Very nice and complete explanation. Spot on! I would like to add something that is from the provider/clinician perspective. Working with patients that have Medicare Advantage plans is more time consuming, more expensive, more benefit verification steps, more paperwork, more referral info, more authorizations, more denials, more requests for information after claim submission, more phone calls. There is more of everything than working with Medicare and a supplement. The patients that we serve that have advantage plans receive more statements at the end of the month for balances at a 20/1 ratio compared to straight up Medicare and a supplement. However, that is not the most concerning factor. Patients that have advantage plans now invited the insurance company in on the medical decisions. With Medicare and a Medicare Supplement its your physician that has the final word. I cant tell you the number of calls I get from friends of mine crying saying that a parent had an medical issue and their physician wanted one procedure based on their diagnosis and the insurance wanted something else and asking me what can be done to follow the physicians plan of care rather than the insurance company. I say not much other than paying out of pocket. In my opinion, go with Medicare and a supplement. Good healthcare is between you and your physician. Not between you, your insurance company, and your physician. When it comes time I will be getting Medicare and a supplement.
This is a great comment to add to the discussion. We have separate videos in the works that goes into more detail around each plan. We have heard this feedback from providers often. The two plans are geared to 2 different types of people and risk tolerances for sure. Thank you for watching and taking the time to comment!
As a provider (speech pathology) I find that most Medicare advantage plans either deny authorization for care or require authorization and reauthorization at frequent intervals. They are also slow to respond to authorization requests. This causes extended gaps in patient access to rehabilitation while that authorization is being processed. I believe this is by design. That is to,say the plan reduces their cost by dragging their feet to authorize treatment and then only authorizing a little bit at a time. In rehabilitation we privately call these plans Medicare Disadvantage because patients get much less care than traditional Medicare participants.
I cannot say enough awesome things about this site. Second video I watch and I can pretty much say with certainty I am going to be watching them all. Thank you so much for putting the information out there in simple terms. Hope you are still here when I am 3 months from 65 as I will be so grateful for all the videos. "The Cajun Ninja's Dad"
Oh my, thank you so much for answering my comment/question. I just enjoy seeing your videos. You give so much information and that's why I follow you. Please keep up the good work. Even though we are in different States, I still get very important information from your videos.
@@MariaRamirez-id2hu you are so welcome and feel free to reach out with any questions you may have. There is a lot of general Medicare information that applies no matter where you live. Once we start digging into plan specifics, things get much more complicated depending on where you live and the state plans. We'll keep putting out new videos each week so be sure to hit the bell icon next to the subscribe button on our page so you are notified when we put out a new video. We appreciate you watching, following, and commenting!
It's the same old insurance game that we've always had. You can either pay up front with a Medicare supplement plan or try to come out ahead with an Advantage plan betting that your medical costs will be less. I've always paid more for fixed costs and better coverage so I'd stick with the original Medicare and a good supplement plan. Another troubling thing not mentioned is that if you choose an Advantage plan and keep it for a year you can NEVER go back to original Medicare without going through underwriting which means higher rates if you have pre-existing conditions.
Well said. We have a video coming soon that addresses what you mention around risk and what choices you have once you choose one and want to switch to another. Thank you for watching and commenting!
@@davidharris678 That's the rub...underwriting on supplement plans which can get expensive if you've got pre-existing conditions as most folks do at that age.
@@tomj528 True. But remember something. With Medicare Advantage you will come out ahead 85-90% of the time. ( This is based on actual real world numbers. I have done the research). Also again. 9/10 you will spend more money on healthcare on a Med Sup than Med advantage. It happens over about a 10 year period. Med sup premium goes up every year 5-10% or more. Can't avoid that.
This is probably one the fairest comps you have done. Supplementals do have the ongoing premium which not all can afford. Advantage plans however can result in delayed and denied coverage, even more so outrageous costs if you step out of network and something happens. I may seem to be jaded, but if someone pushes Advantage outside of individual affordability- they have motive without a doubt. Thanks again.
Thank you for watching and commenting! We see a lot of people come into our office who can afford supplement plans but still want advantage plans, even after informing them of the downsides. The 2nd big factor is risk tolerance. There are people who would rather take the risk of something potentially going wrong and saving the monthly dollars than they would paying for something they may not use (yet). Lots of different people and mindsets out there. Our role is to educate on both and let people decide.
Medicare eligibility can start for Americans when they turn at least 64 years & nine months old or upon retirement. Those with a disability, End Stage Renal Disease (ESRD), ALS or on Social Security disability for 24 months in a row may also qualify for early Medicare benefits. A person must be enrolled in both Part A and B of Medicare before they can enroll in a Medigap plan. Upon enrollment, Medicare enrollees become eligible for Medigap Open Enrollment. This period starts on the first day of the month one turns 65 & enrolled in Medicare Part B and lasts for six months. During this period, a person can buy any Medigap plan regardless of their health status (called "Guaranteed Issue Rights"). This is different than if someone is losing group coverage or retiring. When this occurs, the person is eligible to exercise his or her "Guarantee Issue" right. With a Medigap guarantee issue right, a person can buy a Medigap Plan A, B, C, F, K, or L that is sold by any insurance company in their state. In addition, the insurance company cannot deny or raise the premium due to past or current health conditions. Also, the insurance company must cover any pre-existing conditions. Instead of exercising the guarantee issue right, a person can opt to go through the underwriting process in order to buy a plan G or N. Once a person is outside their open enrollment period and/or guarantee issue, they can change their Medigap plan, but they will be subject to health underwriting by the insurance company they are applying with. Monthly premiums apply, and plans may not be cancelled by the insurer for any reason other than non-payment of premiums/membership dues. Furthermore, a single Medigap plan may cover only one person but may offer spousal discounts. Finally, Medigap insurance is not compatible with a Medicare Advantage plan. You cannot have both a Medicare Supplement and a Medicare Advantage plan at the same time. You can only have a Medigap plan if you are still on Medicare Part A and Part B and have not replaced your coverage with a Medicare Advantage Part C coverage.
how easy is it to switch from part C back to a suppliment? I'll be 65 in May and was going to start with a C to get some dental work done and then switch over to original and add G.
Great question. The answer, as with a lot of things Medicare-related, is "it depends." This video tries to clear that up based on a few different scenarios: th-cam.com/video/djuGeI829M4/w-d-xo.html
Your logic makes sense though. If you are going on Medicare at 65 and take an Advantage plan, you have 12 months to try it. You can switch back to Original Medicare and a Supplement within those 12 months without needing to go through underwriting.
At present, I have plans N and D which are costing me over $100 a month. I've been to see my doctor one time in two years. All of my medicine and doctor visit are through the VA. I'm very happy with my VA treatment which is 100% free and includes free eye care and glasses. I don't have dental through the VA. I'm seriously considering moving to an advantage plan just for dental and to save me over $100 a month, there may be other benefits of which I could take advantage. So far I've spent over $2000 and have only seen the doctor one time, not a good return on my money.
For those with VA coverage, we usually don't recommend Supplement plans, especially if you are happy with you VA coverage. There are a lot of Advantage plans out there like you mentioned that are $0 and have other perks. We have a video specifically on VA and Medicare here: th-cam.com/video/jkmpKCEw2H4/w-d-xo.html Thank you for watching and commenting!
Excellent summary. I keep getting confused about emailed 'reminders', stating I need to review my plans. I've called, and unless I'm getting bad info, both my Medicare and the supplement (the older plan 'F'), will remain by default. I sure hope that is correct.
That’s correct. If you have Original Medicare and a supplement, nothing will change and you don’t have to do anything. You may however, want to look into doing a cost comparison of your Plan F with a Plan G if you haven’t done so in a few years. Especially if you are in fairly good health and can qualify, you can probably find the same coverage at a lower rate.
Both you and Mary Beth Mc Coy are correct. Your plan will stay active and you don't need to do anything. Mary Beth Mc Coy is also correct around looking into potential cost savings by going from F to G. Definitely worth a conversation with your agent.
@@Theretirementnerds Thank you for your reply. The agent did suggest potential savings. But the differences seemed more nuanced than substantial, and are dependent upon speculative scenarios. So far, I've not used either Medicare or the supplement. If I believed that would indefinitely remain the case, I could focus on cost cutting. But since insurance largely covers unpredictable events (broken bone, heart attack, cancer, etc.), I'm OK with paying a little more for (hopefully) a little better coverage for whatever event I'll likely, eventually experience. Meanwhile, I focus on the REAL cost cutter - maintaining a healthy lifestyle.
@@gregparrott Maintaining a healthy lifestyle is a very wise approach. Prevention is much less problematic than treatment. It sounds like you have a good relationship with your agent, which is important. Maintain that relationship. We wish you excellent health and thank you for your comments!
Hi Robin, In most cases, yes. There are MA plans for Veterans as well as those on Medicaid (low income) that have Part B reimbursements. There are a few that have reimbursements even for those who are not Veterans or on Medicaid. It will all depend on where you live, but most people outside of again, Veterans and low income Medicaid will also need to pay their Part B premiums as well. This video goes into that a little more: th-cam.com/video/3Mwm87ST2dw/w-d-xo.html Thank you for watching and commenting!
The presenter tells me to "stop talking bad about [Dis] Advantage plans" because "you don't understand them." Oh, but I DO understand them. I don't talk bad about them - I merely provide information about the risks and what they really are. Guys like this presenter - along with every ad on TV or in your mailbox - fail to disclose the whole story. That's reprehensible.
Just to clarify. The person you are debating in the comments is not the presenter in the video. Our channel is coming out with more detailed videos around Supplement and Advantage plans in the coming days that will address some of your points. We appreciate you watching and taking the time to comment and be involved in the Medicare conversations.
What he did not talk about is if you get sick on an advantage plan and you get sick it gets very expensive! Then if you want to go on a Medigap plan now you have to go through underwriting and will have to pay a higher premiums . He left lots of information out!
Hi! And thank you for watching and leaving a comment. We address total risk of both plans in this video: th-cam.com/video/3Mwm87ST2dw/w-d-xo.html We are currently editing a video that goes into much more detail about Advantage plans specifically so keep an eye out for that and it should address the points in your comments that were not in this particular video. Thanks again for watching!
Would you agree that it seems like a better food analogy would be, Advantage plan= you have to eat at Burger King. Supplement plan=eat almost anywhere you want including another town.
I do like your food analogy. Based on the plans available where we are, we would put the Advantage plan on a higher level than Burger King :) but yes, a classier chain restaurant vs almost any restaurant is a pretty great analogy in this case.
The main con, which allows all of the "pros" is the hurdle of prior authorization. These advantage plans receive funding by the govt and they turn a profit by denying you care via this authorization process, not by being more efficient at delivering care. In fact they make a ton of money off these plans which is why they push them so hard. As a physician I can tell you multiple times per week I receive denials from advantage plans. Sometimes I'm successful in changing that decision but a fair amount of the time I'm not. This never occurs with traditional medicare. Additionally, if you do need a test/procedure/imaging study/etc this can be done the next day. With the advantage plans the authorization process can take weeks delaying care and prolonging suffering. If you can afford a medicare supplement it is almost always a better decision. The only time an advantage plan is likely better is if the financial burden of a supplement plan is too large and you assume you will never be significantly sick. The sad reality of anyone pushing these advantage plans is that they are paid everytime they convince someone to sign up for one. This is probably true of the gentleman in this video as well. So I caution everyone, buyer beware.
Seeing you did a copy and paste of this comment on any video that mentions an Advantage plan, we'll copy and paste the response. Appreciate you watching and adding your perspective. Would caution about making judgements like that. Our group does not push Advantage plans and we have several videos that outline how they really work. There are several cases against physicians committing fraud against Medicare because they know Original Medicare will pay. Extra, unnecessary tests and procedures are added to get more dollars. Would it be fair to say that you, as a physician, probably do this and people shouldn't trust physicians even though we know nothing about you except that you are a physician? Doesn't seem like a decent way to treat people. We would rather hope that you are ethical like the VAST majority of physicians we know trying to do right for your patients and not one of the bad apples that cheat the system for profit. We welcome all opinions. We agree with your assessment of how some Advantage plans have the prior authorization hurdles, can be difficult to work with, and deny care. Just careful with character judgements.
@@Theretirementnerds No character judgements were made. I didn't question your ethics or morals. Your comments did that for me. I was simply highlighting for the viewers the important fact that many people promoting these plans do so for profit. In contrast, you did make a character attack against me and imply I defraud Medicare. Based on what, I have no idea. Also, you seemed to make an argument in favor of Advantage plans as a way to prevent fraud. I assume then, you are not aware of the dozens of lawsuits against these plans by whistleblowers, the govt, etc. for improper coding regarding the level of health issues of their subscribers? So these plans, which were sold as being more efficient, are instead costing tax payers untold billions. Given you have never had the "pleasure" of arguing for weeks with one of these plans about a necessary treatment for your patient, only to be denied because of their own unique company policy, I would assume you would show some humility. Even worse yet, is having to be the person to explain to the patient why their treatment was denied and bearing the brunt of their anger, frustration, sadness and despair. This is an ever growing cause of physician burnout and something insurance agents never have to deal with. Instead, you choose to cast aspersions and change the focus of the debate, which is the fact that these plans have many drawbacks and are universally worst for most.
A lot of copy pastes happening, but it is important. In a different way, we do address the prior authorizations and denials with our clients who, in turn, are patients of providers like yourself. Our conversations, while difficult, do not compare in difficulty to yours as the physician counseling your patient in the high-stress environment of healthcare. The unfortunate part of this comment string is that I think we both agree on the crux of the issues. We both agree that prior authorizations and the managed care aspect of Advantage plans are a drawback to these plans and a matter to look at and make sure it improves, which from what we see and experience, is happening. Is it where it should be? No, but we, along with agents in this community are advocating for the same thing you are. Our whole point in the caution against character judgements was the implication made that we are pushing our clients into Advantage plans - at their detriment - for a higher 1st-year commission that comes with Advantage plans, which we disclose in this video and others. Our business model, just like your practice, would not be sustainable if we were pushing people into inappropriate plans. We do not accuse you of Medicare fraud. It is the exact opposite. It would be foolish of us to accuse you or any other provider of fraud solely based on the fact that you are a physician because we heard that there are physicians out there who do those practices. The way we phrased it, which is the downside of comments made through a keyboard, was meant to show how unfair it would be to make such a blanket statement with no information about how you run your practice or treat your patients. Same thing here. To assert that we are pushing people into Advantage plans, having never sat down and seen the at-times-hours long conversations we have with our clients about their health, finances, risk tolerance, and plans available to them prior to their decision, seems equally unfair. There are agencies out there who put people on a plan and hope to never speak to them again. We aren't that agency. And to your excellent point in your most recent comment, the additional hours of conversations and phone calls that we have with our clients and the insurance carriers to help and push where we can with those prior authorizations and denials - happens every day. When we see that you are a physician, our first thought and assumption is that you are amazing at what you do and are a help to your patients, NOT the fringe, worst-case scenario. Genuinely hope we can work together on these issues, not separate.
Thanks, but what you said is SOMETIMES not true. My wife signed up with an advantage plan from United Healthcare provided by our state retirement system. (Wife was a teacher.) Their PPO plan lets us go to ANY doctor, in-network OR out-of-network, as long as they take Medicare. Read that again, ANY doctor. We were going to go with a supplement, but this advantage plan is better and cheaper. I know this isn't typical of advantage plans, but they are out there. In addition, prescriptions have a max. cost of $35/month for any type above generics. Generics are $10/month. There is the typical donut hole, but overall, the cost is lower than any standalone part D plan I have seen. Again while many Advantage plans are like you mention, some are a fair bit better, and for those that have access, the Advantage plan is better in almost every way.
You are correct on many levels. Advantage plans are specific to zip codes so it is near impossible to cover every variation on these plans across the country. We tried to cover the vast majority of cases, but there are exceptions, much like the plan you currently enjoy. Thank you for watching and taking the time to comment!
Yes, some employers, institutions, unions, etc., offer those types of Advantage plans to their Medicare-eligible retirees. Those plans may not be offered as individual policies. They may have higher premiums than typical individual Advantage plans, but those premiums may also be subsidized.
I too am switching to an advantage plan thru the federal government plans. It is a horse of a different color and not like these advantage plans you see being hawked on TV. They are more costly but come with 0 copays 0 coinsurance 0 deductibles even for drugs. Basically No Network except medicare. No donut hole $1 generic $35 name brand and max $100 for the most expensive category. $100 per month kickback, really good dental and vision. $120 per person per year for otc pharmacy items. No underwriting ever if you opt out and switch back to their reg plan to use as a secondary insurance. So yes there are cases of advantage plans being far better than Medicare and a medigap combination
Unfortunately, I have heard horror stories about people being denied certain drugs or procedures on an advantage plan which they would have gotten right away with the supplement plan. You didn´t mention the drawbacks of why advantage plans are cheaper.....they (insurance co.) manage your care, instead of your doctor managing your care. And, once you are on the advantage plan and get real sick, you will most likely be denied the ability to move onto a supplement plan.
He did not mention the out of pocket max $7,550.00 for Advantage and that is in network, out of network I think it is $11,300.00 per year. so idk why anyone would pick Medicare C or Advantage.
@@smoke1830 The monthly cost of a Medicare supplement plan coupled with a PDP is not possible for many to afford. If you can't understand that, I can't put it any plainer.
Medicare supplement is more then a 100 bucks a month!! Its more like 160 a month and 17 a month for drug coverage. plus you still pay the 148.50 social security part B a month. So its like 325.50 a month and Advantage plans are only 148.50 a month. If your not a world traveler, Advantage makes more sense. just sayin !!!!
@@davidharris678 Don't quite understand what you are saying. I don't have a PPO. I used to, at over $220 a month, and could pretty much choose my doctor. What I have now is an HMO.
Well, it depends. Medicare Advantage plans are great as long as you don’t get sick. They are “pay as you go” plans and you give up your control over your own healthcare. If you are comfortable with the the MA plan dictating what treatments you can receive, the hassle having to get approved for services and possibly being denied, being required to see specific doctors, paying an annual maximum out of pocket deductible of up to $7500 per year (depends on the plan) in addition to the Medicare monthly deductible, having to pay a 20% copay for any Part B drugs, such as chemotherapy drugs, paying large copays should you be hospitalized, and having limited coverage for skilled nursing care, then an MA plan may be right for you. I would not want to take that risk. At least with a supplement plan, you know that your out of pocket expenses are minimal should you become severely ill.
@@sherrellbennett1333 I was responding to your comment about the shit end of the stick as far as doctors and hospitals go. I assume you meant that with a Med advantage program you don't have alot of choice? correct me if i am wrong.
@@davidharris678 I thought their was probably a catch. I'm 60 and I was just wondering. I currently have a Medicare advantage plan and it pretty good. Copays and deductibles aren't bad, and my prescription coverage is really good. So I'm good for now I think. Thanks a lot.
@@jerryjarrett7831 Yes. What happens is they charge an arm and a leg before you turn 65 because if you have medcare before 65 it generally means you are on disability and health may not be the greatest. Because of this the Med Sup companies charge accordingly. I am glad you are happy with the Med Advantage program. I am an agent who works with both types of programs. I really dislike when some youtube agents only push Med sup on people. There is so much misinformation out here about Med Adv it is crazy.
It's not easy to understand the differences between Medicare Advantage and Original Medicare. That's not an accident, because Medicare Advantage is more profitable for Insurance companies. If you, like me, researched and googled and cussed before making a decision, you know what I'm talking about. Who cares about gym memberships and frequent flyer miles when your life is at stake? Stick with Original Medicare with a Plan G or Plan N supplement and a Plan D drug policy!
Oops. Another bad job of comparing. I'm an agent. Over 1,000 (yes, 1,000) clients. This guy left out CRITICAL info. Number one omission: DisAdvantage plans have the right, exercised OFTEN, to deny coverage. Yep - overrule your doc/hospital and simply REFUSE TO PAY. Ain't gonna happen on a supplement (Medigap) plan. That's cuz DisAdvantage plans are private REPLACEMENTS for Original Medicare (Parts A-B). You're not covered by Original Medicare AT ALL, and Medicare won't help you if you have one of those denial moments. Number two omission. On a PPO DisAdvantage plan, the max out-of-pocket numbers are STUPENDOUS - and that assumes they haven't pulled a we-refuse-to-cover-that stunt. On the UnitedHealthcare/AARP, it's $10,000 (!!!). On Humana, $11,200. That is WAY higher than the WORST "ObamaCare" plan max. Third omission. The DisAdvantage plans only exist because of MASSIVE CORPORATE WELFARE. They get an average of $9,900 per person per year as a subsidy. It comes from MY Medicare money, YOUR Medicare money, and our KIDS' Medicare money. This year ALONE, it's estimated that the WELFARE will be almost $350 BILLION. The goal is to END MEDICARE as we knew it. They're almost 50% of the way toward privatizing Medicare - almost half of the beneficiaries have been suckered into these plans, gambling with their health insurance, and shooting themselves - and their kids - in the feet. Shame.
@Mike Nurmela I am glad you posted. I have left some replies on some of the comments pointing out the same issues you raised here because this video doesn’t go into all the drawbacks of MA plans. I am not an agent, but am very well versed on the subject. I get so irritated when videos such as this one don’t give all the facts, especially since this is supposed to be a comparison between Medigap and Medicare Advantage plans.
Hi Robin, The donut hole is quite complex. We have this video that goes over how Part D works, including the donut hole. th-cam.com/video/qKz9qgf8jSw/w-d-xo.html Hope it helps! Thank you for commenting!
When you become eligible for these programs you are entering a healthcare casino. Very few people “win” in this casino. The only way you can leave this casino “ahead” is by choosing an appropriate plan, getting quite ill, and having Medicare, Medicare Advantage or Medigap paying more than you ever pay. You don’t want to leave this casino a “winner”. What you are looking to do is to lose as little money as possible. Medicare is the biggest loser in this casino and that’s why they are insolvent. The only winner in any casino is the house and in this casino the house is the insurance companies that participate in these Medigap & Advantage plans. They make far more selling these policies than they will ever pay out and that’s why people turning 65 get inundated with coverage solicitations.
Very nice and complete explanation. Spot on! I would like to add something that is from the provider/clinician perspective. Working with patients that have Medicare Advantage plans is more time consuming, more expensive, more benefit verification steps, more paperwork, more referral info, more authorizations, more denials, more requests for information after claim submission, more phone calls. There is more of everything than working with Medicare and a supplement. The patients that we serve that have advantage plans receive more statements at the end of the month for balances at a 20/1 ratio compared to straight up Medicare and a supplement. However, that is not the most concerning factor. Patients that have advantage plans now invited the insurance company in on the medical decisions. With Medicare and a Medicare Supplement its your physician that has the final word. I cant tell you the number of calls I get from friends of mine crying saying that a parent had an medical issue and their physician wanted one procedure based on their diagnosis and the insurance wanted something else and asking me what can be done to follow the physicians plan of care rather than the insurance company. I say not much other than paying out of pocket. In my opinion, go with Medicare and a supplement. Good healthcare is between you and your physician. Not between you, your insurance company, and your physician. When it comes time I will be getting Medicare and a supplement.
This is a great comment to add to the discussion. We have separate videos in the works that goes into more detail around each plan. We have heard this feedback from providers often. The two plans are geared to 2 different types of people and risk tolerances for sure.
Thank you for watching and taking the time to comment!
As a provider (speech pathology) I find that most Medicare advantage plans either deny authorization for care or require authorization and reauthorization at frequent intervals. They are also slow to respond to authorization requests. This causes extended gaps in patient access to rehabilitation while that authorization is being processed. I believe this is by design. That is to,say the plan reduces their cost by dragging their feet to authorize treatment and then only authorizing a little bit at a time. In rehabilitation we privately call these plans Medicare Disadvantage because patients get much less care than traditional Medicare participants.
I cannot say enough awesome things about this site. Second video I watch and I can pretty much say with certainty I am going to be watching them all. Thank you so much for putting the information out there in simple terms. Hope you are still here when I am 3 months from 65 as I will be so grateful for all the videos. "The Cajun Ninja's Dad"
Thank you so much for the kind words and for watching! We'll keep putting out videos like this for you!
Oh my, thank you so much for answering my comment/question. I just enjoy seeing your videos. You give so much information and that's why I follow you. Please keep up the good work. Even though we are in different States, I still get very important information from your videos.
@@MariaRamirez-id2hu you are so welcome and feel free to reach out with any questions you may have.
There is a lot of general Medicare information that applies no matter where you live. Once we start digging into plan specifics, things get much more complicated depending on where you live and the state plans.
We'll keep putting out new videos each week so be sure to hit the bell icon next to the subscribe button on our page so you are notified when we put out a new video.
We appreciate you watching, following, and commenting!
This is by far the best description of both supplement and advantage plans👍🏻
We appreciate you saying this! Thank you so much for watching!
What you said is definitely true here in Puerto Rico 🇵🇷, but yes you have to go to a network
It's the same old insurance game that we've always had. You can either pay up front with a Medicare supplement plan or try to come out ahead with an Advantage plan betting that your medical costs will be less. I've always paid more for fixed costs and better coverage so I'd stick with the original Medicare and a good supplement plan. Another troubling thing not mentioned is that if you choose an Advantage plan and keep it for a year you can NEVER go back to original Medicare without going through underwriting which means higher rates if you have pre-existing conditions.
Well said. We have a video coming soon that addresses what you mention around risk and what choices you have once you choose one and want to switch to another.
Thank you for watching and commenting!
Great point.
You can always go back to original Medicare. Its just that you may not qualify for a Med supp. Original Medicare is an earned benefit.
@@davidharris678 That's the rub...underwriting on supplement plans which can get expensive if you've got pre-existing conditions as most folks do at that age.
@@tomj528 True. But remember something. With Medicare Advantage you will come out ahead 85-90% of the time. ( This is based on actual real world numbers. I have done the research). Also again. 9/10 you will spend more money on healthcare on a Med Sup than Med advantage. It happens over about a 10 year period. Med sup premium goes up every year 5-10% or more. Can't avoid that.
Thank you so much. I found this confusing until your explanation. Much appreciated!
Thank you Susan! We appreciate you watching and taking the time to leave such a nice comment!
This is probably one the fairest comps you have done. Supplementals do have the ongoing premium which not all can afford. Advantage plans however can result in delayed and denied coverage, even more so outrageous costs if you step out of network and something happens. I may seem to be jaded, but if someone pushes Advantage outside of individual affordability- they have motive without a doubt. Thanks again.
Thank you for watching and commenting!
We see a lot of people come into our office who can afford supplement plans but still want advantage plans, even after informing them of the downsides. The 2nd big factor is risk tolerance. There are people who would rather take the risk of something potentially going wrong and saving the monthly dollars than they would paying for something they may not use (yet).
Lots of different people and mindsets out there. Our role is to educate on both and let people decide.
Medicare eligibility can start for Americans when they turn at least 64 years & nine months old or upon retirement.
Those with a disability, End Stage Renal Disease (ESRD), ALS or on Social Security disability for 24 months in a row may also qualify for early Medicare benefits.
A person must be enrolled in both Part A and B of Medicare before they can enroll in a Medigap plan.
Upon enrollment, Medicare enrollees become eligible for Medigap Open Enrollment.
This period starts on the first day of the month one turns 65 & enrolled in Medicare Part B and lasts for six months.
During this period, a person can buy any Medigap plan regardless of their health status (called "Guaranteed Issue Rights").
This is different than if someone is losing group coverage or retiring.
When this occurs, the person is eligible to exercise his or her "Guarantee Issue" right.
With a Medigap guarantee issue right, a person can buy a Medigap Plan A, B, C, F, K, or L that is sold by any insurance company in their state.
In addition, the insurance company cannot deny or raise the premium due to past or current health conditions.
Also, the insurance company must cover any pre-existing conditions.
Instead of exercising the guarantee issue right, a person can opt to go through the underwriting process in order to buy a plan G or N.
Once a person is outside their open enrollment period and/or guarantee issue, they can change their Medigap plan, but they will be subject to health underwriting by the insurance company they are applying with.
Monthly premiums apply, and plans may not be cancelled by the insurer for any reason other than non-payment of premiums/membership dues.
Furthermore, a single Medigap plan may cover only one person but may offer spousal discounts.
Finally, Medigap insurance is not compatible with a Medicare Advantage plan.
You cannot have both a Medicare Supplement and a Medicare Advantage plan at the same time.
You can only have a Medigap plan if you are still on Medicare Part A and Part B and have not replaced your coverage with a Medicare Advantage Part C coverage.
Thank you, I just found your video and It helps more knowledge about Medicare Advantage Plan and Medicare Supplement Plan. I was enlightened.
Thank you for sharing this with us. We are glad it helps. We appreciate you watching and for taking the time to comment!
Very nice explanation. I will forward this my sister, I couldn’t explain it well enough (as you did) for her to understand me.
Thank you for watching! We appreciate you taking the time and are glad it is helpful. Hopefully it helps your sister too :)
Thank you for the info. Your explanations is so simple to understand. 👍🏻
Thank you for watching and taking the time to leave such a nice comment!
Thank you! Simple and easy to understand.
Thank you for watching and commenting!
how easy is it to switch from part C back to a suppliment? I'll be 65 in May and was going to start with a C to get some dental work done and then switch over to original and add G.
Great question. The answer, as with a lot of things Medicare-related, is "it depends."
This video tries to clear that up based on a few different scenarios:
th-cam.com/video/djuGeI829M4/w-d-xo.html
Your logic makes sense though. If you are going on Medicare at 65 and take an Advantage plan, you have 12 months to try it. You can switch back to Original Medicare and a Supplement within those 12 months without needing to go through underwriting.
Once I take supplementary plan initially can I move to medical advantage plan if financial condition require?
Yes, during the Annual Enrollment Period that is October 15 - December 7 each year.
Great presentation!! Thank you for sharing.
Thank you for watching and taking the time to comment!
Well Done! We need to get the word out about you channel.
180 subscribers for quality information doesn’t cut it. 👍🤔
You are too kind Dan! Slowly but surely, we'll keep building :) Thank you for watching!
At present, I have plans N and D which are costing me over $100 a month. I've been to see my doctor one time in two years. All of my medicine and doctor visit are through the VA. I'm very happy with my VA treatment which is 100% free and includes free eye care and glasses. I don't have dental through the VA. I'm seriously considering moving to an advantage plan just for dental and to save me over $100 a month, there may be other benefits of which I could take advantage. So far I've spent over $2000 and have only seen the doctor one time, not a good return on my money.
For those with VA coverage, we usually don't recommend Supplement plans, especially if you are happy with you VA coverage. There are a lot of Advantage plans out there like you mentioned that are $0 and have other perks.
We have a video specifically on VA and Medicare here:
th-cam.com/video/jkmpKCEw2H4/w-d-xo.html
Thank you for watching and commenting!
Great, easy explanations... well done..
Thank you!
Great comparison! Loved the combo meal vs a la carte anology!
Thank you Sherry!
I thought these two terms referred to the same type of extended coverage.
Great info! So very useful
Excellent summary. I keep getting confused about emailed 'reminders', stating I need to review my plans. I've called, and unless I'm getting bad info, both my Medicare and the supplement (the older plan 'F'), will remain by default. I sure hope that is correct.
That’s correct. If you have Original Medicare and a supplement, nothing will change and you don’t have to do anything. You may however, want to look into doing a cost comparison of your Plan F with a Plan G if you haven’t done so in a few years. Especially if you are in fairly good health and can qualify, you can probably find the same coverage at a lower rate.
Both you and Mary Beth Mc Coy are correct. Your plan will stay active and you don't need to do anything.
Mary Beth Mc Coy is also correct around looking into potential cost savings by going from F to G. Definitely worth a conversation with your agent.
@@MaryBethMcCoy Thank you for your reply. I see '90 Days from Retirement' also affirmed the continuity.
@@Theretirementnerds Thank you for your reply. The agent did suggest potential savings. But the differences seemed more nuanced than substantial, and are dependent upon speculative scenarios.
So far, I've not used either Medicare or the supplement. If I believed that would indefinitely remain the case, I could focus on cost cutting. But since insurance largely covers unpredictable events (broken bone, heart attack, cancer, etc.), I'm OK with paying a little more for (hopefully) a little better coverage for whatever event I'll likely, eventually experience. Meanwhile, I focus on the REAL cost cutter - maintaining a healthy lifestyle.
@@gregparrott Maintaining a healthy lifestyle is a very wise approach. Prevention is much less problematic than treatment.
It sounds like you have a good relationship with your agent, which is important. Maintain that relationship.
We wish you excellent health and thank you for your comments!
What about paying for the Medicare part b plan? Do you have to pay this with the MA plan?
Hi Robin,
In most cases, yes. There are MA plans for Veterans as well as those on Medicaid (low income) that have Part B reimbursements. There are a few that have reimbursements even for those who are not Veterans or on Medicaid. It will all depend on where you live, but most people outside of again, Veterans and low income Medicaid will also need to pay their Part B premiums as well.
This video goes into that a little more:
th-cam.com/video/3Mwm87ST2dw/w-d-xo.html
Thank you for watching and commenting!
Good Explanation...
Thank you for watching!
Love your videos Erik!
Thank you Brandi!
Very good analogy
Thank you Judith!
The presenter tells me to "stop talking bad about [Dis] Advantage plans" because "you don't understand them." Oh, but I DO understand them. I don't talk bad about them - I merely provide information about the risks and what they really are. Guys like this presenter - along with every ad on TV or in your mailbox - fail to disclose the whole story. That's reprehensible.
Just to clarify. The person you are debating in the comments is not the presenter in the video.
Our channel is coming out with more detailed videos around Supplement and Advantage plans in the coming days that will address some of your points.
We appreciate you watching and taking the time to comment and be involved in the Medicare conversations.
Explained so well
Thank you for watching and your nice comment!
Great video
Thank you Sharon!
What he did not talk about is if you get sick on an advantage plan and you get sick it gets very expensive! Then if you want to go on a Medigap plan now you have to go through underwriting and will have to pay a higher premiums . He left lots of information out!
Hi! And thank you for watching and leaving a comment. We address total risk of both plans in this video: th-cam.com/video/3Mwm87ST2dw/w-d-xo.html
We are currently editing a video that goes into much more detail about Advantage plans specifically so keep an eye out for that and it should address the points in your comments that were not in this particular video.
Thanks again for watching!
For me it would be advantage Plan thank you 🇵🇷🇺🇸🌎
Would you agree that it seems like a better food analogy would be, Advantage plan= you have to eat at Burger King. Supplement plan=eat almost anywhere you want including another town.
I do like your food analogy. Based on the plans available where we are, we would put the Advantage plan on a higher level than Burger King :) but yes, a classier chain restaurant vs almost any restaurant is a pretty great analogy in this case.
The main con, which allows all of the "pros" is the hurdle of prior authorization. These advantage plans receive funding by the govt and they turn a profit by denying you care via this authorization process, not by being more efficient at delivering care. In fact they make a ton of money off these plans which is why they push them so hard. As a physician I can tell you multiple times per week I receive denials from advantage plans. Sometimes I'm successful in changing that decision but a fair amount of the time I'm not. This never occurs with traditional medicare. Additionally, if you do need a test/procedure/imaging study/etc this can be done the next day. With the advantage plans the authorization process can take weeks delaying care and prolonging suffering. If you can afford a medicare supplement it is almost always a better decision. The only time an advantage plan is likely better is if the financial burden of a supplement plan is too large and you assume you will never be significantly sick. The sad reality of anyone pushing these advantage plans is that they are paid everytime they convince someone to sign up for one. This is probably true of the gentleman in this video as well. So I caution everyone, buyer beware.
Seeing you did a copy and paste of this comment on any video that mentions an Advantage plan, we'll copy and paste the response.
Appreciate you watching and adding your perspective. Would caution about making judgements like that. Our group does not push Advantage plans and we have several videos that outline how they really work.
There are several cases against physicians committing fraud against Medicare because they know Original Medicare will pay. Extra, unnecessary tests and procedures are added to get more dollars. Would it be fair to say that you, as a physician, probably do this and people shouldn't trust physicians even though we know nothing about you except that you are a physician? Doesn't seem like a decent way to treat people.
We would rather hope that you are ethical like the VAST majority of physicians we know trying to do right for your patients and not one of the bad apples that cheat the system for profit.
We welcome all opinions. We agree with your assessment of how some Advantage plans have the prior authorization hurdles, can be difficult to work with, and deny care. Just careful with character judgements.
@@Theretirementnerds No character judgements were made. I didn't question your ethics or morals. Your comments did that for me. I was simply highlighting for the viewers the important fact that many people promoting these plans do so for profit. In contrast, you did make a character attack against me and imply I defraud Medicare. Based on what, I have no idea. Also, you seemed to make an argument in favor of Advantage plans as a way to prevent fraud. I assume then, you are not aware of the dozens of lawsuits against these plans by whistleblowers, the govt, etc. for improper coding regarding the level of health issues of their subscribers? So these plans, which were sold as being more efficient, are instead costing tax payers untold billions. Given you have never had the "pleasure" of arguing for weeks with one of these plans about a necessary treatment for your patient, only to be denied because of their own unique company policy, I would assume you would show some humility. Even worse yet, is having to be the person to explain to the patient why their treatment was denied and bearing the brunt of their anger, frustration, sadness and despair. This is an ever growing cause of physician burnout and something insurance agents never have to deal with. Instead, you choose to cast aspersions and change the focus of the debate, which is the fact that these plans have many drawbacks and are universally worst for most.
A lot of copy pastes happening, but it is important.
In a different way, we do address the prior authorizations and denials with our clients who, in turn, are patients of providers like yourself. Our conversations, while difficult, do not compare in difficulty to yours as the physician counseling your patient in the high-stress environment of healthcare. The unfortunate part of this comment string is that I think we both agree on the crux of the issues. We both agree that prior authorizations and the managed care aspect of Advantage plans are a drawback to these plans and a matter to look at and make sure it improves, which from what we see and experience, is happening. Is it where it should be? No, but we, along with agents in this community are advocating for the same thing you are.
Our whole point in the caution against character judgements was the implication made that we are pushing our clients into Advantage plans - at their detriment - for a higher 1st-year commission that comes with Advantage plans, which we disclose in this video and others. Our business model, just like your practice, would not be sustainable if we were pushing people into inappropriate plans.
We do not accuse you of Medicare fraud. It is the exact opposite. It would be foolish of us to accuse you or any other provider of fraud solely based on the fact that you are a physician because we heard that there are physicians out there who do those practices. The way we phrased it, which is the downside of comments made through a keyboard, was meant to show how unfair it would be to make such a blanket statement with no information about how you run your practice or treat your patients. Same thing here. To assert that we are pushing people into Advantage plans, having never sat down and seen the at-times-hours long conversations we have with our clients about their health, finances, risk tolerance, and plans available to them prior to their decision, seems equally unfair.
There are agencies out there who put people on a plan and hope to never speak to them again. We aren't that agency. And to your excellent point in your most recent comment, the additional hours of conversations and phone calls that we have with our clients and the insurance carriers to help and push where we can with those prior authorizations and denials - happens every day.
When we see that you are a physician, our first thought and assumption is that you are amazing at what you do and are a help to your patients, NOT the fringe, worst-case scenario.
Genuinely hope we can work together on these issues, not separate.
Thanks, but what you said is SOMETIMES not true. My wife signed up with an advantage plan from United Healthcare provided by our state retirement system. (Wife was a teacher.) Their PPO plan lets us go to ANY doctor, in-network OR out-of-network, as long as they take Medicare. Read that again, ANY doctor. We were going to go with a supplement, but this advantage plan is better and cheaper. I know this isn't typical of advantage plans, but they are out there. In addition, prescriptions have a max. cost of $35/month for any type above generics. Generics are $10/month. There is the typical donut hole, but overall, the cost is lower than any standalone part D plan I have seen. Again while many Advantage plans are like you mention, some are a fair bit better, and for those that have access, the Advantage plan is better in almost every way.
You are correct on many levels. Advantage plans are specific to zip codes so it is near impossible to cover every variation on these plans across the country. We tried to cover the vast majority of cases, but there are exceptions, much like the plan you currently enjoy.
Thank you for watching and taking the time to comment!
Yes, some employers, institutions, unions, etc., offer those types of Advantage plans to their Medicare-eligible retirees. Those plans may not be offered as individual policies. They may have higher premiums than typical individual Advantage plans, but those premiums may also be subsidized.
I too am switching to an advantage plan thru the federal government plans. It is a horse of a different color and not like these advantage plans you see being hawked on TV. They are more costly but come with 0 copays 0 coinsurance 0 deductibles even for drugs. Basically No Network except medicare. No donut hole $1 generic $35 name brand and max $100 for the most expensive category. $100 per month kickback, really good dental and vision. $120 per person per year for otc pharmacy items. No underwriting ever if you opt out and switch back to their reg plan to use as a secondary insurance. So yes there are cases of advantage plans being far better than Medicare and a medigap combination
Unfortunately, I have heard horror stories about people being denied certain drugs or procedures on an advantage plan which they would have gotten right away with the supplement plan. You didn´t mention the drawbacks of why advantage plans are cheaper.....they (insurance co.) manage your care, instead of your doctor managing your care. And, once you are on the advantage plan and get real sick, you will most likely be denied the ability to move onto a supplement plan.
He did not mention the out of pocket max $7,550.00 for Advantage and that is in network, out of network I think it is $11,300.00 per year. so idk why anyone would pick Medicare C or Advantage.
@@smoke1830 Cost is why Part C makes the most sense for many.
@@TK-cl1jm Cost and or risk is the main reason not to chose Advantage, in particular the out of pocket possible costs.
@@smoke1830 The monthly cost of a Medicare supplement plan coupled with a PDP is not possible for many to afford. If you can't understand that, I can't put it any plainer.
@@TK-cl1jm I hear you, and I am sure many are in that boat...however when they get the huge out of pocket bill they will be in worse shape.
Medicare supplement is more then a 100 bucks a month!! Its more like 160 a month and 17 a month for drug coverage. plus you still pay the 148.50 social security part B a month. So its like 325.50 a month and Advantage plans are only 148.50 a month. If your not a world traveler, Advantage makes more sense. just sayin !!!!
Financially maybe, but you get the shit end of the stick as far as doctors and hospitals.
@@sherrellbennett1333 Nope PPO plans give you just as many options for doctors as med sup and OG medicare do.
@@davidharris678 Don't quite understand what you are saying. I don't have a PPO. I used to, at over $220 a month, and could pretty much choose my doctor. What I have now is an HMO.
Well, it depends. Medicare Advantage plans are great as long as you don’t get sick. They are “pay as you go” plans and you give up your control over your own healthcare. If you are comfortable with the the MA plan dictating what treatments you can receive, the hassle having to get approved for services and possibly being denied, being required to see specific doctors, paying an annual maximum out of pocket deductible of up to $7500 per year (depends on the plan) in addition to the Medicare monthly deductible, having to pay a 20% copay for any Part B drugs, such as chemotherapy drugs, paying large copays should you be hospitalized, and having limited coverage for skilled nursing care, then an MA plan may be right for you. I would not want to take that risk. At least with a supplement plan, you know that your out of pocket expenses are minimal should you become severely ill.
@@sherrellbennett1333 I was responding to your comment about the shit end of the stick as far as doctors and hospitals go. I assume you meant that with a Med advantage program you don't have alot of choice? correct me if i am wrong.
DO YOU HAVE TO BE 65 TO BE ELIGIBLE FOR A MEDICARE SUPPLEMENT PLANS?
No. But they are real expensive if you are below 65.
@@davidharris678 I thought their was probably a catch. I'm 60 and I was just wondering. I currently have a Medicare advantage plan and it pretty good. Copays and deductibles aren't bad, and my prescription coverage is really good. So I'm good for now I think. Thanks a lot.
@@jerryjarrett7831 Yes. What happens is they charge an arm and a leg before you turn 65 because if you have medcare before 65 it generally means you are on disability and health may not be the greatest. Because of this the Med Sup companies charge accordingly. I am glad you are happy with the Med Advantage program. I am an agent who works with both types of programs. I really dislike when some youtube agents only push Med sup on people. There is so much misinformation out here about Med Adv it is crazy.
Some states don't allow these plans for SSDI recipients.
It's not easy to understand the differences between Medicare Advantage and Original Medicare. That's not an accident, because Medicare Advantage is more profitable for Insurance companies. If you, like me, researched and googled and cussed before making a decision, you know what I'm talking about. Who cares about gym memberships and frequent flyer miles when your life is at stake? Stick with Original Medicare with a Plan G or Plan N supplement and a Plan D drug policy!
Oops. Another bad job of comparing. I'm an agent. Over 1,000 (yes, 1,000) clients. This guy left out CRITICAL info. Number one omission: DisAdvantage plans have the right, exercised OFTEN, to deny coverage. Yep - overrule your doc/hospital and simply REFUSE TO PAY. Ain't gonna happen on a supplement (Medigap) plan. That's cuz DisAdvantage plans are private REPLACEMENTS for Original Medicare (Parts A-B). You're not covered by Original Medicare AT ALL, and Medicare won't help you if you have one of those denial moments. Number two omission. On a PPO DisAdvantage plan, the max out-of-pocket numbers are STUPENDOUS - and that assumes they haven't pulled a we-refuse-to-cover-that stunt. On the UnitedHealthcare/AARP, it's $10,000 (!!!). On Humana, $11,200. That is WAY higher than the WORST "ObamaCare" plan max. Third omission. The DisAdvantage plans only exist because of MASSIVE CORPORATE WELFARE. They get an average of $9,900 per person per year as a subsidy. It comes from MY Medicare money, YOUR Medicare money, and our KIDS' Medicare money. This year ALONE, it's estimated that the WELFARE will be almost $350 BILLION. The goal is to END MEDICARE as we knew it. They're almost 50% of the way toward privatizing Medicare - almost half of the beneficiaries have been suckered into these plans, gambling with their health insurance, and shooting themselves - and their kids - in the feet. Shame.
Stop talking bad about Medicare Advantage. You don't sell them and don't understand them.
For someone with so many clients, you sure are spewing a lot of absolute false information about Medicare Advantage plans. $10,000 MOOP is nonsense.
@@TK-cl1jm No it’s not.
@Mike Nurmela I am glad you posted. I have left some replies on some of the comments pointing out the same issues you raised here because this video doesn’t go into all the drawbacks of MA plans. I am not an agent, but am very well versed on the subject. I get so irritated when videos such as this one don’t give all the facts, especially since this is supposed to be a comparison between Medigap and Medicare Advantage plans.
What about the Medicare donut hole?
Hi Robin,
The donut hole is quite complex. We have this video that goes over how Part D works, including the donut hole.
th-cam.com/video/qKz9qgf8jSw/w-d-xo.html
Hope it helps! Thank you for commenting!
Advantage plans have gatekeepers - bigtime!
When you become eligible for these programs you are entering a healthcare casino. Very few people “win” in this casino. The only way you can leave this casino “ahead” is by choosing an appropriate plan, getting quite ill, and having Medicare, Medicare Advantage or Medigap paying more than you ever pay. You don’t want to leave this casino a “winner”. What you are looking to do is to lose as little money as possible. Medicare is the biggest loser in this casino and that’s why they are insolvent. The only winner in any casino is the house and in this casino the house is the insurance companies that participate in these Medigap & Advantage plans. They make far more selling these policies than they will ever pay out and that’s why people turning 65 get inundated with coverage solicitations.
Wow, you talk very good, but way TOOOOOO... fast.
Sorry! We will try to slow it down in future videos.
Thank you for watching and commenting!
Sucks