Medicare Advantage vs. Medicare Supplements (Explained)
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- Опубликовано: 17 сен 2024
- Deciding between Medicare Supplement or Medicare Advantage coverage is often the most important decision that Medicare beneficiaries will face when making their transition to Medicare. Fortunately, we have created this video to help you navigate this complex topic
To learn more about how we at Giardini Medicare can help with your Medicare Transition, visit our website at www.gmedicaret... and feel free to schedule a call with one of our licensed agents!
Click here to learn more about Medicare Advantage plans: gmedicareteam....
Click here to learn more about Medigap plans: gmedicareteam....
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Sources:
Prior Authorization used with Medicare Advantage: www.kff.org/me...
99.6% of providers paid on assignment: www.boltzresea...
How many providers accept Medicare: www.medicarere...
How MAPD bidding and payments work: bettermedicare...
Government funding for MAPD: www.kff.org/me...
MAPD’s cover all Medicare services: www.medicare.g...
Prior Auth for SNF’s: www.uhcprovide...
KFF MAPD Costs: www.kff.org/me...
What are Medicare Advantage DRG’s: www.medicaread...
KFF 2022 Medicare Advantage Spotlight: www.kff.org/me...
It was very informational
Honest non biased comparison. Most RUclips insurance agents put down Advantage Plans. Most are totally wrong with their assessments. My wife has a Supplement G and with a drug plan spends $2,400 a year. I on the other hand have had an Advantage Plan (PPO) with United Health Care for 10 years. I have spent almost nothing for it. I have actually gained a few thousand dollars with the vision and dental benefits. It's very rare to find any doctor or hospital that does not accept my plan. I can go anywhere in the United States without any referral. Bottom line. Supplements, you pay in advance for your coverage. Advantage Plan, you pay as you go. Over the past 10 years my choice has literally saved me many thousands of dollars. They all work. It's based on your risk tolerance. Nothing more.
Thanks David. Risk tolerance AND your health (being good) is a great combo for choosing an Advantage plan. They aren't "good" or "bad" inherently. They're different from one another and as long as you know what can go wrong for either product? All is good.... Glad that things have worked well in your household!
@@GiardiniMedicare Thank you for the response. I've study these options over the years and I believe most people are better served with an Advantage Plan. I stated my wife has had a G Plan and granted everything is covered etc. But my Advantage Plan cost ZERO with ZERO primary care visits and only $35 per specialist visit. I looked at my wife's doctor visits in a given year versus her $2,400 a year expense. She been disabled for years and does see numerous doctors in a calendar. But when I add the number of times she goes to a specialist for zero co-pay I find it would have cost less to just pay the $35 dollars. Way less. In this day and age a long hospital stay is quite rare. Medicare and insurance companies want you out ASAP. Unlike years ago most treatments for all types of ailments are handled through your out patient coverage. I would rather pay if and when I have a problem instead of paying in advance of a potential problem. Most of these insurance guys on RUclips appear to scare people into not considering an Advantage Plan. Some imply Original Medicare approves anything your doctor recommends. That simply NOT TRUE. As time goes on and the Advantage Plans offer more for less I think more and more people will choose them. I always look at the odds versus the costs.
@@dmjh932 We appreciate the thorough input from a consumers perspective! it's not often that one person will choose and Advantage plan, while the other has Medigap so it's nice to hear a real life version of the video we presented.
Good information. Looking forward to being one of your clients as I retire in 2024.❤
We look forward to it as well!
That was a lot of great information. I may have missed it, but I think it's important to talk about how premiums INCREASE EACH YEAR BY AGE with Medigap. Can you tell us where to find a CHART showing a typical age premium escalation? That being said, is there a "breakeven" between the two at a certain age? Can Advantage plans escalate or reduce benefits by AGE? Thanks.
Great question! Unfortunately, I don't have an easy chart that shows all of the age increases for "attained age" Medigap plans since it will vary by each insurance carrier and by each state. In our experience, these increases for attained age policies tend to be about 2-5% depending on the company. There also is not a clear "breakeven" comparing Medicare Advantage and Medigap plans since it will depend entirely on an individual's health... More health issues will result in a better value from Medigap, whereas fewer health issues can result in better value for Medicare Advantage. Lastly, Medicare Advantage plans can and will change benefits on a yearly basis, but they will not make these changes based on your age! Instead, they would affect everyone on the Medicare Advantage plan equally,
some medigap do not increase with age..Attained-age-rated is the type that increases through time...Medigap policies can be priced or "rated" in 3 ways:
Community-rated (also called “no age-rated”)
Issue-age-rated (also called “entry age-rated”)
Attained-age-rated
@@Paufit correct, but all Medigap plans will increase their premiums overtime. Thanks for watching and commenting
All Medigap plans increase over time. One thing that is very important to know when considering a Medigap plan is that Plan G will usually have a substantially higher rate increase percentage than Plan N, making Plan N the better value for people who are generally healthy and don’t see their doctor a lot. This is because Plan G is the Guaranteed Issue Plan and must accept many more very sick people in specific situations. The insurance companies will raise their Plan G premium rates to compensate for their losses due to high claims. Plan N tends to have healthier people, since people usually have to medically qualify to get Plan N unless they selected it during their initial 6 month enrollment period when they were new to Medicare.
Great video with clear distinctions. A question I think one of your graphics answered for me is: do I have to be 65 or older to qualify for medigap? I am on SSDI with a terminal disease (ALS). I assume the “gap” would provide better coverage for me in the long run. Or due to my age am I essentially forced to go with “advantage” plan? I do have part A and B currently.
Hi John, thank you very much for taking the time to watch and comment with your feedback! in regards to having Medicare under age 65 due to ALS, you are not "forced" to have a Medicare Advantage plan. However, in most states the Medigap options for those under age 65 are very limited, or very expensive. If you let us know which state you are in, we may be able to connect you with someone that can provide a much more detailed answer about your options.
I enrolled in Medicare when I turned 65, but I am still working and have insurance through my employer. If I were to retire next year, at 68, when would my Medigap open enrollment be? Or is there an enrollment period, because retiring is a qualifying event? Same question for advantage plan. I am in Washington state.
I’m just now taking the time to educate myself on my post retirement healthcare and I have found your TikToks and, now, Your RUclips, channel to be really helpful. Thank you!
Thanks for the comment and the question! Your Medigap open enrollment period depends on your Part B start effective date. If your Part B is already effective and has been effective for more than 6 months, you would not have access to your Medigap Open Enrollment (although it doesn't mean you are entirely out of luck)... However, if you have not started Part B yet, your open enrollment will begin the first month your Part B becomes effective and it will last for an additional 6 months. Hope this makes sense!
@@GiardiniMedicare Part B isn't active and won't need to be active until I retire.
So, this needs clarifying, please: "...if you have not started Part B yet, your open enrollment will begin the first month your Part B becomes effective."
How is that effective date determined? What is the first month my Part B becomes effective?
Thank you!
@@klharndt You will pick your Part B start date when you get closer to retirement. Let's say as an example, you retire in May of 2024 and you need your Part B to begin June of 2024. You would apply for Part B a few months before June of 2024 and your Part B would begin 06/01/2024... This would also start your Medigap Open Enrollment Period which would begin 06/01/2024 and then continue for 6 months.
So as long as you’re switching between plans during the open enrolment period there is no higher premium or denial of coverage to worry about
Even during Open Enrollment you will likely have to qualify for a Medigap plan based on your health. It can vary based on company and state, but most of the time you still have to pass health underwriting to enroll in a new Medigap plan
Looking for clarity: If I switch from Original Medicare to an Advantage Plan in 2023 and determine an Advantage Plan is NOT advantageous for me, can I return to Original Medicare without penalty, and if so, do I have to wait for the following Open Enrollment period in Oct - Dec 2023?
Hi Marian, you can disenroll from Medicare Advantage during the Medicare Advantage Open Enrollment from January 1st to March 31st. You won't be exposed to a Part B penalty for switching from Original Medicare to Medicare Advantage. Keep in mind this does not take into account if you have Medigap, since leaving and going back to Medigap has added rules and guidelines.
@@GiardiniMedicare So....if I try to "return" to an Advantage Plan later in life, I may face requirements for medical underwriting and higher premiums, correct?
@@mariancarter4255 There is no medical underwriting for Medicare Advantage. However, a Medigap plan may require underwriting in the future, and you may be denied or pay higher premiums based on your health at the time. Hope that helps!
Stay away from these HMO for seniors -"Advantage" or "C" ... seniors that need care are dying waiting for authorizations to get treatment under these plans. Keep your Medicare and get a supplement.
Do you know a company in Washington state that does the same as you are doing?
Hi Merribeth. Thanks for watching and YES, we can help connect you with a good agency that is licensed in WA. If you'd like, you can fill out his form and your contact info will be provided. form.jotform.com/221815498396065 Thanks!
I just retired recently and I have original Medicare A and B. Rather than adding Medigap coverage, I have supplemental coverage through an employee retiree plan offered by my former employer. My plan includes prescription coverage through Express Scripts (Medicare PDP). I also have SEPARATE Dental/Vision coverage from my former employer, distinct from the employer's supplement to Medicare A and B. (This is through Empire BCBS, who provides the coverage for their active employees.) My question: if my former employer were ever to terminate its employee retiree plan, (which, in fact, is not being offered to employees hired after 2007), would I be able to buy a standard Medigap plan to replace the terminated employer plan?
I just received my monthly statement from Express Scripts Medicare (PDP), and on the statement they say, "This summary is your Explanation of Benefits (EOB) for your Medicare Part D prescription drug plan," (followed by more language). So, I guess I was enrolled in Medicare D Supplement Plan by my employer. This seems to make my query above at least partly moot. Any thoughts?
@@robertcook2680 Hi Robert, Thanks for the question! The Part D they are referring to is just your prescription coverage and not the actual retiree supplemental coverage. If your employer terminates your retiree coverage, you would be eligible for guarantee issue for medigap. Depending on your age, you would likely enroll in a Medigap Plan G or Plan F at that point. Here is a link to Medicare.gov showing how losing retiree coverage should make you eligible for Guarantee Issue: www.medicare.gov/supplements-other-insurance/when-can-i-buy-medigap/guaranteed-issue-rights
@@GiardiniMedicare Thank you so much for your clear and considerate responses and videos. (I will be 67 in a few months, btw.) I will continue to follow your videos for additional information that might be helpful to me, and I will recommend your videos to my younger brother and to friends who are still working but will retire in the next 2 to 3 years.
@@robertcook2680 Happy early birthday! We really appreciate you taking the time to watch and comment, and we look forward to making new videos soon!
Probably the least biased comparison of Medicare Advantage vs. Medicare +Supplement + Drug Plans I have seen. Original Medicare + Supplement + Part D gives you the widest choice of providers for MEDICAL, without the need for pre-authorization, in most cases. But then, you don't have dental, vision, or hearing benefits, if you go that route, and your premiums will still be higher.
Thanks for the feedback! At the end of the day, this is your "insurance" - you just need to understand it and choose wisely. Thanks for watching ~
Dental pays for very little, just fillings and cleanings. Most older people have serious dental issues dental insurance won’t cover, like crowns, veneeers, bridges, implants, dentures
@@CalmKit True, and that’s why a separate plan that offers coverage for dental, vision and hearing is a wise idea.
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Does that mean you need to watch it a few more times? It can be a tough decision & confusing!