Medicare Advantage vs Supplement | Most Get This Wrong
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But this is critical, Original Medicare was never meant to be a stand-alone insurance program. It was a huge improvement over what else was available in the mid-1960s, but is nowhere near 100% coverage and provides no limit on the financial risk for the consumer.
That is why, in 1966 as Medicare was launched, insurance companies introduced the Medicare supplement insurance program. Not the government, insurance companies.
Original Medicare plus a supplement is full healthcare coverage.
Now both Medicare and supplement plans have evolved significantly since then. In 1980 the federal government took over oversight of Medicare supplements and in 2010 they were standardized and re-designed to the improved coverage we have today.
In 1997 the first Medicare Advantage plan was introduced as an HMO, to give consumers a choice between Traditional Medicare or an HMO.
It was intended to offer the consumer more choices by providing a privatized replacement of Original Medicare Part A and B, and eventually save money for the government.
That’s the important point that I have been leading to, Medicare Advantage plans are designed to compete with Original Medicare alone.
They do not compete with Medicare plus a supplement.
Links for referenced material in this video:
www.morningstar.com/news/busi...
www.markfarrah.com/mfa-briefs...
www.kff.org/report-section/me...
www.kff.org/medicare/issue-br...
Margins: www.kff.org/report-section/fi...
Income: www.kff.org/medicare/issue-br...
#medigapseminars #medicareadvantage #medicaresupplement
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I had already picked a supplement plan. This just reinforced my decision.
I have a niece who worked for one of the largest MA provider in the US. She worked in several finance sections prior to working in the dept that reviews and approves/denies surgery, procedures, tests, prescription drugs etc. She resigned shortly after discovering the tactics that the company employed through their denials and how they treated their customer's by denying the necessary treatments that doctors had ordered. She said it was the most depressing experience in her life to follow company protocols that she knew were killing people prematurely. She couldnt handle it and is now an outspoken critic of the industry.
I've had a Medicare plan and a Medicare supplement plan for about 8 years. And the supplement plan pays whatever Medicare doesn't. Minus whatever deductible you choose. Monthly premium has gone up over the years. In some years I may have paid more for the plan than I got in services, but there have been years when it's literally saved me thousands of dollars. So over the time frame I've had it. It's definitely paid for itself not only financially but in not having to worry about having a procedure done. And not needing a pre-authorization. If my doctor says go I go I can go to any doctor. I want anywhere in the nation. Medicare advantage plans are basically private insurance. High deductibles, high rejection of coverage. Pre-qualifications. Looks cheaper on the front end but you're going to lose on the back end. So listen to this man
Very helpful ❤
Matthew is probably the most informed and objective source for Medicare insurance information. The relentless advertising and promotion of advantage plans to the uninformed General Public is unfortunate. Keep up the great work Matthew!!
Thank you TJ
I was a Medicare sales agent with an FMO and I almost was brainwashed against Medicare Supplements. Thanks to your videos and others that tell the truth about medicare advantage plans, the damage done by that company was reversed. Before I left that company, we were told that they would no longer be offering supplements. That disturbed me but I was still under the spell of the lies, I eventually left the company due to health reasons and now I am glad that I did. The more that I learn the less I am willing to go back to companies that enforce advantage plans and leave out information about supplements. If I could find a company that tells the whole truth about Medicare plans, I would go back into the sales field. I live in Florida and so far I have not found such a creature. So, I have to rely on you for the "truth" because I will be going on Medicare in July. I will be getting a supplement!! Thank you for your honesty. I have learned so much.
Thank you for spelling all this out in a way thats easy to understand. I play pickleball and love it. Im turning 65 in a week and started medicare this month. I chose to keep A and B and add N since im very healthy and can afford N. I like the idea of chosing what ever Dr. I want where ever I am. I like to travel. I also at this point in my life only see a Dr for my annual physical or an emergancy once in a while. I take no meds and stay active. Everyone I have talked to has an advantage plan. I think its the zero cost that sold them and they all like the silver sneakers free gym thing. Im very happy I chose what I did and will recommend anyone watch your vidoes, thank you.
In the year leading up to turning 65, I researched this topic and discovered Matthew's videos, and I'm SO glad I did. I chose traditional Medicare with a Plan N supplement. The more I learn about the topic, and there's a lot to learn, the more I confident that I made the right choice for me. Thank you, Matthew!
You are very welcome. Thank you for sharing.
How much you pay it’s the key
It’s crazy now that I am a senior my hard earn money is going to feed the insurance companies no matter which one I choose wether is advantage or original I have to pay the only way is been poor and getting both Medicare and Medicaid now This is am devastated
Good luck with the plan n. You can pay multiple copays in one visit
@@tioswift3676 No, you can't pay multiple copays in ONE visit. But you can pay multiple copays in one day, if you have more than one visit that day.
Matthew is why I went with traditional Medicare and supplement. It was a great decision.
Excellent! Finally a straight shooter who tells it like it is. I am a physician and I can tell you we hate the administrative red tape The Advantage Plans put us through. That is why we are dropping our participation in these plans. They are not worth the trouble or added administratve payroll that is required of us to provide care. Good luck with your new doctor you had to switch over too be cause you chose advantage plan.
This was definitely an eye opener for me and my husband! He was “sold” on a Medicare Advantage plan but I was not. I have been watching your videos for a few years now and I really, really trust you. I can’t say that enough. I really trust you! We have now decided NOT to get the advantage plan. Every year at open enrollment I become a nervous wreck and feel sick because I just don’t understand so much about Medicare , especially part D. My hubby is now sold on MedigapSeminars!!! If we could afford a supplement, we would get one, but it’s not an option for us. Thank you so much. I’m sending you a big hug!
Pretty much have decided on original Medicare (A&B) plus N and Part D, whenever I decide to retire. The cost and "perks" of an Advantage plan sound appealing, but not worth the risk of possible out of pocket expenses compared to original Medicare with a supplement plan. Health conditions can change quickly and with us in the over 65 crowd, that's a huge consideration at least in my opinion. And i want my medical decisions to be made between me and my doctor, not an insurance company.
One point I cut out of this video to keep it from being too long is that a recent study by Medicare showed that about 90% of Advantage plan companies advertise their plans by drawing attention to the extra benefits (I call shiny objects). They do so to take the focus off the healthcare benefits so people assume they are as good as Original Medicare.
Agree
Thank you for explaining this. When I get mailings soliciting my participation in a medical insurance plan, it’s ALWAYS for an advantage plan. Until I watched your video, I didn’t know why there are so many advantage plans looking to hook me up. They talk about free gymn membership, vision and hearing test coverage…all kinds of tempting offerings. But I suspected, and your video confirmed this, there is big money to be made by companies offering advantage plans. Money for them, not medical coverage for me. I just toss these mailings. I have a Medicare Supplement plan, and I’m keeping it!
Very good explanation of the differences between Medicare A+B, Advantage Plans and Supplemental Plans. Thank you.. My wife and I are very pleased to have chosen to go with supplemental plans from Mutual of Onaha.
Excellent, thank you!
I have to make a decision like "today". I am on disability and barely have money to pay my regular bills. I guess advantage plans are not for me. I am 52 and pretty healthy. I haven't been sick in over 22 years. I tried to do the research and found these videos. They helped to realize that i am to poor to afford ANY coverage that will actually help me. No advantage plans and supliment plans are almost as bad for OKLAHOMA. I dont know what TF to do..
Please give him a call him and his team will guide you through benefits you may qualify for. You got through part 1 now stay strong 💪🏾
I’m retired with a pension, RV travel a lot supplemental was my choice and very easy 👍
MA plan was basically created to increase profits for the insurance companies and Mathew thanks for confirming it.
Very informative and concise.
Thank you for being honest about this
Thank you
Nice job, very informative!
Excellent explanation. I have done all my due diligence over the past year and made my choices already, as I'm turning 65 next month. I'm going with traditional Medicare parts A and B, taking part D drug supplement and selecting part G high-deductable as my supplement. I live in Washington State, so I can change this to regular G anytime if I have serious medical issues coming up. Right now, I'm on Obamacare paying $75 a month. When I transition to Medicare on February 1st, I'll be paying $275 (including part B). My social security increased by $100 this month, so I'm really only losing a grand total of $100 a month. Luckily, I worked in corporate America for 30 years and sold my old home, so I'll simply ask Fidelity to transfer that $100 to my bank account each month. All that hard work and saving money since the creation of the 401k in 1986 has finally blessed me. I hope everyone else is as fortunate.
Thank you 👍
So informative, thank you so much for explaining everything. Medicare supplement is the way to go.
thank you
Matthew enjoy listening to your videos as they have helped me navigate the Medicare world, which I entered into early 2023. I am so glad I selected a Medicare Supplement N plan as I have had some unique and life threating illness come up over the past six month. Had no issue in finding a doctor and getting the necessary treatments which have placed me on the road to recovery.
Matthew, thank you for the clear explanations. You have been very helpful.
Factually Brilliant!!! I have shared my limited research with friends and family on this. You have identified key points I shared but better yet, many i didn't. A bragging point - bonuses on employee retirement insurance. Thank you again.
you are welcome
I am definitely going with a Supplement. I have been on disability for 15 years and have seen the up and downs of Advantage plans. I am turning 65 in May. I have been working with a broker and she has been talking to me about this. I was nervous about the amount I would pay. Since I am being paid disability only. I come out better with the G plan. Thank you!
Choosing Medigap
Wonderful info, Thank you.
You are welcome!
Thank you for a concise overview of the Medicare plans and their history. You have convinced me that my decision to go with a Supplemental plan instead of the Advantage Plan is correct. I will advise others to watch this video before succumbing to the "eye-candy" Advantage Plans with their perks. Again, thank you!"
Outstanding video. I have been in independent life sales since 2020 but this year I have decided get into Medicare. It is something I have always wanted to do. Luckily I was hired in a a full time roll that is providing all of the training and a small base to get me ready for AEP. I will continue to watch your content! I understand that many simply will not be able to afford a supplement, but I will make sure to do my due diligence with every client and educate them on all their options.
Very informative, found out critically important information!
Excellent video. Important information framed in a new way. One of your very best.
Thank you! 🤗
I really like the history lesson. It gives me a better understanding of original Medicare and the origins of Medical Advantage. Thank you very much
You are welcome. I appreciate your letting me know.
I’m a Medicare provider and advantage plans pay providers less than original Medicare. This is why providers reject clients who are with Advantage plans!
Not always true. Depends on your contacts. Some MA plans will pay much higher than original Medicare
Matthew Thanks for the eye opening 👀 I wasn’t sure a the advance plan , now all I have do is decide on G Or N plan thanks again .
very educational video, for clients and agents. If an agent gives you insider knowledge good sign the agent cares more about the client then the company.
After a year of researching my Medicare options, I chose original Medicare with Plan N. Living in SW Florida, it was a close call between Plans N & High Deductible G, but because of underwriting requirements here, I had to pick the plan that would be best for the long-term.
Initially, my HD-G's total costs would be cheaper (if I remain healthy). But after about 10 years, it's likely that my N's total costs would be cheaper as I need more medical services and HD-G's max out-of-pocket would keep getting higher.
In the end my decision came down to my concern about HD-G's deductible increasing each year at an unpredictable rate of inflation versus the much more predictable & budgetable N monthly premiums.
You made a good choice. Pre- 2020 I would have chosen a G-HD myself. But now that inflation is back, it's not a risk I want to take.
@@MedigapSeminarschoose Plan N to avoid high rate increases of plan G, avoid HDG for inflation and EOB issues, avoid advantage plans and pay dental and vision with an HSA to avoid networks and denials.
I chose G-HD. I have a well funded HSA which I never touched (except to contribute!) prior to Medicare. I live in a state that allows me to switch from one Medigap to another at any time (no birthday rule) and community only rating. So I can switch in later years with guaranteed issue and no age related issues.
@@robannmateja5000 HDG deductible has gone up 27 percent over 5 years. Having said that most people will not reach that deductible. Remember your paying only 20 percent of Medicare approved charges. Unless you have cancer you simply will not hit that deductible. NY you can switch back and forth so you can play that game. Of course that's why the regular G rates are so high.
Yes, I am aware of that, thank you. And thank you for your videos. My state allows me to switch to any other plan except Plan A (no longer sold?) and Plan F (don't qualify for that one due to my age) , so I can switch to a Plan N later, if that makes more sense. Right now, this is the path that works best for me. I have done extensive research and also discussed and got assistance from my SHIP representative. I had to get some Medigap plan within the bounds of my SEP (because, although my state - not NY btw- has better guaranteed issue rights than many others, I am still bound by the SEP timing or I lose guaranteed issue. HD-G premiums in my state are lower than Plan N, I am healthy right now (thank God!) and have few doctor's visits, so this seemed like a good choice for me. Am I taking advantage of the system, well, just doing what is right for me. I wish everyone the best. This is much more convoluted than it should be, and as I mentioned, your videos are very helpful in finding the way through the maze.
Ill go with medigap fir sure.
Thank you so much. Very informative discussions you bring to the table.
It's no wonder that during open enrollment period Insurance companies are all
over the airwaves with their commercials trying to enroll the unsuspecting.
They really need to change the name of Medicare Part C / Advantage Plans. They are not Medicare and they confuse people.
Matthew, very interesting about the 37% of Advantage plan people are on SN Medicaid plans or Employer Retirement Advantage plans.
Ya, it's always what they don't tell you that matters most.
Thanks for the video. I am fortunate enough to be able to get a Medicare Supplement plan. Lots and Lots of horror stories with Medicare advantage and I will not miss my opportunity for a Med Sup.
Selected original Medicare, part d and supplemental g. When I did a cost analysis, the cost was an additional $100 per month. I rather pay a little each month and not have to worry about maximum out of pocket when I get sick.
This was based on the comparison of Medicare advantage PPO and original Medicare. The PPO cost was $125 a month more. Although the HMO had $0 premium, it had a smaller network than the PPO. Both had limited within network, pre authorization, and referral requirements. Could I have chosen supplemental N and save some money? Yep, I could have but I am very happy with my choice. For me it has been peace of mind. Thank you for providing great videos. If I did not see your videos and get educated on the differences in both programs, I would still be with Medicare advantage. Thank you Matt!
Very enlightening 😮😊
14:30 matches what I heard from a Statistician who had then just completed an INSANELY lucrative contract with a large health insurance provider. He told me to expect an onslaught of ads trying to lure me in to "privatized Medicare" as he called it. Now 64, my friends and I are all receiving these. They are very professionally done - not on glossy paper with all red caps, but in an official communication from my current (private) insurer implying that I have little choice but to go through their Medicare. They didn't use the word "Advantage" anywhere but it clearly is MA.
Thanks for sharing. The simple truth is there is too much money in Advantage plans, all fueled by our tax dollars. Everyone involved benefits except the consumer. Wherever there is too much government money, there is greed and corruption.
Thank you a lot for this video. This is very interesting and informative. Keep posting like those amazing videos, this is awesome.
Thanks. History and reason very helpful. I am 81 with Medicare BC/BS supplement that increased 21%. Looking for cheaper but you convinced me to stay with supplement, maybe just different plan
Thanks again for your informative videos! I still have a few years to go before I’m eligible for Medicare, but I feel confident that I will understand my choices.
You are welcome.
For the algorithm, plus the info is great
Not sure how it works here in Mn but my advantage plan with Health Partners PPO seems to cover all the things that are needed as they have there own Dr’s and Clinics and Hospitals
Joe, no disrespect intended but your already behind the 8 ball if your in an Advantage plan. Run, don't walk to get out. It will in the end cost you a lot more money unless you remain healthy and die in your sleep. The bigger issue is the overall quality of care when you do develop a serious illness. These private insurers make their money by denying and delaying services to seniors when they need it most. My sister in law died prematurely waiting for denials to be resolved for tests and acute care which her doctor ordered. She died at home when she should have been in rehab.
You told us in this video very much what our agent told us when we enrolled in A+B+Supplement, we pay a monthly fee for the supplement but beyond that the only thing we have paid is the once yearly $230 Medicare deductible and last year I had 3 overnight hospital stays for a total out of pocket cost of $0.00. I am trying to spread the word, that if you have the choice and the funds, stick with a supplement. Medicare Advantage or should we say Medicare Dis-Advantage is great as long as you never get sick.
I really liked your video. Though I must take issue with the example from NY. They received snap and rant assistance. I'm in Texas, I've been ob disability since 2000, turned 65 in 2022. I chose a supplement plan. Due to my initial part B date of 2000 I was actually able to get a Plan F.
The monthly premium is applied as a spend down on my income, reducing my portion of rent. I got $128 p/m off my rent. Of the remaining $28 p/m paid toward premium I get $23 p/m in snap benefits I previously didn't qualify for.
My option F supplement essentially cost me only a few $$ per month.
Very nice video. While I am able to have a company sponsored advantage plan, I ended up with a supplement and a part d plan. I went with plan N for many of the reasons you listed. My wife found the snake oil salesman (M) that convinced her that anything but a G would be filled with excess charges. I'll be sure to let folks turning 65 that they need to watch your videos!
I would never choose an Advantage plan. It’s only a privatized plan.
You have the best explanations! I wish I had found your videos sooner, especially before I met with a broker whose explanations and knowledge was less than desirable or willfully incomplete.
But I still have time and I think I will choose a HDG, will have to make some sacrifices but the freedom is too important. I have worked in skilled nursing facilities for years and I have seen the consequences of denied therapy and it was heartbreaking.
Feel free to contact us . We can help. medigapseminars.org/contact-us/
Great Video. Great explanation of history of medicare and advantage vs medigap. So much misleading information out there.
Thank you
turning 65 in november 2024.trying to learn as much as i can.think i will go with the G or N plan.
I'll be signing up for Medicare later this year. I helped my older brother sign up last year. Encouraged him to buy a supplement and not take an Advantage plan. He bought a supplement. Worked out great when he had a few medical issues arise soon after. I plan on taking a supplement even though I have no health issues. Haven't decided which one yet. I just can't deal with the Advantage plan horror stories I've heard about. Plus, as mentioned in below comments, I've heard medical providers are pulling out of Advantage plans.
Well done. We have appreciated your help and advice since we entered the world of Medicare when we retired nearly four years ago. I do have a question, however, about dental insurance supplements. Are there any out there that are affordable and worth looking into?
Yes. Several dental plans have had extraordinary changes in just the past few years. medigapseminars.org/contact-us/
I'm about to turn 65 in May, and yes I have been watching a lot of videos on the subject of medicare but I'm a federal retire with FEHB so what would be my best option? The thing confused in my research for instance I have Blue Cross Blue Shield Basic Federal plan and I hear and saw information on there web site that have medicare plan that uses or connects your FEHB plan so I don't understand this would this be the Medicare part B with a monthly premium and I don't understand the term medigap and I heard that the FEHB is considered the mediigap?
Your right i got on a ship program pays my 175 got a plan d 4.50 to 11.dollars like 200 a yr my medgap is 125 but they take part b out regardless so its like less than the 175 and im in reg original medcare with the best benefits
Nice. So how do the HMO vs PPO classes fit into this.
You can state whatever you want to say, about original medicare with a supplement is best. It's just not best for everybody. I for one, chose an Advantage plan. It's a plan with one of the big insurance companies, and the best part is that I don't have to worry about having to purchase a separate drug plan, then have to add a dental and vision plan, and pay an astronomical $250 to $300 a month. I also get the part B monthly give back of $125. I have a great primary care physician and a Cardiologist. I just cannot afford those kind of premiums.
It's very important u stay healthy with the Advantage plans. Most people are very happy with them until they experience a serious health issue. That's when the reality of these plans kick in.
Me either I'm a widow and they just tax you to death...
Great video. My husband turned 65 this year and I turn 65 in February 2024. I worked for many of the Advantage Plans as a Network Development Contractor. I did the actual negotiations with Providers for the Plan. I watched many Specialty Groups and Hospitals term their contracts mid year. So many do not know that the Providers can term with a 90 day notice. This is one of the Big Dis-Advantages on the Plans. Also, the Insurance Plan has a huge Department that reviews the Prior Authorizations and will deny, deny & deny many services. The Free benefits out way the stressful issues that come along with the prior authorizations and Denial that happen with a so called Advantage Plan. My hubby and I will be staying with a supplement. Thank you for this video!!!!
You are welcome and thank you for sharing your story.
With advantage PPO, can I choose any doctor who accepts Medicare? Thanks.
no. You can ask a doctor if they will accept your insurance as an out of network doctor. But thay can and usually do say no. They are under no obligation to accept your PPO.
Is it true that you can be locked into an advantage plan by your answers to certain medical questions? If so, what are some representative questions?
I would like to know how many healthcare providers don't accept MA PPO out of network patients.
Lisa the list grows monthly.
I am still not sure what to choose. I pay a LOT for Mededicare B and Plan G and drug plan as i am already in my 67th, so i pay 10-20% more more as i am older than 65. 2ndly, i have a low soc. Benefit but still a very high income. So my monthly payments are much much much higher. Also I have European health insurance which pays worldwide. So all that points to an Advantage plan, right?
It depends on a lot of other factors as well...But mostly, Medicare Advantage plans are NOT cheaper than a supplement. They simply divert your costs from the premium to the cost of care when you need it. feel free to call us for specific 800-847-9680
Such a fantastic channel with wealth of info. I have a qq if you don't mind. I (62) have employer coverage with HSA for me and my wife (non working). My wife is turning 65 soon and she plans to enroll only on Part A. Do I need to cancel my HSA if ever my wife enrolls also on Part B before me or can I continue to contribute to my HSA since I am still the one working (even though we file tax jointly)?
Hi - good question. This article i wrote might help: medigapseminars.org/hsa-and-medicare/ I am not an accountant and can not provide accounting advice. My understanding is that because Medicare is individual, her starting Medicare does not impact your ability to contribute to an HSA. That said, I know my own accountant believes that filing jointly puts you at risk. Sorry for not being definitive. Look at "HSA for Married couples" here: crsreports.congress.gov/product/pdf/IF/IF11425
@@MedigapSeminars Thank you for the link and response. It looks like HSA is specific only to the person contributing to it and must be stopped for that same person upon going into Medicare A and/or B. In short, since my spouse is not contributing to HSA, I don't have to stop my own HSA contributions when she goes on Medicare. I will double check with my accountant, but it might be prudent to stop HSA altogether just to be on the safe side. Thank you so much for your advice.
Matthew question....i just turned 65, getting a medicare supplement plan. My husband cannot hes not 65 yet and on disability. Wouldvit be wise to just stay on A and B. Its just for a year. Im afraid of advantage plans any input?
I've been told that if I'm on Medicare Part B with a Medigap Supplement Plan G and (assume I've met the Part B deductible for that year) I have an outpatient service that Medicare Part B approves and covers and pays for (80%), the Medigap policy *must* pay their 20% and have no ability to deny coverage, delay payment, etc., i.e., they are required to pay without review or qualification. Is that correct?
Since I can’t afford original Medicare with a supplement plan plus a part d plan, it looks like I’m stuck getting an advantage plan. That sucks for me.
The government should make watching your videos required at least one year prior to age 65.
I would agree with that! Thank you.
Unfortunately the government is in bed with the Insurers and their lobbyist. That's how we ended up in this mess. Advantage was misrepresented when it was voted on and a lot of people warned the public and their representatives that this was going to be a huge problem as the public aged.
My Medicare premium is $675 per month. My supplemental G plan is $138 per month. I think this is reasonable for the care I get.
advantage plans cover dental and vision which can be a huge cost relief
But at what other cost??
If you apply for a healthcare plan for the shiny objects instead of the healthcare benefits, you have just been taken. Especially considering the plan can and will change benefits every year, but your decision to use an Advantage plan can be permanent. As I mention in this and other videos, compare losing the two greatest benefits of Original Medicare to whatever you believe is the benefit of the Advantage plan. It's that simple. Is it worth it? For some yes. But don't assume the healthcare benefits between Advantage and Original Medicare are the same, but the Advantage plan ads shiny objects and magically makes more money.
Would be nice to see All plans for retired seniors with Low Income(20K a year), Any way to avoid the 20% out of pocket?
You can. There are agents who specialize in the low income market. But you have to be careful. A lot of new agents work this market as well.
I see, so Medicare will not, and medicaid pays for Medicare premium only, seems cut off is like $1340 a month, over that we pay@@MedigapSeminars
I was wondering, once you've met your deductible and Medicare gets a bill and pays their 80%, does Medicare bill your Medigap policy for the rest or does my Doctors office do it. I just want to be sure because I am going to Quest labs for a PSA test and I sign in on the kiosk. When I put my insurance info in, do I just put in my Medicare info?
put in both medicare and your supplement. But yes, Medicare will typically communicate with your supplement
@@MedigapSeminars Thank You
What Medicare plan do you recommend for a dependent spouse enrolled in Champva? So far I did not get any clear intelligent response to this question.
Champ VA is secondary, Medicare A & B is primary. You do not need nor should you get a Medicare supplement. ChampVA is your supplement. That's all you need.
What is an Advantage PPO? How does it compare to Orig Medicare and a supplement?
If you go to my website medigapseminars.org/ Click on the talking head that pops up in the lower right. I offer a free 4-part Medicare mini course that will answer your question and much more.
sorry, my fault. I have scheduled an appt now.
One key point not mentioned. Drug coverage! Medicare + Supplement doesn't cover prescription drugs. You need to add a Plan D if you want help with prescriptions. On my current advantage plan, my prescriptions are covered and with lower out of pocket copays than a Plan D. Plus there is very basic dental coverage included too. I'm considering moving to Medicare+supplement+D, for the reasons you mentioned, but I need to look at these additional things you didn't talk about.
Having a stand alone Part D plan is a huge benefit. You can change your Part D plan each year without messing with your healthcare plan. partdshopper.com/ With an Advantage Plan, we often see people forced into a potion of either choosing a low cost prescription drug plan, or a higher cost with an Advantage plan accepted by their doctor.
Good verbal explanation but why aren't there any charts / flow charts how to go about the choices? This requires work but a picture is worth 1000 words ...
That is a good idea. Yes, time is a big factor.
What is the difference between advantage plans and the network group plans most of us have been dealing with for decades?
Health can take a nose dive after 65 compared to your younger years.
This really explained it well. I have been advised by many people that supplement plan was "better", but this explains why. I hate that insurance companies have taken control of our health care, as I have been on employer plans with pre-authorizations for decades. My only issue with supplement will be the monthly extra cost, plus the Part D plan.... Now, onward to your 2024 Part D video. Thank you for these.
My Dad lives in Pennsylvania and is in his early 80's. He has stage 3A chronic kidney disease. Dose he have a chance of passing medical underwriting to get a medigap plan at a decent price?
No. A person must be at least two years cancer free
Thanks for replying my Dad does not have cancer he has mild kidney disease.@@MedigapSeminars
@@MedigapSeminars My Dad has chronic kidney disease not cancer.
@@jilllingoff3947 still - he can't pass underwriting
Great video! Maybe a little off topic and something that applies to younger people, or wealthier retirees, but any idea how many doctors are opting out of accepting any insurance whatsoever? I guess it was that way in the old timey days. A younger relative had to change their primary physician recently because the doctor stopped accepting any insurance at all, instead setting their own prices, which my relative could no longer afford. The upside for their former doctor and current patients is more unrushed one on one time and not having to deal with insurance paperwork and red tape. Do you know if this is getting to be a thing now, or are these doctors few and far between? Doesn't apply to me, for sure - I just thought it was interesting. Kinda like paying a doctor on retainer I guess.
this is the closest thing I can find on that topic: www.kff.org/medicare/issue-brief/how-many-physicians-have-opted-out-of-the-medicare-program/
Thanks!
Why all the discussion about in or out of network? I have a supplemental G plan and there are no networks. Why would I want some bureaucrat to limit my healthcare options???
I'm turning 65 this year and I'm currently working and covered under my employer qualified plan. I currently have United Healthcare PPO and my insurance recently declined a procedure that would fix my back pain, because the said procedure was experimental and not yet FDA approved. I would have to pay $24k out of pocket if I wanted this cutting edge procedure done. Would original Medicare pay for this procedure or does cutting edge state of the art medical treatment only reserved for the rich?
Medicare does not usually cover experimental procedures
@@MedigapSeminars I have watched several videos and most seem to imply that the standard of care is better with the original Part A and B plus Supplemental because the insurance decides and not the doctor about what treatment is necessary when you have Medicare Advantage.
I can tell you that my father in law had the Medicare Advantage plan and when he got sick with many surgeries done to the tune of over a million dollars, he received the best care with no treatment denials. He would have been bankrupt if he had just original Medicare so I still can't see where Original Medicare is better. My current credible insurance plan from United Healthcare resembles the Medicare Advantage Plan.
So can one change from an Advantage plan to a medicare/supplement plan during open enrollment?
You can exit an Advantage Plan and apply for a supplement during open enrollment. Your acceptance into a supplement, in all but a few states, is not guaranteed.
You can switch, but the supplement plan will review your medical condition. They can deny you a policy, might have a higher premium or deny coverage for preexisting conditions for a three month period. This type of underwriting is not done when you first go on Original Medicare and add a supplement plan. It’s important to select a supplement plan best for you since it’s more difficult to switch later which I know from personal experience.
@@warrenphelps5342 The pre-existing clause can last a maximum of 6-months - it depends on multiple factors
Is it true that if I get an Advantage plan and don't like it, I have 12 months from the time I signed up for Part A to change to a medigap plan without underwriting? Thanks.
in general, yes. But because it is a guaranteed issue plan, insurance agents are not compensated for helping you. You will be one your own is selecting a policy and company.
Thank you.@@MedigapSeminars
YOU need to Clearly elaborate on what "Those who are incentivized through a employer Bonus Plan" Actually means??? Does this mean the employer (current or past / a Retiree) is incentivized with a monthly payment to Choose one of "Their Provider" Medicare Plans?? I use VIA Benefits only because if I don't, I will not recieve $125/month toward my Plan B. Is this what you are referring to?? Please Clarify. Thank You
I think he's referring to the fact that on these retiree plans from corporations, they arrange for ONE insurance company to provide the advantage plan for their retirees. (In other words, the retiree can't choose which insurance company to use.). In that scenario, if ABC Corp chooses that one insurance company and ALL of their retirees have to take it to get the special deal/discounts/incentives from ABC Corp., don't you think that ABC Corp is getting some kind of kick-back/sweetener from the one insurance company? I do. As an example, the City of New York tried to force ALL of their retirees into an advantage plan provided by Aetna and only Aetna. It's being challenged and litigated currently.
Everyone that I know that have a advantage plan love it until they have something serious wrong with them Cancer ect. I have had a ppo at work for years IM GLAD to be going with a GAP plain. No more HMO or PPO
There is a saying in the industry "Medicare Advantage Plans are great, until you need them."
I had an Aha moment, thanks
I hv an advantage plan, can I change to a supplement during Jan and March, I'm 87 nd do not trust the advantage group
You will need to qualify medically in order to change. That is difficult for most 87 year old's, but not impossible.
Well im on disability need a lung transplant do was on Medicaid w va im be 65 in this April i applied for to see if i could get both so i applied for ship program i make 1395 minus the 175 the state put me in a d plan though the state thou the plan with united healthcare 0 cost but like 11buck a script at200a yr is that deductible,4( waiting on the states decision i like to stay in original medcare dont need eye teeth gym a letter said from ssi i qualify csn u help me plesse likw yo keep advantage plans tout of my needs
Can you make it simple and summarize everything in 3 min?
I love my Medicare adv plan, its not even close to compare what i save over the medicare supplement plan N or G! The amount I save is yielding me income which pays for any out of pocket costs, which are capped!
It's more the pre-authorizations, referral requirements and service denials/appeals that are the problem with advantage plans.
@@tomm7505 Never had a problem with any of the above.
As with most Advantage insured you will love it until you develop a serious medical issue. As my sister in law said several years ago. " I hope I dont live to regret choosing an Advantage plan". I jokingly said or worse die because of that choice. Sadly we were both correct. She died waiting on denial of coverage appeals filed by her family after suffering a stroke. If she would have recieved the care her Doctor ordered and not been denied she would likely be alive today. Instead she languished in a coma in ICU for months and 6 months later died in a long term care facility. Racking up over a million in billings. Which the Advantage Plan is responsible for most of. Wife has spoken to half a dozen attorneys. Not 1 willing to go after the insurer. All willing to go after the hospital, doctors,and nursing home who had nothing to do with the denial of coverage. She refused all of them.
Funny thing is, I had an employer HMO plan with UnitedHealth, which is comparable as an Advantage plan, for 24 years and never had an issue with it. Referrals no problem, even had a hip replacement that went south due to an orthopedic surgeon placed wrong prothesis, total cost of surgery was 136k, and UHC covered entire cost. Advantage plans do work extremely well for many people.
Until you become ill. One year of illness, couple of hospitalizations and cancer will cost you over $70,000 out of pocket. Same medical services on supplement G would be close to 4K. It’s math. Advantage plans are great until you get sick.
After listening this video for 30 min, I still did not get any point excel some useless statistics!
Hmmm - I can only say you are in a very small minority. Most people, like one of the commenters below, say "Thank you for spelling all this out in a way thats easy to understand."