Why I Would Never Choose Medicare Advantage
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- เผยแพร่เมื่อ 22 พ.ค. 2024
- In this video, I'll share why I would never choose Medicare Advantage. If you're considering your Medicare options, this is a must-watch!
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In this video I discuss why I personally would never choose to have a Medicare advantage HMO plan. You can make your own decisions.
00:00 Intro
00:25 Keith Armbrecht
02:01 Managed Care
03:34 Please Subscribe
03:53 Cost Difference
07:25 Pre Authorizations
08:35 Referrals
09:30 Networks
10:35 Travel
14:34 Leave a Comment
Reasons I would never choose a Medicare Advantage HMO plan:
Reason #1 - Limited network of doctors and hospitals. A Medicare Advantage HMO plan will have a network of doctors and hospitals you are required to use to receive care. Generally the lower the premium the smaller the network. Many times you will find a lower quality of doctors and hospitals in the network.
Reason #2 - Pre Authorization. For most specialty items you will need to ask for permission before service is rendered. You can find many horror stories where care was denied for something a doctor had recommended.
Reason #3 Out of Pocket expense. MAPD can be very expensive when you use it.
Reason #4 - Doctors and hospitals leave plans on a regular basis. You may need care and find out that your doctor is no longer in the plan.
Reason #5 - Very limited coverage when traveling. Most HMO plans only cover emergencies when outside of network. If you have an extended care you will have to travel back in network.
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I am an RN who worked for an HMO at one time that offered Medicare Advantage Plans. I was trained to deny claims as a prior approval/utilization review nurse. I only lasted 3 months there because I could not in good conscious continue to deny services to clients who in good faith signed up for the plan only to have something really bad happen and find they could have the procedure they needed or the stay in rehab that would help them recover. I remember one 80 year old Spanish speaking only, tracheostomy patient that need home health to come an teach the wife to do the trach suctioning. The HMO would only pay for 1 home health visit and NO disposable supplies. I was supposed to tell the family to reuse the sterile trach suction catheters by soaking them in 3 parts water and 1 part Clorox. That was the end for me, I could not lend my name to that kind of 3rd world care in this country where poor people suffer disproportionally in cases like this.
How does one get out of it?
The atrocities that occur in our healthcare system are astounding….I know 1s hand working with the clinical trials…
That's awful! I totally agree as I was a CNA for eight years.
Happened to me, I have Medicare advanced plan they denied my tooth inplant after so many calls with no help to me end Paying over a $1000 to have y implant. Thank you for this information 👍
I think the ISP you worked for is very un ethical, my ISP is the opposite , treat me fast and well, I was under HMO at that time
My wife and I signed up for Medicare plus the G supplement plus Medicare D. At First it was fine, but after 3- 4 years it was costing us 700 dollars a MONTH. We kept it when we were traveling. It did pay claims, but we did have to pay some stuff. It just became too expensive to keep. So, we changed to the Advantage type after moving to a higher population area. Referrals are not a problem most of the time. Now our max out-of-pocket is 700 dollars a YEAR. My drug copays were 25 bucks for the YEAR, no deductible. True, we have to stay within the provider groups, but we have quite a few to pick from. Original Medicare is great, if you're rich or can go to wherever you have the money to afford to seek out expensive care. Not so much if you live in a backward state or a medical wasteland. Either way you go, you're screwed. Insurance companies, PBMs, hospitals, medical groups, drug companies, crooks who cheat Medicare at every turn are what we Americans are stuck with at this point. The ruling rich overlords will never change it. Congress and the courts have been bought, and YOU AND I have been stuck with the bill.
Can usually keep the price down by comparing each year.
@@MedicareonVideo Wouldn't that be hoping that the client could also pass through underwriting?
Absolutely. This comment spells it out the way it is. Doctors don't like to take original Medicare. In effect, you have a more limited network by staying on Medicare original, and you have to pay for both the supplement the medication premium. I strongly recommend the Medicare advantage plans with no monthly premium. They have enough providers of all types that you still have choice.
True- either pay up front(supplement) or pay if you have an unexpected hospital stay (advantage)
@@JohnDavis-yz9nq John I am licensed agent and EITHER way can bleed ya...it is the hope of Medicare that NO ONE uses it.
Inflation and Recessions are part of the economic cycle, all you can do is make sure you're prepared and plan accordingly. I graduated into a recession (2009). My 1st job after college was aerial acrobat on cruise ships. Today I'm a VP at a global company, own 3 rental properties, invest in stocks and biz, built my own business, and have my net worth increase by $500k in the last 4 years.
You need a Financial Advisor my friend so you don't get ripped off in the market. They provide personalized advice to individuals based on their risk appetite, placing them among the best of the best. There are bad ones, but some with good track records can be very good.
I know I've wanted to start investing for a few months, but just haven't had the courage to start because the market has been down for most of this year. Please how can I reckon with such skills and what are his services like?
Congratulations on your impressive achievements! It's inspiring to hear how you were able to overcome the challenges of graduating during a recession and pivot your career to achieve such success. Your story highlights the importance of being prepared and adaptable in uncertain economic times. It's great to hear that you have diversified your investments and built a solid net worth. Your journey is a testament to the power of hard work, resilience, and strategic planning. Thank you for sharing your story with us!
Big deal.
@user-ep5ce1cc5m
What the f*** does that have to do with any of this?
I have a PPO advantage plan and I have never been denied anything, and I've had many MRIs and expensive cardiac tests. Pre-approval for one test was done within 24 hours. However, my mother was on a supplemental plan and they denied her a life-saving surgery after already approving it. They didn't deny it until she was in the hospital, being prepped for surgery. She had no choice but to have the surgery and ended up paying THOUSANDS out of pocket. We had to sue that company to recoup her losses. Plus, supplemental plans cost so much in FL that as someone with low income, I could never afford them. You can push these plans all you want, but they are just as bad as any advantage plan. All insurance companies are crooked.
Most of our friends have a PPO and no issues so far
Yep!
@gk_filer That is because it is probably. You must live in a fairly wealthy area. That is why plans depend on your zip code. Average and lower income persons would not be offered plans offered in wealthy areas. They cannot afford them. So they get hmo plans. At least with Medicare it always pays 80% . Get reliable secondary insurance. With scripts if possible.
@patriciaberry4630 You are wrong in so many ways. Original Medicare does NOT pay 80%! Figure it out! With what you pay for Medicare and with ALL the deductibles and no guarantee on max out of pocket, they pay no where near 80%! But please stay with Medicare.....you are one of those paying for my great MA plan. I live in a low income area.....where it's all a service area. With my MA plan I feel like I'm wealthy with them giving me money for groceries and OTC supplies and now even paying my utilitiy bills. Please folks STAY with original Medicare. I don't want ANY more folks going with MA plans as if too many go with MA we will lose our great benefits. I like hearing this guy tell you all those lies, he sounds like trump splaining! Just like trump telling folks how bad off they are. We've never had it so good in reality. Under trump the cost of Medicare went up every year but with our real President Biden everyone's Medicare costs have gone DOWN. I'm happy so many of you believe all these lies as it makes it so much better for the rest of us.
@@GAderly-fn5ly Sorry you are the one that is wrong. I have had medicare since 2009. I have never paid a Co pay. A couple times paid small amounts. My secondary picks up what medicare does not pay. You are not very bright calling someone a liar. Opinions are okay. But not accusations. I have also done medical billing and coding and knowledge of patients imput. What do you have?
You’re right on point. I’ve worked in healthcare business for 20yrs. When asked, I tell people to hold onto their traditional Medicare. Don’t buy into the selling points. When my parents became Medicare eligible, I advised them the same way. Stay with traditional.
Why? Doesn’t that mean you don’t get part D or C the prescription drug cost and more? I’m confused and new to this
@@kiaraosorio7276 part C is Advantage. Part D is drug. You can get drug coverage with your supplemental insurance. Or you can buy a stand alone Part D coverage.
The problem with brokers are they make their $$$ by selling insurance and insurance plans. One insurance plan pays them more $$$ than the other one, example, if they sell plan G they get paid more by the insurance company so, who do you trust 🤷♀️.
@@10speed4 Who do you trust? I trusted my doctor's Financial Office workers' opinions. They deal with Original Medicare, Medicare Advantage programs and supplemental coverages on a daily basis. I used their advice as a guide to help me find an insurance broker. That person told me the same as this speaker has related.
Medicare is backed by the government. If your Dr decides you need a test, procedure, or surgery, you get it with original Medicare, no questions, no refusals. The amount Medicare does not cover is paid for by your supplemental insurance, no questioning. But, if you have Medicare Advantage, it is run by private insurance companies who:
- can refuse coverage, even though your Dr has prescribed the test, procedure or surgery.
- they (insurance companies that run Advantage plans) can go out of business, leaving you with no coverage.
- The private insurance company that runs your Medicare Advantage plan can significantly increase your cost of coverage by increasing your premiums & deductibles, as much as they want, as many times as they want. Medicare does have increases in cost & deductibles, but not as much, or as often as Advantage Medicare's increases.
- Original Medicare is the same coverage, no matter where you live in the US. If you have Medicare Advantage, the coverage can vary, depending on which state you are in. Private insurance companies do not have the same coverage in each state. So, if you move to another state, you may not get the same coverage that you had in the state you moved from.
This experience shaped my decisions on choosing my Medicare coverage.
Years ago, I was very ill (not on Medicare then, had private insurance policy). It was a long, serious illness. Long story short: though I had an insurance policy that was supposed to cover the care I needed- the insurance company continually refused tests, procedures, and surgery needed to save my life. They refused to pay for things that were supposed to be covered under my policy- that I continued to pay each month. They were trying to save money- at the risk of my life. Obviously, I survived. But- due to my previous experience with insurance companies, I was not about to go with Medicare Advantage when they could do the same thing to me again- deny coverage they had promised.
This is my experience, my opinions & my conclusions from the info I was given.
I suggest you research the differences in Medicare & Medicare Advantage carefully before you decide which to choose.
Thanks, I hope many stay with regular Medicare. That way those of us getting all the extras at no cost will continue to reap the rewards. If everyone went with the Advantage plans they would take away our great benefits. I also tell some folks to stay with Medicare. As for my wife and myself, we have had the Medicare Advantage plans for 17 years and they have saved us hundreds of thousands of dollars. We never see a medical bill and pay NOTHING for our plan. Our plan pays us back what is taken out of our Social Security checks plus gives us a grocery card for 50 dollars each for groceries. We also get 75 dollars each for OTC products. We have comprehensive dental and vision included at NO COST. And of course it includes prescriptions at no cost. Oh, yes, they have a nice minivan to take us to our appointments or pharmacy. We do our grocery shopping while at our Walmart pharmacy . But, PLEASE , folks stay with regular Medicare! You are paying for our extra benefits! Our doctor's office even pay us to see the doctor and to get our flu shots. Our Doctors office ALSO has a van to take us to and from appointments . So PLEASE folks stay with the old Medicare.
I have a Medicare advantage plan and I wouldn’t ever think of leaving unless there was some dramatic change. This coverage has gotten me through two bouts of cancer, and they have never caused me any grief or delays. Also, I had rotator cuff surgery recently, and I was shocked at how little I had to come out of my own pocket, really, really shocked!
Thank you for sharing your positive experience with Medicare Advantage! It's wonderful to hear that you've received excellent coverage and support during your health challenges. Medicare Advantage plans can be a great option for many individuals, especially when it comes to providing comprehensive care and minimizing out-of-pocket expenses. It's important to find a plan that suits your specific healthcare needs, and we're glad you have found one that works well for you. Thank you for watching and for your valuable feedback! 🙌🏼
I get so confused with all these variety suggestions and warnings,
I’m about to start Medicare and have been told to always go with advantage plan.
This is stressful and so very confusing shouldn’t be.
@@debbieklose8776 I remember being in your shoes and I will agree at first it is incredibly confusing. However, the supplemental plan comes with a monthly premium that you must pay. With a Medicare advantage plan there’s no cost ….you just select if you want an HMO or PPO plan, and confirm that your providers are included in the network. Good luck
Go by proof of experience? takes one to make a video.@@debbieklose8776
What is the name of your medicare advantage plan? Sounds good!!
I really like my Advantage plan!
Haven't had any problems, never denied coverage never any monthly output, always had complete coverage.
Have you been really sick yet? The kind of sick that cost over a $100K I have..Thats when you will hate that advantage plan...Did you buy that advantage plan because Donald Trump and the GOP supports them?
Wellcare was not accepted at enough facilities and they refused to cover scripts and diagnostics ordered by Doctors not in their plan
Check out Cigna, I really like it, Cigna advantage plan..
3.000 a year dental, nothing is not covered, like a blank check!
Broke my back in several places a year ago this October, no exaggeration, Ive had every diagnostic procedure there is plus any doctor, any hospital therapy, Chiropractor, braces medicine, never a copay yet, much more..
I'm sorry I didnt check this out years ago..
I've had Viva (can't be trusted), used my ss plan when I first started ss which is zero helpful! 😅
I don’t know which Advantage plan you have but I’m a physical therapist and every patient that has an advantage plan have consistently been cut short on coverage for services! Every Advantage plan cuts services!
@@meditation6054 That's the plan advantage (for them)
Unfortunately, many of us can’t afford anything else. We have had a Medicare Advantage plan for the last 10 years and it has delivered excellent care for us. It all depends on which plan you choose. Do some research and compare the different companies for their customer satisfaction ratings, and get input from friends who have these plans.
Until you have something catastrophic go wrong and you aren't in your coverage area.
@@rhondarowley6705 My UHC advantage plan documentation says it covers emergencies no matter where I am or what hospital I go to. Are they lying?
Is it possible to switch back to original Medicare, having no medical scenario?
@@km4hr They won't cover emergencies 100%...you will be left with what ever the doctor charges that your plan C won't cover. Read the fine print and NEVER believe an insurance company.
Very slated and MIs information by this you tuber..but what do u expect from You tube! LOL’s
I’ve had a Medicare advantage plan for about ten years, and never had a problem even though I had a stroke, rheumatoid arthritis, and pneumonia.
I take nine Rx a month and this past month, February,I paid out 37.00. thanks for your input I’ve had the same doctors for many years.
What insurance did you have
Wow - I pay a fortune for RX
Agree. Me2 ZERO PROBLEMS
❤️KELSEY-SEBOLD HOUSTON TX
Get em Joy you don’t need the supplement plans my Mom paid $179.00 a month for G and never used it $6000.00 down the drain
Joy, that's great to know. I stayed on the original Medicare for a few years but finally switched to Medicare Advantage and am very pleased with it thus far. Seems much easier to me all the way around. I like my docs and the network.
I spent the last half of my career working in the billing office for a medical specialist group. I dealt with everything from private insurance, worker's compensation, medicare, medicaid, etc. By a large margin, the problems I encountered with payment denials came from Medicare Advantage plans. And most of those happened because people did not understand the rules of their plans. Thanks for the informative video.
Exactly!
Although, it would seem as though a lot of the issue is with provider groups not confirming Advantage plan coverage prior to treatment. It seems like pre-auths are needed - I’m not sure how most patients would even know how to communicate with insurance carrier or have the relevant information. Stuff only the provider could know.
I'm seeing the payment denials because of in proper billing to the insurance company (using the wrong code) I'm showing that on one of my claims in my portal.
So, who at Medicare is working on weekends, holidays, and evenings? I worked for Medicaid and we never worked those hours.
@@Melanie-ix4nq That is common but it is often the nurse's fault.
After working in healthcare (I'm a psychologist) through the heyday of managed care, and knowing how important it is to me to be able to choose my own doctor (they aren't all the same!), I went straight to Traditional Medicare. I know that there are some great Medicare Advantage plans that people really like. But people often love their plan until they get very sick. Then the claims start getting denied.
My best friend and I were seeing the same physical therapist. I could get as many sessions as my doctor would recommend. She had to beg for more sessions, haggle for a reasonable cost due to confusing payments from her Medicare Advantage plan, and end PT before she was better. It was appalling!
You may believe you are saving money with a MA plan. But if you have to pay for physical therapy or some other service that isn't covered, you'll send up spending more. And God forbid you need prior authorization for something before getting much-needed treatment! There are horror stories of people who have died waiting for that prior authorization.
Ever notice how many ads there are for MA plans? Guess where they get that money? It comes out of the premiums they collect. That's money that won't go to healthcare. This is just wrong.
Most of these stories are made up by those selling those supplement plans. The MA plans MUST cover EVERYTHING that original Medicare does BY LAW! In more than 15 years on a MA plan we have NEVER been turned down for ANY care covered by Medicare or the .A plan! There are rules these plans MUST go by. Several times my MA plan has even gone out of network for me and paid the ENTIRE cost even though I would have had a copay in network. If you can't read your plan, please have someone else read a d explain it to you. I call CMS first if I expect a problem. If my MA plan doesn't have a supplier within a reasonable distance, they have gone out of network. At one point Walmart optical refused to sell me the transition lens for the plans agreed upon price so I purchased the glasses anyway but complained vigorously and they sent me out of network to purchase another complete glasses both frames and lenses and paid the entire 420 dollars!
@@GAderly-fn5ly Nobody should to have to complain that much to get what they need. Very glad that it worked out for you but it may be denied for another.
@glw5166 You have to be your own person when it comes to your health! NO one can speak for you better than yourself. Those on original Medicare are much more at risk than those on an MA plan. MA plan personal and doctors help you oversee your health plan. They want you to stay healthy. Original Medicare folks want you to come as often as possible to see all kinds of doctors as that's where they make the big bucks. With MA plans your primary care doctor gets your referrals for you. They KNOW if you really need a specialist and they willingly refer you to a specialist if needed. It's not the MA plan that gives you the referrals but your PCP. IT'S NOT the MA plan that gets you the referrals, it's your PCP. It doesn't cost your PCP for your referrals and even your MA plan has specialists on contract so referrals are NOT a problem. With original Medicare doctors get paid from each other for referrals so they will give you referrals even if they know you don't need that specialist. They will pass you around from one specialist to another just for the money. With MA it doesn't work like that. You have no advocate with original Medicare, you are on your own. You can go bankrupt on original Medicare. MA plans protect you with max out of pocket expenses. If you need lots of Healthcare and many doctors you reach your max early and then there's no charge after that. Even you prescription drugs have a max out of pocket, then it's all free. This doesn't happen with original Medicare even with those super expensive supplements. My wife had both knees replaced, at different times of course. The first cost us 295.00 and the second cost us 195.00 TOTAL! That INCLUDED aftercare and rehab! Her second knee replacement, they gave her a sw
Totally agree ALL the ads are for advantage plans , and 0 dollars for the premium 🙄, you don’t get something for nothing… never Advantage for me
@@Rnjeepshoelver Right. They are making money off of those plans, and that's money that just doesn't go to healthcare. Plain and simple.
For regular folk the Medi-gap premium can get really high as you get older. Best option is to research and educate yourself the difference between Medi-Gap vs Medicare Advantage. The entry rate for Medi-gap may be great but increases rapidly. The competition in the Medicare advantage is really providing great benefit but remember to alway look at the Medical Group you choose. The Medical Group make all the difference in the quality of your care.
You are correct. there are thousands upon thousands of us out here that survive on Social Security only and we simply can afford nothing other than the zero premium medicare advantage. I dont know what you mean by medical "Group"
I don't care what medical group I get. You can change every month. Very few care about your health, they only want that free Medicare money! If they are good doctor and have a good practice they don't want to deal with Medicare. In Florida very few actually understand English. They can say English words but have no idea what you are really saying. You HAVE TO. E YOUR OWN ADVOCATE!
@johnsonpaul1914 ALL the MA plan are owned by groups then bought out by a major company like Anthem. Those owned by those big broker houses are the o es that give you trouble. You MUST know what your plan pays for and what they don't. ALL must cover EVERYTHING that original Medicare does. Most cover some type of Dental but many don't ACTUALLY have dental offices that will honor their plan. These EXTRA services are proctored by other companies that care NOTHING about you. There actually is NO OVERSIGHT over any of these plans except Congress itself. CMS just turns your complaint back to your plan. That's like letting a fox guard your chickens. CMS is like a union for the Medicare Advantage plans. They protect the MA plan NOT YOU! CONGRESS does have control over all these plans so make certain you know your congressman. IF you are lucky he is a Democrat, the Republicans won't help you.
I’m on an advantage plan now for 8 years. I’m very grateful for my plan.
When you went back to original Medicare did you go thru the medical underwriting (as this man claims?)
Evidently you have not have had to use it. When you have to use it you will be in for a big surprise and will be ungrateful for your plan. Hope that you own a bank because you are going to need a lot of money in the end. Sad part is you are stuck and cannot go back to the original Medicare.
@@kellikelli4413 this person cannot go back to original Medicare once they choose Medicare Advantage. Their situation is very sad.
@@JohnDavis-yz9nq
The original Medicare was RUINED anyway by the Bush43 regime when it passed that "forced" PART-D.
The current (not the real original) Medicare system is a Rockefeller big pharmakea scam.
Original Medicare is the only way to go unless you choose the Advantage and then you cannot go back to the original. Agree with you that Bush was a bad president as he tried to destroy social security. He was born with a silver spoon in his mouth and he doesn’t have a clue what the average American faces in everyday life. Other presidents born poor have forgotten where they came from. Even at best the original Medicare is not a good deal but it is the only thing that we have. The doctors that we have nowadays are awful. They are owned and controlled by the pharmaceutical companies and do not care about your well-being. What is sad is that some third world countries take better medical care of their people than the United States does. This man in this video is only telling part of the truth. For me he is a wolf at your back door just like the rest of them. Watch doctor David Belk on his videos the truth about Medicare supplements. That will surely wake you up. Good luck and I hope that you didn’t sign up with Medicare Advantage.
I totally agree! I was a RN case manager for 5 years & frequently after a hospitalization the Medicare Advantage plans would not pay for skilled nursing facilities or long term care facilities. Everyone would talk about the great “dental & vision benefits”, but if you’re 85 & break your hip & can’t go to skilled nursing, you’re hosed.
I broke my hip at 50and went home. What do they do at skilled nursing? I had a pt and my family helping. Did have pain sleeping on that side for years.
@@melindalicht6699 my friend that is 70 just had hip replacement and she didn't have anyone at home to help. Because she has a supplemental plan she was able to go to a rehab hospital for two weeks and then had home pt for a few weeks.
@@MrDONTEATUS It's not because she had a supplemental plan! She had original medicare along with a supplemental plan (which picks up the 20% medicare doesn't). Medicare Disadvantage is a ripoff.
well maybe the nurses were not skilled at the facility😂😂😂😂
I know for a fact this stuff is untrue! My brother broke his hip when he was 89 and he lives in a very small town and they transported him to Sayre Pennsylvania to have the hip replacement and took care of all expenses including aftercare!
You are 100% correct. I have plan F, which I chose because I had a serious illness shortly before I became Medicare eligible. It was an easy decision because I knew I was going to be seeing specialists, having tests, procedures etc. and did not want to be in a network. Also, the benefits for each Medicare supplements are clearly spelled out , while the Advantage plans are murky. I have had tons of imaging, bloodwork, see lots of specialists (who I did not have to get a referral to see), have had surgeries and have NEVER got a bill. I know that not everything is covered , and eventually I might need something Medicare does not fully cover. But I ALWAYS ask if it’s covered by Medicare, and so far have never found anything a doctor ordered to not be covered. So, the supplement picks up the rest. Plan F is excellent.
I’m going on plan F he said I would have copays every time I go to the dr!! Wonder why you don’t have copayments?
@@debhelms4106 You need to check your plan. Plan F cover all deductible copay.
@@debhelms4106 Plan F and Plan G have no office visit or ER fees at all. Ever. Make sure of what you are signing up for. You want a Medigap Supplement, not Medicare Advantage.
Plant F is very very expensive. If you have a pre-existing condition such as cancer, they won’t even ensure you.
I am a Medicare Advantage Survivor. After many issues that convinced me of their intention to deny all claims they possibly could, I went back to Original Medicare with a G Supplement. You cannot qualify for this if you have certain medical conditions. Fortunately I did not wait to make the change.
I’m in the process of getting back to regular Medicare and going on plan F… praying I’ll get back to my red white and blue card🙏🙏
@@debhelms4106 Plan F is no longer available since January 1 ,2020. My husband had signed up for Plan F in October 2019.
so how much are your payments for plan G
I'm going to try the same, I didn't know there was a difference, Medicare Original V Medicare Advantage.
Odd you say these things! MA plans have to cover EVERYTHING STANDARD MEDICARE does! BY LAW! So when those saying MA plans DENIED something , original Medicare would ALSO have denied it. I'm NIT in ANY kind of sales but you all must get educated so you can know when someone is lying to you. If you never learn ANYTHING else....just know the MA plans have to cover EVERYTHING that original Medicare does! BY LAW!
My husband and I were paying over $700 a month for premiums alone with Medicare and a Supplement plan, so we changed to Medicare advantage plan Preferred Care with UHC and here in Miami it works fairly well. We never had any issues to go to specialists. Even though my husband takes a lot of medications, at the end of the year we end up saving money.
Thank you. These dummies never consider $700 per month or $8400 a year for supplement insurance. Have had Advantage plan so have saved nearly $90000.
@@domerbuz3813 I agree with you. For me a Medicare Advantage Plan works great.
@@domerbuz3813 How many times have you been hospitalized ?
@@danielhurley2894 I have an Advantage plan. I’m raising a red flag but doubt that our representatives in Congress will. They receive massive donations from the healthcare and pharmaceutical industry who also spend massive amounts on lobbyists. My doctor and physical therapist recommended further treatment, but after the initial 90 days (which included only ~16 visits because my copay was $35), request for authorization was sent to a contractor for Aetna who did not respond to phone calls, voicemails, or emails-so no further treatment. I filed a grievance w Aetna; their response 2 months later was that I had treatment and they had no further request for authorization. Phone calls to Aetna- rep said there was no request w Aetna, didn’t know anything about the contractor but admitted they do use outside contractors. I had a previous experience with an insurer who also contracted with outside companies whose job it is to deny claims. My neurosurgeon received a payment of $150 months following my 6 hour surgery. There is no good health insurance company or plan in this country.
@@domerbuz3813 Stay healthy!!
I’ve been on Medicare Advantage for eight years. Nobody “sold” me anything; I just researched my options online. There are no additional premiums for Medigap or drugs. The network includes every provider I’ve ever heard of except one. Co-pays are reasonable. It’s probably the best insurance I’ve ever had.
Wait till you get seriously ill or are hospitalized. You might change your mind.
Copays for some are $50. For specialists. If you see cardiologist, podiatrist, urologist, etc couple times a year it adds up.
Just don't get seriously.
Bob Pickering: Was your father in the Air Force? (My dad was and my folks were very close to “The Pickerings!”) I even think his first name was…Bob!
It was the same thing for my parents. Then my father actually got sick at the age of 83 and he has been severely impacted by having a Medicare advantage plan limiting the amount of care that he could receive - which could be life-changing. Everyone is healthy until they aren’t.
I am a utilization management nurse, been doing this since 2008. There are Medicare PPO that don't require referrals. There are Medicare HMOs that require referrals. Most require pre authorizations for many types of services up unless you have a fee for service plan. Also Medicare Advantage plans constantly call members asking if they are doing all the preventative testing.
I am 85 and had cancer at 61, had good insurance where I worked, was off work for a full year, and returned to work and retired at 67, got medicare and full supplement and the cancer returned 12 years later, got treatment and the cancer returned 7 years later and again 3 years later and still in treatments. I am not restricted anywhere or by any doctor or hospital. Where would I be on an ADVANTAGE PLAN??? I know I have indeed been blessed. I can pay my premiums, thanks goodness. I don't have any co-pays!
I'm an insurance agent, been selling med supps and advantage plans for years. The right thing to do is explain the pros and cons for each and let the client decide which is best for them. Be honest and learn how to present in such a way that they understand and CAN make an informed decision. There ARE cons to med supps. The price increases throughout the years can become more than a person on a fixed income can handle. And scaring them with tales of not getting service/approval is not helpful. I have hundreds of clients on mapds, and rarely get complaints about rejected services. HMOs are so different now than even 5 years ago, max out of pockets are better, networks are better, we even have plans with national networks.... There's a lot of advantages to mapds. I'll be honest, I didn't listen to the presentation, mostly because I've been doing this for years, and I know the details, but I had to comment because it's disengenuos to say one should "never" get an mapd. That's just as bad as saying mapds are the best option. Everyone is different and we need different solutions.
His advice is predicated entirely on the need for expensive supplement insurance, which assumes that you’re going to have a pricey hospitalization every year if the insurance is going to pay for itself. I have a relative who paid (5 yrs ago) over 10,000 a year in various premiums for him and his wife. They’re wealthy so afford the 20% for rare illness so it’s a stupid decision in my opinion. We switched to an Advantage plan because it provided a maximum out of pocket for protection in the event of a expensive illness. He also said out of network doctors can charge whatever they want because there’s no negotiated price but that’s not true in practice. There are usual and customary charges (a range) that doctors charge. I don’t agree with most of what he says.
I very much agree with you!
Thank you Windi for your answer that both Advantage and Supplement plans need to be presented with pros and cons--we don't need someone telling us NOT to buy one or the other. I have been on an Advantage plan for years and have never experienced some of the things said in the video. I am a healthy person so far, so maybe that's why I've been happy. I love all the extras I get on my plan, most of all the GYM membership. I am on a PPO plan and all hospitals and doctors in my area are on the plan so that is not an issue. However, Most of my friends are on a supplement plan so I have been thinking about changing mainly due to my high out of pocket maximum if I would have to go out of network. But I weighed my costs and this video says your cost for a Medicare supplement is only the $233 deductible. That is false. In our area, the supplement plans are at least $100/month, so that has to be added to the $233 along with $10-$25/month for a pharmacy plan. My premiums are $0.00 and I get all those extra benefits, so a supplement plan for me is going to be way more expensive. BUT, it's like rolling the dice--if you do have a catastrophic illness, then a supplement is going to be better than the out of pocket maximum. VERY hard choice to make since we can't see whaT WILL happen in our future. Thanks for all the comments and the video.
My mother has been on a Medicare advantage plan and has never had a problem getting medical care.
I'm an agent myself and his presentation is so one-sided it's ridiculous. He is not doing any of the consumers any favors by not providing all options.
I worked both for a HMO and medical biller in my working life. Yes, traditional Medicare AND a supplement are the way to go. HMOs ALWAYS had lots of customer service calls regarding problems- especially when a person was traveling and had a medical emergency and could not use a network provider. I remember one time the HMO denied paying ambulance service saying it was not "medically necessary". The person died IN the ambulance. That was nuts- the family got the bill after denial. They were livid.
I have heard that as well
I don't believe that at all!
There is much more money to be made selling these supplement plan so they make up lots of stories.
Not true -agents selling Medicare advantage plans usually get paid 3x as much commissions as original Medicare
I'm sure the logic was, "Well, they died enroute; they could have died just as easily at-scene and saved the ambulance call; so, obviously, the ambulance was not Medically Necessary!"
Jerks!
I had very different experience with HMO plan. I think ( correct me if I am wrong ) all the long waiting of referral and complaint are really depending which Medical Group that you Choice, For my 40 years with HMO and the same Family doctor and Medical Group, I had no issues being on HMO. I even got sent to USC to treat my Bone Tumor under HMO, my ISP authorize a biopsy in 24 hours, and to see a spec list. because my ISP was willing to sign special contract to send me since at that time only 1 Doctor in the West Coast can save my life.... I don't think private insurance compamy has anything to do with you., It is your Dcotor and ISP are or are not willing to treat ( manage ) you fast and well, PICK A GOOD ISA AND PRIMAY DOCTOR
What medical insurance we choose (Advantage or suppliment) starts with us d3ciding what is most important to use, i.e., monthly/yearly cost, choice of provider, catastrophic coverage, deductible, bells and whistles, etc.
You will not make the best decision if not clear about what is most important to you.
Each of us should be able to explain why we chose X rather than Y.
Being a Utilization management RN for a Florida based hospital for over 15 years, I totally agree with you. So often patients experience medical emergencies while on vacation and are limited to choices for care while away from home and “out of network.” I advise my friends and family to always invest in supplements and keep Medicare, steering them away from advantage or replacement plans. I think it’s a crime when I have to argue with advantage plans to authorize physician directed care after the acute health emergency has been addressed. Most folks don’t realize that once a patient is determined to be stable, their care is limited to what their advantage plan will allow, even while they remain hospitalized. Often their choices decrease significantly when they are discharged. Those who require home health or rehabilitation services post-hospitalization can be severely restricted and are usually required to return home to their local area for coverage. You are providing a great service with your videos. Keep it up!
Sure wish everyone could read your comment!
Again, you have to consider your situation and many older people don’t travel so this would not be a problem. There are many things to consider on a personal level, it’s not one size fits all.
What you do is choose a provider that is ubiquitous. Meaning, they are everywhere. Kaiser, for example.
@@TheCheryl57 I heard Advantage plans are more costly in the long run especially if you need a lot of medical care.
Also, that those plans are more costly for the government, because those Advantage plans charge more for services because the middlemen/women and the in those companies need to make a profit.
Thank you for this valuable information.
As a physician I wholeheartedly agree with the points you made in this video. The worst I deal with is prior auth for rehab or SNF that are denied after many days being in the hospital waiting for auth, and then the peer to peer is rejected- the patient is not safe to go home but we must discharge them home because their insurance stopped paying for them to be in the hospital days prior and our ER is full of patients boarding waiting for beds in the hospital. Then they are readmitted in a few days/weeks from complications post discharge because they did not go to rehab.
Prior authorization and SNF issues are rampant with plain Medicare. I have seen this both as a provider (retired) and as Medicare adjudicator.
Medicare Advantage has to start at the exact same place as Traditional (Original) Medicare. Then, MA plans add extra benefits for example vision, hearing, no health deductible, gym membership, etc. The fact that a network is utilized mimics private under 65 health insurance. Medicare Advantage plans help the patient afford hospital stays so they don't get stuck with 20% of the total cost of staying in the hospital.
@@juliemills6716 Why are you telling me this? Not only am I a retired provider (and nearly all of my patients were on a Medicare Advantage plan), I have been on one myself for years now and am very satisfied.
This exact thing happened to my mother this past March! Every three days they reviewed her case, and about four times we had to appeal - soooo stressful living in limbo... At the 4th time, we lost the appeal. This is despite the recommendation of the doctor/therapists at her in-patient rehab ... However, Ive always been under the impression the Medicare + supplement route was for richer people who could pay a lot each month up front, and hence, the better coverage for the bigger on-going things down the road when they happen .... My mom was a life time social worker for the state until she retired -- an honorable job but not high paying (even with her Masters Degree, sigh).
Been on Medicare + AARP/United Plan F for 7 years. Never needed a referral or had a problem with authorizations. Have paid zero for medical co-pays and minimal co-pays for drugs. Compared to my Medicare Advantage friends who are restricted to certain doctors, need referrals and pay co-pays for every doctor visit and hospital stay. One friend and I were both having problems after cataract surgery. I made an appointment for a second opinion at UM medical school. She couldn’t get approval from her Advantage plan. Yes, the supplement isn’t cheap but I budget for it and have complete control.
I am so glad I found you and this video. I need a supplement plan and was confused about Medicare Advantage. Thanks for the help! I'll be watching your video on supplement plans.
I have advantage in TN. I Don't understand what you're talking about. Max out of pocket 4.5K. Next year 3.5 K. I have Humana, which is accepted by most of the practices. Deasent cooayments. I had multiple procedures this year. Cooayments for outpatient surgeries and labs in a range of $30 to $200. Very low meds cooayments.
Very satisfied.
Went on Medicare last year and went to a couple of advantage presentations and the sales pitch was a hard one. Kind of felt like I was talking to a car salesman. Being a retired RN I was already somewhat aware of the advantage problems and stuck with original Medicare plus a supplement. Your presentation is spot on and I think the clearest explanation of the differences I have heard thus far. Thank you so much for this great informative video!!!
I dub them used people salesmen, and they have NO biz handling the medicare generation imho.
I see the Medicare advantage commercials on TV everyday and how they are misrepresented. They only point out the pros and never explain the cons. Being a past Chartered Life Underwriter, I am surprised the Insurance commissioner lets this slide.
To me they are a scam. Just look at how many tv commercials they run. (just like aspca, shriners, save the elephants, etc)
Advantage plans make the insurance companies who write them a TON of profit. There’s a reason there are so many ads for them.
I am suspicious of any product that advertises so heavily, but I was leaning to an advantage plan because of the limit on out-of-pocket. I now think I'll stick with Medicare and a supplement. Thanks for you comment. I like to hear from people who are not selling anything.
My mother just passed at 96 1/2 & regular Medicare paid for literally all of her end-of-life care. I was amazed that we never got any medical bills. They even covered the helicopter transport to a larger hospital after a heart attack.
When your mom was enrolled in Medicare it was a whole different plan than what is offered today. Her plan doesn’t exist anymore. I’m sorry for your loss.
If she was low income and medical everything would be free to her
Sorry for your loss, but so great she had a long life, a blessing from God.
@@MrElby100 I'm finding that also. It seems all of this - insurance plans and medicare - keep cutting coverage and charging more. And refusing services to stall medical treatment.
I have the ARRP United healthcare plan and have zero complaints. In fact, if I have a complaint, it is they are constantly calling me to offer services which I do not need. Like a home health nurse visit. I have used it when working out of state and my out of pocket costs have been minimal. I have never had a doctor refuse to take me as a patient with this coverage. Recently I had a mild heart attack. I went to our local ER who had me transported to the regional medical center. I had a hearth cath and stent implanted. 3 days in the hospital total, 2 ER visits, transportation, my out of pocket was $315. A deal in my book.
This was so informative: Thank you. Been doing tons of reading: You explained it....THANK YOU
I tend to agree with most of your points. However it is truly scary that many people on Medicare and paying for a supplement are completely unaware that their care is still being "managed" by providers who are in ACO/Shared Savings/Direct Contracting arrangements. So, the beneficiary is getting the worst of both worlds. They are paying for a supplement but unknowingly have providers "managing" their care behind the scenes to line their own pockets.
traditional medicare plans with supplemental plans are not managed by anyone but the patients Dr's. That is a false statement
Very true! Ask questions, Be informed, Get informed and then decide!
I don't know what you are talking about and I dont think you do either. When I get sick I can go to any big city hospital in any state I happen to be in without having to call and check to see if I am in a network...Any Hospital that takes medicare will also have to take your supplement period...You do not have to get permission for your care. You are not managed. Thats a lie.
All health care is managed for profit and business. People are so used. People are taught to be sick. And big money is made. This country rips people off more than any other country.
Undisputedly “Beneficiaries” are definitely managing their care
Just went through this with my 96 year old mother. Advantage plan fought with doctors recommend care and we had to go to arbitration. It worked out but if we were not available to help her , she would not have understood what was going on.
Easy way to understand difference. Regular Medicare , doctors control your health care. Medicare advantage , underwriting controls your health care.
Hi Richard,
Unfortunately I've heard that story too many times. Happy that it worked out for her but many times it does not. Hope she is doing better.
@@MedicareonVideo thanks yes she is at 96 still very alert and on the mend.
I am 76 and my phone has been ringing all day since last Thanksgiving with different people from different states trying to.sell me Medicare Advantage.
I am happy to hear what you've said.
@@riadanabtawi5880 It really is a shame that it has to be that way
Medicare doesn’t always pay for what doctors recommend. I had to have minor oral surgery to remove a growth from my pallet for biopsy and Medicare refused to pay anything. Never got an explanation why. Because Medicare refused to cover the biopsy my supplemental insurance refused to pay anything. I got stuck for the entire cost. Submitted Medicare a review petition. Called several times after the date Medicare was obligated to respond. I was repeatedly told my petition was still under review. Medicare never responded to my petition. It just disappeared. Never rely on Medicare.
Excellent video!!!!!!!
Thank you for drilling down on your talking points as you make things very clear.
Jim-
The big issue is if you can even afford being on a Medicare supplement. Sure it might be better to have a supplement but there are so many cost. I have been on UnitedHealthcare HMO Advantage plan for 14 years and they never have denied me coverage for a procedure. Medicare and a supplement is completely out of the picture.
As an MPH I so appreciate your open honesty. Corporate medicine is unconcerned with their patient outcomes. Their top priority is making management and shareholders happy- at any dire cost of life or quality of life for the patient.
I worked for one of the biggest 4 profit corporations in the United States and abroad and I can attest to what you're saying it wasn't about patient care , it was about the profits and the stack holders.
And of course I've also done some work for non profits and the same old thing there too!
That is sad, but true! The big medical insurance companies like bcbs are notorious for this! These companies open a book when someone gets sick, with price tags next to the illness! If it's kidneys or liver issues, there is a price next to it!!!!😢😢😢😢
I am a licensed agent since 2006 and have clients on both Medigaps and Advantage Plans. It's our duty and obligation to give each client to do a thorough presentation and give them their options. Medigap plans are excellent but not all can budget a Medigap plan which increase every year and when it's a husband and wife the expense can really be a hardship. Then they have to pay separate for their part D and separate for dental insurance and so on. On the other hand, my parents and in-laws with medical issues like cancer and diabetes have done very well with advantage plans and still continue up to this day. Not to mention some clients may also qualify for Low-income Subsidies and Medicaid programs from their state so truly they are covered even 100% for all Medicare costs. Although they are managed care plans there are many professional physicians who participate in these advantage plans and the referral process is not a headache. There are not a one size fits all plan. Every client has unique situations, lifestyles, income and so forth. So, at the end of the day give your clients the option because if you don't do a good job explaining their options as discussed on Medicare and You handbook, another agent will come along and enroll them in a managed care plan.
Spoken like a true insurance salesman!
@@rodbutler4054 and how do insurance salesmen make money?
Everything you said is spot on! I I don’t understand how this guy can generalize something as broad as a medicare into a little 16 minute video. There’s so many other reasons why somebody would choose a Medicare Advantage plan as opposed to a supplement plan. Aside from your part B why would you pay a monthly premium for some thing that keeps going up for the most part every single year plus pay a separate premium for your part D drug plan plus pay copayment on top of that.You mentioned low income subsidy there’s also state Medicaid and that comes along with a bunch of other benefits.
I too sell both and agree with you 110%.
Would you recommend an advantage plan to someone who is really sick like a quadriplegic, cancer patient, heart patient, chronically ill, etc?
I have never heard of a supplemental plan to Medicare that only cost $100/month. The cheapest I've seen are about $300/month.
Anthem 132. California g plan
This is the video that kind of "blew the smoke away" from all those Medicare Advantage ads on TV. I had a feeling that there was something fishy about them, but Keith Armbrecht explains the pros and (mostly) cons of Medicare Advantage plans very clearly in this clip. After watching more of Keith's videos I decided to enroll in a supplemental Medicare plan through Keith's office. It was Julia Jones, from Keith's office, who called me, walked me through the Medicare enrollment process, found the best supplement and drug plans for me and walked me through those enrollments. The next thing I knew I was all set to start Medicare coverage on the first day of the month of my eligibility. I want to thank Keith and Julia for simplifying what seemed to be a insurmountable challenge !
Thank you for choosing original Medicare! You are paying for all my benefits. I do appreciate it.
@@GAderly-fn5ly Taxpayers are paying your way, freeloader.
@@GAderly-fn5ly You're obviously a paid Medicare Advantage advocate or else you would keep quiet, not rock the boat and keep them paying for all your benefits. Not all of us are as senile as you take us for!
I agree with you 100%.. As my wife and I grow older, We have had serious medical issues. My wife had a heart murmer all her life, and at age 76 it turned into a valve replacement and a bypass all done at the same time. Within 30 days I was advised to have a pacemaker and it was done within a week. NO HMO for us, not ever!!!
Many advantage plans have PPO’s too. He failed to mention that!
@@roberthoeller5516 PPO are NOT advantage plan and outside the scope of his comments.
@@roberthoeller5516 PPO costs can rack up in the thousands for serious health problems. There is little advantage to "Medicare Advantage".
@@landiserla3668 I had surgery in June, my bill was $21,794. I paid $464 out of that amount with my Advantage plan.
@@roberthoeller5516 Medicare paid most of that. You would have paid $0 with a Medigap plan instead of advantage after meeting deductible.
7 years on a Med Advantage plan (for several years was on United Healthcare, but have since switched to Aetna), and I've had virtually no problems, with perhaps the one exception of sometimes having to wait a bit extra for an appointment with my PCP. No problems at all when having to visit specialists. Super and I mean super low cost - in fact, virtually no cost to Advantage. Not arguing with this gentleman, but I'm fine with my plan.
When you’re younger it’s OK, but when you need to get post Acute services they suck. They denied Acute rehab for a patient of mine who had a hip fracture. They also denied skilled nursing for her. She ended up going home with home PT twice a week.
Sure, Medicare Advantage employee, but I think I'll pass.
@@MerkinMuffly What are you in high school? Who gives AF what medical plan you choose.
I enroll people in Medicare advantage plans. 95% of the people I deal with survive just on their ssn, ssi, or ssdi benefits. If you can afford a Supplemental plan, I highly recommend it but you will have to purchase a standalone dental, vision, and/or hearing plan which could run another $100/mo. 75% of the people I help are C-SNP or D-SNP eligible.
Club Mogambo...agree..I have a lot of health issues. No problem at all with my Advantage plan. Even had 3 surgeries...I do have some med co pays but not bad...can see any Dr as well!
Great presentation....being new to the industry I strongly believe a supplement plan is the best option.
Thank you for you information I'll be 65 next July and just starting learning what to get before I'll get there, so many people confusing me, so is good to get the right information from smart people like you thanks.
Thank you, [User], for your kind words! We're thrilled to hear that our channel has been helpful in navigating the complexities of Medicare. We understand that there are many choices and it can be overwhelming, but our goal is to provide clear and accurate information to make the decision-making process easier for you. If you have any specific questions or topics you'd like us to cover in our future videos, feel free to let us know. Best of luck with your Medicare journey, and don't hesitate to reach out if you need any further assistance!
Would love to see a video talking about 2 or 4 scenarios of different couples, different medical needs and different financial situations and a detailed decision process based on example benefits, costs, and availability; and maybe show a Decision matrix about when Advantage might be better vs straight medicare... Maybe in a liberal state like MN, where it seems the HMO's have a good reputation for good coverage... GREAT video by the way Thank you.
I am in agreement with you 100%. The problem also is that many people get fooled by MedAdvantage plans with the little perks that are thrown at them. For example, free travel to and from doctors, some minor eyeglass coverage or even dental. But they do not realize that if anything
Catastrophic happens to them that it becomes a waiting game for approvals and in one instance in my family we lost a uncle due to this. It’s crazy how they put a dollar value on someone’s life. Thank You for spreading the truth!
They also don't realize the "free" is for a very small portion of low - no income folks.
@@MedicareonVideo fact check. It’s “free” for rich people, too. I’m a working physician and on Humana Gold I pay nothing a month. I had a $20 copay for my ophthalmologist referral but the cataract surgery is 100% covered. Oh, by the way, latest info-Medicare Advantage now has 47% of Medicare enrollees. Are these people all stupid, or they on to something?
I enroll people in Medicare advantage plans. 95% of the people I deal with survive just on their ssn, ssi, or ssdi benefits. If you can afford a Supplemental plan, I highly recommend it but you will have to purchase a standalone dental, vision, and/or hearing plan which could run another $100/mo. 75% of the people I help are C-SNP or D-SNP eligible.
I know of more than one person who claimed they paid nothing out of pocket for serious medical issues under advantage plans. They were singing a different tune later when all of the bills and shortcomings came to light later on.
Problems is a great many retired people have limited income. Need more equitable coverage & price.
I am beginning to wonder about my BCBS advantage plan. When I got medicare I had no health issues and the sales person said this would be the best for me so I got it. On the second year of having the plan I got stage 1 breast cancer. They pretty much covered everything except they disagreed with my doctor on the number of radiation treatments. They said for my stage of breast cancer I only needed 4 instead of 5 or 6 treatments. So I got the 4. Turns out so far they paid all but 6000+ of my treatment. When I had to have another biopsy done they only covered $208. of the procedure. They are both still pending and I'm worried I am going to be stuck with the bill totalling over $10,000.
They messed me up, BIGTIME I changed from Advantage Plan to straight Medicare. I was not told I would lose my drug coverage. And now I can't apply for it and have lost my drug coverage.
I was paying $235 a month for my medicare supplement. I am relatively healthy, take no prescription drugs, pay out of pocket for dental and eye care. I just cancelled my supplement and signed on to a highly rated medicare advantage program. I think this was a good move for me.
I'm weighing that too. Though I guess it is kind of a gamble. If I continue as I am, it would be the best option. But if fall into depression or something and regain my previous weight and get cancer or something, it would start costing me a lot. I have to decide.
There are many Good Advantage Plans, and Good Supplement Plan G or Plan N.
They are both good,depending on your situation! GET THE FACTS! You have 1yr from the time to change your Supplement Plan G to go back if you do not like the Advantage Plan without any medical questions.
I have plan N which is $96 monthly. I was very healthy, just a wellness check by-yearly. I slide in the bathroom and broke the tibia in 4 places, the fibula and ankle, along with damaged tendons. I did not owe anything.
Ouch, @@judymoore7469! Hope you're doing better. Though when I put myself in that situation, I calculate five years of $96/month is $5760. But with no medigap at all, I would have had to meet the deductibles and 20% on much of the remainder. So, if I remained otherwise healthy for five years, I wonder which would have been the better deal.
@@judymoore7469 My plan was F which was discontinued. I was grandfathered so they couldn’t drop me. But they kept raising the monthly premium. I went with a very highly rated plan. I have friends who have this plan and they are all very pleased with it. I just learned that I will have to pay a monthly penalty because I wasn’t previously enrolled in prescription coverage. It’s not a lot but it is for life.
If Original Medicare would just cover dental, vision, and hearing services, there would be no need for Medicare Advantage plans at all. It would also help to lower the eligibility age to 60.
It would also help if they gave free medical, dental, vision, transportation, food, clothing and entertainment free. Why not lower the eligibility to 30? That is called socialism. Medicare does cover some vision if it is medically necessary. I had cataract surgeries and macular pucker surgery, all covered by Medicare. In the video above, the agent mentions that Medicare gives the MA plan company about $1000 a month for them taking on the responsibility of and managing of your health needs. Think about that. That's $12,000 each year for each enrollee. That is a lot of money given to these companies. How can they do it? If the income is, for example, 100 enrollees x $12,000 equals $1,200,000. If you only have routine preventative services, then the MA company reaps big bucks profit. If you have serious health issues in a year, with the MA plans, then you could be out the MOOP (Maximum Out Of Pocket) for that plan, which could be $5-10,000 potentially and that could be done a nickel and a dime at a time, driving you mad trying to figure out what you have to pay and when you have to pay because of Co-pays, Co-insurance and deductibles, etc. You get some additional benefits with MA plans, but the trade offs are there lurking and you may or may not be ok with them when they jump out at you. The dental benefits included in the zero premium MA plans are typically preventative dental, not comprehensive. The vision would sometimes provide one or two eye exams annually, and typically included a set amount towards a frame (sometimes only every other year) and the prices on some of those frames were jacked up to make it look like you were getting a bargain. But remember there are tradeoffs. i.e. Friend of mine had main residence in Denver, part-time home in AZ. His MAPD, as all are, was geographically defined to the Denver metro area. Unless an emergency, when he needed medical care while in AZ, he had to fly back to Denver to get it or pay 100% out of his own pocket. And because his medical situation was such as it was, in Denver he could not switch to a Supplement, he wasn't medically eligible. But when he moved permanently to AZ, he was eligible with a guaranteed issue to get a supplement. But if he had only talked to a MA agent or the MA company, or just another MA company, I doubt they would have informed him that the Med Sup option was even available to him. The MA companies want to keep their enrollees, that's $12,000 a year for each one they sign up and keep. Not every agent is out there for you best interests, but it sounds like the gentleman above is. Having Original Medicare, a Med Sup and a stand-alone Part D isn't for everyone, neither is a MAPD plan for everyone. But before a person talks about specific plans, they should first understand concepts, options and choices.
They don't actually cover those things. You get a discount program.
Your lifetime contributions and after 65 premiums do not cover the costs of healthcare. Taxpayers subsidize about $100,000 per person until they die. Adding more coverages means more subsidies by taxpayers.
Yeah. Insurance for old people that doesn't cover dental, vision, and hearing - three of the most common problem areas for the elderly - is like car insurance that doesn't cover collisions. It's nuts. Lowering the age of eligibility would do two good things - it would remove the oldest population from private insurance (the age group that has the most health issues and makes the most claims) thus lowering private insurance costs for everyone else, and move them to Medicare, where they would be the youngest population, the age group that has the fewest health issues and makes the fewest claims, lowering Medicare costs for everyone. It would be a win-win. Gradually lowering the eligibility age to 50 (over say, a ten or fifteen year period) would make the transition easier for everyone.
@@thomasdreyer2389 Nobody said anything about free transportation, food, clothing, or entertainment. Why did you? I think it's because you have no actual argument against Medicare covering dental, vision, and hearing services other than _Something something _*_SOCIALISM!!!_* It wouldn't be socialism, of course, but even if it were - so what? Three of the most common health problems older people have are with their teeth, their vision, and their hearing. Of course Medicare should cover these. Medicare covers *_maternity_* costs, for crying out loud. Why doesn't it pay for hearing aids?
Soooo glad to see this video of all your correct info. I’ve been trying to explain to all my Medicare friends this reason why to choose MEDICARE over as Advantage plan. Surely will send your video to a all. 💕
Thank you so much for your positive feedback! We're thrilled to hear that you found the video informative and that it aligns with the information you've been sharing with your Medicare friends. Feel free to share the video with anyone who might benefit from it, and don't forget to subscribe to our channel for more helpful Medicare content. We really appreciate your support! 💕
thanks for the video and the good info. i always wondered why there is so much high pressure sales on tv for advantage plans. its always about money.
You also have to ask yourself " How much does peace of mind mean to me?" For me, it means a great deal. For that reason...and all the points Keith made, I choose original Medicare and Plan G and a drug plan. Thanks, Keith. Awesome explanation.
Thanks Joe!
Couldn't agree more. (I picked Plan N) :)
How much does that cost you?
@@local_treasures815 I’d like to know as well.
@@local_treasures815 couple hundred a month.
Not being able to go back to Medicare Part A&B after moving to an Advantage plan makes it clear to me which is the best decision. I will stick with the original and get a supplement so I can have health care choices. Thank you for the very informative video.
You can drop the Advantage during open enrollment, if you move, and if you get Extra Help, at any time.
You can go back but getting a supplement may be harder. They now can ask health questions to see if they will approve you.
@@kathyneichoy9384 Depends on where you live. Some states have no underwriting.
You are so wrong about EVERYTHING you posted! You can ALWAYS go back to original Medicare at the end of each month! Why would you post such lies?
One can choose to go back to Traditional Medicare during open enrollment if they do not like the Advantage Plan program.
Thank you so much for this wonderful information! Do you have any recommendations on who to go with for the supplemental? Thanks again!
Good presentation. Thank you. It confirms what I have understood about these options.
This advice is good for those that can afford the Medicare option. Couple of years ago I was climbing up out of homelessness. And I should the age where I had to either go on Medicare or Medicare advantage. I had no choice but to pick the best possible Medicare advantage plan that I could. Still don’t have sufficient money for month-to-month living expenses. But I’m not on the street anymore. Every situation is different and specific. Is he saying something good? Yes. Is it the best advice for everyone? Not by a long shot.
Why didn’t u apply for Medicaid? Even cheaper!
I worked for doctors for a vvvery long time. And everyone of them told me “if you can afford it, never give up your Medicare”.
He is not taking about giving up Medicare, Medicare advantage isn't Medicare. its a supplement if its a zero plan its worthless.
@@ozarksfarmerhansen8782 I understand. I was agreeing with him.
because Drs make more that wy
@@mwconservative Not really. It’s much more complex than that.
I've read that Medicare covers only 80% of medical costs, so if you have a very expensive hospitalization or medical condition, the 20% you pay can go into multiple thousands of dollars. I've always had either a Medicare PPO or Advantage plan in order to avoid these costs, and now I hear that this course of action isn't the best way to go. As a senior on a fixed income, I get Medicaid Extra Help from the state of Colorado, which pays my Medicare premium, and also helps pay other expenses. I've been happy with it so far. How can I be on just regular Medicare, without paying extra for the supplement programs you mentioned? With inflation climbing more every day, and with the new rent increase from my landlord, I can't pay a penny more for my health coverage. I live in a small town in Otero county, Colorado, 68 miles away from Pueblo, the nearest big city, where the medical specialists are located.
My Medicare Advantage plan has been wonderful for me here in Fresno CA. I have Kaiser and have had outstanding care. My Medicare Advantage plan is so much better than straight Medicare. With straight Medicare, I had constant problems with what medications were being denied.
As someone that sells medicare advantage and supplement I can let you know that the plan should be presented based on the persons needs. A healthy person that takes a few medications and sees a doctor 2 times a year is going to benefit greatly from a medicare advantage plan more so than a supplement. You figure on the low end 100$ a month for a sup and about the lowest part d in most areas is now about 20. So they are spening alittle over 1200 a year just to have service that they barely use and gain no extra benefits from it like dental or vision insurance. There are pros and cons to both . I often prefer to position medicare advantage to people that have less medical issue and see fewer doctors as t hat makes the most sense because they will have a few copays all year and then they get the added benefits tied in. Some of these plans even have upwards of 200 $ for otc products. And then once you get into people that also have medicaid it is almost always better to have a dual medicare advantage plan than anything else because it works along side the medicaid and covers things exponentially better. So honestly this is part of the problem when I am talking to people and they hear the " bad " things about medicare advantage its usually from someone that has alot of medical problems and they got talked into it rather than getting someone that will sit down and go over the benefits with them.
A very informative video. I recently signed up for a Medicare Advantage plan, and now realize how completely ignorant I was about what those plans are. I had no idea that it took me off actual Medicare. The person who put me on the plan never mentioned that to me. It just sounded like a supplement to my Medicare coverage.
You can switch back but have to go through underwriting and your premiums will be more, if you do switch back do it as soon as possible as the lifetime increase in premiums goes up every month you are off Traditional Medicare. Also, for the Supplement, you are guaranteed acceptance up to 90 days after enrolling in Medicare B, unless you switch back, you have to apply for acceptance now in a Supplement and the premiums may be higher.
You do not lose your Medicare by joining a Medicare Advantage Plan.
Give your Broker a chance to explain it to you again.
Most Brokers sell both and if a Supplement was a better fit I'm sure they would have been happy to put you on it.
This guy is pushing half truth.
@@frankpfister1456 When you sign up for a Medicare Advantage plan, your bills are paid by an insurance company, not Medicare. None of my medical expenses are paid by Medicare, they are paid by Anthem. Medicare Advantage plans must offer the same coverage as Medicare, but you use their network of providers. Basically, your premium is paid to the Medicare Advantage provider by Medicare, but you are not covered by Medicare.
Does SSI pay Medicare/Medicare ?? Or out of pocket?? I’m on SSI and didn’t realize these restrictions when signing up for Advantage…I thought that was that..
@@phyllisdevonish859 Medicare is separate from Social Security. Just as most paid into Social Security through deductions from their paychecks, they also had Medicare deductions. Medicare actually pays for Medicare Advantage plans.
Thank you SOOOO much. You have answered questions for me that I have been asking for years! You made the information about choice of doctors and coverage area simple to understand without double talk that confused me. After listening to you I now understand the difference and I will always stay with Medicare.
I have Medicare Advantage and love it! No monthly premium, no co-pays except $25 co pay for a specialist. Nothing for my monthly meds. I’ve had countless tests, a few surgical procedures and have had incredible care and the best of the best drs. I chose my specialists which are all 5 star in the Houston area. I’ve never been happier with my healthcare. Everything is amazing and I’ll never have anything else. Nothing in here you’re speaking of happened to me.
What Medicare advantage plan are you on
His out of pocket of 7,500 is very rare. I am now debating on going with Summacare where the max. out of pocket is 3,800
Hello Dee how are you doing today?
Thank you!! I've been on disability since 2016, and just turned 65. So I've been slammed with phone calls and mailings. I didn't know what to do. The Advantage Plan sounded so good, but I have been totally covered with Medicare and a good supplemental plan. Absolutely no issues!! So your words of wisdom helped me understand. I will just keep what I've got because it does all I want it to do. THANK YOU AGAIN!!
Which supplemental plan did you choose? I’ve been on SSDI since 2019, I have plan a, 64 still covered by my husbands Kaiser plan but there are no facilities nearby.
Once on Medicare, it is the primary payer. The supplement has to pay no matter who you go with.@@msvalarnett
My very first doubts came when I heard the name "Medicare ADVANTAGE!" Sadly, in our (1984) culture, terms are often designed to trick the buyer by using a name that is the exact opposite of what your going to get. These HMOs should be called "Medicare DISadvantage."
Well, it is an advantage to those selling them, lol.
Typical corporate speak. Any terms around the subject usually mean the reality is the exact opposite. Advantage. Value. Quality. Trust. Integrity.
there are advantage plans that ae not HMO
@@bethdavis7812 and they are PPO, or Preferred Provider Organization. Yes, you can use doctors, etc not on the preferred list, but you'll pay more to do so. Also premiums, and out of pocket expenses are higher.
@@markwilson4315 Those are good points ... thanks for taking the time to further explain Medicare Advantage.
The biggest problem with Medicare Advantage plans are that people don't understand that they, unlike Medicare Supplement Plans, are all DIFFERENT, from one plan to the next, and certainly different in quality, too. That is why, unlike Medicare Supplement Plans, CMS rated each one every year. But people continue to lump them all together, and assume that if they had problems with one, there must be problems with all of them. NOPE. But look at the star rating for each, because that is the most important factor. Steer clear of a 3 star or below.
Superb, thanks for the explanation.....I'm new to medicare and have been getting a million advertisements for plans....AGAIN, THANKS!!!
My mother was on a medicare advantage plan as part of the retirement program for State of Texas retirees and never paid a dime through multiple hospital stays and procedures for her heart condition. All meds and followup care were provided and she was free to choose any doctor she wanted and there were no limitations on location of care. YMMV but it was the best coverage of any medical plan I’ve ever seen in my 45 year professional career.
My mom has similar experience with Kaiser and Medicare Advantage in Virginia.
Wow! An insurance salesman with a conscience. Kudos to you for doing what's right for your clients, even though you could be making more money.
Thanks Leland - best to believe in what you sell!
He’s doing just fine on money. Those supplements he’s selling make him just as much as Advantage plans.
@@G--do8ro Hi G2 - I have just about everything Medicare on my channel. If you look in the description of this video you can download my book and sign up for my Medicare Mini Course. All free. And yes - Medicare supplements are what I do. Feel free to give a call when time. 877-885-3484
AMEN....
not
As a retiree Medicare eligible soon, I've been swamped with offers of Medicare Advantage plans for nearly a year. Not fully understanding the options, your video enlightened me plenty. Am glad to see you doing the right thing now.
That's great! You'll get a lot more mail and phone calls the closer to 65 :(
Wonderful it works in your favor.
I'm of the opinion that Kaiser can be great if your medical problems are not complicated and things are stable.
And it also depends on the choice of practitioners at the particular Kaiser you join. I've seen top notch physicians, specialists and nurses at some Kaisers, and other Kaisers where I wouldn't send my Yorkie to.
@@catbee1452 my mom had Kaiser thru her union, it was fine until they said she needed a pacemaker. Then she subjected her to 3 surgeries installing faulty pacemakers. In her area, Kaiser was a teaching hospital and she was the guinea pig. I got IN THEIR FACE and said enough I don't want these experimental new contraptions. I did research and DEMANDED a well known unit and she FINALLY was fine. But then I knew how to navigate the broken system as a LICENSED AGENT and I went to the insurance commissioner and demanded they stop experimenting on her. I was an advocate as well having volunteered in hospital for decades. I knew the cages to rattle to get results, and I went after them ALL like a pit bull and got my mom the care she deserved. Kaiser can be good or seriously iffy.
@@savannahsmiles1797 As a nurse for 43 years, I've seen a lot of "iffy" in different health care settings.
To navigate the "iffy", one must know enough about the system to jump through the required hoops.
@@catbee1452 I used to work at Kaiser. If you have minimial health problems. Kaiser will work for you. I always caution people that if you have expensive chronic medical problems, then there system is not so good. You have to learn how to work their system to get what you want/need.
THANK YOU for this video. I hope you take time to answer my question. I have not switched over to medicare, because I am still employed and very much enjoy my company-provided benefits. However, a friend of mine recently retired and went on traditional medicare supplements; he is having a horrible experience since his doctor prescribed a 3 month regimen for Eliquis. My friend is expecting close to $3000 out of pocket expenses for this brief regime.
So, while your video was extremely helpful and better prepared me to learn the jargon as well as how to evaluate and discuss the differences between the 2 paradigms, I feel like it ignored a huge elephant in the room, and that is a cost of prescriptions.
I don't think anyone questions that traditional medicare is a great choice for medical coverage, but I think people get very nervous when it comes to considering prescriptions, vision, dental, etc.
So the most simple way to pose my question is this: how can I use medicare supplements while still protecting myself from high prescription out of pockets? How do I get a plan that is more like the group health plan I currently have with my employer? The cost of prescriptions is frightening
I sell both Supplement and Advantage plans. There is no one-size-fits-all. And in terms of the network size, if you live in a metro area (I live in San Diego) there are tons of doctors available, even on Advantage plans. My clients rarely, if ever, have a hard time getting the medical support they need. But you're right...the choice and simplicity of Supplement plans is very attractive. $0 premiums on Advantage plans are also attractive. Depends on the situation and need.
Thank you so much for this video. I started with regular Medicare eight years ago and have stayed with it. Advantage plans sound so good and some family members were taken in by that and with all the "free" stuff they receive. It just didn't sound right to me. I didn't know why but now after this video I know why. I hope anyone looking at Medicare sees this video. Again thank you.
I enroll people in Medicare advantage plans. 95% of the people I deal with survive just on their ssn, ssi, or ssdi benefits. If you can afford a Supplemental plan, I highly recommend it but you will have to purchase a standalone dental, vision, and/or hearing plan which could run another $100/mo. 75% of the people I help are C-SNP or D-SNP eligible.
@@roberthoeller5516What do these folks do when they have surgery and have to pay their $6000 max out of pocket?
Amazing. Going on Medicare at 65 was incredibly confusing with tremendous conflicting statements. Could not understand the big picture. Now all the bs fed me makes sense. Clear presentation. Thanks
Thanks CT!
A lot of doctors don't acceot original Medicare insurance .
Doctors prefer Medicare advantage or PPO. Ask. Specialist they prefer Medicare advantage. Rather than original Medicare.
@@carollabutay4654 Emm... I think you have this completely backwards.
It is a maze and it is subject to changes...so try to keep on what is going on.
@@carollabutay4654 It depends...
Not all doctors except Medicare. I'm relatively healthy and have a Medicare Advantage plan and have had the same doctor before I turned 65 and haven't had any issues.
I will be checking on the pros and cons again like I do ever year. I'm 71 now and who knows how much longer I will be in good health.
Thank you so much. This video was very helpful ❤
With Med Supp you have 3 premiums; medicare part B, the cost of the supplement and the cost of your part D premium. The deterrent to joining a Med supp plan is the large monthly premium. United Healthcare and Aetna have the best Medicare Advantage plans hands down.
It all depends on how much peace of mind is worth to you. Basically, in many ways, it's a "pay me now (with controlled, known premium payments), or pay me later, (with unknown amounts looming). I know exactly how much my premiums are (yes, like everything else, they go up a little every year). I can budget for them. But if you have an advantage plan with big deductibles, copays and unknowns, you can take a big hit all at once.
My mother has AARP United Healthcare, Medicare advantage PPO, and so far its been great, I know someone else who has the same plan and he loves it too, I turn 65 this year so I plan on getting thd same plan three months ahead of my birthday.
@@Gwynlovesdisco good plan! My parents are both on med advantage and love it, same with my Medicare clients. Advantage isn't for everyone, and I have some clients on supplements because that is their preference and they can afford the premiums, but the vast majority are happily on advantage PPOs with huge networks & solid care. I have also seen older folks paying $700 plus total monthly for part B, med supplement, and drug plan because they're stuck in an obsolete med supplement and can't qualify for another one, and are scared to move because of videos like this.
In my area Humana’s is best. My deductible is thousands less than either of these two. However since being on MA now for my third year I would NOT suggest to anyone to take a med advantage plan. If you are in the hospital you will end up paying it out of pocket.
Yeah, and when there is 2 of you it is even more expensive.
I agree! I had a HMO and they sent me to a
Surgeon who was training to learn how to remove my top lung. He didn't get it right and 3 days later had to open me back up for lung surgery #2. He left an air leak. I returned to work 2 months later, could not breathe. Xrays were taken twice. I worked for a year like that.No one said a word to me. I changed Insurance immediately found out my lung was collapsed and glued to my chest wall. Cedar Sinai fixed me as good as possible. My current lung Dr. said you can't leave a lung collapsed for a year. Now I'm stuck with 33% lung function. Get the best Doctor available. Don't let them send you to a surgeon in training.
No HMO for me....
Sorry you had that experience :(
I've been on Medicare and Plan F since 2008.
It's worth the peace of mind.
@@alysewitt3729 I am so sorry to hear you went through such a horrible experience, and am glad you have a good supplement plan. I also have Original Medicare and a Plan N and you are absolutely right! The peace of mind is worth the cost.
You do realize that can happen no matter what insurance you have. Sorry for health problems.
@@TheCheryl57 I found out later that if I had gone to Cedar-Sinai to a true lung surgeon they would have made two tiny cuts instead of the 16 inch cut across my back that went into my breast. They would have got it right the first time. I would not have stayed one month in the hospital. You are right that anything can go wrong and it sure did. Leaving me with a collapsed lung knowing it was collapsed, is my biggest concern. I worked that way for an entire year.
I have had Blue Cross Medicare Advantage Plan PPO. I kept all my original doctors and dentist. Nothing has been turned down. I pay nothing and there are extra nice benefits. I admit I am a healthy senior, but had a friend who had prostate cancer and had surgery and chemo and was only out $1000. I think this plan is perfect for some people. I wonder if you make more money off gap plans than advantage plans.
Never had a problem with quality of care, referral times or anything else with my KP Medicare Advantage plan.
My personal physician also suggested that I not choose an Advantage Plan when I retired at 65 but she didn't go into detail. Your video is very informational and is articulated well. Now I can pass on what I've learned from you when someone younger asks my opinion about this medical insurance issue. Thank you so much!
Thanks Keith!
Don’t listen to him/ look at all your options and DO THE MATH- be smart with your money because insurance carriers will experience inflation next and the rates will become astronomical. Especially when part B is now 170 a month! Think about what it will be in 5 years...if you are that worried get an indemnity plan that pays you back the copays and get a heart/cancer stroke plan...much better spend of your money than paying 1200/1500 a year with no added benefits except the medical coverage (dental and vision and hearing all extra where as an advantage plan includes them...) he’s really doing most of the population a disservice with this video when most can’t afford a supplement over 70 when you probably could use it! By that time you could save thousands!!
@@carieyoung1111 exactly! You have to go with what you can afford!
@@TheCheryl57 I agree with you have to go with what you can afford. Everyone. Just be selective if you ever need major surgery like heart or Lung. My sister just had hip replacement on an Advantage plan and the surgeon did a good job. He did however break 1 of her ribs during the surgery....that was painful for her. Her hip works good though.
@@alysewitt3729 Huh
Thanks for the thorough explanation. I’ve been asking Medicare questions well before the requirement age of 65. And now 6 years later. I am just as confused. To top it off, I worked at an agency that did not pay into social security. Which means I have to pay a larger Medicare premium. Nobody has given an explanation like this about the differences in this Overwhelmingly confusing process. I subscribed.
Thanks Connie! Sorry you'll have to pay more than you should.
@@MedicareonVideo
ka n
There are some employers (read school districts) that don't contribute to Social Security, however, there is a separate line item for Medicare. I would check you paystub. If there is a medicare line with a dollar amount, and it has been paid for 40 quarters or more then you will get no premium Part A. Part B cost $170.10/month for most middle class
Its so uneccesarily difficult to understand. I still don't know what to do!! I live in Manhattan, NY , just got approved for disability and I feel there are no options that I can afford .
Great Video and clear thoughts. Thank you. Thanks again. Thanks once again.
Good presentation Keith. I downloaded the book as a way of refreshing myself. Thanks for the helpful videos.
My sister just sent me your link and I'm so glad she did. I handled all of my mother's medical affairs, though I know nothing about the world of Medicare. I know that she would get very frustrated with Medicare Advantage and being required to keep going to her PCP over and over, which meant paying him over and over. You are correct - ultimately, it ended up costing her more to be on Medicare Advantage. Now that my sister and I are about to be at the age where we need to make informed decisions, your video has helped us tremendously. Thank you for taking the time to do this.
Happy to help!
Usually you don't pay anything to go to your PCP in a Medicare Advantage Plan.
I'm an agent and I enjoyed watching your video. I advise my clients in much the same way you do Keith. Go with a supplement out of the gate and stay with until it hurts. I laughinly say that I wish Broadway Joe and JJ had invested their money better back when they were bringing in the bucks and not having to pitch MA plans in their golden years. Bill Shatner sure doesn't need the dough.
Hello. So if I may, are you also recommending to stay away from Medicare Gold or any other private managed plan and stay with A & B with a supplement or two to include coverages for dental, vision, hearing, prescriptions?
What a great informative video. I just retired and had to dig through what you are describing without help. It can be so overwhelming hoping you are making the correct choice. I am 61 so I had to find insurance on the marketplace for myself. My wife is 70 so I had to figure out Medicare for her. Luckily, I chose original Medicare B with a Medigap (G) for her. Sounds like I made the right call. Wish I had found you before I went through all of the headaches. Thanks so much for this information!!
Good job!
I enroll people in Medicare advantage plans. 95% of the people I deal with survive just on their ssn, ssi, or ssdi benefits. If you can afford a Supplemental plan, I highly recommend it but you will have to purchase a standalone dental, vision, and/or hearing plan which could run another $100/mo. 75% of the people I help are C-SNP or D-SNP eligible.
This is a great explanation. Signing up for Medicare was one of the most confusing things I have ever done. Based on this info, however, it seems I made the right choice to go with original Medicare.
You are right. Almost ALL Doctors and Hospital accept Medicare and the Supplements pay the same no matter which company you buy it from. Unless your primary care Physician, Hospital or specialists is in the Advantage network you pay out of network charges.
Laura, if you ONLY have Medicare, you will have to pay the 20% that Medicare doesn’t cover. A $100,000 hospital bill will cost you $20,000. You still keep Medicare whether you chose to use a supplement or a Medicare advantage plan. But they each cover that 20% for you to some degree.
Call and ask an insurance agent that sells Medicare Supplements and Medicare Advantage plans to educate you about your choices. I sold both about 12 years ago. I took my dad off a supplement and put him on a MAPD, medicare advantage plan with prescription drug coverage. He saved $150/month by switching to the MAPD. Over the 10 years, he has saved over $9,000 in premiums to his supplement company.
If the insurance person can’t explain everything and answer all your questions, find another one. It will cost you nothing to speak to someone.
@@yeppers7225 It is my understanding when you go to a Medicare Advantage plan, you go entirely to the plan. In other words the insurance company covers ALL of your medical expenses not just the 20%. That's why the Fed. Gov. pays them at least a $1,000 a month for every Senior they sign up. One can always go back to Medicare from an advantage plan for the 80% they pay but they would have to be underwritten for a Supplement plan and can be turned down and then have to pay that 20% themselves.
@@bobbycoln5626 that is incorrect. Medicare advantage participants and Medicare supplement participants still pay their part B premium. Most don’t know that because it comes out of their social security checks automatically. If either of these groups were “entirely on the plan” that would not be the case.
Also, if you check Medicare.gov, it clearly explains both groups remain on original Medicare. That’s why these plans are called “gap” plans, both Medicare supplements and advantage plans fill the “gaps” original Medicare doesn’t cover.
As a side note, I sold both supplements and advantage plans many years ago. I was able to write policies with any company in the US. In order to get the same coverage with most advantage plans, you must pick one of the most expensive plans in the supplements. That used to be plan F, as it was the most comprehensive coverage available for supplements. Plan N is fairly close as well, but doesn’t cover everything plan F does.
Regardless of which option you choose, the worst thing to do is choose neither and have no extra coverage since original Medicare only covers 80% of the costs which leaves you paying the remaining 20%.
@@yeppers7225 Yes, you continue to pay the part B premium but the Federal Government pays the Insurance company a monthly costs of around $1,000 to cover ALL of the insured's claims. The Federal Gov. or Medicare pays nothing if you own an Advantage plan. Some companies even refund the part B premium when you purchase a Advantage plan.
Thank you , I was thinking to go to Medicare Advantage plan it is advertised everywhere. Thanks to you now I know that I have to stay to the original Medicare and get the supplement, for a lower cost. Thank you .
Problems with Medicare private insurance, it is a multi billion dollar business of roll-over business. First, no matter your health condition, there will always be a company that doesn't ask health questions and at a competitive price (shop the mkt.). 2nd. Private Medicare insurance policyholders endure a never ending price increase, and eventually for lots of folks there back shopping in the private medicare insurance market looking for same coverage with less premium and should not be a problem. Health questions today are mainly yes and no questions. Experience from June 1984-1998 acting as an Managing General Agent or MGA with 33+ broker/agents. In my day, we were referred to by the state as Master General Agents.
There is lots of money in the medicare day workers mkt. Be ware of the excess MGA's and, private insurance brokers sell what pays them the most commission..
And, medicare programs offered through the mail, we referred to as less sophisticated med sups.
We have been on a 5 star Advantage plan since turning 65 12 years ago. Our plan is a non profit coop managed by medical professionals. Even though we had one major surgery, I find this plan to provide great coverage at a modest cost. Highly recommend our Martin's Point plan which is only available in the state of Maine. If you can find a similar plan in you area it will save you a bundle. The only way I can see that the supplement plans will pay is if you have multiple severe morbidities where you are spending most of your time in the hospital or doctor's office with a lot of expensive drugs. For the average normal person the advantage plans are a good alternative.
The average normal person is about 50% of the public that rarely see a doc and the other half who are in the doctors office quite often.
I was in a unique situation because I got Medicare at age 64 due to disability. I chose a Medicare Advantage plan (Anthem). I had 2 surgeries, another procedure at the hospital that required general anesthesia and a lot of hospital based tests plus I am on several RX's. I paid nothing up front but by the end of the year, I had paid over $5000 in co-pays etc not counting RX copays. Plus it was a pain to followup on bills they disallowed. Thank goodness I found out I could change back to regular Medicare with a supplement at age 65 with no underwriter requirement or extra costs. This year has been a breeze compared to last year! I have had one surgery that required numerous trips to a wound care doctor specialist, an ER visit, starting PT and stopping PT several times, lots of expensive RX's, etc. I am going to have another major surgery next month too and know I will need one or 2 more next year. My uncovered medical costs out of pocket have been $150 for this year for a specialized medical device that Medicare will not cover. My RX cost have been a lot less too. The nice thing is I can go to any doctor that accepts Medicare!!! My first surgery this year was done in a Bon Secour hospital and the next surgery will be in a Riverside hospital. All covered!!!! I can research and find the best doctors in my area and not be restricted to one group. I also travel so no worried about being out of network. Last year while out of state, I ended up with a simple eye infection and it cost me over $250 for the doctor visit and RX that was not covered out of network. Yes, I pay extra but at $190.29 a month (supplement policy, a drug plan and a dental plan) I am still way ahead of last year. I need to say I got a high end drug plan because it equals less out of pocket for my drugs over the year. I also chose to do a dental plan with the dentist I have used for over 30 years at $29 a month. The Anthem plan only had dentist an hour away from me. I get my glasses at Costco or Sams so the cost is reasonable so no insurance needed. So $190.29 X 12 = $2283.48 for the year......a lot less than the over $5000 from last year. Even if I add the $150 that none of the insurances would cover I am less than the $5000! I am a retired math teacher so the numbers are my thing and I researched a lot of plans before I chose the right supplement plan for me. After months of searching I picked Mutual of Omaha for me. Then when I was almost confident in my research I stumbled on a EXCELLENT group that does it all for you and even helps you if problems come up. BOOMER BENEFITS. They were wonderful even months later when there was an issue with my drug plan. I was always informed during the process. I even did not have to run the figures to find the best drug plan, I just sent them a list of my regular RX's. Save yourself a lot of work and money and call them. No, I am not a rep or am I paid to say this. Just someone who put a lot of time and effort to get the best cost plan for myself only to find a free phone call could have saved me A LOT of time and work. And yes they do advise you on the Advantage plans if that is what you want. They take the time to find THE best plan for their clients and it is all FREE!
Great if you have the income to afford the supplement. But why have Medicare coverage for only those who have been able to save thousands of $ for premiums? System needs to work for all income levels.
If you live in NY State the rules for going onto a supplemental plan after an Advantage plan are different than most other states.
I’m looking at health coverage options as I am near retirement. I found this video very helpful. Thank you for this.
I just saw the end of the video.
I also use my advantage plan a LOT. Again I know each circumstance can work with the plans differently. But so far no complaints from me.
My husband and I are on original Medicare with a supplemental plan and love it. My husband had major surgery last year and was back in the hospital multiple times due to complications. Our out-of-pocket costs were minimal, and did not have to fight with an insurance company.
Sounds great!
@@MedicareonVideo Again, if you can afford the extra premiums.
Thank you so much for speaking out about this! I’m 75 yrs old & I’m so tired of Medicare trying to push this Advantage down my throat! It is a rip off & the care is terrible!
Thank you so much for speaking up about the travesty of Medicare Advantage!
Glad it was helpful!
It's not a rip off and the care is fantastic. I've had advantage for 5 years now, and absolutely love it.
@@Rickm505 Yep I agree, great plan. I don't get the complaint this guy has in the least.
They have gotten excellent- someone who has trouble affording 200/300 a month for a supplement living on 1500 social security or less need to use the advantage plan and they are good! Do your own research with someone who has both options
@@carieyoung1111 Yes................ Just don't get sick.
Keith and his team are very helpful. They understand Medicare and Supplements too get you the best coverage at the best price .
I am HAPPY I found them and you will be too .
I love this ❤ this video. I have worked as a medical biller, claims processor, done surgical authorizations, and now am a certified professional coder; you Sir, are on the money. I just went through this with my Mother. I was furious 😠 at the attempt to push an MADP on her; it was utter garbage. Keep educating on the reality of these plans.