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Being beyond the 6 month window fir switching I was wondering about the possibility of moving off of an Advantage plan to a supplemental and feared that was not at all possible. Thank you for clarifying that it may be open, if I pass the health check. It is worth the effort to find out. Thank you for the straight forward clarification.
I have a supplement, for all the reasons you explain. But a question I have is: for Part D, we are always encouraged to input our drugs and pick the PDP that is the best value based on the combination of premium and drug costs we'd have to pay. But when comparing a supplement vs. MAPD, we consider not just our present health, but also consider the unknowns - how our health might change for the worse. No one suggests we do that for Part D - in other words, no one says to see what plans might be best if you take some more expensive (but fairly common) drugs. A good place to start might be with that list of drugs that Medicare just negotiated for, which cost Medicare a lot not just because they are fairly expensive but also because they are very frequently prescribed. (As in a drug like Eliquis.) Chances are the more affordable plans are no longer great values if one needs expensive drugs. But it strikes me that there are 3 reasons why the approach to picking a Part D plan would be different than the approach to choosing between a supplement vs. MAPD: 1) Because it's really impossible to know in advance which Part D plan actually WOULD be the best coverage in the future, since we don't know what drugs we might need someday; and 2) Because even if you make a bad plan selection, the choice is not irrevocable - if needs change, you can switch plans the following year, so you figure if you need a drug that isn't covered or is covered poorly, you might struggle with the costs on average for 6 months, then you'd switch. (And also, appeals to cover a non-formulary drug, or to get an exception that moves a drug into a less expensive tier, actually can work if medically justified.) But: I would like to hear your own thoughts about selecting a Part D plan, and if the best choice is always to go with the cheapest one based on the combination of plan premium PLUS cost-sharing of the drugs you currently use. Can you give your own reasoning, in a video. some day? Also, you are the best!
@@MedicareSchool Just watched it again. Yes, it does answer my question - thanks! (And, I love your whiteboard! It looks like you enjoy using it, too.)
My Watchman was to protect against stroke. Advantage paid, as I said. Depends on the health system. As you know, UKHS near your office works with insurance. They know how to work the system.
One additional way to get out of Advantage and into a Supplement is; if you are in an Advantage plan, and you are lucky enough that your Advantage provider discontinues the Advantage plan that you are in, then you MAY be able to choose a supplement without medical underwriting. This just happened to my wife, who was in a Regence (Oregon) BCBS Advantage plan, and they sent a letter stating that they were discontinuing that specific Advantage plan. Marvin's team got her set up with an AARP UHC Supplement Plan G without having to go through medical underwriting! THANK YOU Blue Cross/Blue Shield, for dropping her Advantage plan! :) Marvin, please correct me if any of this is inaccurate!
I suppose the quality of an Advantage plan varies with the insurance company and the region. If I lived in a rural area I probably would not choose an Advantage plan. The 2024 premier Advantage plan in the KC region, Aetna's Smartfit PPO, will no longer be available in 2025. Aetna, however, has a trimmed down Advantage plan that looks to be the top choice for 2025. It's the Aetna CORE HMO. Usually I would not choose an HMO because I want to self-refer to specialists. This Aetna HMO plan allows self-referrals. The network is essentially the same as the PPO network. Copays for network specialists still $20. Missing in 2025 is the quarterly $200 debit card to cover copays. Quarterly OTC money has shrunk from $165 to $50. If you live in North KC you may want to choose United Healthcare instead because North Kansas City Hospital is no longer in the Aetna network.
I don't see much difference in Medicare Advantage plans than those medical plans offered by employers. Pretty much the same coverage, with prior authorizations needed.
Yes, my observation, as well. Employer plans may give you a choice of a PPO or HMO, but usually no choice of carriers or networks. Employer plans can sometimes have high deductibles and high max out-of-pocket. The one good thing is the substantial employer premium subsidy, so the employee maybe only pays a small portion of that. When it comes time to enroll in Medicare, it can be sticker shock, when you add up the Part B premium + Supplement + Part D. And no Dental or Vision coverage. So many end up going with Advantage, instead. At least they have a choice of plans, now.
I would say the main difference is how many pre authorizations require which is much more important as you get older and will likely use a lot more medical care than when you were younger.
@@g0989 Advantage plans still lock you into a network, traditional medicare does not, and the denial of service can cost you the care you need. Medigap plans still need to have the pre-existing conditions removed to allow change of plans each year in my opinion. I was put at risk healthwise with an employer/advantage type for profit plan, which delayed care with "approvals". The only reason those plans need approval is the profit they intend to make by paying out less than what they are subsudized with by the federal government thru CMS.
I thought you have said we only have 6 months after starting Medicare to change to a supplemental plan. I started on a Advantage plan so do i have 1 year instead to switch? I read, "You have a guaranteed issue right to buy any Medigap policy sold in your state if you signed up for Medicare Advantage and want to switch to Original Medicare in the first year of coverage. After the one-year trial period, you can be subject to medical underwriting and denials."
That is a trial right period, and it is very tedious that you fit all the guidelines to make changes. You can call our office to confirm if your situation fits the guideline for this period. You can contact us at 800-864-8890.
It’s based on zip code!Humana my sister has a pre loaded debit card every month,Humana here in my zipcode nothing!Kaiser in California doesn’t even have any dental!Regular Medicare it is!
If I want to switch from Advantage (> 6 years) to Supplement I understand that I am subject to underwriting. Is there a standard underwriting questionnaire, or does it vary from carrier to carrier? Can I get a copy of the underwriting questionnaire BEFORE I apply for the supplement plan?
Perhaps the main reason people think Advantage plans are controversial is that they imagine "One Size Fits All." The plan and insurance company that is best for any particular person depends on many different details about that person's situation. I have studied the Medicare website and state Medicare insurance laws where I live (they are not the same in every state). Anyone else can do that. I have paid attention to the few dependable TH-cam channels such as this one. Ignore all the obviously biased TH-cam channels about Medicare, and the ignorant user comments. Each person should discuss his/her situation in detail with a Medicare insurance broker licensed where he/she lives. Then you are prepared to decide what is best for you. Only I am the most knowledgeable about my health and financial etc. situation, together with the broker's advice (and my own experience) about the plans and insurers in my location.
My employer offers a PPO advantage plan in retirement, one of the bullet points said it was nationwide. I can't find it on their website. Could that be true?
Yes, if you are eligible for a retiree plan through a former employer or union, those plans are almost always better than any individual Advantage plan available to just anybody, especially when it comes to copays and maximum out-of-pocket.
I pay $258.00 per month for Obama Care or health insurance market place (under 65 years old). It is HMO with max out of pocket of $7500.00 and $750.00 health deductable. The benefits are not as good as some zero premium advantage plans.
If one stays with Supplemental Plan for several years and decides to switch to Advantage Plan later, one should face a medical underwriting anyway. Switching plans are exhibiting problems, if you are older and not healthy.
@@nghiepdam2061 That would double down on what is already wrong with these plans - the requirement for underwriting is basically a pre-existing condition clause which exists almost no where else in health insurance since the ACA went into effect.
It's managed care. If you want a pay as you go system choose HDG. If your budget allows get plan N. Stay away from the guaranteed issued supplement, which is now G.
We offer both options. Our main objective isn't to sell but to provide all the information needed so that everyone can make an informed decision about the best plan for their specific needs. This ensures there are no unexpected surprises down the road.
Advantage plans can become a disadvantage plan. If they do not cover and you realize it is critical to get the care you can pay for the care which can really mount up. th-cam.com/video/3ToxELDyc4Q/w-d-xo.html
✅ Watch the internet's #1 Online Medicare Educational Workshop for FREE:
medicareschool.com/master-medicare/?
✅ To get 1 on 1 Help from our Team, Schedule a Call Here: medicareschool.com/talk-to-a-guide/?
Being beyond the 6 month window fir switching I was wondering about the possibility of moving off of an Advantage plan to a supplemental and feared that was not at all possible. Thank you for clarifying that it may be open, if I pass the health check. It is worth the effort to find out. Thank you for the straight forward clarification.
That is what we are here for. If you ever have any questions just give us a call at 800-864-8890.
I have a supplement, for all the reasons you explain. But a question I have is: for Part D, we are always encouraged to input our drugs and pick the PDP that is the best value based on the combination of premium and drug costs we'd have to pay. But when comparing a supplement vs. MAPD, we consider not just our present health, but also consider the unknowns - how our health might change for the worse. No one suggests we do that for Part D - in other words, no one says to see what plans might be best if you take some more expensive (but fairly common) drugs. A good place to start might be with that list of drugs that Medicare just negotiated for, which cost Medicare a lot not just because they are fairly expensive but also because they are very frequently prescribed. (As in a drug like Eliquis.) Chances are the more affordable plans are no longer great values if one needs expensive drugs.
But it strikes me that there are 3 reasons why the approach to picking a Part D plan would be different than the approach to choosing between a supplement vs. MAPD: 1) Because it's really impossible to know in advance which Part D plan actually WOULD be the best coverage in the future, since we don't know what drugs we might need someday; and 2) Because even if you make a bad plan selection, the choice is not irrevocable - if needs change, you can switch plans the following year, so you figure if you need a drug that isn't covered or is covered poorly, you might struggle with the costs on average for 6 months, then you'd switch. (And also, appeals to cover a non-formulary drug, or to get an exception that moves a drug into a less expensive tier, actually can work if medically justified.)
But: I would like to hear your own thoughts about selecting a Part D plan, and if the best choice is always to go with the cheapest one based on the combination of plan premium PLUS cost-sharing of the drugs you currently use. Can you give your own reasoning, in a video. some day? Also, you are the best!
Not sure if you've seen this video we've done about Part D for 2025 th-cam.com/video/AxKt0syYNEs/w-d-xo.html
@@MedicareSchool Just watched it again. Yes, it does answer my question - thanks! (And, I love your whiteboard! It looks like you enjoy using it, too.)
My Watchman was to protect against stroke. Advantage paid, as I said. Depends on the health system. As you know, UKHS near your office works with insurance. They know how to work the system.
One additional way to get out of Advantage and into a Supplement is; if you are in an Advantage plan, and you are lucky enough that your Advantage provider discontinues the Advantage plan that you are in, then you MAY be able to choose a supplement without medical underwriting. This just happened to my wife, who was in a Regence (Oregon) BCBS Advantage plan, and they sent a letter stating that they were discontinuing that specific Advantage plan. Marvin's team got her set up with an AARP UHC Supplement Plan G without having to go through medical underwriting! THANK YOU Blue Cross/Blue Shield, for dropping her Advantage plan! :) Marvin, please correct me if any of this is inaccurate!
I have been reading about a hospital dropping Advantage Plans almost daily
But have you read the actual facts and statistics about how uncommon this is, and the circumstances?
I have called a few of my hospitals in my area, and they all still accept them.
I suppose the quality of an Advantage plan varies with the insurance company and the region. If I lived in a rural area I probably would not choose an Advantage plan. The 2024 premier Advantage plan in the KC region, Aetna's Smartfit PPO, will no longer be available in 2025. Aetna, however, has a trimmed down Advantage plan that looks to be the top choice for 2025. It's the Aetna CORE HMO. Usually I would not choose an HMO because I want to self-refer to specialists. This Aetna HMO plan allows self-referrals. The network is essentially the same as the PPO network. Copays for network specialists still $20. Missing in 2025 is the quarterly $200 debit card to cover copays. Quarterly OTC money has shrunk from $165 to $50. If you live in North KC you may want to choose United Healthcare instead because North Kansas City Hospital is no longer in the Aetna network.
I don't see much difference in Medicare Advantage plans than those medical plans offered by employers. Pretty much the same coverage, with prior authorizations needed.
Yes, my observation, as well.
Employer plans may give you a choice of a PPO or HMO, but usually no choice of carriers or networks. Employer plans can sometimes have high deductibles and high max out-of-pocket. The one good thing is the substantial employer premium subsidy, so the employee maybe only pays a small portion of that. When it comes time to enroll in Medicare, it can be sticker shock, when you add up the Part B premium + Supplement + Part D. And no Dental or Vision coverage. So many end up going with Advantage, instead. At least they have a choice of plans, now.
I had a good employer plan for 18 years. My Advantage is very similar, maybe better. Both from Aetna.
I would say the main difference is how many pre authorizations require which is much more important as you get older and will likely use a lot more medical care than when you were younger.
Agree and my employer coverage at end of last year and this year almost delayed my care so long that I could have lost my ability to walk permanently.
@@g0989 Advantage plans still lock you into a network, traditional medicare does not, and the denial of service can cost you the care you need. Medigap plans still need to have the pre-existing conditions removed to allow change of plans each year in my opinion. I was put at risk healthwise with an employer/advantage type for profit plan, which delayed care with "approvals". The only reason those plans need approval is the profit they intend to make by paying out less than what they are subsudized with by the federal government thru CMS.
This year $3500 dental. $40 for dr. visits. I needed dental most.
Anthem has $4k dental PPO
I thought you have said we only have 6 months after starting Medicare to change to a supplemental plan. I started on a Advantage plan so do i have 1 year instead to switch? I read, "You have a guaranteed issue right to buy any Medigap policy sold in your state if you signed up for Medicare Advantage and want to switch to Original Medicare in the first year of coverage. After the one-year trial period, you can be subject to medical underwriting and denials."
That is a trial right period, and it is very tedious that you fit all the guidelines to make changes. You can call our office to confirm if your situation fits the guideline for this period. You can contact us at 800-864-8890.
It’s based on zip code!Humana my sister has a pre loaded debit card every month,Humana here in my zipcode nothing!Kaiser in California doesn’t even have any dental!Regular Medicare it is!
Bottom Line: Supplemental plans are better in most ways IF you can afford them. That is the basic call.
If I want to switch from Advantage (> 6 years) to Supplement I understand that I am subject to underwriting. Is there a standard underwriting questionnaire, or does it vary from carrier to carrier? Can I get a copy of the underwriting questionnaire BEFORE I apply for the supplement plan?
It varies carrier to carrier.
Just turn 65 no health issues use it maybe once per year?Advantage plans are great!
Perhaps the main reason people think Advantage plans are controversial is that they imagine "One Size Fits All." The plan and insurance company that is best for any particular person depends on many different details about that person's situation. I have studied the Medicare website and state Medicare insurance laws where I live (they are not the same in every state). Anyone else can do that. I have paid attention to the few dependable TH-cam channels such as this one. Ignore all the obviously biased TH-cam channels about Medicare, and the ignorant user comments. Each person should discuss his/her situation in detail with a Medicare insurance broker licensed where he/she lives. Then you are prepared to decide what is best for you. Only I am the most knowledgeable about my health and financial etc. situation, together with the broker's advice (and my own experience) about the plans and insurers in my location.
My employer offers a PPO advantage plan in retirement, one of the bullet points said it was nationwide. I can't find it on their website. Could that be true?
It possibly could be, but I would call them to verify directly. If so, ask them to send this to you so you have record of it!
@MedicareSchool I worry that with the policy being renewed each year that it could change at some point.
The coverage is better if you are a municipal, state or Federal worker.
Yes, if you are eligible for a retiree plan through a former employer or union, those plans are almost always better than any individual Advantage plan available to just anybody, especially when it comes to copays and maximum out-of-pocket.
Far too many vultures involved that offer zero value to Customers other than themselves. No offense to vultures!
I pay $258.00 per month for Obama Care or health insurance market place (under 65 years old). It is HMO with max out of pocket of $7500.00 and $750.00 health deductable. The benefits are not as good as some zero premium advantage plans.
If one stays with Supplemental Plan for several years and decides to switch to Advantage Plan later, one should face a medical underwriting anyway. Switching plans are exhibiting problems, if you are older and not healthy.
@@nghiepdam2061 That would double down on what is already wrong with these plans - the requirement for underwriting is basically a pre-existing condition clause which exists almost no where else in health insurance since the ACA went into effect.
I need to talk to someone please
BAD!!!!
bad bad do med sup plan d
It's managed care. If you want a pay as you go system choose HDG. If your budget allows get plan N. Stay away from the guaranteed issued supplement, which is now G.
Why trust this guy? What is he selling?
We offer both options. Our main objective isn't to sell but to provide all the information needed so that everyone can make an informed decision about the best plan for their specific needs. This ensures there are no unexpected surprises down the road.
Advantage plans can become a disadvantage plan. If they do not cover and you realize it is critical to get the care you can pay for the care which can really mount up. th-cam.com/video/3ToxELDyc4Q/w-d-xo.html