As an Oncology provider for over 40 years I will tell you that there are other issues to consider which in my opinion make a G plan even more helpful. One of these issues is that G plans allow you to seek expert care outside of an Advantage plan PPO list of providers and institutions. I practice in a rural community and often send my patient to larger Comprehensive Cancer Centers around the country where they can get the best care for their unique situation. As I understand it, some Advantage plans may not pay as well in these situations. The other issue is prior approvals. If I order a diagnostic study such as a PET scan or MRI, or an IV chemotherapy medication agent, with a G plan there is no authorization process and these items will be paid for (assuming I am practicing within accepted guidelines). An Advantage plan may require a prior authorization before the test or medication can be ordered. These prior authorizations are a huge burden to providers and staff. Indeed, at many large institutions they will not spend any time on these and that means a less than ideal test or drug may need to be substituted.
Unfortunately, Medicare is going bankrupt. There will be a huge push to cut costs see out 32 trillion US debt, our lovely congress may force everyone onto these medicare advantage plans to save money. as they say "entitlements such as Medicare and Social security drive the national debt higher"
Thank you so much for this information! I've had cancer I'm going on Medicare very soon I'm terrified to be honest with you! I was on Medicaid and everything thankfully was covered. But with these changes I'm scared and don't know what to do
@@Theretirementnerds This video is really good, I also live in a rural area but less than 6 hours (driving) from Mayo Clinic, so a Plan G is a no brainer. On top of that, if you do not have cancer, you can run up that $5000 (or $3000) max out of pocket in a hurry.
Wow, those costs are incredible. I am a senior living in Ontario Canada. There would be zero cost to me for all that treatment. That is not because I am a senior. The cost would also be zero for any citizen. All my medications are covered with the exception of a 100-dollar deductible at the beginning of the year. I cannot imagine having to go through a serious illness and having to worry about paying for the treatment.
Thank you for watching and sharing your perspective! We have heard all kinds of pros and cons to both healthcare systems. We don't live in nor have we experienced the Canadian Healthcare system, just heard through friends or contacts. From your perspective, is there a tradeoff in timing? Would you need to wait longer to get care or is that not your experience?
Dealing with insurance companies and hospitals is a special hell also. I've had friends wait 3 months to get a Dr's appointment. This country should have universal health care for everyone. The cost of medical care in this country is astronomical and many people have to declare bankruptcy or don't get the care they need
@@ohsweetmystery If you have health insurance, then you already DO have other people bearing the burden of the costs for your medical treatment. How do you think insurance works? The healthy help to pay for the procedures of the unhealthy.
Let's also remember that many Advantage plans are HMOs. As a former health insurance broker, EVERY HMO health plan that I ever reviewed defines 'medically necessary' as 'the least aggressive, least expensive treatment options available'. If my family member has cancer, I don't want my treatment options limited by this definition. Advantage plans get to set their own rules and they don't necessarily have to comply with Medicare rules. NOBODY in my family will ever be on an Advantage plan if I have a say in the decision.
Love the passion. A lot of PPO advantage plans options as well. Supplement plans are amazing. We're not sure how people can watch this video or any of our comparisons and feel like supplement plans aren't amazing coverage. They are. They just cost more in premiums. For some people, that is important. For others, it's not. Remember, there are certain populations where it is illegal to recommend a supplement plan, so as long as your family members don't end up on Medicaid and they can afford the supplement plan and other plan premiums, recommend a supplement plan!
well said. the REAL Difference do you want a INS. CO. dictating what /when/and where making the decisions of treatments involving your health. by the way MA is a FOR PROFIT less they spend on you more profit. thats capitalism. commissions for agents sellings MA are at least double selling a supplement for ORIGNAL MEDICARE [MA is NOT orignal medicare] thus all the commercials.
1/ you did not add premiums to SUP for part D drugs, vision, hearing of about $400/yr. So total for SUP would be 1800+226+400= $2426/yr 2/ some ADV gives back part B premium of 75/mo or $900/yr 3/ some ADV provides free gym membership 4/ some ADV provides free to/from doctor/hospital transportation (12 times round trips/yr) 5/ assuming every NORMAL YEAR there are 12 dr visits ($5 copay -> 60/yr), 2 specialist visits ($50 copay -> 100/yr), 1 emergency ($100/yr), so total yearly ADV costs: 1800 (part B) - 900 (part B give back) + 260 (yearly health services) = $1160/yr, resulting savings of (2426 SUP - 1160 ADV) = $1266/yr for going with ADV 6/ assuming for the next 20 years there is 1 CANCER YEAR then ADV would be 6600 (7500:your chart - 900 part B give back) compared to SUP 4426 (4026 + 400 for drugs, vision, hearing) -> 6600-4426= $2174 savings for choosing SUP Bottom line: 19 normal years: ADV savings of $24054 (1266x19yrs) 1 cancer year ADV negative of $. 2174 Total savings after 20 years: $21,880 (still more than coverage of even 2, 3 cancer years!)
I survived stage four cancer ten years ago. When I turned sixty five last year I got supplement N plan. I would never let my life depend on an HMO again. Dealing with the HMO was worse than the cancer.
I have news for you. If you get cancer again, it’s going to be even a worse nightmare and you’ll think your first experience was a walk in the park. Stop fooling yourself..
I am all over the place on this video. First of all so selfless of you to do this video using your mom as the example while going through such a personal heartbreaking issue with her. Second this hits home for me as we were visiting my mom and sister to have dinner. My wife being a nurse noticed something was not right with my mom. She took her to the doctor the next day. They put her in the hospital and 2 weeks later she passed away while still there. She had Pancreatic Cancer. That was in 1999. As far as biased, well none of your videos are ever biased. You put out the most informative, easy to understand videos that anyone can understand. This one was no different. My thoughts and prayers are with your mom, you and all the family. From all the videos I have watched on this site if there is one thing I know about your mom it is that she has raised an awesome son.
Appreciate your kind words! Super sad about your mom. We have another family member going through Pancreatic cancer right now (referenced as the other person in the video). Cancer shows no mercy. Thank you for watching our videos and taking the time to share your thoughts and experiences!
You are doing a public service by making these easy to understand (as is possible) videos about the insanely difficult world of Medicare & Medicare Advantage! Sympathy to both you and this commenter about your difficult experiences with cancer...........💌
Oh, you are a wonderful man and your Mom is proud! Great presentation 👍🏻 At 69 yrs of age, I was diagnosed with cancer. Five weeks of daily radiation and weekly chemo, followed by 5 sessions of internal radiation which included anesthesia. Throw in 4 ER visits, plus a few bags of blood and platelets. I’m on Medicare with Plan G Supplement. My total treatments and hospitalization? Out of pocket $190 - whew, I am amazed! We ALL deserve adequate healthcare! ❤ May God bless every one of you fighting cancer. 🙏🏻 Thank you for your video!
In 2013, my husband was diagnosed with a terminal, metastasized, primary liver cancer, he was gone in 4 months; and, had previously had many treatments for skin cancers, including costly surgeries. We had a supplemental. Our total out of pocket (after annual deductible) was about $30. Those "expensive" supplemental premiums were SO worth it. Two years after he died, I was diagnosed with triple negative breast cancer and was under treatment for 15 months, including 15 months chemo, 35 radiation treatments, and surgery. My total outof pocket after annual deductible was about $30 also (some kind of funny thing slipped through somehow). If we had not had the "expensive" supplemental, I would have lost my house. There would have been NO way for me to pay those bills. The higher premiums for a solid supplemental guarantee me that I will never face catastrophic medical bills that I can't pay. In my opinion (and I'm 79 years old with all the predictable hearing and dental problems)....I would never feel comfortable letting my supplemental go for the attraction of a low premium on an advantage plan.
Sharon, so sorry about your husband and what an intense few years for you and your family. So glad you are still with us. Supplement plans are amazing, aren't they? For those who can afford them, they give great peace of mind. Thoughts and prayers 🙏
My total annual income is right at $25,000 w/a house payment of $671. Just to clarify in response to your kind remark: some would say I can't "afford" a supplement. It's a priority for me because I can't afford to be blindsided by bills I can't pay! Thank you for your encouragements.@@Theretirementnerds
Your mother is a strong woman and we are rooting for her and the rest of your family! Keep doing the great work you do and adding transparency to the market.
Your video is so very helpful and thought out. I just prayed for your mom. We have a daughter who has stage 4 breast cancer and has been battling it for 4yrs. It is an evil disease
I’m 77, enrolled in Plan F which is no longer available for new enrollees. You deserve an award for this channel. I have known several people who think they are doing great with Advantage until a diagnosis of cancer happens. In Florida where I live, Mayo Clinic is not considered in network for Advantage plans because they are only one facility. Sad.
As a parent of older children I know how proud your parents are of their boy........you mom did good. Excellent video and as someone who worked in a fortune 100 company for 35 years you have excellent presentation skills.
Another excellent video! Sadly, as an Agent in CA, I can't find a Cancer policy that issues to individuals over 65. For those looking to go the Advantage route, the Max out of pocket is very much a deciding factor. You can usually find a way to save on eyewear, hearing aids, even dental work if you're not picky, but $1000's extra each year for Chemo adds up! My mom beat her first breast cancer diagnosis, but 10 years later I lost her, at age 88. She went with it, not from it. Here's hoping your mom does better!
California has some strange rules. My understanding is that it is illegal to sell a supplemental insurance policy (as in ancillary, not medicare supplement/medigap) to anyone age 65 and up. The exceptions being dental and vision policies.
Also not mentioned is the advantage deductible is annually. So if you need treatment in December into January, yes!! Double the deductible. Sorry about your moms struggle. To start off the video with that, obviously made it about more than just numbers.
Thank you so much for this very enlightening video! I truly appreciate you doing this video, my husband has had cancer twice and the cost was astronomical. We choose the G plan and we are very happy with it but I learned so much from your video that helped me understand why we need to stay with our plan. Please tell your mother we will keep her and your family in our prayers! 🙏🏻🙏🏻🙏🏻
It would be interesting to see what the numbers are for various kinds of medical problems, such as cardiovascular, auto-immune, alzheimers, etc. This is a great revelation for a major medical problem.
We try to do videos like this relatively regularly. We have a few on a joint surgery, heart attack, etc that we've released and are on our channel. Thank you for watching!
My Open Heart Surgery for heart Valve replacement and bypass 3 years ago cost me ZERO under my Medicare Advantage HMO in plan. There were 3-4 doctor visits that cost $35 each. Hospital charged ZIP. Spouse Gall Bladder Emergency surgery cost $250 , Major Stomach surgery $600. My Stage 4 Cancer treatments/visits/tests over 4 months etc. $2500 . All over the last 3 years all under a Medicare HMO plan in Plan. This is in Austin, Texas. And most likely BECAUSE it was in Austin.
@@Theretirementnerds my husband had a small stroke a few months ago, he's not on Medicare yet, he's on a BCBS plan. The $55,000 hospital bill + tests cost us about $200. He then had a few outpatient visits and had a few more tests and a LOOP recorder (for heart monitoring under the skin) installed by his regular cardiology practice to check for AFIB which cost more money for a total of about $1,000. He is supposed to go onto a Medicare Advantage plan through his union's retirement package. I wonder how something like this would be covered under United Healthcare Medicare Advantage. We haven't gotten the card yet with the ID# on it so I can't look up what the out of pocket costs are. We live in the NYC area, his union is in NYC. So I assume he's covered under most of the better NYC hospitals. He made a great recovery from his stroke but who knows what the future holds.
What most people don’t know or think about is that with an Advantage plan, you have access to a nurse Case Manager to help you navigate all of the specialists and treatments, check up on you when you go home from the hospital and basically be there to be sure you have what you need. The older you get, the more important that type of support becomes. You don’t get that benefit with traditional Medicare or a supplement plan.
The reality is, it sounds much better on paper than it is in person. None of that ever happens. It’s just a bunch of exaggerated reassurances to make old people feel good. And the nurses that come around are usually horrible. At my clinic when I was going quite frequently every single day, it was nothing but chaos with those Medicare nurses not showing up, taking off to go shopping or whatever and leaving the senior alone in the clinic without anyone and then not coming back in time to pick up the senior after their appointment. I saw little old ladies, weeping uncontrollably in the sun in their wheelchair because they had been parked out on the parking lot and left while the clinic nurse went to find out where their home nurse was and it had been 30-45 minutes. I can’t tell you how many times I was Paul crying seniors back into the clinic into the air conditioning myself, and then go yell at the nurses and find out where their home care nurse was. In fact, the clinic got upset with me and sent me a letter telling me to mind my own business . That’s a bunch of baloney. Advantage plans are all a bunch of baloney. Just another way to take senior money and then give nothing in return. I used to talk with all the ladies in the breast clinic because I would have to wait hours and we would all just get to talking about our experiences with the healthcare system. Not one person told me that I should get on an advantage plan, because they were having nothing but nightmares, and not getting what they paid for.
@@chelseacraft4669My husband’s union, The Carpenters Union switched from a supplemental plan about 7 or 8 years ago to a Medicare Advantage plan and he turns 65 next year. I worry about what will happen on the United Healthcare advantage plan.
In reality that nice person on the phone is really part of the insurance utilization (cost control) part of the machine. We had this for a high risk pregnancy. The help provided was something you could get from a postcard in the waiting room. This person is really surveilling you, against all ethical canons that they signed to gain their nursing certs. Medicare should just provide this service, it would pay for itself in spades. That nurse has a fiduciary duty to her employer not an ethical one to your health.
I have Medicare part a & b with a supplement plan Which is free Tri-Care-for-Life from being retired military. As a backup I have a 10% VA rating. I HAVE HAD a quad bypass, A TUMOR ON MY pituitary gland, Bladder and Kidney Stone operations and almost no out of pocket expenses. Plus not required to have a In-network doctor or hospital.
Erik: Best of health outcome for your Mother. I myself, my brother and sister became orphans with the passing of our Mother after she survived mid-stage uterine cancer which brought on heart damage that lead to her passing. Sorry about going off on that tangent. Your videos and methodical, comprehensive and present the Medicare related details in a thoughtful manner. Regards, Steve
This is very informative. Will be turning 65 in a couple months, currently have an HMO, and was diagnosed with uterine cancer a year ago. Diagnostic tests, surgery with 2 night hospital stay, chemotherapy, radiation treatments, prescriptions, and various specialist appointments were all covered with out of pocket co-pays totaling just over $1000. This HMO has an Advantage plan which I am going to get because it will ensure that there will be no interruption of the close monitoring necessary to catch a recurrence (20% probability in next five years).
Thank you for this unbiased information. It’s very helpful for understanding all the aspects of senior health plans and the added cancer plans to help with those costs. I’m sorry to hear about your mom. Thank you for being so transparent. Praying for another 27 years for her ❤
One reason I like a supplement plan is that as I get older keeping track of medical bills becomes more difficult..particularly if you don't have someone to manage that for you
My mom worked for the City of NY and she has original Medicare (the city pays for her part B premiums, they send her a reimbursement check for herself and her husband) and she also has a supplement plan that the city pays for (for herself and her spouse) and she barely pays for any medical expenses even though she has a chronic disease. She was very fortunate to have a job with NYC that she got at age 50 after my dad passed unexpectedly. She was only a kitchen worker and didn't make much money but she got these incredible benefits which covered herself and her 2nd husband for the last 37 years till he passed away last year. But he was covered under her policy the whole time they were married.
This was very informative and when I worked for health insurance companies, decades ago, I never liked HMO types of companies. I am healthy. I have Plan G with a high deductible and a funded HSA. Thank you for sharing this information.
My Medicare Advantage HMO has done a Pretty good job of covering my Stage 4 Cancer treatment. All my services were available IN PLAN and the Authorizations were fast. After Biopsies, PET Scans, tests and Doctor visits too numerous to mention and 45 radiation treatments and T-blocker pills , My out of pocket costs over the last 4 months were under $2,500. My PSA scores went from 10 to 0.03. Retired on Social Security. The trick here is to have good doctors in your plan who know the system. My Docs knew exactly what MY costs would be BEFORE the treatment or prescription or test. I was in complete control, and was given choices. Am I cured....No. They bought me a year. Maybe 2 before we go at this again. At age 71 that's pretty good.
First off, so glad to hear you are still with us and your PSA scores are looking so good. Second, thank you for sharing your experience with your plan. That is helpful for people to see. Third, I hope you get as much time as possible and you feel strong and without pain! Appreciate you!
Your video made me realize how lucky we are here in Stockton, CA to be with Central Health Plan that has a maximum liability of $900 a year. We have a Cancer Center connected to one of our three local hospitals. We also get a debit card with $300 every quarter for healthy foods and medical sundries. Our previous Well Care plan had a maximum of $2,500.
I was diagnosed with an incurable form of leukemia on my 64th birthday. It was an easy decision to get original Medicare plus an F supplement. My medical bills since going on Medicare would have hit the max out of pocket for any advantage plan every year. I really like that I don't even think about medical bills or pre-authorizations. I just get my treatments.
Glad it seems to be working good for you. Hopefully it continues! Had a question about you saying your Leukemia was diagnosed at age 64. I’m assuming that since you wasn’t 65 yet, did this then qualify you to be able to sign up for disability medicare and if so were you then able to go on Medicare w/medigap instead of being forced to go on advantage plan? I never heard anyone that was on disability say they had a choice of original medicare or advantage so i was surprised with what you said. My brother went on disability i think the same age as you and i could tell his wife did all the paperwork because he didn’t know what he had for sure but he said he didn’t use his medicare card. So I just assumed then it was Advantage and he had no choice since he could afford Supplemental Coverage. His is wife is a nurse and i thought she would know better! Don’t mean to pry but i trying to write notes about all this stuff to tell my family about since they will eventually handling this for themselves and making decisions on its use for me later. The information regarding all this comes piece by piece and sometimes not in time when you need to know or what you should know! Thank you!
@@Once_in_a_Lifetime I wasn't treated until just after my 66th birthday when I was definitely on Medicare. I have traditional Medicare with a supplement.
My aunt died of cancer. They refused to do the necessary tests to see what her issues were. She was feeling really bad in her stomach. Visited the Doctor 8x and he refused to refer her. Advantage Plans are very dangerous to have if you actually get cancer. They want to keep those dollars to themselves instead of refer out. She was around age 80 so maybe they felt she had a good live. I'd only get a supplement.
Sorry to hear about mom , I was just curious which one did you recommend for mom before she got sick . My wife was diagnosed with stage 3 lung cancer about a year before getting Medicare so she was on a good employer insurance. So when she went on Medicare went with plan G even though she was in remission. We both felt it was best for her because of the chance of reoccurrence the main reason was the freedom to pick her doctors . We felt comfortable with cost being higher . I can see the benefits of both plans . For us it was really a comfort thing for us.
I'm sorry to hear about your wife. My mom has a supplement Plan G. The chance of reoccurring cancer influenced that decision. Another big factor was that as part of her retirement from the company she worked at for most of her adult life , they would provide an annual healthcare stipend to cover all her healthcare premiums. That made the decision pretty easy for her.
These numbers are way low re: the costs of procedures and care. I was diagnosed with Stage 3+ cancer. I had a urologist, an oncologist, two surgeons, 7 operations, 6 months in 3 hospitals, chemo for four months 3 days a week, and home nursing for 30 visits over 2 months. At the end of that first year, I got a letter from Florida Blue- my provider -that said " Congratulations! You have saved $1.8 Million dollars."
A lot of variables in cancer. The type you have, the treatment you have, the provider and hospital you use, where you live, and other variables. So yes, your costs could be substantially higher or lower. Those used in this video are pulled from actual claims. Thank you for watching and hope you are well!
Thanks for another outstanding video, 90 Days From Retirement! Don't expect what you don't inspect. When you know the numbers, you make informed decisions, much like a doctor explaining the pros and cons.
This is reassuring. I commented on your last video about how a patient navigator at my hospital strongly suggested traditional Medicare with a Plan G because I will need chemotherapy for the rest of my life. Looks like she was right. Eventhough there was one cheaper option, other factors still make it seem more favorable than an Advantage Plan. Looking forward to a Plan D for cancer patients video, or at least mention.
Thank you for watching and taking the time to comment on these. We are trying putting a video like that together that isn't too full of disclaimers and asterisks 🙂
Wow! Chemo for the rest of your life? My mom was just diagnosed with Uterine Cancer. She had her full hysterectomy and we’ll see her oncologist in a week. He said she’ll need chemo And Radiation!? We don’t know what to expect. She is a strong, independent 78 years old. May I ask what type of cancer requires chemotherapy forever? I hope you are winning the battle!
@@OceanLife772 Basically, any form of Stage 4 metastatic cancer that can't be surgically removed or burned away will require chemo indefinitely since the tumors can easily start growing again without it. For now, I am "stable", but that's as good as it can get.
Prayers for your mom. She's lucky to have you to help navigate through all the claims processes and know what to expect so $ isn't an extra stressor at this time. New whiteboard is pretty, but I liked the personal touch of seeing you write it out by hand. I'm sure it makes it easier to film, though.
Thanks for being willing to share your family's personal experience. A real-life example with numbers is extremely helpful. Wishing your mom and all of you the best. ❤
I had prostate cancer a few years ago. I went through numerous tests, scans, etc and then 29 radiation treatments. My PSA is very low now. Through it all I was denied NOTHING by my UHC Advantage plan. The total cost for all treatments, doctors, etc. was over $100,000. I ended up paying about $1200 out of pocket.
Thank you for sharing! It's important for people to see Advantage plans are not evil. They work different than OM, but they aren't inherently bad. Thank you!
I had a reverse left shoulder replacement as and outpatient Facility Fee 170,000 Dollars /Medicare/Plan N Paid about 17,000/ I paid 45 dollars Insane amount of PT 3 times a week 8 months at 200 a visit / 0 cost no copay on PT
With a Plan N, you would've also had the Part B deductible (not sure what year this happened), but outside that, yes, your out of pocket for these types of procedures is very low with supplement plans!
@tommays56 totally understand. I think the whole point is that with supplement plans, high-dollar medical costs don't scare people as much because supplement plans handle a lot. Hope you and your wife have good health moving forward!
The other advantage to plan G is that you can go to whatever dr you want and you don't have to worry about the advantage plan telling the drs how you should be treated....denying a procedure or medication that the dr would like you to have.
Mostly correct! Much more flexibility with Supplement Plan for sure. Just want to make sure people understand that not EVERYTHING is covered under Original Medicare. Still has to be medically necessary. Cannot be experimental. But you are correct otherwise of if it is medically necessary and approved by Original Medicare, no question asked, no denials... very straightforward. Thank you for watching!!
I have Supplement Plan F and just got Cancer. Sooo Glad that I did not go with an advantage plan. Another thing about a supplement plan is that you are not restricted into using only the Advantage plan doctors. You can go to any doctor in the USA that takes Medicare. With Advantage, you can see their doctor when they can see you. If you have to wait a month, too bad. When you get cancer, time can be a most important thing.
My wife had cancer. Year 1 docs, surgeries and chemo was 220K billed, 160K paid, we paid $6750 max out of pocket. Year two just doc visits and test paid at $20 per visit and 0 for labs. Year three docs, surgeries and last hospital visit were 40K billed, 28K paid and our share was $2500 +-. Once she entered hospice we did not pay anything for the last two weeks of life. since then the out of pocket max has dropped to 5500. One thing about the cancer policy, you assume it was only paid for for one year, do it for five years and the cost / benefit goes upside down.
My widowed MIL got a breast cancer Dx in Nebraska in a very rural town. With Original Medicare and a Plan G Supplement we were able bring her to Atlanta for treatment. The only thing we paid for was the Medicare deductible and mastectomy bras co-pay. Her brother, on Medicare Advantage, had to stay in his region and was unable to come to the "big city" for better treatment. MIL believes not getting full and proper care cost him his life.
This is very helpful and very well laid out and I appreciate that. That said that is why I will continue with my Medicare advantage plan because I’ll take the same risk of not having cancer for 10 more years that would mean not paying the supplement and saving that money then if cancer does come, but the difference wasn’t that much for something that may or may not happen plus, like you said you didn’t talk about the medication’s in the Medicare advantage that’s free to me along with free dental and vision. It’s just very hard to beat now. Yes I understand if I am retiring and I had problems then definitely get the supplement. Great video and I subscribed.
So sorry thst your mom is facing cancer again. Thank you for this very informative video. One thing not covered is the limited treatment options for Medicare vs. Advantage plans. The Advantage plans are very restrictive for what procedures they approve and what providers they allow. I had surgery for pancreatic cancer in January and just finished chemo. I won't be 65 and on Medicare until August 2024. Since pancreatic cancer frequently makes an encore appearance, considering the Advantage plan restrictions, I'll be sticking with traditional Medicare and a supplemental plan. Thank you for the info. I'll be praying for your mom!
Super video! Thanks! I'm not yet 65 and am trying to decide between medigap/supplemental or advantage plans. Yep, advantage plans are lots cheaper... but one gets what they pay for. I'm definitely going the medigap/supplemental route. As for N or G....eh, probably part G! I know how special mothers are. Please continue to treat that mother of yours like the princess that she is. I know painfully too well that mother's aren't around forever.
I am really happy that you broke down these costs. I am an insurance broker. This stuff is complicated, so I always like to double check myself. I recently had someone ask me why they needed something in addition to original medicare. I am a visual person so this really helped confirm (to myself) what I told them. Thank you so much. I have also been timid about discussing cancer plans for fear that they won’t pay when needed. Sounds like you have seen them in action. Well done on your presentation.
Different areas of the country have different Advantage plans. Rural/small town areas tend not to be great for Advantage plans but some cities have Kaiser Permanente which is a non-profit, integrated health care delivery organization that eliminates some of the problems associated with HMO's. I priced out cancer care for both Plan G and Advantage through Kaiser and it was about the same in our area but more specialists work for Kaiser since it its the biggest health employer so actually have more choice with them. It is all so difficult to try to figure it all out.
You are 100% correct. Assuming you are in California? Kaiser has a strong impact in California. A couple other states as well. Thank you for watching and sharing!
i was with Kaiser in my city and then they built a big new facility in another area and my local clinic became primary care and routine x-rays only. After massive complaints they began doing mammos again. However, for absolutely anything beyond these, and scripts and an optometrist for routine glasses, you had to travel what for me was two buses and an hour and a half on and waiting for buses. Then getting back could be up to three hours depending on when i got out and when the first bus came. for older people who do not drive, access to care is an important consideration.
65 and getting close to retirement. I love your diagrams as it helps explain! I just subscribed! 😊Can you tell me what the difference is between speaking with an agent versus a broker about insurance?
Thank you for watching and subscribing! The terms are interchangeable. If we want to get technical, a broker implies they represent several different companies rather than just one, which is what we recommend. We are brokers but refer to ourselves as agents more often. So... if you're working with someone, ask if they represent multiple companies. Hope that helps!
I guess I'm fortunate , my potential Advantage plan is owned by a regional center of excellences. I don't need a referral to see a specialist if in network. Thats a big part of my though process, pretty much they have everything, it's something some should consider if they are lucky enough to have it.
My wife is being treated for Hodgkin's Lymphoma. To date Medicare has paid out $252,165 and my secondary insurance (Tricare 4 Life) has paid $52,292. Costs will go up a bit as the 12th chemo treatment is not in the totals yet, nor the PET scan scheduled for early Dec. We're lucky that T4L costs us nothing. I have a great deal of empathy for those who can't afford to have a supplement. Total paid out to date is over $305,000!
I had the same cancer in early 2022. Went through 5 months of chemo twice a month before a PET scan showed in remission. Still in remission in 2024. Still seeing my Oncologist every few months and still get regular PET scan every 4 months or so. Best wishes to your wife.
My Advantage plan has an annual maximum OOP of only $3650. I'm 71 and have never had cancer. I have no deductibles, and specialist visits are $40. As far as I can tell, I'm better off with my Advantage Plan, which also has a part D drug plan. (But I hope I don't ever develop chronic kidney disease, because chronic dialysis appears to be pricey on my plan.) Best wishes to your dear mom with her chemo and cancer regimen.
I did a ton of research before turning 65 and because I could afford it went with Medicare and G as a supplement. Now with that said cost didn't actually figure into the equation. What turned me off to the Advantage plans was quality of care. I spoke to dozens of seniors between 65 and early 90s. Most that had been on the Advantage plans less than 5 years were happy with the cost and because they were relatively healthy were happy with the quality of care. When speaking with progressively older seniors, and interstingly health care administrators, the consensus is that the older you get the more costly the Advantage plans become but more importantly to most people the quality of care becomes much worse. Tests, treatments, and meds are not covered or your options may only be old treatments and meds and out dated protocols. It's very discouraging, almost criminal, to see a loved one recieve inadequate care because of their insurance. My prediction is this is only going to get much worse.
A Medicare Advantage plan + Cancer policy might be the *least expensive* total cost, but I am seeing in other videos that many hospitals are no longer accepting Advantage plans coverage due to their burdensome pre-authorization processes and higher incidences of fraud. So that might not be the *best* option. An Original Medicare plan is accepted everywhere, and bundled with a good Supplement plan, appears to be a close second in terms of cheapest overall cost.
Where I live 2 office visits with an oncologist would max out the Advantage Plan max. I have Medicare only and I like it for the ability to choose my own doctors and to make appointments without referral.
Can you explain the 2 office visits maxing out the Advantage plan max? Is that for chemo or just visiting with the oncologist? The math doesn't seem to make sense here. The out of pocket max is not a deductible, so for your office visits, you'll have a copay or coinsurance that won't be anywhere near the out of pocket max. If you're talking chemo treatments, most Advantage plans have an 80/20 split where you will have a 20% coinsurance for each chemo treatment until you hit the max out of pocket, at which point, you have no more cost responsibility. If you are on Medicare only and no supplement, you have that same responsibility of 20% coinsurance for chemo, but with no out of pocket max, meaning you will need to continue paying that 20% coinsurance for as long as you need those treatments. There are a lot of Advantage plans that do not require a referral. We agree with you that Original Medicare only gives you more freedom around providers, but that 20% costs share with no max is a huge financial risk.
Of course the other issue is where you go for treatment. Advantage plan may have very few choices with very few doctors signed up. Will they pay the bill for that world famous cancer center?
In general, we agree. Some exceptions, but yes, in general, supplement plans will deal with cancer in a much more stress-free way. Thank you for watching!
An issue with both Advantage and supplement plans is that some medications are super expensive and no matter what plan you have medicare wants cost sharing of around 30% on tier 5 drugs (expensive). I researched this and on some of the medications I was taking it will be around 4000 a month just for the cost share. I can't afford to retire since my work insurance pays 100%. of the drug cost. None of the part D plans pay even close to that.
You are correct. Medications billed through Part D are tough. Things are changing in 2024 and again in 2025 to make that hopefully better. ruclips.net/video/eWy6y77cYBM/видео.html
Thank you for watching. It is all dependent on where you live, hospitals you visit, etc. The Medicare negotiated amount is less than what most see as the sticker price. Hope that helps! Appreciate you!
I am getting medicare in Jan but I also have an FEHB plan ( federal Gov), fed blue basic, So I'm good, current plan is blue shield standard with 303.00 monthly premium, when I get medicare and the blue shield basic my combined premiums will be 269.00 ( blue shield basic gives a 800 rebate if you have medicare)
I have been very happy with my Medicare plus supplemental coverage for cancer treatment. However, having survived the treatment, I am now on maintenance drugs covered by Plan D. These drugs are tier 5 and are extremely expensive. So expensive that most people would be bankrupt. Not a good outcome after surviving treatment, having good results and going bankrupt to survive.
First off, happy yo know you are ok. Second, yes, drug coverage is tough. Changes are coming in 2024 and again in 2025, which we outline here that we hope will make things better: ruclips.net/video/eWy6y77cYBM/видео.html
I'm glad to hear that your mama's strong and she's a fighter I prayed I'd go and stay by her side to her upcoming trials I myself and my heart is going to pray for how old is am I no course Nelly that she's very proud of you so much for the information❤❤❤❤❤❤❤
I have an older co worker friend who is 56 and has been found disabled by the Social Security Admin. so she it going to retire due to her medical issues. She has been off work for a couple of years. They backdated her disability to 6/21 and she's eligible for Medicare 12/23. If she purchases Original Medicare Plan G, is her supplement to Medicare higher than a retired person over 65 or about the same price? Due to her health issues, she was not comfortable with an Advantage plan as she doesn't want to do referrals and she travels out of state a lot to visit her children and stays with them at times. Also best wishes to your Mom. I wish her all the best.
Thank you so much! This can get a bit complicated depending on where she lives. Some states don't have supplement plans for those on disability. At her 65th birthday, she could get a supplement Plan G and shouldn't face any price difference. What a great friend you are!
Very interesting video. I am curious about the two advantage plans though. The benefits and cost for both plans appear to be equal at least for this situation with the exception of the out of pocket limit so why would anyone buy the plan with the higher limit.🤔
Thanks for watching! To your question, a few important reasons someone might take the higher max: 1. Networks - a lower max plan my not have an individual's doctor or hospitals in-network. 2. Service - Some companies just have better service than others. 3. Other benefits - plans often come with dental, vision, hearing, gym memberships, and other perks. If those are more important to an individual, a plan with stronger dental benefits may have a higher max out of pocket. It is unlikely that you will see plans with that dramatic of a difference in the same area. In our area, it's between about $4,500 - $6,000 on the max out of pockets. Those two in the video were just to help people that live in an area that has a lower Max Out of Pocket on average than what we experience. Hope that helps!
A humana rep told me that many people like to stick with their older plan instead of checking out the newer better plans they offer. So they just pay more rather than comparing the newer plans.
The Whiteboard "Detailed " comparisons of the different Plans are very good. But... You need to add in the other Gap Plans required (Drugs etc) into the final $ Totals to make it Apples to Apples. Well done though... The White board makes it VISUAL... That is important.
Now ad it the cost of a $50mo separate rx plan, separate dental vision and hearing coverage. No extras like transportation or OTC allowance with a supp plan. Factor all that on MAPD with a low MOOP is the way to go if available in your area. I've seen some MOOP in florida and Cali as low as $800-$900
Where someone lives and the plans available definitely make a difference. Areas with low MOOPs change this conversation quite a bit. Other areas don't show quite as strong. Thank you for watching and you raise excellent points!
My Medicare Supplement plan is much more expensive. My mom, who lives across country is also much more expensive, obviously she’s older. Time to look at Medigap alternatives!
Great video!! Have a known cost vs unknown. I have watched so many older family members literally blow $100,000+ with Medicare fighting cancer with in-network and out of network drama and fighting for 4-5 years and still dying....For sure have a known cost per year with an advantage plan and a cancer policy vs unknown....It's just not worth it to have the risk of not having it.... My Mom died in 2021 and we are still getting bills-so much drama.... Hope your Mom makes a fully recovery!!!
Very helpful. I am a big believer in supplements vs advantage plans. However I am seeing dramatic increases as I age (currently 74) in the supplement premium as many others probably are. There does seem to be a point (and I am there) where the Plan G Premium easily exceeds the Advantage PPO max OOP. I will look at switching from Mutual of Omaha. I did not meet their underwriting standards for a lower cost plan G. If I can't find a different company for Plan G it is only going to get worse and I will be forced out of Supplements. It's the ugly side of Supplements as you age. Everybody, please don't set and forget your supplement. Price shop it every three years or so. If I had I would be much better off now.
You bring up an important point that many don't realize. Many people are facing what you face where their supplement premiums have grown to an unsustainable level. Thank you for watching and sharing your experience!
If you have a Plan F, you should be able to down grade it to a G. But if your company doesn’t do that, (some do with no underwriting if it’s within the same company ) then you’re stuck.
Do the birthday rule. A company can't get health questions answered. Do 30 days before your birthday or 30 days after to get a better cost. You could do this every year. You can ck this out with a health care agent, bur I think this is ok.
@lindalopez7710 Hi Linda, thank you for sharing. Not all states have this as an option. In fact, most don't. Sounds like you may live in one of the 8 states that does have the birthday rule.
Erik, good stuff and I hope the best for your Mom and your family. Could you do something similar with High Deductible Plan G? This would illuminate the differences between this and regular Plan G quite well. Thanks again!
Hi there. Thank you for your kind words. We have a few videos on HD-G that go over these comparisons. Not necessarily this same cancer videos, but other situations. Here are a couple that I hope will help: Real Cost Example with G, HD G, and Advantage ruclips.net/video/MWrNhZW8ZcQ/видео.html Comparing G, HD G, and N ruclips.net/video/Gw5mg3H8CWg/видео.html 20-year look at costs ruclips.net/video/DgpS_RlA4gk/видео.html Hope these help! Thank you so much for your support!
Excellent video. Do the cancer plans pay every year after cancer? My wife has been fighting cancer since 2007. Luckily we have a special employer provided Advantage plan with a max of $150 or we would be broke. Year after year cancer treatment can be devastating.
A few arrangements. Some are 1 and done. Some are the initial payout and then it builds back up again over time and will pay again if a 2nd, separate diagnosis happens.
Gap G vs H can be simple - the higher cost to avoid dr. visit $20 copay would even out after monthly plan payment. Some states the plans can be a bit more pricy.
Hi Erik, I turn 65 in August of this year. I currently get the majority of my medical from the VA. I had my wife get original Medicare with a plan G supplement last year since she's a little older than me. Her supplement for my zip is currently around $96.00 a month. If I got the same one, mine would be $101.00. With that being said, I was thinking of getting original medicare plus the supplement in case I want to go outside the VA or they change the way they cover veterans in the future. I have heard and talked with some that says a MA plan would work better for me because I could get a reduction of my part B premium since the VA drug plan is considered a covered plan, although as far as I know it only would cover prescriptions that the VA prescribed. I get all the cost savings of the MA plans, but if I can afford original MC, would it be the best option in the long term even though I can, and do go to the VA. I have past heart issues, and I wonder just how long the VA will continue covering veterans with ratings under 30%. I'm service connected for my back but only at 10%, and 10% for tennitius. With my past heart issues I would also hate to get on a cheaper MA plan, only to possibly need more in the future. Thanks, enjoyed your video.
Hi Tim, appreciate you watching! It's an interesting conversation and the details around your VA coverage are important. Happy to help in any way we can. My email is erik@90daysfromretirement.com. your zip code will make a difference. Yes, most with VA coverage go to the VA as much as possible and grab an MA plan for cost reasons, but we can look into options. Appreciate you!
I think if you have cancer with an advantage plan you'll need to go through underwriting if anything ever changes in the plan (which it will). Then, you are subject to higher quoted plan prices due to pre-existing conditions. That's one of the reasons why plan G is best for anyone with cancer. The other reason is you can have any doctor you want and don't need referrals. 😊
There is no underwriting with Advantage plans, even if they change benefits for the next year. Supplement plans are much less complicated in cancer costs, but for those on Advantage plans, they will not get kicked off or see higher rates as a result of any sort of underwriting
Correct. If it was a $5,000 cancer policy and using the numbers used in the video. In fact, you'd have about $1,000 in your pocket. Most don't get a cancer policy in addition to a supplement plan. You're more than welcome to, but most don't. They use cancer policies to hedge against risk for the advantage plan max out of pocket.
As others have pointed out, this scenario only applies if you've only paid Part B and G for one year. But if you've paid Part B and G for 10-20 years then MAs are way cheaper. Extrapolate out to 10, 15, 20 years. Those B and G premiums add up to a LOT.
As an Oncology provider for over 40 years I will tell you that there are other issues to consider which in my opinion make a G plan even more helpful. One of these issues is that G plans allow you to seek expert care outside of an Advantage plan PPO list of providers and institutions. I practice in a rural community and often send my patient to larger Comprehensive Cancer Centers around the country where they can get the best care for their unique situation. As I understand it, some Advantage plans may not pay as well in these situations. The other issue is prior approvals. If I order a diagnostic study such as a PET scan or MRI, or an IV chemotherapy medication agent, with a G plan there is no authorization process and these items will be paid for (assuming I am practicing within accepted guidelines). An Advantage plan may require a prior authorization before the test or medication can be ordered. These prior authorizations are a huge burden to providers and staff. Indeed, at many large institutions they will not spend any time on these and that means a less than ideal test or drug may need to be substituted.
Thank you for watching and sharing your insights!
well said
Unfortunately, Medicare is going bankrupt. There will be a huge push to cut costs see out 32 trillion US debt, our lovely congress may force everyone onto these medicare advantage plans to save money. as they say "entitlements such as Medicare and Social security drive the national debt higher"
Thank you so much for this information!
I've had cancer
I'm going on Medicare very soon
I'm terrified to be honest with you!
I was on Medicaid and everything thankfully was covered.
But with these changes I'm scared and don't know what to do
@@Theretirementnerds This video is really good, I also live in a rural area but less than 6 hours (driving) from Mayo Clinic, so a Plan G is a no brainer. On top of that, if you do not have cancer, you can run up that $5000 (or $3000) max out of pocket in a hurry.
Wow, those costs are incredible. I am a senior living in Ontario Canada. There would be zero cost to me for all that treatment. That is not because I am a senior. The cost would also be zero for any citizen. All my medications are covered with the exception of a 100-dollar deductible at the beginning of the year. I cannot imagine having to go through a serious illness and having to worry about paying for the treatment.
Thank you for watching and sharing your perspective!
We have heard all kinds of pros and cons to both healthcare systems. We don't live in nor have we experienced the Canadian Healthcare system, just heard through friends or contacts.
From your perspective, is there a tradeoff in timing? Would you need to wait longer to get care or is that not your experience?
I cannot imagine wanting other people to bear the burden of the costs of MY medical treatment.
Waiting in line for care if I was sick doesn’t appeal to me
Dealing with insurance companies and hospitals is a special hell also.
I've had friends wait 3 months to get a Dr's appointment.
This country should have universal health care for everyone. The cost of medical care in this country is astronomical and many people have to declare bankruptcy or don't get the care they need
@@ohsweetmystery If you have health insurance, then you already DO have other people bearing the burden of the costs for your medical treatment. How do you think insurance works? The healthy help to pay for the procedures of the unhealthy.
Let's also remember that many Advantage plans are HMOs. As a former health insurance broker, EVERY HMO health plan that I ever reviewed defines 'medically necessary' as 'the least aggressive, least expensive treatment options available'. If my family member has cancer, I don't want my treatment options limited by this definition. Advantage plans get to set their own rules and they don't necessarily have to comply with Medicare rules. NOBODY in my family will ever be on an Advantage plan if I have a say in the decision.
Love the passion. A lot of PPO advantage plans options as well.
Supplement plans are amazing. We're not sure how people can watch this video or any of our comparisons and feel like supplement plans aren't amazing coverage. They are. They just cost more in premiums. For some people, that is important. For others, it's not.
Remember, there are certain populations where it is illegal to recommend a supplement plan, so as long as your family members don't end up on Medicaid and they can afford the supplement plan and other plan premiums, recommend a supplement plan!
well said. the REAL Difference do you want a INS. CO. dictating what /when/and where making the decisions of treatments involving your health. by the way MA is a FOR PROFIT less they spend on you more profit. thats capitalism. commissions for agents sellings MA are at least double selling a supplement for ORIGNAL MEDICARE [MA is NOT orignal medicare] thus all the commercials.
Thanks for saying that.
@@dhix2388Insurance brokers get 3x the commission as opposed to a supplemental plan. No wonder why so many push the DisAdvantage plans!
1/ you did not add premiums to SUP for part D drugs, vision, hearing of about $400/yr. So total for SUP would be 1800+226+400= $2426/yr
2/ some ADV gives back part B premium of 75/mo or $900/yr
3/ some ADV provides free gym membership
4/ some ADV provides free to/from doctor/hospital transportation (12 times round trips/yr)
5/ assuming every NORMAL YEAR there are 12 dr visits ($5 copay -> 60/yr), 2 specialist visits ($50 copay -> 100/yr), 1 emergency ($100/yr),
so total yearly ADV costs: 1800 (part B) - 900 (part B give back) + 260 (yearly health services) = $1160/yr,
resulting savings of (2426 SUP - 1160 ADV) = $1266/yr for going with ADV
6/ assuming for the next 20 years there is 1 CANCER YEAR then ADV would be 6600 (7500:your chart - 900 part B give back) compared to SUP 4426 (4026 + 400 for drugs, vision, hearing) -> 6600-4426= $2174 savings for choosing SUP
Bottom line: 19 normal years: ADV savings of $24054 (1266x19yrs)
1 cancer year ADV negative of $. 2174
Total savings after 20 years: $21,880 (still more than coverage of even 2, 3 cancer years!)
I survived stage four cancer ten years ago. When I turned sixty five last year I got supplement N plan. I would never let my life depend on an HMO again. Dealing with the HMO was worse than the cancer.
I'm so glad to hear you survived and are here. Thank you for watching and sharing.
Thanks for your personal input into Medicare Advantage plan. They are horrible, and I will not be using one.
HMO is an abbreviation that means give as little care as possible to make the most profit for the HMO
If you are not always visiting your doctor(s), Plan N is about the most cost-effective supplement. It's what I have and am very happy with it.
I have news for you. If you get cancer again, it’s going to be even a worse nightmare and you’ll think your first experience was a walk in the park. Stop fooling yourself..
I am all over the place on this video. First of all so selfless of you to do this video using your mom as the example while going through such a personal heartbreaking issue with her. Second this hits home for me as we were visiting my mom and sister to have dinner. My wife being a nurse noticed something was not right with my mom. She took her to the doctor the next day. They put her in the hospital and 2 weeks later she passed away while still there. She had Pancreatic Cancer. That was in 1999. As far as biased, well none of your videos are ever biased. You put out the most informative, easy to understand videos that anyone can understand. This one was no different. My thoughts and prayers are with your mom, you and all the family. From all the videos I have watched on this site if there is one thing I know about your mom it is that she has raised an awesome son.
Appreciate your kind words! Super sad about your mom. We have another family member going through Pancreatic cancer right now (referenced as the other person in the video). Cancer shows no mercy. Thank you for watching our videos and taking the time to share your thoughts and experiences!
❤
You are doing a public service by making these easy to understand (as is possible) videos about the insanely difficult world of Medicare & Medicare Advantage! Sympathy to both you and this commenter about your difficult experiences with cancer...........💌
❤
Oh, you are a wonderful man and your Mom is proud! Great presentation 👍🏻 At 69 yrs of age, I was diagnosed with cancer. Five weeks of daily radiation and weekly chemo, followed by 5 sessions of internal radiation which included anesthesia. Throw in 4 ER visits, plus a few bags of blood and platelets. I’m on Medicare with Plan G Supplement. My total treatments and hospitalization? Out of pocket $190 - whew, I am amazed! We ALL deserve adequate healthcare! ❤ May God bless every one of you fighting cancer. 🙏🏻 Thank you for your video!
Thank you so much! Glad to hear you are doing well. Quite the treatment plan!
👍🏻Indeed!
@@Theretirementnerds
In 2013, my husband was diagnosed with a terminal, metastasized, primary liver cancer, he was gone in 4 months; and, had previously had many treatments for skin cancers, including costly surgeries. We had a supplemental. Our total out of pocket (after annual deductible) was about $30. Those "expensive" supplemental premiums were SO worth it.
Two years after he died, I was diagnosed with triple negative breast cancer and was under treatment for 15 months, including 15 months chemo, 35 radiation treatments, and surgery. My total outof pocket after annual deductible was about $30 also (some kind of funny thing slipped through somehow).
If we had not had the "expensive" supplemental, I would have lost my house. There would have been NO way for me to pay those bills. The higher premiums for a solid supplemental guarantee me that I will never face catastrophic medical bills that I can't pay. In my opinion (and I'm 79 years old with all the predictable hearing and dental problems)....I would never feel comfortable letting my supplemental go for the attraction of a low premium on an advantage plan.
Sharon, so sorry about your husband and what an intense few years for you and your family. So glad you are still with us.
Supplement plans are amazing, aren't they? For those who can afford them, they give great peace of mind.
Thoughts and prayers 🙏
My total annual income is right at $25,000 w/a house payment of $671. Just to clarify in response to your kind remark: some would say I can't "afford" a supplement. It's a priority for me because I can't afford to be blindsided by bills I can't pay! Thank you for your encouragements.@@Theretirementnerds
@@Theretirementnerds
Your mother is a strong woman and we are rooting for her and the rest of your family! Keep doing the great work you do and adding transparency to the market.
Thank you so much!
@@nnam9416 hahaha love it
Your video is so very helpful and thought out. I just prayed for your mom. We have a daughter who has stage 4 breast cancer and has been battling it for 4yrs. It is an evil disease
Thank you so very much! Our thoughts and prayers are with your daughter as well!
Appreciate you!
🙏for your daughter.
Sending positive thoughts to you. There are new treatments every day. F cancer.
@@deniseyweesy thank you so very much!
@@happycook6737 Thank you! I you so very much for your prayers!!
I’m 77, enrolled in Plan F which is no longer available for new enrollees. You deserve an award for this channel. I have known several people who think they are doing great with Advantage until a diagnosis of cancer happens. In Florida where I live, Mayo Clinic is not considered in network for Advantage plans because they are only one facility. Sad.
Thank you so much for watching! Plan F is stellar coverage! Hope the premiums are OK for you
I think the premium has been well worth it.
As a parent of older children I know how proud your parents are of their boy........you mom did good. Excellent video and as someone who worked in a fortune 100 company for 35 years you have excellent presentation skills.
You are too kind Michael. Thank you for watching and taking the time to say such nice things!
Another excellent video! Sadly, as an Agent in CA, I can't find a Cancer policy that issues to individuals over 65. For those looking to go the Advantage route, the Max out of pocket is very much a deciding factor. You can usually find a way to save on eyewear, hearing aids, even dental work if you're not picky, but $1000's extra each year for Chemo adds up! My mom beat her first breast cancer diagnosis, but 10 years later I lost her, at age 88. She went with it, not from it. Here's hoping your mom does better!
Thanks Mark! Sorry to hear about your mom! Cancer is the worst!
California has some strange rules. My understanding is that it is illegal to sell a supplemental insurance policy (as in ancillary, not medicare supplement/medigap) to anyone age 65 and up. The exceptions being dental and vision policies.
Also not mentioned is the advantage deductible is annually. So if you need treatment in December into January, yes!! Double the deductible.
Sorry about your moms struggle. To start off the video with that, obviously made it about more than just numbers.
Thank you so much for this very enlightening video! I truly appreciate you doing this video, my husband has had cancer twice and the cost was astronomical. We choose the G plan and we are very happy with it but I learned so much from your video that helped me understand why we need to stay with our plan.
Please tell your mother we will keep her and your family in our prayers! 🙏🏻🙏🏻🙏🏻
Thank you Patricia. I hope your husband is doing well. Appreciate you!
It would be interesting to see what the numbers are for various kinds of medical problems, such as cardiovascular, auto-immune, alzheimers, etc. This is a great revelation for a major medical problem.
We try to do videos like this relatively regularly. We have a few on a joint surgery, heart attack, etc that we've released and are on our channel.
Thank you for watching!
My Open Heart Surgery for heart Valve replacement and bypass 3 years ago cost me ZERO under my Medicare Advantage HMO in plan. There were 3-4 doctor visits that cost $35 each. Hospital charged ZIP. Spouse Gall Bladder Emergency surgery cost $250 , Major Stomach surgery $600. My Stage 4 Cancer treatments/visits/tests over 4 months etc. $2500 . All over the last 3 years all under a Medicare HMO plan in Plan. This is in Austin, Texas. And most likely BECAUSE it was in Austin.
@@Theretirementnerds my husband had a small stroke a few months ago, he's not on Medicare yet, he's on a BCBS plan. The $55,000 hospital bill + tests cost us about $200. He then had a few outpatient visits and had a few more tests and a LOOP recorder (for heart monitoring under the skin) installed by his regular cardiology practice to check for AFIB which cost more money for a total of about $1,000. He is supposed to go onto a Medicare Advantage plan through his union's retirement package. I wonder how something like this would be covered under United Healthcare Medicare Advantage. We haven't gotten the card yet with the ID# on it so I can't look up what the out of pocket costs are. We live in the NYC area, his union is in NYC. So I assume he's covered under most of the better NYC hospitals. He made a great recovery from his stroke but who knows what the future holds.
What most people don’t know or think about is that with an Advantage plan, you have access to a nurse Case Manager to help you navigate all of the specialists and treatments, check up on you when you go home from the hospital and basically be there to be sure you have what you need. The older you get, the more important that type of support becomes. You don’t get that benefit with traditional Medicare or a supplement plan.
Thank you for watching and adding your perspective!
The reality is, it sounds much better on paper than it is in person. None of that ever happens. It’s just a bunch of exaggerated reassurances to make old people feel good. And the nurses that come around are usually horrible. At my clinic when I was going quite frequently every single day, it was nothing but chaos with those Medicare nurses not showing up, taking off to go shopping or whatever and leaving the senior alone in the clinic without anyone and then not coming back in time to pick up the senior after their appointment. I saw little old ladies, weeping uncontrollably in the sun in their wheelchair because they had been parked out on the parking lot and left while the clinic nurse went to find out where their home nurse was and it had been 30-45 minutes. I can’t tell you how many times I was Paul crying seniors back into the clinic into the air conditioning myself, and then go yell at the nurses and find out where their home care nurse was. In fact, the clinic got upset with me and sent me a letter telling me to mind my own business . That’s a bunch of baloney. Advantage plans are all a bunch of baloney. Just another way to take senior money and then give nothing in return. I used to talk with all the ladies in the breast clinic because I would have to wait hours and we would all just get to talking about our experiences with the healthcare system. Not one person told me that I should get on an advantage plan, because they were having nothing but nightmares, and not getting what they paid for.
@@chelseacraft4669My husband’s union, The Carpenters Union switched from a supplemental plan about 7 or 8 years ago to a Medicare Advantage plan and he turns 65 next year. I worry about what will happen on the United Healthcare advantage plan.
@@chelseacraft4669
Thank you
This is very helpful information
In reality that nice person on the phone is really part of the insurance utilization (cost control) part of the machine. We had this for a high risk pregnancy. The help provided was something you could get from a postcard in the waiting room. This person is really surveilling you, against all ethical canons that they signed to gain their nursing certs.
Medicare should just provide this service, it would pay for itself in spades. That nurse has a fiduciary duty to her employer not an ethical one to your health.
I have Medicare part a & b with a supplement plan Which is free Tri-Care-for-Life from being retired military. As a backup I have a 10% VA rating. I HAVE HAD a quad bypass, A TUMOR ON MY pituitary gland, Bladder and Kidney Stone operations and almost no out of pocket expenses. Plus not required to have a In-network doctor or hospital.
Tricare For Life is a wonderful benefit to have! Thank you for watching!
I hope your health is great!
Erik: Best of health outcome for your Mother. I myself, my brother and sister became orphans with the passing of our Mother after she survived mid-stage uterine cancer which brought on heart damage that lead to her passing. Sorry about going off on that tangent. Your videos and methodical, comprehensive and present the Medicare related details in a thoughtful manner. Regards, Steve
Thank you Steve, I appreciate you saying that and so sorry to hear about your mother's passing so early in life.
Erik
This is very informative. Will be turning 65 in a couple months, currently have an HMO, and was diagnosed with uterine cancer a year ago. Diagnostic tests, surgery with 2 night hospital stay, chemotherapy, radiation treatments, prescriptions, and various specialist appointments were all covered with out of pocket co-pays totaling just over $1000. This HMO has an Advantage plan which I am going to get because it will ensure that there will be no interruption of the close monitoring necessary to catch a recurrence (20% probability in next five years).
Thank you for watching. Thoughts headed your way! Hope you are doing okay!
So sorry for your loss of your mom. My condolences to you and family. 💙🌷
Thank you for this unbiased information. It’s very helpful for understanding all the aspects of senior health plans and the added cancer plans to help with those costs. I’m sorry to hear about your mom. Thank you for being so transparent. Praying for another 27 years for her ❤
Appreciate this so much!
One reason I like a supplement plan is that as I get older keeping track of medical bills becomes more difficult..particularly if you don't have someone to manage that for you
Definitely something to consider! Thank you for sharing!
My mom worked for the City of NY and she has original Medicare (the city pays for her part B premiums, they send her a reimbursement check for herself and her husband) and she also has a supplement plan that the city pays for (for herself and her spouse) and she barely pays for any medical expenses even though she has a chronic disease. She was very fortunate to have a job with NYC that she got at age 50 after my dad passed unexpectedly. She was only a kitchen worker and didn't make much money but she got these incredible benefits which covered herself and her 2nd husband for the last 37 years till he passed away last year. But he was covered under her policy the whole time they were married.
This was very informative and when I worked for health insurance companies, decades ago, I never liked HMO types of companies. I am healthy. I have Plan G with a high deductible and a funded HSA. Thank you for sharing this information.
Thank you for watching and taking the time to share your perspective!
My Medicare Advantage HMO has done a Pretty good job of covering my Stage 4 Cancer treatment. All my services were available IN PLAN and the Authorizations were fast. After Biopsies, PET Scans, tests and Doctor visits too numerous to mention and 45 radiation treatments and T-blocker pills , My out of pocket costs over the last 4 months were under $2,500. My PSA scores went from 10 to 0.03. Retired on Social Security. The trick here is to have good doctors in your plan who know the system. My Docs knew exactly what MY costs would be BEFORE the treatment or prescription or test. I was in complete control, and was given choices. Am I cured....No. They bought me a year. Maybe 2 before we go at this again. At age 71 that's pretty good.
First off, so glad to hear you are still with us and your PSA scores are looking so good.
Second, thank you for sharing your experience with your plan. That is helpful for people to see.
Third, I hope you get as much time as possible and you feel strong and without pain!
Appreciate you!
Your video made me realize how lucky we are here in Stockton, CA to be with Central Health Plan that has a maximum liability of $900 a year. We have a Cancer Center connected to one of our three local hospitals. We also get a debit card with $300 every quarter for healthy foods and medical sundries. Our previous Well Care plan had a maximum of $2,500.
That is one of the lower out of pocket max numbers in the country! Thank you for sharing!
? Do you have to live in the Stockton area or can anyone in Calif. Qualify for those benefits ?
Thanks for sharing a personal story to help us understand the costs. Very practical.
Thank you for watching Paul! And for taking the time to comment. Appreciate you!
I am so sorry to hear about your mom. I can well imagine how concerned you are. I hope she does well in her battle against cancer. 💜💚
Thank you so much Sue. Appreciate you!
I was diagnosed with an incurable form of leukemia on my 64th birthday. It was an easy decision to get original Medicare plus an F supplement. My medical bills since going on Medicare would have hit the max out of pocket for any advantage plan every year. I really like that I don't even think about medical bills or pre-authorizations. I just get my treatments.
So sorry to hear about the Leukemia. Glad you're still with us and happy with your plan!
@@Theretirementnerds It is under control. Thanks for the concern.
Glad it seems to be working good for you. Hopefully it continues! Had a question about you saying your Leukemia was diagnosed at age 64. I’m assuming that since you wasn’t 65 yet, did this then qualify you to be able to sign up for disability medicare and if so were you then able to go on Medicare w/medigap instead of being forced to go on advantage plan? I never heard anyone that was on disability say they had a choice of original medicare or advantage so i was surprised with what you said. My brother went on disability i think the same age as you and i could tell his wife did all the paperwork because he didn’t know what he had for sure but he said he didn’t use his medicare card. So I just assumed then it was Advantage and he had no choice since he could afford Supplemental Coverage. His is wife is a nurse and i thought she would know better! Don’t mean to pry but i trying to write notes about all this stuff to tell my family about since they will eventually handling this for themselves and making decisions on its use for me later. The information regarding all this comes piece by piece and sometimes not in time when you need to know or what you should know! Thank you!
@@Once_in_a_Lifetime I wasn't treated until just after my 66th birthday when I was definitely on Medicare. I have traditional Medicare with a supplement.
So bummed to hear about mom and hate that she's the example here but it's a fantastic video about pure costs with an illness that affects so many.
Appreciate you so much!
Sorry to hear about your mother Erik. Hope it goes as well as it did years ago.
Thank you Rick! We hope so too!
My aunt died of cancer. They refused to do the necessary tests to see what her issues were. She was feeling really bad in her stomach. Visited the Doctor 8x and he refused to refer her. Advantage Plans are very dangerous to have if you actually get cancer. They want to keep those dollars to themselves instead of refer out. She was around age 80 so maybe they felt she had a good live. I'd only get a supplement.
I wish your mother a speedy recovery!
Thank you so much!
This is a very good breakdown of a specific case of cancer and how out of pocket costs are affected by your plan choice.
Thank you!
Sorry to hear about mom , I was just curious which one did you recommend for mom before she got sick . My wife was diagnosed with stage 3 lung cancer about a year before getting Medicare so she was on a good employer insurance. So when she went on Medicare went with plan G even though she was in remission. We both felt it was best for her because of the chance of reoccurrence the main reason was the freedom to pick her doctors . We felt comfortable with cost being higher . I can see the benefits of both plans . For us it was really a comfort thing for us.
I'm sorry to hear about your wife.
My mom has a supplement Plan G.
The chance of reoccurring cancer influenced that decision. Another big factor was that as part of her retirement from the company she worked at for most of her adult life , they would provide an annual healthcare stipend to cover all her healthcare premiums. That made the decision pretty easy for her.
Thanks for the info. Praying for your mother
Thank you so much!
These numbers are way low re: the costs of procedures and care. I was diagnosed with Stage 3+ cancer. I had a urologist, an oncologist, two surgeons, 7 operations, 6 months in 3 hospitals, chemo for four months 3 days a week, and home nursing for 30 visits over 2 months. At the end of that first year, I got a letter from Florida Blue- my provider -that said " Congratulations! You have saved $1.8 Million dollars."
A lot of variables in cancer. The type you have, the treatment you have, the provider and hospital you use, where you live, and other variables. So yes, your costs could be substantially higher or lower.
Those used in this video are pulled from actual claims.
Thank you for watching and hope you are well!
I totally believe it. Went through this with my dad and the appts and $$ was insane
Thanks for another outstanding video, 90 Days From Retirement! Don't expect what you don't inspect. When you know the numbers, you make informed decisions, much like a doctor explaining the pros and cons.
Thank you for your support David! It does not go unnoticed!
This is reassuring. I commented on your last video about how a patient navigator at my hospital strongly suggested traditional Medicare with a Plan G because I will need chemotherapy for the rest of my life. Looks like she was right. Eventhough there was one cheaper option, other factors still make it seem more favorable than an Advantage Plan. Looking forward to a Plan D for cancer patients video, or at least mention.
Thank you for watching and taking the time to comment on these. We are trying putting a video like that together that isn't too full of disclaimers and asterisks 🙂
Wow! Chemo for the rest of your life? My mom was just diagnosed with Uterine Cancer. She had her full hysterectomy and we’ll see her oncologist in a week. He said she’ll need chemo And Radiation!? We don’t know what to expect. She is a strong, independent 78 years old. May I ask what type of cancer requires chemotherapy forever? I hope you are winning the battle!
@@OceanLife772
Basically, any form of Stage 4 metastatic cancer that can't be surgically removed or burned away will require chemo indefinitely since the tumors can easily start growing again without it. For now, I am "stable", but that's as good as it can get.
The premiums might be cheaper but the costs would be far more.
Prayers for your mom. She's lucky to have you to help navigate through all the claims processes and know what to expect so $ isn't an extra stressor at this time.
New whiteboard is pretty, but I liked the personal touch of seeing you write it out by hand. I'm sure it makes it easier to film, though.
Thank you!
Ya, new one is easier to fix mistakes and make it legible 🙂 more room too
Thanks for being willing to share your family's personal experience. A real-life example with numbers is extremely helpful. Wishing your mom and all of you the best. ❤
Thank you so much! Appreciate you!
I had prostate cancer a few years ago. I went through numerous tests, scans, etc and then 29 radiation treatments. My PSA is very low now. Through it all I was denied NOTHING by my UHC Advantage plan. The total cost for all treatments, doctors, etc. was over $100,000. I ended up paying about $1200 out of pocket.
Thank you for sharing! It's important for people to see Advantage plans are not evil. They work different than OM, but they aren't inherently bad. Thank you!
Thank you. I appreciate seeing the detailed information and wish your family members well in their healing.
Thank you so much!
Great information. Thank you. Original Medicare is not a profit-making endeavor, which may feel better for some people for getting care.
I had a reverse left shoulder replacement as and outpatient
Facility Fee 170,000 Dollars /Medicare/Plan N Paid about 17,000/ I paid 45 dollars
Insane amount of PT 3 times a week 8 months at 200 a visit / 0 cost no copay on PT
With a Plan N, you would've also had the Part B deductible (not sure what year this happened), but outside that, yes, your out of pocket for these types of procedures is very low with supplement plans!
@@Theretirementnerds
I have CLL and my wife is a Stage 3C 3 year survivor so the 266 or whatever is a rounding error
@tommays56 totally understand. I think the whole point is that with supplement plans, high-dollar medical costs don't scare people as much because supplement plans handle a lot.
Hope you and your wife have good health moving forward!
I had cancer in 2020 and Medicare paid every cost. I have A, B and G
Thank you so much for watching and sharing your experience
This is a great video. I have Plan F and Part D, and they have been great.
Very solid coverage! Thank you for watching!
The other advantage to plan G is that you can go to whatever dr you want and you don't have to worry about the advantage plan telling the drs how you should be treated....denying a procedure or medication that the dr would like you to have.
Mostly correct! Much more flexibility with Supplement Plan for sure. Just want to make sure people understand that not EVERYTHING is covered under Original Medicare. Still has to be medically necessary. Cannot be experimental. But you are correct otherwise of if it is medically necessary and approved by Original Medicare, no question asked, no denials... very straightforward.
Thank you for watching!!
thank you
I have Supplement Plan F and just got Cancer. Sooo Glad that I did not go with an advantage plan.
Another thing about a supplement plan is that you are not restricted into using only the Advantage plan doctors. You can go to any doctor in the USA that takes Medicare.
With Advantage, you can see their doctor when they can see you. If you have to wait a month, too bad.
When you get cancer, time can be a most important thing.
So sorry to hear you have cancer! All the thought headed your way!
My wife had cancer. Year 1 docs, surgeries and chemo was 220K billed, 160K paid, we paid $6750 max out of pocket. Year two just doc visits and test paid at $20 per visit and 0 for labs. Year three docs, surgeries and last hospital visit were 40K billed, 28K paid and our share was $2500 +-. Once she entered hospice we did not pay anything for the last two weeks of life. since then the out of pocket max has dropped to 5500. One thing about the cancer policy, you assume it was only paid for for one year, do it for five years and the cost / benefit goes upside down.
Thank you for sharing your experience. So sorry to hear about the passing of your wife.
Where I live, Massachusetts costs are much higher, but thank you for this information. It definitely gives a good ballpark number for each choice.
Yes, costs vary dramatically by state. Thank you for watching!
My widowed MIL got a breast cancer Dx in Nebraska in a very rural town. With Original Medicare and a Plan G Supplement we were able bring her to Atlanta for treatment. The only thing we paid for was the Medicare deductible and mastectomy bras co-pay. Her brother, on Medicare Advantage, had to stay in his region and was unable to come to the "big city" for better treatment. MIL believes not getting full and proper care cost him his life.
So sorry to hear about your uncle in law. Glad to hear your MIL is okay. Thank you for sharing your experience!
This is very helpful and very well laid out and I appreciate that.
That said that is why I will continue with my Medicare advantage plan because I’ll take the same risk of not having cancer for 10 more years that would mean not paying the supplement and saving that money then if cancer does come, but the difference wasn’t that much for something that may or may not happen plus, like you said you didn’t talk about the medication’s in the Medicare advantage that’s free to me along with free dental and vision. It’s just very hard to beat now. Yes I understand if I am retiring and I had problems then definitely get the supplement.
Great video and I subscribed.
Thank you so much for watching and sharing your perspective! Glad to have you along for the ride and hope to keep putting out useful videos for you!
So sorry thst your mom is facing cancer again. Thank you for this very informative video.
One thing not covered is the limited treatment options for Medicare vs. Advantage plans. The Advantage plans are very restrictive for what procedures they approve and what providers they allow.
I had surgery for pancreatic cancer in January and just finished chemo. I won't be 65 and on Medicare until August 2024. Since pancreatic cancer frequently makes an encore appearance, considering the Advantage plan restrictions, I'll be sticking with traditional Medicare and a supplemental plan.
Thank you for the info. I'll be praying for your mom!
Thank you for your kind words and thoughts. Also, thank you for sharing your insights and experience!
Pretty good. The cancer plan cost and payments I'd never considered.
Thank you for watching!
Super video! Thanks! I'm not yet 65 and am trying to decide between medigap/supplemental or advantage plans. Yep, advantage plans are lots cheaper... but one gets what they pay for. I'm definitely going the medigap/supplemental route. As for N or G....eh, probably part G!
I know how special mothers are. Please continue to treat that mother of yours like the princess that she is. I know painfully too well that mother's aren't around forever.
Thank you so much for watching and your kind words!
I am really happy that you broke down these costs. I am an insurance broker. This stuff is complicated, so I always like to double check myself. I recently had someone ask me why they needed something in addition to original medicare. I am a visual person so this really helped confirm (to myself) what I told them. Thank you so much. I have also been timid about discussing cancer plans for fear that they won’t pay when needed. Sounds like you have seen them in action. Well done on your presentation.
So glad this was helpful! Thank you so much for watching and saying such nice things!
Thank you I'm really happy about your mom
Thank you Eddie!
@@Theretirementnerds your welcome
Different areas of the country have different Advantage plans. Rural/small town areas tend not to be great for Advantage plans but some cities have Kaiser Permanente which is a non-profit, integrated health care delivery organization that eliminates some of the problems associated with HMO's. I priced out cancer care for both Plan G and Advantage through Kaiser and it was about the same in our area but more specialists work for Kaiser since it its the biggest health employer so actually have more choice with them. It is all so difficult to try to figure it all out.
You are 100% correct. Assuming you are in California? Kaiser has a strong impact in California. A couple other states as well. Thank you for watching and sharing!
i was with Kaiser in my city and then they built a big new facility in another area and my local clinic became primary care and routine x-rays only. After massive complaints they began doing mammos again. However, for absolutely anything beyond these, and scripts and an optometrist for routine glasses, you had to travel what for me was two buses and an hour and a half on and waiting for buses. Then getting back could be up to three hours depending on when i got out and when the first bus came. for older people who do not drive, access to care is an important consideration.
Had prostate cancer got a robotic prostatectomy cost me 0 because I live in Massachusetts on SS and just Medicare alone. But low income.
Yes, low income situations change things in regards to how things are covered. Hope you are doing well! Thank you for watching and sharing!
65 and getting close to retirement. I love your diagrams as it helps explain! I just subscribed! 😊Can you tell me what the difference is between speaking with an agent versus a broker about insurance?
Thank you for watching and subscribing!
The terms are interchangeable.
If we want to get technical, a broker implies they represent several different companies rather than just one, which is what we recommend.
We are brokers but refer to ourselves as agents more often.
So... if you're working with someone, ask if they represent multiple companies.
Hope that helps!
Yes it does! Thank you so much!
I guess I'm fortunate , my potential Advantage plan is owned by a regional center of excellences. I don't need a referral to see a specialist if in network. Thats a big part of my though process, pretty much they have everything, it's something some should consider if they are lucky enough to have it.
Agreed!
My wife is being treated for Hodgkin's Lymphoma. To date Medicare has paid out $252,165 and my secondary insurance (Tricare 4 Life) has paid $52,292. Costs will go up a bit as the 12th chemo treatment is not in the totals yet, nor the PET scan scheduled for early Dec. We're lucky that T4L costs us nothing. I have a great deal of empathy for those who can't afford to have a supplement. Total paid out to date is over $305,000!
Thank you for sharing and I hope your wife I'd doing well! 💕
I had the same cancer in early 2022. Went through 5 months of chemo twice a month before a PET scan showed in remission. Still in remission in 2024. Still seeing my Oncologist every few months and still get regular PET scan every 4 months or so. Best wishes to your wife.
My Advantage plan has an annual maximum OOP of only $3650. I'm 71 and have never had cancer. I have no deductibles, and specialist visits are $40. As far as I can tell, I'm better off with my Advantage Plan, which also has a part D drug plan. (But I hope I don't ever develop chronic kidney disease, because chronic dialysis appears to be pricey on my plan.) Best wishes to your dear mom with her chemo and cancer regimen.
Sounds like you are in a good spot! Thank you for sharing your perspective and for your kind words!
I did a ton of research before turning 65 and because I could afford it went with Medicare and G as a supplement. Now with that said cost didn't actually figure into the equation. What turned me off to the Advantage plans was quality of care. I spoke to dozens of seniors between 65 and early 90s. Most that had been on the Advantage plans less than 5 years were happy with the cost and because they were relatively healthy were happy with the quality of care. When speaking with progressively older seniors, and interstingly health care administrators, the consensus is that the older you get the more costly the Advantage plans become but more importantly to most people the quality of care becomes much worse. Tests, treatments, and meds are not covered or your options may only be old treatments and meds and out dated protocols. It's very discouraging, almost criminal, to see a loved one recieve inadequate care because of their insurance. My prediction is this is only going to get much worse.
@@JohnJohn-wr1joyes but its getting harder to find doctors that take regular medicare. Most are switching to advantage. Im in Oregon.
Great job. I love this kind of analysis/comparisons.
Thank you so much for watching!
Excellent information! Sending prayers and good thoughts for your Mother and family! Thank you Erik!
Thank you Jodie!
A Medicare Advantage plan + Cancer policy might be the *least expensive* total cost, but I am seeing in other videos that many hospitals are no longer accepting Advantage plans coverage due to their burdensome pre-authorization processes and higher incidences of fraud. So that might not be the *best* option. An Original Medicare plan is accepted everywhere, and bundled with a good Supplement plan, appears to be a close second in terms of cheapest overall cost.
Not all doctors take Medicare.
Great job - cost comparison is very useful. Ignore the haters in the comments. Can’t please some of the people ANY of the time.
Thank you!
Medicare is great. Don't need anything else.
sent! thank you
Got it! Replying now
Where I live 2 office visits with an oncologist would max out the Advantage Plan max. I have Medicare only and I like it for the ability to choose my own doctors and to make appointments without referral.
Can you explain the 2 office visits maxing out the Advantage plan max?
Is that for chemo or just visiting with the oncologist?
The math doesn't seem to make sense here.
The out of pocket max is not a deductible, so for your office visits, you'll have a copay or coinsurance that won't be anywhere near the out of pocket max.
If you're talking chemo treatments, most Advantage plans have an 80/20 split where you will have a 20% coinsurance for each chemo treatment until you hit the max out of pocket, at which point, you have no more cost responsibility.
If you are on Medicare only and no supplement, you have that same responsibility of 20% coinsurance for chemo, but with no out of pocket max, meaning you will need to continue paying that 20% coinsurance for as long as you need those treatments.
There are a lot of Advantage plans that do not require a referral. We agree with you that Original Medicare only gives you more freedom around providers, but that 20% costs share with no max is a huge financial risk.
Excellent.
Thank you!
Of course the other issue is where you go for treatment. Advantage plan may have very few choices with very few doctors signed up. Will they pay the bill for that world famous cancer center?
Medicare and a Medicare Supplement in most cases blows Medicare Advantage out of the water when it comes to cancer, it's not even a question.
In general, we agree. Some exceptions, but yes, in general, supplement plans will deal with cancer in a much more stress-free way. Thank you for watching!
This was very good video showing a good idea of how these plans compare!
Thank you so much!!
An issue with both Advantage and supplement plans is that some medications are super expensive and no matter what plan you have medicare wants cost sharing of around 30% on tier 5 drugs (expensive). I researched this and on some of the medications I was taking it will be around 4000 a month just for the cost share. I can't afford to retire since my work insurance pays 100%. of the drug cost. None of the part D plans pay even close to that.
You are correct. Medications billed through Part D are tough. Things are changing in 2024 and again in 2025 to make that hopefully better.
ruclips.net/video/eWy6y77cYBM/видео.html
I agree. I’m more worried about my prescription drug coverage than everything. There’s no way to get a good plan!!! Then there’s the doughnut hole…
Very helpful. Though, the cost for surgery seems absurdly low.
Thank you for watching. It is all dependent on where you live, hospitals you visit, etc. The Medicare negotiated amount is less than what most see as the sticker price. Hope that helps! Appreciate you!
Just found this! Great timing. Thank you❤
Thank you for watching!
I am getting medicare in Jan but I also have an FEHB plan ( federal Gov), fed blue basic, So I'm good, current plan is blue shield standard with 303.00 monthly premium, when I get medicare and the blue shield basic my combined premiums will be 269.00 ( blue shield basic gives a 800 rebate if you have medicare)
Sounds like you'll be in a good spot! Thank you for sharing!
I have been very happy with my Medicare plus supplemental coverage for cancer treatment. However, having survived the treatment, I am now on maintenance drugs covered by Plan D. These drugs are tier 5 and are extremely expensive. So expensive that most people would be bankrupt. Not a good outcome after surviving treatment, having good results and going bankrupt to survive.
First off, happy yo know you are ok.
Second, yes, drug coverage is tough. Changes are coming in 2024 and again in 2025, which we outline here that we hope will make things better:
ruclips.net/video/eWy6y77cYBM/видео.html
I'm glad to hear that your mama's strong and she's a fighter I prayed I'd go and stay by her side to her upcoming trials I myself and my heart is going to pray for how old is am I no course Nelly that she's very proud of you so much for the information❤❤❤❤❤❤❤
Thank you so much 💓
I have an older co worker friend who is 56 and has been found disabled by the Social Security Admin. so she it going to retire due to her medical issues. She has been off work for a couple of years. They backdated her disability to 6/21 and she's eligible for Medicare 12/23. If she purchases Original Medicare Plan G, is her supplement to Medicare higher than a retired person over 65 or about the same price? Due to her health issues, she was not comfortable with an Advantage plan as she doesn't want to do referrals and she travels out of state a lot to visit her children and stays with them at times. Also best wishes to your Mom. I wish her all the best.
Thank you so much!
This can get a bit complicated depending on where she lives. Some states don't have supplement plans for those on disability.
At her 65th birthday, she could get a supplement Plan G and shouldn't face any price difference.
What a great friend you are!
Very interesting video. I am curious about the two advantage plans though. The benefits and cost for both plans appear to be equal at least for this situation with the exception of the out of pocket limit so why would anyone buy the plan with the higher limit.🤔
Thanks for watching!
To your question, a few important reasons someone might take the higher max:
1. Networks - a lower max plan my not have an individual's doctor or hospitals in-network.
2. Service - Some companies just have better service than others.
3. Other benefits - plans often come with dental, vision, hearing, gym memberships, and other perks. If those are more important to an individual, a plan with stronger dental benefits may have a higher max out of pocket.
It is unlikely that you will see plans with that dramatic of a difference in the same area. In our area, it's between about $4,500 - $6,000 on the max out of pockets. Those two in the video were just to help people that live in an area that has a lower Max Out of Pocket on average than what we experience.
Hope that helps!
A humana rep told me that many people like to stick with their older plan instead of checking out the newer better plans they offer. So they just pay more rather than comparing the newer plans.
The Whiteboard "Detailed " comparisons of the different Plans are very good. But... You need to add in the other Gap Plans required (Drugs etc) into the final $ Totals to make it Apples to Apples. Well done though... The White board makes it VISUAL... That is important.
Appreciate you watching.
Is this one more in line with what you're thinking?
ruclips.net/video/TJCE4pKoKvc/видео.html
Now ad it the cost of a $50mo separate rx plan, separate dental vision and hearing coverage. No extras like transportation or OTC allowance with a supp plan. Factor all that on MAPD with a low MOOP is the way to go if available in your area. I've seen some MOOP in florida and Cali as low as $800-$900
Where someone lives and the plans available definitely make a difference. Areas with low MOOPs change this conversation quite a bit. Other areas don't show quite as strong. Thank you for watching and you raise excellent points!
MAPD?
What is mapd?
Also need to factor in the savings on Medicare Advantage for all the years you are healthy and don’t require significant care.
@@keithgruber3471 Medicare Advantage plan that includes Part D
My Medicare Supplement plan is much more expensive. My mom, who lives across country is also much more expensive, obviously she’s older. Time to look at Medigap alternatives!
Yes, the premiums can be very costly, especially in certain states. Thank you for watching!
My advantage plan uses Medicare providers as its provider list! If they accept Medicare, they are in network!
That is fantastic! Thank you for sharing!
Great video!! Have a known cost vs unknown. I have watched so many older family members literally blow $100,000+ with Medicare fighting cancer with in-network and out of network drama and fighting for 4-5 years and still dying....For sure have a known cost per year with an advantage plan and a cancer policy vs unknown....It's just not worth it to have the risk of not having it.... My Mom died in 2021 and we are still getting bills-so much drama.... Hope your Mom makes a fully recovery!!!
Thank you so much!
Very helpful. I am a big believer in supplements vs advantage plans. However I am seeing dramatic increases as I age (currently 74) in the supplement premium as many others probably are. There does seem to be a point (and I am there) where the Plan G Premium easily exceeds the Advantage PPO max OOP. I will look at switching from Mutual of Omaha. I did not meet their underwriting standards for a lower cost plan G. If I can't find a different company for Plan G it is only going to get worse and I will be forced out of Supplements. It's the ugly side of Supplements as you age. Everybody, please don't set and forget your supplement. Price shop it every three years or so. If I had I would be much better off now.
You bring up an important point that many don't realize.
Many people are facing what you face where their supplement premiums have grown to an unsustainable level.
Thank you for watching and sharing your experience!
If you have a Plan F, you should be able to down grade it to a G. But if your company doesn’t do that, (some do with no underwriting if it’s within the same company ) then you’re stuck.
Do the birthday rule. A company can't get health questions answered. Do 30 days before your birthday or 30 days after to get a better cost. You could do this every year. You can ck this out with a health care agent, bur I think this is ok.
@lindalopez7710 Hi Linda, thank you for sharing. Not all states have this as an option. In fact, most don't. Sounds like you may live in one of the 8 states that does have the birthday rule.
Erik, good stuff and I hope the best for your Mom and your family. Could you do something similar with High Deductible Plan G? This would illuminate the differences between this and regular Plan G quite well. Thanks again!
Hi there. Thank you for your kind words.
We have a few videos on HD-G that go over these comparisons. Not necessarily this same cancer videos, but other situations.
Here are a couple that I hope will help:
Real Cost Example with G, HD G, and Advantage
ruclips.net/video/MWrNhZW8ZcQ/видео.html
Comparing G, HD G, and N
ruclips.net/video/Gw5mg3H8CWg/видео.html
20-year look at costs
ruclips.net/video/DgpS_RlA4gk/видео.html
Hope these help!
Thank you so much for your support!
Many thanks, Erik, and now your Mom can keep my Mom company up there!@@Theretirementnerds
Also all retired military have Tricare For Life like we do.
Excellent video. Do the cancer plans pay every year after cancer? My wife has been fighting cancer since 2007. Luckily we have a special employer provided Advantage plan with a max of $150 or we would be broke. Year after year cancer treatment can be devastating.
A few arrangements. Some are 1 and done. Some are the initial payout and then it builds back up again over time and will pay again if a 2nd, separate diagnosis happens.
Thank you for the excellent comparison video.
Thank you so much for watching!
Thank you for a very interesting analysis! Glad I found this video. Lots of food for thought, both in your video, and in the comments.
Thank you for watching!
Great Presentation! Thank You.
Thank you so much!
Gap G vs H can be simple - the higher cost to avoid dr. visit $20 copay would even out after monthly plan payment. Some states the plans can be a bit more pricy.
Hi Erik,
I turn 65 in August of this year. I currently get the majority of my medical from the VA. I had my wife get original Medicare with a plan G supplement last year since she's a little older than me. Her supplement for my zip is currently around $96.00 a month. If I got the same one, mine would be $101.00.
With that being said, I was thinking of getting original medicare plus the supplement in case I want to go outside the VA or they change the way they cover veterans in the future. I have heard and talked with some that says a MA plan would work better for me because I could get a reduction of my part B premium since the VA drug plan is considered a covered plan, although as far as I know it only would cover prescriptions that the VA prescribed. I get all the cost savings of the MA plans, but if I can afford original MC, would it be the best option in the long term even though I can, and do go to the VA. I have past heart issues, and I wonder just how long the VA will continue covering veterans with ratings under 30%. I'm service connected for my back but only at 10%, and 10% for tennitius. With my past heart issues I would also hate to get on a cheaper MA plan, only to possibly need more in the future.
Thanks, enjoyed your video.
Hi Tim, appreciate you watching!
It's an interesting conversation and the details around your VA coverage are important. Happy to help in any way we can. My email is erik@90daysfromretirement.com. your zip code will make a difference.
Yes, most with VA coverage go to the VA as much as possible and grab an MA plan for cost reasons, but we can look into options.
Appreciate you!
I think if you have cancer with an advantage plan you'll need to go through underwriting if anything ever changes in the plan (which it will). Then, you are subject to higher quoted plan prices due to pre-existing conditions. That's one of the reasons why plan G is best for anyone with cancer. The other reason is you can have any doctor you want and don't need referrals. 😊
There is no underwriting with Advantage plans, even if they change benefits for the next year. Supplement plans are much less complicated in cancer costs, but for those on Advantage plans, they will not get kicked off or see higher rates as a result of any sort of underwriting
Not included is the big picture for Supplemental vs Advantage - all the extra premiums you pay for drug, dental, vision and hearing plans.
Watch this one:
ruclips.net/video/TJCE4pKoKvc/видео.html
So, with the Medigap plan in this example, plus the cancer policy, the total cost would be $0.
Correct. If it was a $5,000 cancer policy and using the numbers used in the video. In fact, you'd have about $1,000 in your pocket. Most don't get a cancer policy in addition to a supplement plan. You're more than welcome to, but most don't. They use cancer policies to hedge against risk for the advantage plan max out of pocket.
As others have pointed out, this scenario only applies if you've only paid Part B and G for one year. But if you've paid Part B and G for 10-20 years then MAs are way cheaper. Extrapolate out to 10, 15, 20 years. Those B and G premiums add up to a LOT.
I get the feeling you'd like this video:
ruclips.net/video/DgpS_RlA4gk/видео.html
@@Theretirementnerds thanks!