyway.... always impressed! and ya Anecdote!
Appreciate you so much for tuning in... to the end! :)
When I was 58 I Had two stents placed in two arteries, the hospital billed me $240,000. My insurance paid them $18,000 and I had to pay $1,600, and the hospital was happy with that. The $19,600 was the real cost for the procedure. The $240,000 bill was for the insurance companies benefit to scare you in having insurance, and making them look like the good guys to public.
Pretty wild costs!
Interesting...
I’ve done medical billing for 40+ years. What do I have for coverage? Medicare and supplement plan G. I see who I choose for my medical care, have nightly dialysis, and never see a bill.
Wow! $500k?? I had a huge heart attack six years ago, cardiac arrested twice in the hospital and was there eight days. The bill was “only” $152,000.
I just carried my healthcare plan over into retirement. That's what the woman from OPM said her husband did--everything is covered, and I only pay about $215.00 a month.
Make sure you are back in Oct. when things change re Adv and Gap plans.
Bracing ourselves for that. Have a whole list of videos ready to make once final plans are made public.
I take care of my elderly mom full time. She's got limited mobility with severe arthritis and we live off of her social security. I have no income, therefore no insurance. I've told her repeatedly that if I ever have a medical emergency, not to call an ambulance, to just let me go. A $5000 cremation fee is more doable than a single ambulance/ER visit for someone uninsured. See you all on the other side.
There are programs that pay you for looking after a disabled family member. I don't know if they exist in all states. But try looking for such programs.
No income, get medicaid.
Thank you for a very comprehensive information … Anecdote 😊
Appreciate you watching! To the end! :)
Anecdote. I'll stick with my traditional Medicare and supplement plan. Thank you!
Supplements are fantastic! Thank you for watching!
No anecdotes but the minimal savings with Advantage is not worth the restrictions placed on you if it’s not an emergency.
For many people, they agree with you.
For many others, they don't.
I have a corgi, too :)
In 2022, my 98 year old mother was in a suburban NY hospital for 10 or 12 nights, largely fighting an infection. She had no major tests except for 1 CT scan. Medicare was billed $96,000 for this stay, all but roughly $200 was covered by them and her Blue Cross supplement. She then transferred to a rehab facility for roughly 20 days, which was 100% covered. The hospital didn't even bother sending us a bill for the $200 or so that wasn't covered.
I reside in California and receive SSDI. I pay $320 a month for Plan G AARP MEDICARE supplement
I am 63 years of age
Been practicing medicine for almost 20 years in Washington, Up until last year I had no personal experience with paying for hospitalization. Forced me to reconcile what I had heard with actual dollars of my own money. Thank you for walking through a real example. We had one hospitalization where the charges were about 300,000. After watching your videos it seems that medicare with a supplement covers better than my healthcare supplied insurance. Due to coinsurance and in network and out of network maximums we paid around $20,000 for the years healthcare, not even counting premiums which are around $2,000 per month.
@@PaulKnouffMD thank you for watching and sharing. What was the max out of pocket on your plan?
$6000 in network, $12,000 out of network. there were two hospitals involved. This is an employee plan. Not medicare. Just making the point that you think it just going to be your $5000 deductible until reality sets in@@Theretirementnerds
This country is so messed up. We can't even provide our Seniors, free health care. Never mind our whole country, like other countries do. Supposed to be the most powerful and richest country in the world, but somehow we can't do what other countries can. Health is the most important issue there is, nothing beats our health for importance. But we have plenty of money for war etc..
If you believe our healthcare system is messed up now (thanks to Obamacare, thanks to John Roberts), imagine how screwed up it would be if the government ran the healthcare system - with the efficiency of the post office and the compassion of the IRS. No thanks. Let’s fix the current system and keep the government out of it. The issue is that politics and the government get in the way, so the probability of any fix is remote. But just know that in Canada, it often takes nine months to get an appointment to see a PCP. I can see a PCP today anywhere in Texas if I want to.
Anecdotally, this is why I object to "Medicare for all." Remember, just like seniors are now forced to pay monthly Medicare premiums, everyone in the country will similarly be forced to pay them too, only at a much higher rate than seniors, who paid into the system for 45+ years and are still forced to pay for their Medicare insurance after retirement. Nothing is free, especially when the government is involved. It's just an opportunity for corrupt politicians to skim more money off for their own pockets. Why do you think some are pushing for it so badly? It's not because they love us, it's so they can better enrich themselves at our expense.
Other countries are much smaller than the U.S. Can you imagine the cost to provide healthcare for 350 million people. By the way, there is no such thing as "free" healthcare anywhere, someone is paying for it.
@@billmM3605 We have a lot of more money than other countries. The problem is, you shouldn't have neglected seeing te Dr, because you can't afford to go. Nothing is more important than health. We seem to find a trillion dollars in for miliary, which we will never use.
@@micker9830 Just what we need to do. Give the government another three trillion dollars a year to waste on things that it's not supposed to be used for. Your faith in our government doing the right thing is a nice thought, but very misguided.
LOCATION is EVERYTHING with Medicare Advantage!!!!
In which area IS the patient???
@@GearMaven State and county if everything. Mich Colorado not good, Florida All major systems take Advantage, except Mayo, who is not taking new old people.
Recently I traveled to Italy and had a heart problem. The hospital put in one stint and I spent 3 days there. They released me and I had what I thought was a relapse the next morning. I went back in, did more tests, and spent the next 10 days in the hospital including a pacemaker installation. I got the bill about 3 months later. The total: $33,000 USD. I paid this out of pocket. I have plan G. I will submit this to try to get some of it back. However the care I received was excellent and the cost incredibly cheap. I expected much more. In addition a follow up here with a Dr in the USA went over everything they did and was shocked they di it so quickly. I really don't understand why its so much more expensive in the USA.
(ANECDOTE) Forgot to mention that Advantage plans have provider networks. So unlike original Medicare, you're restricted to using only providers that are in the network. This doesn't matter too much if you're lucky enough to live in an area that has excellent and abundant medical care, usually the larger urban areas. But it matters a lot if you're in a suburban / rural area, and the better-rated providers that are a good distance from you aren't even in the network.
Networks are in this one :) Just at the end
@@Theretirementnerds Oops, sorry, I missed it. I was probably concentrating too hard on hearing the "secret word" :)
@@freecycling6687 haha! It's a lot of trickery we have going on in there 🙂
Our rural medical systems in Ohio refuse to take Advantage Plans due to the lower reimbursement rate.
I'm a Physical Therapist, and 36 visits after a heart attack, absent a significant event accompanying it, is probably excessive care, and probably occurred because the provider knew they were dealing with straight Medicare. Keep in mind that sometimes, services are denied because they aren't warranted, just as the Advantage Plan may decide...
Thank you for sharing this perspective!
Anecdote. My husband and I have a MAP that so far has worked very well for us. We are concerned however about the limitation of choices people have described regarding rehab facilities. We have excellent Long Term Care Plans. Would we be able to activate those if needed after a hospital stay? Thanks for your great videos... just subscribed
CW anecdote. Thanks for your videos. They are very informative.
Appreciate you taking the time to watch!
Very well described from this anecdote.
Appreciate you! 🙂
This is an interesting anecdotal description, however I suspect it wouldn’t be so cheap for me,