I am an RN who worked for an HMO at one time that offered Medicare Advantage Plans. I was trained to deny claims as a prior approval/utilization review nurse. I only lasted 3 months there because I could not in good conscious continue to deny services to clients who in good faith signed up for the plan only to have something really bad happen and find they could have the procedure they needed or the stay in rehab that would help them recover. I remember one 80 year old Spanish speaking only, tracheostomy patient that need home health to come an teach the wife to do the trach suctioning. The HMO would only pay for 1 home health visit and NO disposable supplies. I was supposed to tell the family to reuse the sterile trach suction catheters by soaking them in 3 parts water and 1 part Clorox. That was the end for me, I could not lend my name to that kind of 3rd world care in this country where poor people suffer disproportionally in cases like this.
Happened to me, I have Medicare advanced plan they denied my tooth inplant after so many calls with no help to me end Paying over a $1000 to have y implant. Thank you for this information 👍
My wife and I signed up for Medicare plus the G supplement plus Medicare D. At First it was fine, but after 3- 4 years it was costing us 700 dollars a MONTH. We kept it when we were traveling. It did pay claims, but we did have to pay some stuff. It just became too expensive to keep. So, we changed to the Advantage type after moving to a higher population area. Referrals are not a problem most of the time. Now our max out-of-pocket is 700 dollars a YEAR. My drug copays were 25 bucks for the YEAR, no deductible. True, we have to stay within the provider groups, but we have quite a few to pick from. Original Medicare is great, if you're rich or can go to wherever you have the money to afford to seek out expensive care. Not so much if you live in a backward state or a medical wasteland. Either way you go, you're screwed. Insurance companies, PBMs, hospitals, medical groups, drug companies, crooks who cheat Medicare at every turn are what we Americans are stuck with at this point. The ruling rich overlords will never change it. Congress and the courts have been bought, and YOU AND I have been stuck with the bill.
Absolutely. This comment spells it out the way it is. Doctors don't like to take original Medicare. In effect, you have a more limited network by staying on Medicare original, and you have to pay for both the supplement the medication premium. I strongly recommend the Medicare advantage plans with no monthly premium. They have enough providers of all types that you still have choice.
You’re right on point. I’ve worked in healthcare business for 20yrs. When asked, I tell people to hold onto their traditional Medicare. Don’t buy into the selling points. When my parents became Medicare eligible, I advised them the same way. Stay with traditional.
@@kiaraosorio7276 part C is Advantage. Part D is drug. You can get drug coverage with your supplemental insurance. Or you can buy a stand alone Part D coverage.
The problem with brokers are they make their $$$ by selling insurance and insurance plans. One insurance plan pays them more $$$ than the other one, example, if they sell plan G they get paid more by the insurance company so, who do you trust 🤷♀️.
@@10speed4 Who do you trust? I trusted my doctor's Financial Office workers' opinions. They deal with Original Medicare, Medicare Advantage programs and supplemental coverages on a daily basis. I used their advice as a guide to help me find an insurance broker. That person told me the same as this speaker has related. Medicare is backed by the government. If your Dr decides you need a test, procedure, or surgery, you get it with original Medicare, no questions, no refusals. The amount Medicare does not cover is paid for by your supplemental insurance, no questioning. But, if you have Medicare Advantage, it is run by private insurance companies who: - can refuse coverage, even though your Dr has prescribed the test, procedure or surgery. - they (insurance companies that run Advantage plans) can go out of business, leaving you with no coverage. - The private insurance company that runs your Medicare Advantage plan can significantly increase your cost of coverage by increasing your premiums & deductibles, as much as they want, as many times as they want. Medicare does have increases in cost & deductibles, but not as much, or as often as Advantage Medicare's increases. - Original Medicare is the same coverage, no matter where you live in the US. If you have Medicare Advantage, the coverage can vary, depending on which state you are in. Private insurance companies do not have the same coverage in each state. So, if you move to another state, you may not get the same coverage that you had in the state you moved from. This experience shaped my decisions on choosing my Medicare coverage. Years ago, I was very ill (not on Medicare then, had private insurance policy). It was a long, serious illness. Long story short: though I had an insurance policy that was supposed to cover the care I needed- the insurance company continually refused tests, procedures, and surgery needed to save my life. They refused to pay for things that were supposed to be covered under my policy- that I continued to pay each month. They were trying to save money- at the risk of my life. Obviously, I survived. But- due to my previous experience with insurance companies, I was not about to go with Medicare Advantage when they could do the same thing to me again- deny coverage they had promised. This is my experience, my opinions & my conclusions from the info I was given. I suggest you research the differences in Medicare & Medicare Advantage carefully before you decide which to choose.
Thanks, I hope many stay with regular Medicare. That way those of us getting all the extras at no cost will continue to reap the rewards. If everyone went with the Advantage plans they would take away our great benefits. I also tell some folks to stay with Medicare. As for my wife and myself, we have had the Medicare Advantage plans for 17 years and they have saved us hundreds of thousands of dollars. We never see a medical bill and pay NOTHING for our plan. Our plan pays us back what is taken out of our Social Security checks plus gives us a grocery card for 50 dollars each for groceries. We also get 75 dollars each for OTC products. We have comprehensive dental and vision included at NO COST. And of course it includes prescriptions at no cost. Oh, yes, they have a nice minivan to take us to our appointments or pharmacy. We do our grocery shopping while at our Walmart pharmacy . But, PLEASE , folks stay with regular Medicare! You are paying for our extra benefits! Our doctor's office even pay us to see the doctor and to get our flu shots. Our Doctors office ALSO has a van to take us to and from appointments . So PLEASE folks stay with the old Medicare.
Have you been really sick yet? The kind of sick that cost over a $100K I have..Thats when you will hate that advantage plan...Did you buy that advantage plan because Donald Trump and the GOP supports them?
Check out Cigna, I really like it, Cigna advantage plan.. 3.000 a year dental, nothing is not covered, like a blank check! Broke my back in several places a year ago this October, no exaggeration, Ive had every diagnostic procedure there is plus any doctor, any hospital therapy, Chiropractor, braces medicine, never a copay yet, much more.. I'm sorry I didnt check this out years ago.. I've had Viva (can't be trusted), used my ss plan when I first started ss which is zero helpful! 😅
I don’t know which Advantage plan you have but I’m a physical therapist and every patient that has an advantage plan have consistently been cut short on coverage for services! Every Advantage plan cuts services!
I'm an insurance agent, been selling med supps and advantage plans for years. The right thing to do is explain the pros and cons for each and let the client decide which is best for them. Be honest and learn how to present in such a way that they understand and CAN make an informed decision. There ARE cons to med supps. The price increases throughout the years can become more than a person on a fixed income can handle. And scaring them with tales of not getting service/approval is not helpful. I have hundreds of clients on mapds, and rarely get complaints about rejected services. HMOs are so different now than even 5 years ago, max out of pockets are better, networks are better, we even have plans with national networks.... There's a lot of advantages to mapds. I'll be honest, I didn't listen to the presentation, mostly because I've been doing this for years, and I know the details, but I had to comment because it's disengenuos to say one should "never" get an mapd. That's just as bad as saying mapds are the best option. Everyone is different and we need different solutions.
His advice is predicated entirely on the need for expensive supplement insurance, which assumes that you’re going to have a pricey hospitalization every year if the insurance is going to pay for itself. I have a relative who paid (5 yrs ago) over 10,000 a year in various premiums for him and his wife. They’re wealthy so afford the 20% for rare illness so it’s a stupid decision in my opinion. We switched to an Advantage plan because it provided a maximum out of pocket for protection in the event of a expensive illness. He also said out of network doctors can charge whatever they want because there’s no negotiated price but that’s not true in practice. There are usual and customary charges (a range) that doctors charge. I don’t agree with most of what he says.
Thank you Windi for your answer that both Advantage and Supplement plans need to be presented with pros and cons--we don't need someone telling us NOT to buy one or the other. I have been on an Advantage plan for years and have never experienced some of the things said in the video. I am a healthy person so far, so maybe that's why I've been happy. I love all the extras I get on my plan, most of all the GYM membership. I am on a PPO plan and all hospitals and doctors in my area are on the plan so that is not an issue. However, Most of my friends are on a supplement plan so I have been thinking about changing mainly due to my high out of pocket maximum if I would have to go out of network. But I weighed my costs and this video says your cost for a Medicare supplement is only the $233 deductible. That is false. In our area, the supplement plans are at least $100/month, so that has to be added to the $233 along with $10-$25/month for a pharmacy plan. My premiums are $0.00 and I get all those extra benefits, so a supplement plan for me is going to be way more expensive. BUT, it's like rolling the dice--if you do have a catastrophic illness, then a supplement is going to be better than the out of pocket maximum. VERY hard choice to make since we can't see whaT WILL happen in our future. Thanks for all the comments and the video.
I'm an agent myself and his presentation is so one-sided it's ridiculous. He is not doing any of the consumers any favors by not providing all options.
I spent the last half of my career working in the billing office for a medical specialist group. I dealt with everything from private insurance, worker's compensation, medicare, medicaid, etc. By a large margin, the problems I encountered with payment denials came from Medicare Advantage plans. And most of those happened because people did not understand the rules of their plans. Thanks for the informative video.
Although, it would seem as though a lot of the issue is with provider groups not confirming Advantage plan coverage prior to treatment. It seems like pre-auths are needed - I’m not sure how most patients would even know how to communicate with insurance carrier or have the relevant information. Stuff only the provider could know.
I'm seeing the payment denials because of in proper billing to the insurance company (using the wrong code) I'm showing that on one of my claims in my portal.
I’ve had a Medicare advantage plan for about ten years, and never had a problem even though I had a stroke, rheumatoid arthritis, and pneumonia. I take nine Rx a month and this past month, February,I paid out 37.00. thanks for your input I’ve had the same doctors for many years.
Joy, that's great to know. I stayed on the original Medicare for a few years but finally switched to Medicare Advantage and am very pleased with it thus far. Seems much easier to me all the way around. I like my docs and the network.
For regular folk the Medi-gap premium can get really high as you get older. Best option is to research and educate yourself the difference between Medi-Gap vs Medicare Advantage. The entry rate for Medi-gap may be great but increases rapidly. The competition in the Medicare advantage is really providing great benefit but remember to alway look at the Medical Group you choose. The Medical Group make all the difference in the quality of your care.
You are correct. there are thousands upon thousands of us out here that survive on Social Security only and we simply can afford nothing other than the zero premium medicare advantage. I dont know what you mean by medical "Group"
I don't care what medical group I get. You can change every month. Very few care about your health, they only want that free Medicare money! If they are good doctor and have a good practice they don't want to deal with Medicare. In Florida very few actually understand English. They can say English words but have no idea what you are really saying. You HAVE TO. E YOUR OWN ADVOCATE!
@johnsonpaul1914 ALL the MA plan are owned by groups then bought out by a major company like Anthem. Those owned by those big broker houses are the o es that give you trouble. You MUST know what your plan pays for and what they don't. ALL must cover EVERYTHING that original Medicare does. Most cover some type of Dental but many don't ACTUALLY have dental offices that will honor their plan. These EXTRA services are proctored by other companies that care NOTHING about you. There actually is NO OVERSIGHT over any of these plans except Congress itself. CMS just turns your complaint back to your plan. That's like letting a fox guard your chickens. CMS is like a union for the Medicare Advantage plans. They protect the MA plan NOT YOU! CONGRESS does have control over all these plans so make certain you know your congressman. IF you are lucky he is a Democrat, the Republicans won't help you.
My husband and I were paying over $700 a month for premiums alone with Medicare and a Supplement plan, so we changed to Medicare advantage plan Preferred Care with UHC and here in Miami it works fairly well. We never had any issues to go to specialists. Even though my husband takes a lot of medications, at the end of the year we end up saving money.
@@danielhurley2894 I have an Advantage plan. I’m raising a red flag but doubt that our representatives in Congress will. They receive massive donations from the healthcare and pharmaceutical industry who also spend massive amounts on lobbyists. My doctor and physical therapist recommended further treatment, but after the initial 90 days (which included only ~16 visits because my copay was $35), request for authorization was sent to a contractor for Aetna who did not respond to phone calls, voicemails, or emails-so no further treatment. I filed a grievance w Aetna; their response 2 months later was that I had treatment and they had no further request for authorization. Phone calls to Aetna- rep said there was no request w Aetna, didn’t know anything about the contractor but admitted they do use outside contractors. I had a previous experience with an insurer who also contracted with outside companies whose job it is to deny claims. My neurosurgeon received a payment of $150 months following my 6 hour surgery. There is no good health insurance company or plan in this country.
As a physician I wholeheartedly agree with the points you made in this video. The worst I deal with is prior auth for rehab or SNF that are denied after many days being in the hospital waiting for auth, and then the peer to peer is rejected- the patient is not safe to go home but we must discharge them home because their insurance stopped paying for them to be in the hospital days prior and our ER is full of patients boarding waiting for beds in the hospital. Then they are readmitted in a few days/weeks from complications post discharge because they did not go to rehab.
Medicare Advantage has to start at the exact same place as Traditional (Original) Medicare. Then, MA plans add extra benefits for example vision, hearing, no health deductible, gym membership, etc. The fact that a network is utilized mimics private under 65 health insurance. Medicare Advantage plans help the patient afford hospital stays so they don't get stuck with 20% of the total cost of staying in the hospital.
@@juliemills6716 Why are you telling me this? Not only am I a retired provider (and nearly all of my patients were on a Medicare Advantage plan), I have been on one myself for years now and am very satisfied.
This exact thing happened to my mother this past March! Every three days they reviewed her case, and about four times we had to appeal - soooo stressful living in limbo... At the 4th time, we lost the appeal. This is despite the recommendation of the doctor/therapists at her in-patient rehab ... However, Ive always been under the impression the Medicare + supplement route was for richer people who could pay a lot each month up front, and hence, the better coverage for the bigger on-going things down the road when they happen .... My mom was a life time social worker for the state until she retired -- an honorable job but not high paying (even with her Masters Degree, sigh).
Been on Medicare + AARP/United Plan F for 7 years. Never needed a referral or had a problem with authorizations. Have paid zero for medical co-pays and minimal co-pays for drugs. Compared to my Medicare Advantage friends who are restricted to certain doctors, need referrals and pay co-pays for every doctor visit and hospital stay. One friend and I were both having problems after cataract surgery. I made an appointment for a second opinion at UM medical school. She couldn’t get approval from her Advantage plan. Yes, the supplement isn’t cheap but I budget for it and have complete control.
After working in healthcare (I'm a psychologist) through the heyday of managed care, and knowing how important it is to me to be able to choose my own doctor (they aren't all the same!), I went straight to Traditional Medicare. I know that there are some great Medicare Advantage plans that people really like. But people often love their plan until they get very sick. Then the claims start getting denied. My best friend and I were seeing the same physical therapist. I could get as many sessions as my doctor would recommend. She had to beg for more sessions, haggle for a reasonable cost due to confusing payments from her Medicare Advantage plan, and end PT before she was better. It was appalling! You may believe you are saving money with a MA plan. But if you have to pay for physical therapy or some other service that isn't covered, you'll send up spending more. And God forbid you need prior authorization for something before getting much-needed treatment! There are horror stories of people who have died waiting for that prior authorization. Ever notice how many ads there are for MA plans? Guess where they get that money? It comes out of the premiums they collect. That's money that won't go to healthcare. This is just wrong.
Most of these stories are made up by those selling those supplement plans. The MA plans MUST cover EVERYTHING that original Medicare does BY LAW! In more than 15 years on a MA plan we have NEVER been turned down for ANY care covered by Medicare or the .A plan! There are rules these plans MUST go by. Several times my MA plan has even gone out of network for me and paid the ENTIRE cost even though I would have had a copay in network. If you can't read your plan, please have someone else read a d explain it to you. I call CMS first if I expect a problem. If my MA plan doesn't have a supplier within a reasonable distance, they have gone out of network. At one point Walmart optical refused to sell me the transition lens for the plans agreed upon price so I purchased the glasses anyway but complained vigorously and they sent me out of network to purchase another complete glasses both frames and lenses and paid the entire 420 dollars!
@@GAderly-fn5ly Nobody should to have to complain that much to get what they need. Very glad that it worked out for you but it may be denied for another.
@glw5166 You have to be your own person when it comes to your health! NO one can speak for you better than yourself. Those on original Medicare are much more at risk than those on an MA plan. MA plan personal and doctors help you oversee your health plan. They want you to stay healthy. Original Medicare folks want you to come as often as possible to see all kinds of doctors as that's where they make the big bucks. With MA plans your primary care doctor gets your referrals for you. They KNOW if you really need a specialist and they willingly refer you to a specialist if needed. It's not the MA plan that gives you the referrals but your PCP. IT'S NOT the MA plan that gets you the referrals, it's your PCP. It doesn't cost your PCP for your referrals and even your MA plan has specialists on contract so referrals are NOT a problem. With original Medicare doctors get paid from each other for referrals so they will give you referrals even if they know you don't need that specialist. They will pass you around from one specialist to another just for the money. With MA it doesn't work like that. You have no advocate with original Medicare, you are on your own. You can go bankrupt on original Medicare. MA plans protect you with max out of pocket expenses. If you need lots of Healthcare and many doctors you reach your max early and then there's no charge after that. Even you prescription drugs have a max out of pocket, then it's all free. This doesn't happen with original Medicare even with those super expensive supplements. My wife had both knees replaced, at different times of course. The first cost us 295.00 and the second cost us 195.00 TOTAL! That INCLUDED aftercare and rehab! Her second knee replacement, they gave her a sw
Unfortunately, many of us can’t afford anything else. We have had a Medicare Advantage plan for the last 10 years and it has delivered excellent care for us. It all depends on which plan you choose. Do some research and compare the different companies for their customer satisfaction ratings, and get input from friends who have these plans.
@@km4hr They won't cover emergencies 100%...you will be left with what ever the doctor charges that your plan C won't cover. Read the fine print and NEVER believe an insurance company.
I worked both for a HMO and medical biller in my working life. Yes, traditional Medicare AND a supplement are the way to go. HMOs ALWAYS had lots of customer service calls regarding problems- especially when a person was traveling and had a medical emergency and could not use a network provider. I remember one time the HMO denied paying ambulance service saying it was not "medically necessary". The person died IN the ambulance. That was nuts- the family got the bill after denial. They were livid.
I'm sure the logic was, "Well, they died enroute; they could have died just as easily at-scene and saved the ambulance call; so, obviously, the ambulance was not Medically Necessary!" Jerks!
I am a licensed agent since 2006 and have clients on both Medigaps and Advantage Plans. It's our duty and obligation to give each client to do a thorough presentation and give them their options. Medigap plans are excellent but not all can budget a Medigap plan which increase every year and when it's a husband and wife the expense can really be a hardship. Then they have to pay separate for their part D and separate for dental insurance and so on. On the other hand, my parents and in-laws with medical issues like cancer and diabetes have done very well with advantage plans and still continue up to this day. Not to mention some clients may also qualify for Low-income Subsidies and Medicaid programs from their state so truly they are covered even 100% for all Medicare costs. Although they are managed care plans there are many professional physicians who participate in these advantage plans and the referral process is not a headache. There are not a one size fits all plan. Every client has unique situations, lifestyles, income and so forth. So, at the end of the day give your clients the option because if you don't do a good job explaining their options as discussed on Medicare and You handbook, another agent will come along and enroll them in a managed care plan.
Everything you said is spot on! I I don’t understand how this guy can generalize something as broad as a medicare into a little 16 minute video. There’s so many other reasons why somebody would choose a Medicare Advantage plan as opposed to a supplement plan. Aside from your part B why would you pay a monthly premium for some thing that keeps going up for the most part every single year plus pay a separate premium for your part D drug plan plus pay copayment on top of that.You mentioned low income subsidy there’s also state Medicaid and that comes along with a bunch of other benefits.
I’ve been on Medicare Advantage for eight years. Nobody “sold” me anything; I just researched my options online. There are no additional premiums for Medigap or drugs. The network includes every provider I’ve ever heard of except one. Co-pays are reasonable. It’s probably the best insurance I’ve ever had.
It was the same thing for my parents. Then my father actually got sick at the age of 83 and he has been severely impacted by having a Medicare advantage plan limiting the amount of care that he could receive - which could be life-changing. Everyone is healthy until they aren’t.
I have a PPO advantage plan and I have never been denied anything, and I've had many MRIs and expensive cardiac tests. Pre-approval for one test was done within 24 hours. However, my mother was on a supplemental plan and they denied her a life-saving surgery after already approving it. They didn't deny it until she was in the hospital, being prepped for surgery. She had no choice but to have the surgery and ended up paying THOUSANDS out of pocket. We had to sue that company to recoup her losses. Plus, supplemental plans cost so much in FL that as someone with low income, I could never afford them. You can push these plans all you want, but they are just as bad as any advantage plan. All insurance companies are crooked.
@gk_filer That is because it is probably. You must live in a fairly wealthy area. That is why plans depend on your zip code. Average and lower income persons would not be offered plans offered in wealthy areas. They cannot afford them. So they get hmo plans. At least with Medicare it always pays 80% . Get reliable secondary insurance. With scripts if possible.
@patriciaberry4630 You are wrong in so many ways. Original Medicare does NOT pay 80%! Figure it out! With what you pay for Medicare and with ALL the deductibles and no guarantee on max out of pocket, they pay no where near 80%! But please stay with Medicare.....you are one of those paying for my great MA plan. I live in a low income area.....where it's all a service area. With my MA plan I feel like I'm wealthy with them giving me money for groceries and OTC supplies and now even paying my utilitiy bills. Please folks STAY with original Medicare. I don't want ANY more folks going with MA plans as if too many go with MA we will lose our great benefits. I like hearing this guy tell you all those lies, he sounds like trump splaining! Just like trump telling folks how bad off they are. We've never had it so good in reality. Under trump the cost of Medicare went up every year but with our real President Biden everyone's Medicare costs have gone DOWN. I'm happy so many of you believe all these lies as it makes it so much better for the rest of us.
@@GAderly-fn5ly Sorry you are the one that is wrong. I have had medicare since 2009. I have never paid a Co pay. A couple times paid small amounts. My secondary picks up what medicare does not pay. You are not very bright calling someone a liar. Opinions are okay. But not accusations. I have also done medical billing and coding and knowledge of patients imput. What do you have?
Being a Utilization management RN for a Florida based hospital for over 15 years, I totally agree with you. So often patients experience medical emergencies while on vacation and are limited to choices for care while away from home and “out of network.” I advise my friends and family to always invest in supplements and keep Medicare, steering them away from advantage or replacement plans. I think it’s a crime when I have to argue with advantage plans to authorize physician directed care after the acute health emergency has been addressed. Most folks don’t realize that once a patient is determined to be stable, their care is limited to what their advantage plan will allow, even while they remain hospitalized. Often their choices decrease significantly when they are discharged. Those who require home health or rehabilitation services post-hospitalization can be severely restricted and are usually required to return home to their local area for coverage. You are providing a great service with your videos. Keep it up!
Again, you have to consider your situation and many older people don’t travel so this would not be a problem. There are many things to consider on a personal level, it’s not one size fits all.
@@TheCheryl57 I heard Advantage plans are more costly in the long run especially if you need a lot of medical care. Also, that those plans are more costly for the government, because those Advantage plans charge more for services because the middlemen/women and the in those companies need to make a profit.
Just went through this with my 96 year old mother. Advantage plan fought with doctors recommend care and we had to go to arbitration. It worked out but if we were not available to help her , she would not have understood what was going on. Easy way to understand difference. Regular Medicare , doctors control your health care. Medicare advantage , underwriting controls your health care.
I am 76 and my phone has been ringing all day since last Thanksgiving with different people from different states trying to.sell me Medicare Advantage. I am happy to hear what you've said.
Medicare doesn’t always pay for what doctors recommend. I had to have minor oral surgery to remove a growth from my pallet for biopsy and Medicare refused to pay anything. Never got an explanation why. Because Medicare refused to cover the biopsy my supplemental insurance refused to pay anything. I got stuck for the entire cost. Submitted Medicare a review petition. Called several times after the date Medicare was obligated to respond. I was repeatedly told my petition was still under review. Medicare never responded to my petition. It just disappeared. Never rely on Medicare.
I agree with you 100%.. As my wife and I grow older, We have had serious medical issues. My wife had a heart murmer all her life, and at age 76 it turned into a valve replacement and a bypass all done at the same time. Within 30 days I was advised to have a pacemaker and it was done within a week. NO HMO for us, not ever!!!
I am a Medicare Advantage Survivor. After many issues that convinced me of their intention to deny all claims they possibly could, I went back to Original Medicare with a G Supplement. You cannot qualify for this if you have certain medical conditions. Fortunately I did not wait to make the change.
Odd you say these things! MA plans have to cover EVERYTHING STANDARD MEDICARE does! BY LAW! So when those saying MA plans DENIED something , original Medicare would ALSO have denied it. I'm NIT in ANY kind of sales but you all must get educated so you can know when someone is lying to you. If you never learn ANYTHING else....just know the MA plans have to cover EVERYTHING that original Medicare does! BY LAW!
My mother just passed at 96 1/2 & regular Medicare paid for literally all of her end-of-life care. I was amazed that we never got any medical bills. They even covered the helicopter transport to a larger hospital after a heart attack.
When your mom was enrolled in Medicare it was a whole different plan than what is offered today. Her plan doesn’t exist anymore. I’m sorry for your loss.
@@MrElby100 I'm finding that also. It seems all of this - insurance plans and medicare - keep cutting coverage and charging more. And refusing services to stall medical treatment.
I tend to agree with most of your points. However it is truly scary that many people on Medicare and paying for a supplement are completely unaware that their care is still being "managed" by providers who are in ACO/Shared Savings/Direct Contracting arrangements. So, the beneficiary is getting the worst of both worlds. They are paying for a supplement but unknowingly have providers "managing" their care behind the scenes to line their own pockets.
I don't know what you are talking about and I dont think you do either. When I get sick I can go to any big city hospital in any state I happen to be in without having to call and check to see if I am in a network...Any Hospital that takes medicare will also have to take your supplement period...You do not have to get permission for your care. You are not managed. Thats a lie.
All health care is managed for profit and business. People are so used. People are taught to be sick. And big money is made. This country rips people off more than any other country.
I totally agree! I was a RN case manager for 5 years & frequently after a hospitalization the Medicare Advantage plans would not pay for skilled nursing facilities or long term care facilities. Everyone would talk about the great “dental & vision benefits”, but if you’re 85 & break your hip & can’t go to skilled nursing, you’re hosed.
I broke my hip at 50and went home. What do they do at skilled nursing? I had a pt and my family helping. Did have pain sleeping on that side for years.
@@melindalicht6699 my friend that is 70 just had hip replacement and she didn't have anyone at home to help. Because she has a supplemental plan she was able to go to a rehab hospital for two weeks and then had home pt for a few weeks.
@@MrDONTEATUS It's not because she had a supplemental plan! She had original medicare along with a supplemental plan (which picks up the 20% medicare doesn't). Medicare Disadvantage is a ripoff.
I know for a fact this stuff is untrue! My brother broke his hip when he was 89 and he lives in a very small town and they transported him to Sayre Pennsylvania to have the hip replacement and took care of all expenses including aftercare!
I had very different experience with HMO plan. I think ( correct me if I am wrong ) all the long waiting of referral and complaint are really depending which Medical Group that you Choice, For my 40 years with HMO and the same Family doctor and Medical Group, I had no issues being on HMO. I even got sent to USC to treat my Bone Tumor under HMO, my ISP authorize a biopsy in 24 hours, and to see a spec list. because my ISP was willing to sign special contract to send me since at that time only 1 Doctor in the West Coast can save my life.... I don't think private insurance compamy has anything to do with you., It is your Dcotor and ISP are or are not willing to treat ( manage ) you fast and well, PICK A GOOD ISA AND PRIMAY DOCTOR
This advice is good for those that can afford the Medicare option. Couple of years ago I was climbing up out of homelessness. And I should the age where I had to either go on Medicare or Medicare advantage. I had no choice but to pick the best possible Medicare advantage plan that I could. Still don’t have sufficient money for month-to-month living expenses. But I’m not on the street anymore. Every situation is different and specific. Is he saying something good? Yes. Is it the best advice for everyone? Not by a long shot.
As an MPH I so appreciate your open honesty. Corporate medicine is unconcerned with their patient outcomes. Their top priority is making management and shareholders happy- at any dire cost of life or quality of life for the patient.
I worked for one of the biggest 4 profit corporations in the United States and abroad and I can attest to what you're saying it wasn't about patient care , it was about the profits and the stack holders. And of course I've also done some work for non profits and the same old thing there too!
That is sad, but true! The big medical insurance companies like bcbs are notorious for this! These companies open a book when someone gets sick, with price tags next to the illness! If it's kidneys or liver issues, there is a price next to it!!!!😢😢😢😢
I agree! I had a HMO and they sent me to a Surgeon who was training to learn how to remove my top lung. He didn't get it right and 3 days later had to open me back up for lung surgery #2. He left an air leak. I returned to work 2 months later, could not breathe. Xrays were taken twice. I worked for a year like that.No one said a word to me. I changed Insurance immediately found out my lung was collapsed and glued to my chest wall. Cedar Sinai fixed me as good as possible. My current lung Dr. said you can't leave a lung collapsed for a year. Now I'm stuck with 33% lung function. Get the best Doctor available. Don't let them send you to a surgeon in training. No HMO for me....
@@alysewitt3729 I am so sorry to hear you went through such a horrible experience, and am glad you have a good supplement plan. I also have Original Medicare and a Plan N and you are absolutely right! The peace of mind is worth the cost.
@@TheCheryl57 I found out later that if I had gone to Cedar-Sinai to a true lung surgeon they would have made two tiny cuts instead of the 16 inch cut across my back that went into my breast. They would have got it right the first time. I would not have stayed one month in the hospital. You are right that anything can go wrong and it sure did. Leaving me with a collapsed lung knowing it was collapsed, is my biggest concern. I worked that way for an entire year.
Nobody would choose Medicare advantage plan....but people can barely pay to live now, and the price of supplements plus Medicare B cost is just too much for most per month
You also have to ask yourself " How much does peace of mind mean to me?" For me, it means a great deal. For that reason...and all the points Keith made, I choose original Medicare and Plan G and a drug plan. Thanks, Keith. Awesome explanation.
Went on Medicare last year and went to a couple of advantage presentations and the sales pitch was a hard one. Kind of felt like I was talking to a car salesman. Being a retired RN I was already somewhat aware of the advantage problems and stuck with original Medicare plus a supplement. Your presentation is spot on and I think the clearest explanation of the differences I have heard thus far. Thank you so much for this great informative video!!!
I see the Medicare advantage commercials on TV everyday and how they are misrepresented. They only point out the pros and never explain the cons. Being a past Chartered Life Underwriter, I am surprised the Insurance commissioner lets this slide.
I am suspicious of any product that advertises so heavily, but I was leaning to an advantage plan because of the limit on out-of-pocket. I now think I'll stick with Medicare and a supplement. Thanks for you comment. I like to hear from people who are not selling anything.
7 years on a Med Advantage plan (for several years was on United Healthcare, but have since switched to Aetna), and I've had virtually no problems, with perhaps the one exception of sometimes having to wait a bit extra for an appointment with my PCP. No problems at all when having to visit specialists. Super and I mean super low cost - in fact, virtually no cost to Advantage. Not arguing with this gentleman, but I'm fine with my plan.
When you’re younger it’s OK, but when you need to get post Acute services they suck. They denied Acute rehab for a patient of mine who had a hip fracture. They also denied skilled nursing for her. She ended up going home with home PT twice a week.
I enroll people in Medicare advantage plans. 95% of the people I deal with survive just on their ssn, ssi, or ssdi benefits. If you can afford a Supplemental plan, I highly recommend it but you will have to purchase a standalone dental, vision, and/or hearing plan which could run another $100/mo. 75% of the people I help are C-SNP or D-SNP eligible.
Club Mogambo...agree..I have a lot of health issues. No problem at all with my Advantage plan. Even had 3 surgeries...I do have some med co pays but not bad...can see any Dr as well!
I have a Medicare advantage plan and I wouldn’t ever think of leaving unless there was some dramatic change. This coverage has gotten me through two bouts of cancer, and they have never caused me any grief or delays. Also, I had rotator cuff surgery recently, and I was shocked at how little I had to come out of my own pocket, really, really shocked!
Thank you for sharing your positive experience with Medicare Advantage! It's wonderful to hear that you've received excellent coverage and support during your health challenges. Medicare Advantage plans can be a great option for many individuals, especially when it comes to providing comprehensive care and minimizing out-of-pocket expenses. It's important to find a plan that suits your specific healthcare needs, and we're glad you have found one that works well for you. Thank you for watching and for your valuable feedback! 🙌🏼
I get so confused with all these variety suggestions and warnings, I’m about to start Medicare and have been told to always go with advantage plan. This is stressful and so very confusing shouldn’t be.
@@debbieklose8776 I remember being in your shoes and I will agree at first it is incredibly confusing. However, the supplemental plan comes with a monthly premium that you must pay. With a Medicare advantage plan there’s no cost ….you just select if you want an HMO or PPO plan, and confirm that your providers are included in the network. Good luck
I would say there are a few glaring omissions in this presentation. First is that the premium prices for Medicare Supplements differ GREATLY by state and demographics. It is in your best interest to get an OBJECTIVE view of what best suits your particular situation by comparing Original Medicare with a Supplement and Medicare Advantage in your area. It may be that in your area MAPD plans are few or are not competitive. However, I live in an area where the annual premiums for Medicare Supplements are more than the out-of-pocket maximums for the HMO plans. There was also no mention of ancillary benefits like; Vision, Dental, Chiropractic, Fitness, Acupuncture, quarterly coupons for Vitamins, etc. Medicare Advantage DOES cover and Original Medicare does not. I have clients in two states and they could not be more different. It is great that you love Original Medicare but if you do the analysis Medicare Advantage can be much better for people depending on their health and finances. If you life in a rural area Original Medicare is usually the best option if the Supplement and Drug plan are not cost prohibitive. Providers are fewer so networks are more restrictive. In an Urban area the opposite tends to be true. Hundreds of providers and many Medicare Advantage Carriers are competing for business and that brings loads of benefits and LOW out of pockets costs. Yes, you are restricted to the Plan’s network, and on most plans will need referrals, but Referrals should take the same amount of time as it take for your doctor to send a script to the pharmacy. For man things you can also see the Primary Dr virtually to obtain a referral. A broker will show you comparable options available in your area, not just the one they like…
@@barbaracruisemartin9806 that is not a generic question as the plans differ in different states and counties. I enroll in Blue and have 6 states and no two plans are exactly a like. My best advice is find an agent you can trust and go over your concerns with them. Just so you know, there are multi PPO plans under Blue.
Daniel, I completely agree!!! As a licensed independent health insurance agent for almost 15 years, I can tell you there is some serious "truth twisting" in this video. He is basically taking the worst HMO product and the worst MA features and casting a blanket about all MA's across the county. In our area, we have highly rated PPO (Non-referral) plans with huge premium savings and extra benefits compared to Medigap plans. If you want the absolute best coverage and are willing to pay the huge premiums, go ahead and get a Medicare Supplement plan but if you are healthy and want to act as your own insurance company (by keeping those premium savings in your pocket) the MA plans are a VERY good option!
@@mattgreen267 i bet he used the same type of presentation when he was selling hmo. not downloading his book but i wonder what's getting sold i will say my mom had the ppo advantage from fl blue, and the one the corrupt aarp pushes . and i had fl blue hmo 2 yrs with o care, 2 yrs advantage hno, this year they offered ppo same cost but i estimate it will cost me about 150 ded on meds . all but 1 of dr my mom used and hes a very specialize eye dr. he takes ppo . at most took 2 days to get appt with specialist . fl blues a not for profit i recommend it . if you have one home a person like who spend all winter in fl it would not be good
I was paying $235 a month for my medicare supplement. I am relatively healthy, take no prescription drugs, pay out of pocket for dental and eye care. I just cancelled my supplement and signed on to a highly rated medicare advantage program. I think this was a good move for me.
I'm weighing that too. Though I guess it is kind of a gamble. If I continue as I am, it would be the best option. But if fall into depression or something and regain my previous weight and get cancer or something, it would start costing me a lot. I have to decide.
There are many Good Advantage Plans, and Good Supplement Plan G or Plan N. They are both good,depending on your situation! GET THE FACTS! You have 1yr from the time to change your Supplement Plan G to go back if you do not like the Advantage Plan without any medical questions.
I have plan N which is $96 monthly. I was very healthy, just a wellness check by-yearly. I slide in the bathroom and broke the tibia in 4 places, the fibula and ankle, along with damaged tendons. I did not owe anything.
Ouch, @@judymoore7469! Hope you're doing better. Though when I put myself in that situation, I calculate five years of $96/month is $5760. But with no medigap at all, I would have had to meet the deductibles and 20% on much of the remainder. So, if I remained otherwise healthy for five years, I wonder which would have been the better deal.
@@judymoore7469 My plan was F which was discontinued. I was grandfathered so they couldn’t drop me. But they kept raising the monthly premium. I went with a very highly rated plan. I have friends who have this plan and they are all very pleased with it. I just learned that I will have to pay a monthly penalty because I wasn’t previously enrolled in prescription coverage. It’s not a lot but it is for life.
With Med Supp you have 3 premiums; medicare part B, the cost of the supplement and the cost of your part D premium. The deterrent to joining a Med supp plan is the large monthly premium. United Healthcare and Aetna have the best Medicare Advantage plans hands down.
It all depends on how much peace of mind is worth to you. Basically, in many ways, it's a "pay me now (with controlled, known premium payments), or pay me later, (with unknown amounts looming). I know exactly how much my premiums are (yes, like everything else, they go up a little every year). I can budget for them. But if you have an advantage plan with big deductibles, copays and unknowns, you can take a big hit all at once.
My mother has AARP United Healthcare, Medicare advantage PPO, and so far its been great, I know someone else who has the same plan and he loves it too, I turn 65 this year so I plan on getting thd same plan three months ahead of my birthday.
@@Gwen-joyful-light good plan! My parents are both on med advantage and love it, same with my Medicare clients. Advantage isn't for everyone, and I have some clients on supplements because that is their preference and they can afford the premiums, but the vast majority are happily on advantage PPOs with huge networks & solid care. I have also seen older folks paying $700 plus total monthly for part B, med supplement, and drug plan because they're stuck in an obsolete med supplement and can't qualify for another one, and are scared to move because of videos like this.
In my area Humana’s is best. My deductible is thousands less than either of these two. However since being on MA now for my third year I would NOT suggest to anyone to take a med advantage plan. If you are in the hospital you will end up paying it out of pocket.
I have Medicare Advantage and love it! No monthly premium, no co-pays except $25 co pay for a specialist. Nothing for my monthly meds. I’ve had countless tests, a few surgical procedures and have had incredible care and the best of the best drs. I chose my specialists which are all 5 star in the Houston area. I’ve never been happier with my healthcare. Everything is amazing and I’ll never have anything else. Nothing in here you’re speaking of happened to me.
Not being able to go back to Medicare Part A&B after moving to an Advantage plan makes it clear to me which is the best decision. I will stick with the original and get a supplement so I can have health care choices. Thank you for the very informative video.
Why I think you are a crummy agent: 1) Supplement plans in my state go for $220 per month, plus the drug card at $35 per month. That's over $3,000 per year paid in premium WITHOUT FAIL! 2) Most Advantage plans have a $0 premium with reasonable co-pays and no deductibles. 3) Although extremely unlikely, the maximum out of pocket could be as low at $4,500. This compares favorably to the fixed out of pocket cost for a supplement of $3,060. 4) Catch up with the times! Many Advantage plans are PPOs, which allow the enrollee to see any provider who takes Medicare. 5) You have to carry around only one card....only one party to call when there is an issue. With the supplement, you have to handle your Medicare card, the supplement card, and the drug card. Good luck getting to the right people. 6) Advantage plans offer extra stuff that isn't covered by Medicare nor its supplement. Dental, eye care, hearing aids, fitness memberships, Over the Counter items, flex cards to augment the Dental/Vision/Hearing, etc. 7) Even some HMOs, like Aetna, do not require a referral to an "in network" provider. BTW, I have been a Medicare agent for 10 years and have NEVER received a call from one of my clients complaining about a lack of a qualified specialist in the area. So, Mr. Expert, be careful the next time you say the word "NEVER". In the vast majority of situations, an Advantage plan is a much better deal to the consumer. About the only time a supplement is preferred is when the enrollee is on a Part B medication.....very rare.
Many high end hospitals in California will not take advantage plans C supplemental coverage plans anymore they only accept A@B with D prescription coverage and G supplemental. Never get supplemental C advantage plans you will be denied medical care at many hospitals.
If Original Medicare would just cover dental, vision, and hearing services, there would be no need for Medicare Advantage plans at all. It would also help to lower the eligibility age to 60.
It would also help if they gave free medical, dental, vision, transportation, food, clothing and entertainment free. Why not lower the eligibility to 30? That is called socialism. Medicare does cover some vision if it is medically necessary. I had cataract surgeries and macular pucker surgery, all covered by Medicare. In the video above, the agent mentions that Medicare gives the MA plan company about $1000 a month for them taking on the responsibility of and managing of your health needs. Think about that. That's $12,000 each year for each enrollee. That is a lot of money given to these companies. How can they do it? If the income is, for example, 100 enrollees x $12,000 equals $1,200,000. If you only have routine preventative services, then the MA company reaps big bucks profit. If you have serious health issues in a year, with the MA plans, then you could be out the MOOP (Maximum Out Of Pocket) for that plan, which could be $5-10,000 potentially and that could be done a nickel and a dime at a time, driving you mad trying to figure out what you have to pay and when you have to pay because of Co-pays, Co-insurance and deductibles, etc. You get some additional benefits with MA plans, but the trade offs are there lurking and you may or may not be ok with them when they jump out at you. The dental benefits included in the zero premium MA plans are typically preventative dental, not comprehensive. The vision would sometimes provide one or two eye exams annually, and typically included a set amount towards a frame (sometimes only every other year) and the prices on some of those frames were jacked up to make it look like you were getting a bargain. But remember there are tradeoffs. i.e. Friend of mine had main residence in Denver, part-time home in AZ. His MAPD, as all are, was geographically defined to the Denver metro area. Unless an emergency, when he needed medical care while in AZ, he had to fly back to Denver to get it or pay 100% out of his own pocket. And because his medical situation was such as it was, in Denver he could not switch to a Supplement, he wasn't medically eligible. But when he moved permanently to AZ, he was eligible with a guaranteed issue to get a supplement. But if he had only talked to a MA agent or the MA company, or just another MA company, I doubt they would have informed him that the Med Sup option was even available to him. The MA companies want to keep their enrollees, that's $12,000 a year for each one they sign up and keep. Not every agent is out there for you best interests, but it sounds like the gentleman above is. Having Original Medicare, a Med Sup and a stand-alone Part D isn't for everyone, neither is a MAPD plan for everyone. But before a person talks about specific plans, they should first understand concepts, options and choices.
Your lifetime contributions and after 65 premiums do not cover the costs of healthcare. Taxpayers subsidize about $100,000 per person until they die. Adding more coverages means more subsidies by taxpayers.
Yeah. Insurance for old people that doesn't cover dental, vision, and hearing - three of the most common problem areas for the elderly - is like car insurance that doesn't cover collisions. It's nuts. Lowering the age of eligibility would do two good things - it would remove the oldest population from private insurance (the age group that has the most health issues and makes the most claims) thus lowering private insurance costs for everyone else, and move them to Medicare, where they would be the youngest population, the age group that has the fewest health issues and makes the fewest claims, lowering Medicare costs for everyone. It would be a win-win. Gradually lowering the eligibility age to 50 (over say, a ten or fifteen year period) would make the transition easier for everyone.
@@thomasdreyer2389 Nobody said anything about free transportation, food, clothing, or entertainment. Why did you? I think it's because you have no actual argument against Medicare covering dental, vision, and hearing services other than _Something something _*_SOCIALISM!!!_* It wouldn't be socialism, of course, but even if it were - so what? Three of the most common health problems older people have are with their teeth, their vision, and their hearing. Of course Medicare should cover these. Medicare covers *_maternity_* costs, for crying out loud. Why doesn't it pay for hearing aids?
I am a utilization management nurse, been doing this since 2008. There are Medicare PPO that don't require referrals. There are Medicare HMOs that require referrals. Most require pre authorizations for many types of services up unless you have a fee for service plan. Also Medicare Advantage plans constantly call members asking if they are doing all the preventative testing.
You are 100% correct. I have plan F, which I chose because I had a serious illness shortly before I became Medicare eligible. It was an easy decision because I knew I was going to be seeing specialists, having tests, procedures etc. and did not want to be in a network. Also, the benefits for each Medicare supplements are clearly spelled out , while the Advantage plans are murky. I have had tons of imaging, bloodwork, see lots of specialists (who I did not have to get a referral to see), have had surgeries and have NEVER got a bill. I know that not everything is covered , and eventually I might need something Medicare does not fully cover. But I ALWAYS ask if it’s covered by Medicare, and so far have never found anything a doctor ordered to not be covered. So, the supplement picks up the rest. Plan F is excellent.
@@debhelms4106 Plan F and Plan G have no office visit or ER fees at all. Ever. Make sure of what you are signing up for. You want a Medigap Supplement, not Medicare Advantage.
Mcare covers pretty much everthing with no preauthoriztion required. There are only about 30+ procedures they started requiring PA for about 3-4 yrs ago
I've read that Medicare covers only 80% of medical costs, so if you have a very expensive hospitalization or medical condition, the 20% you pay can go into multiple thousands of dollars. I've always had either a Medicare PPO or Advantage plan in order to avoid these costs, and now I hear that this course of action isn't the best way to go. As a senior on a fixed income, I get Medicaid Extra Help from the state of Colorado, which pays my Medicare premium, and also helps pay other expenses. I've been happy with it so far. How can I be on just regular Medicare, without paying extra for the supplement programs you mentioned? With inflation climbing more every day, and with the new rent increase from my landlord, I can't pay a penny more for my health coverage. I live in a small town in Otero county, Colorado, 68 miles away from Pueblo, the nearest big city, where the medical specialists are located.
I am in agreement with you 100%. The problem also is that many people get fooled by MedAdvantage plans with the little perks that are thrown at them. For example, free travel to and from doctors, some minor eyeglass coverage or even dental. But they do not realize that if anything Catastrophic happens to them that it becomes a waiting game for approvals and in one instance in my family we lost a uncle due to this. It’s crazy how they put a dollar value on someone’s life. Thank You for spreading the truth!
@@MedicareonVideo fact check. It’s “free” for rich people, too. I’m a working physician and on Humana Gold I pay nothing a month. I had a $20 copay for my ophthalmologist referral but the cataract surgery is 100% covered. Oh, by the way, latest info-Medicare Advantage now has 47% of Medicare enrollees. Are these people all stupid, or they on to something?
I enroll people in Medicare advantage plans. 95% of the people I deal with survive just on their ssn, ssi, or ssdi benefits. If you can afford a Supplemental plan, I highly recommend it but you will have to purchase a standalone dental, vision, and/or hearing plan which could run another $100/mo. 75% of the people I help are C-SNP or D-SNP eligible.
I am 85 and had cancer at 61, had good insurance where I worked, was off work for a full year, and returned to work and retired at 67, got medicare and full supplement and the cancer returned 12 years later, got treatment and the cancer returned 7 years later and again 3 years later and still in treatments. I am not restricted anywhere or by any doctor or hospital. Where would I be on an ADVANTAGE PLAN??? I know I have indeed been blessed. I can pay my premiums, thanks goodness. I don't have any co-pays!
I’ve had Advantage Plans with three different companies, never had any problems with any of them. All my medical needs have been met with very low out-of-pocket costs. Maybe I’ve been really lucky with the insurance companies I’ve dealt with, but I’m sticking with my current plan.
I have an advantage plan and I get more for my money. I find the extra supplement you have to buy with original medicare is too expensive for me. Look that I dont have to buy a drug plan too. My meds are $0. Just love the extras and my deductible is 4900 Which is cheaper than original medicare! I'm happy with mine.
@@carolynwheeler2739 $4,900??? Is that annually? So you have to pay that until they pay for anything? Maybe I'm not understanding. Is our country so brainwashed that they think thousands to pay is okay? I wish everyone would start protesting and learning that we are the only country that does this, the rest of the civilized world believes healthcare is a right and not a profit system. I always thought Medicare was great and virtually free for disabled and seniors since we pay into it for so long. Never realized what a scam it is! Wow! I wish I never became sick! Ugh!
Thank you so much for speaking out about this! I’m 75 yrs old & I’m so tired of Medicare trying to push this Advantage down my throat! It is a rip off & the care is terrible! Thank you so much for speaking up about the travesty of Medicare Advantage!
They have gotten excellent- someone who has trouble affording 200/300 a month for a supplement living on 1500 social security or less need to use the advantage plan and they are good! Do your own research with someone who has both options
Evidently you have not have had to use it. When you have to use it you will be in for a big surprise and will be ungrateful for your plan. Hope that you own a bank because you are going to need a lot of money in the end. Sad part is you are stuck and cannot go back to the original Medicare.
@@JohnDavis-yz9nq The original Medicare was RUINED anyway by the Bush43 regime when it passed that "forced" PART-D. The current (not the real original) Medicare system is a Rockefeller big pharmakea scam.
Original Medicare is the only way to go unless you choose the Advantage and then you cannot go back to the original. Agree with you that Bush was a bad president as he tried to destroy social security. He was born with a silver spoon in his mouth and he doesn’t have a clue what the average American faces in everyday life. Other presidents born poor have forgotten where they came from. Even at best the original Medicare is not a good deal but it is the only thing that we have. The doctors that we have nowadays are awful. They are owned and controlled by the pharmaceutical companies and do not care about your well-being. What is sad is that some third world countries take better medical care of their people than the United States does. This man in this video is only telling part of the truth. For me he is a wolf at your back door just like the rest of them. Watch doctor David Belk on his videos the truth about Medicare supplements. That will surely wake you up. Good luck and I hope that you didn’t sign up with Medicare Advantage.
I'm an agent and I enjoyed watching your video. I advise my clients in much the same way you do Keith. Go with a supplement out of the gate and stay with until it hurts. I laughinly say that I wish Broadway Joe and JJ had invested their money better back when they were bringing in the bucks and not having to pitch MA plans in their golden years. Bill Shatner sure doesn't need the dough.
My very first doubts came when I heard the name "Medicare ADVANTAGE!" Sadly, in our (1984) culture, terms are often designed to trick the buyer by using a name that is the exact opposite of what your going to get. These HMOs should be called "Medicare DISadvantage."
@@bethdavis7812 and they are PPO, or Preferred Provider Organization. Yes, you can use doctors, etc not on the preferred list, but you'll pay more to do so. Also premiums, and out of pocket expenses are higher.
What you say may be true for some, but if you have a Kaiser HMO everything is different. I love Kaiser. I worked at Kaiser for years and I know it from the inside and out. When I hit 65 I opted for Kaiser‘s Medicare Senior Advantage. Nothing has changed for me except that I have more durable medical equipment options and things extended care and like that. My office visits cost $5 instead of $25. I did have to sign up for Plan B which I wouldn’t have had to if I just continued Kaiser, but I could see that it could become a big cost saver down the road when I get really old. But who knows what the future will bring? That’s the thing with any kind of insurance. It’s a crapshoot. And let’s face it, with medical care, the less you need it, the better. It’s much better to pay into it not use it then not have it when you do need it. And my Kaiser Senior Advantage is always there if I need it, something that as I get older is going to become more important. A lot of people like to bash Kaiser, but it’s the best HMO out there. I can tell you that if you need something, you will get it. For-profit insurance plans make money by doling expensive care. Kaiser is a not-for-profit and their goal is to keep you healthy so you don’t need the expensive care down the road. But if you do, it is there. My husband needed a heart transplant. He checked into Stanford Hospital and was billed the Kaiser hospital admission co-pay of $250. He walked out with no more charges. Zero. He had a heart transplant, something that cost anywhere from a $half million to over $1 million for $250. And despite the huge cost of the immunosuppressive drugs, he has only a $20 co-pay with no cap. Kaiser decided that there’s no point in paying for a heart transplant if they won’t pay for the drugs that you need to keep yourself alive. Most people can’t afford a couple thousand dollars a month for medicines. So we’re fans of Kaiser and I’m a fan of Senior Advantage. I kept my original benefits except that they’ve been expanded now.
Sorry, but that is the Insurance plan I was on. They never told me my lung was collapsed....They took x rays twice. Never said a word after 2 surgeries. Changed insurance Companys and my new Dr. Sent me for an x ray and sent me straight to the hospital. I had to have a 3rd surgery at Cedar Sanai to fix the other 2 botched surgeries.
@@alysewitt3729 Are we talking Senior Advantage or Kaiser here? I’ll just say that anyone can have a bad experience at any hospital with any health plan. It’s always the luck of the draw. Because Kaiser is a good deal. You get a lot of value for your money. They don’t ration or withhold care. Mistakes can happen and things can be missed. I’m glad you got your problem taken care of.
My dad was on that plan and had a lot of health issues. It was the worst plan for him. His out of pocket monthly drug cost was $500 a month. A ER visit was $75 per visit. He had 25 ER visits in one year. His doctors had no clue how to help him and instead wasted our time in the ER. He was in assisted living and per the CA law had to call an ambulance in certain situations. It drove me crazy. My take was if you are healthy you’ll be fine if not it is harder. I had no idea there was original medicare.
I have advantage in TN. I Don't understand what you're talking about. Max out of pocket 4.5K. Next year 3.5 K. I have Humana, which is accepted by most of the practices. Deasent cooayments. I had multiple procedures this year. Cooayments for outpatient surgeries and labs in a range of $30 to $200. Very low meds cooayments. Very satisfied.
The biggest problem with Medicare Advantage plans are that people don't understand that they, unlike Medicare Supplement Plans, are all DIFFERENT, from one plan to the next, and certainly different in quality, too. That is why, unlike Medicare Supplement Plans, CMS rated each one every year. But people continue to lump them all together, and assume that if they had problems with one, there must be problems with all of them. NOPE. But look at the star rating for each, because that is the most important factor. Steer clear of a 3 star or below.
I've had my Medicare Advantage Plan for 5 years now and I like it! But it's a 5 star plan (top rated by CMS) and ratings matter more than anything else when considering these plans.. And yes, it's an HMO that has been in existence now since 1982. I was also covered under the same HMO as a state worker years ago, so I was somewhat familiar. I've had doctors tell me my insurance was excellent!
@@Jess_2025 Hi G2 - I have just about everything Medicare on my channel. If you look in the description of this video you can download my book and sign up for my Medicare Mini Course. All free. And yes - Medicare supplements are what I do. Feel free to give a call when time. 877-885-3484
I guess it depends where you live and what Advantage or Medigap policies are offered. My 75 year old sister-in-law has a United Healthcare Advantage policy and it is paying great for her now that she has really been using it.
@@christineplaton3048- she may, but when we go from our insanely expensive under 65 Presbyterian insurance to an offered Advantage policy next year when we are 65, it won't include these nice perks.
What a great informative video. I just retired and had to dig through what you are describing without help. It can be so overwhelming hoping you are making the correct choice. I am 61 so I had to find insurance on the marketplace for myself. My wife is 70 so I had to figure out Medicare for her. Luckily, I chose original Medicare B with a Medigap (G) for her. Sounds like I made the right call. Wish I had found you before I went through all of the headaches. Thanks so much for this information!!
I enroll people in Medicare advantage plans. 95% of the people I deal with survive just on their ssn, ssi, or ssdi benefits. If you can afford a Supplemental plan, I highly recommend it but you will have to purchase a standalone dental, vision, and/or hearing plan which could run another $100/mo. 75% of the people I help are C-SNP or D-SNP eligible.
My personal physician also suggested that I not choose an Advantage Plan when I retired at 65 but she didn't go into detail. Your video is very informational and is articulated well. Now I can pass on what I've learned from you when someone younger asks my opinion about this medical insurance issue. Thank you so much!
Don’t listen to him/ look at all your options and DO THE MATH- be smart with your money because insurance carriers will experience inflation next and the rates will become astronomical. Especially when part B is now 170 a month! Think about what it will be in 5 years...if you are that worried get an indemnity plan that pays you back the copays and get a heart/cancer stroke plan...much better spend of your money than paying 1200/1500 a year with no added benefits except the medical coverage (dental and vision and hearing all extra where as an advantage plan includes them...) he’s really doing most of the population a disservice with this video when most can’t afford a supplement over 70 when you probably could use it! By that time you could save thousands!!
@@TheCheryl57 I agree with you have to go with what you can afford. Everyone. Just be selective if you ever need major surgery like heart or Lung. My sister just had hip replacement on an Advantage plan and the surgeon did a good job. He did however break 1 of her ribs during the surgery....that was painful for her. Her hip works good though.
Amazing. Going on Medicare at 65 was incredibly confusing with tremendous conflicting statements. Could not understand the big picture. Now all the bs fed me makes sense. Clear presentation. Thanks
A lot of doctors don't acceot original Medicare insurance . Doctors prefer Medicare advantage or PPO. Ask. Specialist they prefer Medicare advantage. Rather than original Medicare.
What medical insurance we choose (Advantage or suppliment) starts with us d3ciding what is most important to use, i.e., monthly/yearly cost, choice of provider, catastrophic coverage, deductible, bells and whistles, etc. You will not make the best decision if not clear about what is most important to you. Each of us should be able to explain why we chose X rather than Y.
My husband and I are on original Medicare with a supplemental plan and love it. My husband had major surgery last year and was back in the hospital multiple times due to complications. Our out-of-pocket costs were minimal, and did not have to fight with an insurance company.
Would love to see a video talking about 2 or 4 scenarios of different couples, different medical needs and different financial situations and a detailed decision process based on example benefits, costs, and availability; and maybe show a Decision matrix about when Advantage might be better vs straight medicare... Maybe in a liberal state like MN, where it seems the HMO's have a good reputation for good coverage... GREAT video by the way Thank you.
It really depends on the client’s health situation. I only recommend Medicare supplements if the clients has a lot medical health issue. Not all MAPD require referral to see specialist.
When you are a senior, health issues pop up out of no where. It's better to have good coverage when you get sick. I went with Medicare and a good supplement that pays hospitalization 100%. Eventually, all of us seniors end up in the hospital.
Can you please comment on Advantage PPO. Do you have the same concerns? Also, I was told that I can start Advantage, then switch within first year if I do not like, OR switch to traditional during enrollment period without a need for review due to using my one time first application for traditional. Accurate?
I have saved almost $20,000 in premiums in 10 years by switching to Medicare Advantage from other Medicare supplements. And each year, it seems Medicare Advantage offers more benefits at no charge. My Medicare Advantage medical only policy costs nothing. This year, dental coverage was added, and I also got a card with which I can purchase $400 in medical supplies, drugs, etc., again at no cost to me.
Wow! I like my 5 star rated Advantage plan, which also comes this year with a $410 debit freebie card, which I used for dental, though itcosts me $34 per month It has not gone up in price even as much overall as $1 per month per year in the 5 years I have had it. My HMO also has a freebie plan, but no debit card, and the drugformulary is different than on my plan. No deductibles for medical or drugs, and medical OOP is only $4,400 or less. I almost chose the freebie Advantage plan, as I rarely need prescription drugs. All area hospitals and doctors participate in mine. Good deal.
Yes my mother has one too and it has saved her a lot of money over the last 3+ years. I guess this guy talking can pay his 20% coinsurance of traditional Medicare if he wants to. To each their own or whatever floats your boat I guess is the saying goes? Because my mother‘s plan has dental, vision, even has OTC built into it or she can go to CVS and get $360 worth of merchandise every quarter. That comes in handy. I don’t know what he’s talking about. She had a surgery done all she paid was her co-pay.
And he is saying that they’re all HMOs which is totally not true they do have PPOs and it takes you off of original Medicare which is not true you always have your original Medicare it’s just that it is idol in the background and your Medicare advantage plan pays instead of Medicare but you still keep your Medicare. I sell Medicare advantage plans that’s how I know this by the way
@@wisheduknew294you're just flat out wrong. And you sell this? You don't even know how it works. You are not in the medicare system with an advantage plan...period. medicare no longer pays you health care costs. The for profit insurance company pays your health costs.
Which MA are you on? Some responses seem to indicate that their MA's are an extreme disadvantage and costly.. Even with Medicare no dentist here will take it. And the vision/eyeglass place dropped Medicare.
We have been on a 5 star Advantage plan since turning 65 12 years ago. Our plan is a non profit coop managed by medical professionals. Even though we had one major surgery, I find this plan to provide great coverage at a modest cost. Highly recommend our Martin's Point plan which is only available in the state of Maine. If you can find a similar plan in you area it will save you a bundle. The only way I can see that the supplement plans will pay is if you have multiple severe morbidities where you are spending most of your time in the hospital or doctor's office with a lot of expensive drugs. For the average normal person the advantage plans are a good alternative.
I was in a unique situation because I got Medicare at age 64 due to disability. I chose a Medicare Advantage plan (Anthem). I had 2 surgeries, another procedure at the hospital that required general anesthesia and a lot of hospital based tests plus I am on several RX's. I paid nothing up front but by the end of the year, I had paid over $5000 in co-pays etc not counting RX copays. Plus it was a pain to followup on bills they disallowed. Thank goodness I found out I could change back to regular Medicare with a supplement at age 65 with no underwriter requirement or extra costs. This year has been a breeze compared to last year! I have had one surgery that required numerous trips to a wound care doctor specialist, an ER visit, starting PT and stopping PT several times, lots of expensive RX's, etc. I am going to have another major surgery next month too and know I will need one or 2 more next year. My uncovered medical costs out of pocket have been $150 for this year for a specialized medical device that Medicare will not cover. My RX cost have been a lot less too. The nice thing is I can go to any doctor that accepts Medicare!!! My first surgery this year was done in a Bon Secour hospital and the next surgery will be in a Riverside hospital. All covered!!!! I can research and find the best doctors in my area and not be restricted to one group. I also travel so no worried about being out of network. Last year while out of state, I ended up with a simple eye infection and it cost me over $250 for the doctor visit and RX that was not covered out of network. Yes, I pay extra but at $190.29 a month (supplement policy, a drug plan and a dental plan) I am still way ahead of last year. I need to say I got a high end drug plan because it equals less out of pocket for my drugs over the year. I also chose to do a dental plan with the dentist I have used for over 30 years at $29 a month. The Anthem plan only had dentist an hour away from me. I get my glasses at Costco or Sams so the cost is reasonable so no insurance needed. So $190.29 X 12 = $2283.48 for the year......a lot less than the over $5000 from last year. Even if I add the $150 that none of the insurances would cover I am less than the $5000! I am a retired math teacher so the numbers are my thing and I researched a lot of plans before I chose the right supplement plan for me. After months of searching I picked Mutual of Omaha for me. Then when I was almost confident in my research I stumbled on a EXCELLENT group that does it all for you and even helps you if problems come up. BOOMER BENEFITS. They were wonderful even months later when there was an issue with my drug plan. I was always informed during the process. I even did not have to run the figures to find the best drug plan, I just sent them a list of my regular RX's. Save yourself a lot of work and money and call them. No, I am not a rep or am I paid to say this. Just someone who put a lot of time and effort to get the best cost plan for myself only to find a free phone call could have saved me A LOT of time and work. And yes they do advise you on the Advantage plans if that is what you want. They take the time to find THE best plan for their clients and it is all FREE!
Great if you have the income to afford the supplement. But why have Medicare coverage for only those who have been able to save thousands of $ for premiums? System needs to work for all income levels.
So we are on Aetna’s Medicare Advantage. Thought we were dealing with an honest guy but he never mentioned what you said about Supplement plans. We are in Texas. How do we move from the advantage plan to a supplement plan and know which supplement plan is best? My wife takes about 12 different types of meds also and two inhalers (regular one and an “emergency” one). She is on 02. She was in hospital 4 times since Jan 20204. The first 2 times was at one we prefer. Then they had a contract dispute with Aetna and so the next 2 times forced to go to another one. Now the 1st one is back in the network and the 2nd one is no longer. We are tired if this shell game, especially when our lives on the line. Just want to do what is best for us and more affordable. She is the only one on Medicare. I am not at this time since not 65 yet. Thanks.
Hi Lynn- When did you wife turn 65? It may be a little tricky if she needs to go through underwriting, but we can look into the details. Send me an email at Keith@MedicareOnVideo.com
As a retiree Medicare eligible soon, I've been swamped with offers of Medicare Advantage plans for nearly a year. Not fully understanding the options, your video enlightened me plenty. Am glad to see you doing the right thing now.
Wonderful it works in your favor. I'm of the opinion that Kaiser can be great if your medical problems are not complicated and things are stable. And it also depends on the choice of practitioners at the particular Kaiser you join. I've seen top notch physicians, specialists and nurses at some Kaisers, and other Kaisers where I wouldn't send my Yorkie to.
@@catbee1452 my mom had Kaiser thru her union, it was fine until they said she needed a pacemaker. Then she subjected her to 3 surgeries installing faulty pacemakers. In her area, Kaiser was a teaching hospital and she was the guinea pig. I got IN THEIR FACE and said enough I don't want these experimental new contraptions. I did research and DEMANDED a well known unit and she FINALLY was fine. But then I knew how to navigate the broken system as a LICENSED AGENT and I went to the insurance commissioner and demanded they stop experimenting on her. I was an advocate as well having volunteered in hospital for decades. I knew the cages to rattle to get results, and I went after them ALL like a pit bull and got my mom the care she deserved. Kaiser can be good or seriously iffy.
@@savannahsmiles1797 As a nurse for 43 years, I've seen a lot of "iffy" in different health care settings. To navigate the "iffy", one must know enough about the system to jump through the required hoops.
@@catbee1452 I used to work at Kaiser. If you have minimial health problems. Kaiser will work for you. I always caution people that if you have expensive chronic medical problems, then there system is not so good. You have to learn how to work their system to get what you want/need.
He is selling supplemental so take that with a grain of salt. Supplemental is going to cost you hundreds-maybe a few hundred, maybe many hundreds-a month extra. I have ACA Marketplace insurance with Kaiser Permanente (an excellent healthcare system) which has generally served me well except for the high deductible. About to turn 65 and I can choose a Kaiser Advantage plan that COSTS NOTHING EXTRA, and continue with the same coverage as I had before. No brainer? Pretty much.
Fortunately you never had to get an authorization for a treatment that your doctor prescribed. I have worked in medical offices and would need to get these authorization. So here I am talking to some kid that was selling bicycles last week, trying to explain why it’s necessary. Finally, the doctor would ask for a peer to peer. After waiting sometimes a week to be able speak with the company’s doctor and convince him/her, that it is necessary.. (wait time) and often they would make you try different treatments that were less expensive before granting the authorization. Advantage plans do work for some... but, sadly not all
He is telling the truth about Medicare DIS-Advantage ! The proof is that the very BEST (Ivy League) physicians and state of the art, cutting edge hospitals are no longer accepting Medicare DIS-Advantage Plans. UNLESS that Medicare DIS-Advantage Plans are issued from a EMPLOYER'S GROUP Plans (patient's fromer employer provided medical coverage). Medicare DIS-Advantage Plans have become a NIGHTMARE and ENDLESS approvals, and increasing patient co-payments, and splitting up single visit lab tests into separate charges to force the patient to pay for co-payments for EACH lab test during a single visit ! Also, they are REDUCING the lifetime limit of hospital visits to force patients to go back to straight Medicare. Manage Care plans offer to drive you to doctor's visits, pay your gym membership, and fluff your pillows, BUT HIDE THE FACT THAT THEY ARE REDUCING COVERAGE ON THE MOST EXPENSIVE MEDICAL COSTS, LIKE SURGERIES, HOSPITAL VISITS & REHAB STAYS ! They even offer plans that pay your Medicare Premium, but HIDE the fact that these very plans that return your Medicare Premium, pay for LESS MEDICAL SERVICES ! The ones that claim to pay for your prescriptions will only do so for GENERIC drugs, but refuse to pay for drugs that have no generic option ! Then if your physician prescribes a drug that has no generic, these plans will only pay a "PORTION" of the drug price. But you can get that same non generic expensive prescription FROM CANADA FOR LESS than what the Medicare Advantage Plan is paying ! If you talk to a Medicare Advantage "agent" who helps you to find a plan during open enrollment, give him/her THE ZIP CODE of WHERE you WANT TO RECEIVE MEDICAL TREATMENT. You will find that the BEST PHYSICIANS & HOSPITALS IN THE MOST EXCLUSIVE NEIGHBORHOODS DO NOT ACCEPT MEDICARE ADVANTAGE PLANS !!! UNLESS that Medicare Advantage Plan is issued by.the patient's EMPLOYER GROUP POLICY! Then if you give them a zip code from a WORKING CLASS OR POOR NEIGHBORHOOD, YOU WILL FIND LOTS OF PHYSICIANS that WILL accept Medicare Advantage, and also WEEKS TO MONTHS TO GET AN APPT !!! EVEN LONG WAIT TIMES FOR EXISTING PATIENTS !!! Btw, IVY LEAGUE DOCTORS DO NOT WORK FOR KAISER !!! ALSO, RICH PEOPLE NEVER GO TO KAISER, FOR A REASON ! Kaiser IS NOT & NEVER HAS OFFERED, "CADILLAC MEDICAL CARE !" KAISER HAS ENOUGH HORROR STORIES, TO FILL A HALLOWEEN MOVIE THEATER FOR THE NEXT CENTURY ! Rich people, go to Johns-Hopkins, Mayo Clinic, UCLA, Cleveland Clinic, St John's Providence (Santa Monica CA), etc.
@@kitcatmeowpurr745 I have had Kaiser Permanente for three years. Kaiser is one of the best health organizations in the US. Although my ACA coverage had a fairly high yearly deductible ($6,000) that’s not unusual anymore. Next month I switch to Kaiser’s Medicare Advantage plan. The coverage and cost is nearly identical.
@@Nicksonian kaisers attitude towards high cost populations is questionable. Oncology, premature babies and elder populations disproportionately cost more. Look closely at how these populations are treated by Kaiser before signing up with them.
My elderly mom is covered by my late father's Advantage plan through Aetna and Express Scripts as part of his pension. I take her to doctor's visits and manage bills and her costs are not higher than when she was on regular Medicare. Obviously his pension happened to include great coverage and terms and perhaps is atypical. Her primary care doctor sends her to specialists of his choice and she's never been refused any specialist or treatment. To continue to be covered by his pension she had to switch to Medicare Advantage a year ago but it has been no problem.
The problem comes when ur diagnose with cancer. You have to pay that 20%co insurance for chemo/radiation and cancer medication, is when it can eat up all your life savings.Medicare Advantage is only good if you don’t end up sick with major illnesses!
@@cherylstade3614 Please don't worry! She's in good hands with good coverage with a reputable carrier. There's nothing wrong with managed care and shared medical expenses. Just differences of opinion, that's all. Your mother won't lose her life savings, as ALL of these plans have an out of pocket maximum. I sell these plans and nearly all of my customers have no complaints and for many years.
I have the ARRP United healthcare plan and have zero complaints. In fact, if I have a complaint, it is they are constantly calling me to offer services which I do not need. Like a home health nurse visit. I have used it when working out of state and my out of pocket costs have been minimal. I have never had a doctor refuse to take me as a patient with this coverage. Recently I had a mild heart attack. I went to our local ER who had me transported to the regional medical center. I had a hearth cath and stent implanted. 3 days in the hospital total, 2 ER visits, transportation, my out of pocket was $315. A deal in my book.
Thank you SOOOO much. You have answered questions for me that I have been asking for years! You made the information about choice of doctors and coverage area simple to understand without double talk that confused me. After listening to you I now understand the difference and I will always stay with Medicare.
Thanks for the thorough explanation. I’ve been asking Medicare questions well before the requirement age of 65. And now 6 years later. I am just as confused. To top it off, I worked at an agency that did not pay into social security. Which means I have to pay a larger Medicare premium. Nobody has given an explanation like this about the differences in this Overwhelmingly confusing process. I subscribed.
There are some employers (read school districts) that don't contribute to Social Security, however, there is a separate line item for Medicare. I would check you paystub. If there is a medicare line with a dollar amount, and it has been paid for 40 quarters or more then you will get no premium Part A. Part B cost $170.10/month for most middle class
Its so uneccesarily difficult to understand. I still don't know what to do!! I live in Manhattan, NY , just got approved for disability and I feel there are no options that I can afford .
I’m a Medicare agent, and there is definitely good argument to go with original Medicare and a supplement, but only about half of what you say is true about the Medicare advantage plan. Just saying!
I agree. Im an agent that handles every Medicare plan thats offered. MAPD, Supplements, and PDP. MAPD plans can work great for some people. Every single person is different and this video is misleading.
@@codydriver6413 Cody MEDADV is "Dubya" scam in an attempt to Privatize all of Medicare like prefunding the Postal Workers Pension for 75 years in '06 was a plan to torpedo the Postal Service prematurely. Privatyze! Cody
@@marya4717 I don't have any hassles with my MADP with Humana. I have a really good Medicare agent who looks for the best plan for me with the least costs and most benefits. I don't pay anything for them and pay very little for my meds and Dr. I get $200/yr for vision and $1000/yr for dental. I have the Humana app on my phone and get $220/3 months for OTC items that would have cost me to buy them in a store. That has been a major help. Please talk to an agent and check out an advantage plan to save you those monthly costs you are paying.
@@codydriver6413 I agree, my first year I went with Original, just fine. Second year I decided to try an Advantage. With the one I was leaning towards all my current docs are in network, my two meds are covered at $2 per refill, and in addition they also give me $40 quarterly in over the counter meds, a paid in full annual vision exam, $100 towards frames, 2 annual dental exams, and if needed it they will pay some towards hearing aides. All this for the (current) $170 Pt B premium. Now, I am healthy and the situation might change if something medical occurs. But so far (second year in) I'm very satisfied with my Advantage plan.
I sell both Supplement and Advantage plans. There is no one-size-fits-all. And in terms of the network size, if you live in a metro area (I live in San Diego) there are tons of doctors available, even on Advantage plans. My clients rarely, if ever, have a hard time getting the medical support they need. But you're right...the choice and simplicity of Supplement plans is very attractive. $0 premiums on Advantage plans are also attractive. Depends on the situation and need.
My sister just sent me your link and I'm so glad she did. I handled all of my mother's medical affairs, though I know nothing about the world of Medicare. I know that she would get very frustrated with Medicare Advantage and being required to keep going to her PCP over and over, which meant paying him over and over. You are correct - ultimately, it ended up costing her more to be on Medicare Advantage. Now that my sister and I are about to be at the age where we need to make informed decisions, your video has helped us tremendously. Thank you for taking the time to do this.
I am a medicare insurance specialist as well and I agree with the video with some exceptions. Not everyone can afford a supplement plan or qualifies for one. The idea that it is a Supplement or nothing leaves some in society medically vulnerable.
My question is if they can't afford a supplement plan, how are they going to afford a $7500 out of pocket expense each year? I guess the Doctor's and Hospitals can always write off the uncollectable debt.
@@bobbycoln5626 Glad you asked...Not all Medicare Advantage Plans are created equal. The first thing to understand is that it is NOT a $7500 expense incurred every year, known as Max Out of Pocket (MOOP). It could happen if you get sick and incur major expenses. You could hit what is commonly known as the donut hole or coverage gap in Medicare. For some plans, it is not $7500, it varies according to the plan, and some are $3500 (MOOP) it depends on the Advantage plan. How it works is, you get hospitalized and need drugs and medicine: You pay 100% percent of the drug cost until the deductible is met You pay copays or coinsurance for your coverage drug determined by your part D plan The donut hole-You pay a percentage of the cost of gen. drugs & brand name drugs until you reach the MOOP Catastrophic Coverage Period- You pay $3 for generic and $8 for brand drugs until Jan. 1 and the calendar resets. Most states have programs for those who are could face MOOP during a year. If a person has chronic illness i.e. diabetes, blind, etc. they may qualify for Dual Special Needs Plan and Low Income Subsidy (Dual/LIS). Medicare and Medicaid are utilized. These are in place because the individuals that I have described above are NOT eligible for Medigap insurance (Medigap is not a medical plan). I could go on describing other scenarios that some of my clients have faced and I have guided them through. The moral of the story is: One Size Does Not Fit All Having said that, Medigap is still the Flagship!
@@bobbycoln5626 My plan has a $2000 out of pocket and there is no way to come close to that in my experience. In 17 years I have never had anywhere near that and my husband has heart disease, on lots of meds with several hospitalizations. The most we've ever been out of pocket per year in those 17 years may be $300 or $400, for specialist visits. The plan we have now has no co-pays at all. As far as drugs, there is one that costs us $20 a month. Seven other drugs $0. So I guess you can say for the 2 years we've had this plan, it does cost us $20 a month for that one drug.
This is a great explanation. Signing up for Medicare was one of the most confusing things I have ever done. Based on this info, however, it seems I made the right choice to go with original Medicare.
You are right. Almost ALL Doctors and Hospital accept Medicare and the Supplements pay the same no matter which company you buy it from. Unless your primary care Physician, Hospital or specialists is in the Advantage network you pay out of network charges.
Laura, if you ONLY have Medicare, you will have to pay the 20% that Medicare doesn’t cover. A $100,000 hospital bill will cost you $20,000. You still keep Medicare whether you chose to use a supplement or a Medicare advantage plan. But they each cover that 20% for you to some degree. Call and ask an insurance agent that sells Medicare Supplements and Medicare Advantage plans to educate you about your choices. I sold both about 12 years ago. I took my dad off a supplement and put him on a MAPD, medicare advantage plan with prescription drug coverage. He saved $150/month by switching to the MAPD. Over the 10 years, he has saved over $9,000 in premiums to his supplement company. If the insurance person can’t explain everything and answer all your questions, find another one. It will cost you nothing to speak to someone.
@@yeppers7225 It is my understanding when you go to a Medicare Advantage plan, you go entirely to the plan. In other words the insurance company covers ALL of your medical expenses not just the 20%. That's why the Fed. Gov. pays them at least a $1,000 a month for every Senior they sign up. One can always go back to Medicare from an advantage plan for the 80% they pay but they would have to be underwritten for a Supplement plan and can be turned down and then have to pay that 20% themselves.
@@bobbycoln5626 that is incorrect. Medicare advantage participants and Medicare supplement participants still pay their part B premium. Most don’t know that because it comes out of their social security checks automatically. If either of these groups were “entirely on the plan” that would not be the case. Also, if you check Medicare.gov, it clearly explains both groups remain on original Medicare. That’s why these plans are called “gap” plans, both Medicare supplements and advantage plans fill the “gaps” original Medicare doesn’t cover. As a side note, I sold both supplements and advantage plans many years ago. I was able to write policies with any company in the US. In order to get the same coverage with most advantage plans, you must pick one of the most expensive plans in the supplements. That used to be plan F, as it was the most comprehensive coverage available for supplements. Plan N is fairly close as well, but doesn’t cover everything plan F does. Regardless of which option you choose, the worst thing to do is choose neither and have no extra coverage since original Medicare only covers 80% of the costs which leaves you paying the remaining 20%.
@@yeppers7225 Yes, you continue to pay the part B premium but the Federal Government pays the Insurance company a monthly costs of around $1,000 to cover ALL of the insured's claims. The Federal Gov. or Medicare pays nothing if you own an Advantage plan. Some companies even refund the part B premium when you purchase a Advantage plan.
It doesn’t have to be complicated. My pcp gives me all the referrals I need in the beginning of the year. All my doctors are in network my premium is $0. I am keeping it simple. Love mecicsre advantage. Everyone’s experience is different
I am a retired RN on original Medicare and a supplement. I chose this over an Advantage plan based on my experience working in a cardiology clinic where we had to get pre-approval for various diagnostics and procedures from Advantage plans. It was sometimes a drawn out procedure, resulting in delays or denials from these insurance companies who are not in a good position to make these determinations. One time, an agent from one Advantage plan sent a message to one of our cardiologists asking why he thought he should do a particular test. The exasperated cardiologist said to tell her “because I am a cardiologist and you are not.” I will say that it is also true that some doctors have stopped accepting original Medicare because their reimbursement is lower, not sure if that is regional or by specialty or what, and I don’t know how widespread that is. But those doctors may then have the added expense of a larger staff to deal with pre-approvals. All I know is there is no one between you and your doctor, slowing or stopping your care with original Medicare, and you have a network wherever you go.
That's crazy they stopped accepting Medicare! I do billing for outpatient practice and in our region, MC pays the 2nd highest rate. Aetna, UHC, BCBS rates are always lower than MC.
I subscribed to "Blue Advantage" because they offered better coverage on drugs. Now they are imposing more restrictions on what they cover, regardless of your medical needs. I want to go back to Medicare, but can't afford to lose the drug coverage. Any suggestions?
I worked as a case manager for a Medicare Advantage company for many years and the only real benefit from an Advantage program I could see was a reduced hospital readmission rate. The reason for the difference was identified as Advantage programs having case managers to coordinate care and assist patients in navigating through the health care system.
Of course, utilization of Home Health, SNF if needed, PT/OT all at $0 copay with the usual covered transportation costs. Our plan also provides free meal service to the home post operatively....which of course helps patients recover more fully....hence avoiding the need for readmission. Shoot, neither my mom or I were in the hospital, and we both just received boxes of fresh fruits and veggies from our Advantage health plan. There are a lot of perks to some Advantage plans that are in place for the right reasons, and yet they haven't been spoken about. What a shame.
@@Charlie9165 Until those theoretical regulations are put in place you're paying monthly premiums for a traditional plan. Those regulations may never come but you pay anyway. I prefer the MA approach, pay for service as needed.
I was the sole caregiver for both of my parents. Each year I checked the information about Medicare & Medicare Advantage to make sure that they got the best plan. I could not explain it like this video explains but to me Medicare Advantage was just like the healthcare plan I have today. I decided long ago that I will enroll in the original Medicare when I'm eligible in a few years. Medicare is a lot easier to maneuver.
I stayed on original Medicare. Had an HMO before and wasn't into an Advantage Plans as I realized the limits of HMOs. Recently had a stroke and the expenses have been minimal so far.
@@DeanCF1 You're correct. This was a key omission on his part. Could be he just doesn't know. I had a knowledgeable agent who took me through it. And, even though all of our doctors and medical situations are "in network" locally, that was not our complete reason for selecting an Advantage Plan. UHC offered four different options when we switch Advantage carriers; three were HMO with four being PPO. It was the best for us. That doesn't mean the best period.
When we first got on medicare we got a part G for 150 for me and 175 (and it went up every year after 3 years was paying over 225) for my husband a month plus RX another 50 for both and app $5 per RX (another 20 a month plus and one time ). Yearly just under $6000 even if we never see a doctor. We are now on an advantage plan 0 per month RX 0. Last year my husband started bleeding internally...was taken to the hospital by ambulance spent 15 hours in ER given 5 liters of blood 5 days in hospital and given more test than I can count...total cost 225!!! Out of pocket for the 2 of us last year was right around 1100. Our plan does cover dr all over the US. We pay 0 for our RX and 0 to see our pc doctor and 20 to see a specialist. And we get over the counter ...cold , pain reliver ect... of 50 a month. Our doctors are great and I really do feel we have much better coverage than when I was working and paying insurance. We had part G for almost 5 years because we didn't know better and our agent use the same scare tactic on us. Been on Kelsey Advantage for 3 years and it is great. AND NO WAITING IN DOCTORS OFFICES!
No waiting? I do not believe that. Wait times even for appointments is weeks to months. I've never seen a doctor without waiting up front or, worse, in an exam room. Never.
@@virginiamoss7045 We are still on KCA and still love it. It could take weeks to get an appointment for routine appointments but emergency right away. They even have Home visits for just $25 (not the once a year wellness exam that most plans do) if you feel to sick to go in that usually takes 24-48 to see, video anointment within 2hours and only 20 to go to urgent care. We do a lot of traveling and have used it in most part of the country (to be honest most parts are Oh NJ and FL are the only states we had to use it) with no problems. I'm sure my plan is NOT the only one out there. When looking start with 5star plans in your state.
Thank you so much for this video. I started with regular Medicare eight years ago and have stayed with it. Advantage plans sound so good and some family members were taken in by that and with all the "free" stuff they receive. It just didn't sound right to me. I didn't know why but now after this video I know why. I hope anyone looking at Medicare sees this video. Again thank you.
I enroll people in Medicare advantage plans. 95% of the people I deal with survive just on their ssn, ssi, or ssdi benefits. If you can afford a Supplemental plan, I highly recommend it but you will have to purchase a standalone dental, vision, and/or hearing plan which could run another $100/mo. 75% of the people I help are C-SNP or D-SNP eligible.
Not been my experience with Medicare Advantage Plan. No referral needed for specialist. All of my doctors are in the plan. Most hospital stays limited to paying 3 days at $300. I haven't had to use the traveling across the US benefit, but I think I would want the emergency treated and then return home for the ongoing care.
Advantage is great if you don't get real sick or have a medical emergency and have to stay in the hospital for an extended stay. Most advantage plans have that max out of pocket for the year from around $3500 to $7550 depending on the plan. Keep in mind drug costs are not included in that max either. Here is an example, on an advantage plan, if you have to go to the hospital for an inpatient stay. Your first 5 or 6 days depending on the plan, you have to pay a co-pay anywhere from $295 to $345 a day. That is $1770 that you would pay out of your pocket for being in the hospital for those 5 or 6 days. That cost alone for one hospital stay is more than most peoples Supplement plan costs including the Part B Deductible for an entire year. Now keep in mind with Supplement plans as well, you can shop them around once the rates start increasing but you will be subject to medical underwriting. I am a licensed agent in the states of NC and SC and I help people save money by keeping them on the same plan but switching them to a different insurance carrier. Another thing about supplement plans is that they are identical from carrier to carrier and all pay out the same. So that is why it is best to shop around your supplement plans once they start increasing in price. That is as long as you haven't had major medical issues in the past two or three years due to the underwriting process.
Most people pay more than $100.00 per month for a med supplement. Once you include the separate cost for prescription drug plan, dental, and hearing Med supplements you are paying atleast $2400. a year. All good agents know you can get a hospital indemnity plan for $25 to $35 a month along with your advantage plan to cover the hospital stay and still pay less than a med supplement. Not to mention the benefits that someone with Medicaid can get with a Medicare advantage plan. Overall the Medicare advantage plan helps both the well off and those in need. Once someone who has been paying $200 a month with a med supplement changes to a Medicare Advantage plan and now have a 0 monthly premium. They love the fact that they have extra money each month. Medicare advantage plans save seniors thousands of dollars on dental. You can get a Medicare advantage plan and get free dentures.
In my Medicare Advantage Plan, the co-pay is $0 per day for the first 90 days. After 90 days, your out of pocket maximum kicks in, which is $2000 for my plan. You've got to research your benefits to get the right plan. Most drugs are $0. The higher tier (Eliquis) is $20 a month.
@@jjbud3124 I am in know way telling people what to do. So glad you found a plan that suits you. Some people Advantage is great for and some not. It just depends on the plan and that persons medical needs.
I have been a health insurance agent several times in my career and did not understand the cost structure of advantage plans. When I started my part B coverage I went with a traditional supplement plan because I understood who was paying for what. If you don't pay for it you may get just what you pay for. Thanks for the explanation.
I sure am glad I didn't see your presentation 12 years ago when I retired. I'm with Senior Advantage and a member of Kaiser Permante here in CA. KP is consistently rated the best health plan in the state, and I can affirm that the health care is excellent.
I moved to AZ from CA where I was on Kaiser senior. I sure miss it here in AZ. Kaiser was constantly urging me to keep up proactive services. They don't do that with my Humana plan.
Having Kaiser for many years I wouldn't say it's good insurance. It is cheaper and it's insurance but but I don't feel that most of the Drs I've seen there are very good. There are a few that are,but not many it's ok if you're never sick.
Problems with Medicare private insurance, it is a multi billion dollar business of roll-over business. First, no matter your health condition, there will always be a company that doesn't ask health questions and at a competitive price (shop the mkt.). 2nd. Private Medicare insurance policyholders endure a never ending price increase, and eventually for lots of folks there back shopping in the private medicare insurance market looking for same coverage with less premium and should not be a problem. Health questions today are mainly yes and no questions. Experience from June 1984-1998 acting as an Managing General Agent or MGA with 33+ broker/agents. In my day, we were referred to by the state as Master General Agents. There is lots of money in the medicare day workers mkt. Be ware of the excess MGA's and, private insurance brokers sell what pays them the most commission.. And, medicare programs offered through the mail, we referred to as less sophisticated med sups.
@@Summersunshinemylove Now both my husband and I started with AARP right away at 65 - so we did enter at a good rate. It might be that the rate goes up depending on what age your parents start the Advantage Plan. But I really did my research and multiple phone calls, etc. and this was the best plan that covered everything we needed. Along with peace of mind. Highly recommend calling AARP for more information. Please feel free to ask any other questions if I'm able to help. I understand how daunting this process can be. 🍃
We are full time RVers who are retired and travel the country in our motorhome. We have a Medicare Advantage PPO plan in our state of Domicile, Louisiana, which we haven't visited in over 2 years. We have used network doctors from AZ to NC and haven't had to go out of network yet. We paid $100 out of pocket last year for the initial visit at a dermatologist. That was it, for the entire year. However, we save $130 every month as a give back from our Medicare part B premiums. That's $1,560 a year in savings! Even with the $100 out of pocket last year (nothing the year before) we still saved $1,460. That's huge for us retirees.
Thank you. I was directed to Medicare Advantage by my doctor when I retired. Fortunately I live in Washington State and I do not have a pre existing condition so I was able (after jumping through a million hoops) to get on traditional medicare Phew. I wish I had heard this video before.
I'm the youngest in my family and having older siblings really helped me understand the difference between Advantage and original Medicare with a Supplemental plan. By the way, F has been phased out for new enrollees. I've got G and it runs $150. per month (note that the premium goes up every year as you age). Also, if you were to get Advantage initially and wanted to change to original Medicare/Supplemental, you may not qualify, as preexisting conditions are taken into account during the approval process for the Supplemental. The only time preexisting is not a factor, is when you already have health insurance and are applying for Medicare/Supplemental for the first time. Depending on your income, some people can't afford original Medicare/Supplemental and have to go with Advantage. Lucky for me, the employer I retired from reimburses me monthly for my Medicare/Supplemental premiums, but even if they didn't, I would still go with original Medicare/Supplemental. I retired in a rural area (it was originally my secondary home) and have heard many horror stories about the lack of coverage, denial for treatment, hidden costs and the scarcity of doctors who accept Advantage in rural areas.
@@pattyeverett2826 Individuals who qualify for Medicare based on a disability (under 65) can be enrolled in the traditional/original Medicare plan. It depends on which state they live in, if there is a supplemental plan offered to this type of Medicare enrollee. If there is a supplemental plan for individuals who are disabled, it maybe more costly for this group of Medicare beneficiaries, than those who purchase supplemental plans at age 65, or when they are first enrolled in Medicare Part A and B (after age 65). Other options are, If they have a spouse or family member they can be covered under a large employer group health plan (100 or more employees). If they qualify for state assistance; Medicaid/Medical and the Medicare Savings Programs. Otherwise; their choices are original/traditional Medicare (without a supplemental plan for most) or a Medicare Advantage Plan. Not to forget the Part D plans--they would be included. This is just a snapshot of information in trying to answer your question. Every state has a program to help people of all ages on Medicare called, State Health Insurance Benefit Advisers (SHIBA) who help people navigate through insurance issues. They usually work under the State Office of the Insurance Commissioner. Many of the people who make up this awesome group of individuals are volunteers.
Many Plan F that stopped taking new enrollees a few years back causing the premiums to sky rocket got moved into Plan G, which is causing those premiums to increase. I went with Plan N as Medicare is phasing out plans that do not have a co-pay for office visits. The co-pay is minimal but it does deter some patients to run to the doctor for nothing because it's free. I would definitely recommend new Medicare Enrollees to consider Plan N. It wouldn't surprise me at all if Medicare phases out Plan G in the future.
Big changes coming to Medicare Advantage. Watch here: ruclips.net/video/Bro5yPQRugc/видео.html&lc=UgyT2GavDuzM9YIeIJV4AaABAg
I am an RN who worked for an HMO at one time that offered Medicare Advantage Plans. I was trained to deny claims as a prior approval/utilization review nurse. I only lasted 3 months there because I could not in good conscious continue to deny services to clients who in good faith signed up for the plan only to have something really bad happen and find they could have the procedure they needed or the stay in rehab that would help them recover. I remember one 80 year old Spanish speaking only, tracheostomy patient that need home health to come an teach the wife to do the trach suctioning. The HMO would only pay for 1 home health visit and NO disposable supplies. I was supposed to tell the family to reuse the sterile trach suction catheters by soaking them in 3 parts water and 1 part Clorox. That was the end for me, I could not lend my name to that kind of 3rd world care in this country where poor people suffer disproportionally in cases like this.
How does one get out of it?
The atrocities that occur in our healthcare system are astounding….I know 1s hand working with the clinical trials…
That's awful! I totally agree as I was a CNA for eight years.
Happened to me, I have Medicare advanced plan they denied my tooth inplant after so many calls with no help to me end Paying over a $1000 to have y implant. Thank you for this information 👍
I think the ISP you worked for is very un ethical, my ISP is the opposite , treat me fast and well, I was under HMO at that time
My wife and I signed up for Medicare plus the G supplement plus Medicare D. At First it was fine, but after 3- 4 years it was costing us 700 dollars a MONTH. We kept it when we were traveling. It did pay claims, but we did have to pay some stuff. It just became too expensive to keep. So, we changed to the Advantage type after moving to a higher population area. Referrals are not a problem most of the time. Now our max out-of-pocket is 700 dollars a YEAR. My drug copays were 25 bucks for the YEAR, no deductible. True, we have to stay within the provider groups, but we have quite a few to pick from. Original Medicare is great, if you're rich or can go to wherever you have the money to afford to seek out expensive care. Not so much if you live in a backward state or a medical wasteland. Either way you go, you're screwed. Insurance companies, PBMs, hospitals, medical groups, drug companies, crooks who cheat Medicare at every turn are what we Americans are stuck with at this point. The ruling rich overlords will never change it. Congress and the courts have been bought, and YOU AND I have been stuck with the bill.
Can usually keep the price down by comparing each year.
@@MedicareonVideo Wouldn't that be hoping that the client could also pass through underwriting?
Absolutely. This comment spells it out the way it is. Doctors don't like to take original Medicare. In effect, you have a more limited network by staying on Medicare original, and you have to pay for both the supplement the medication premium. I strongly recommend the Medicare advantage plans with no monthly premium. They have enough providers of all types that you still have choice.
True- either pay up front(supplement) or pay if you have an unexpected hospital stay (advantage)
@@JohnDavis-yz9nq John I am licensed agent and EITHER way can bleed ya...it is the hope of Medicare that NO ONE uses it.
You’re right on point. I’ve worked in healthcare business for 20yrs. When asked, I tell people to hold onto their traditional Medicare. Don’t buy into the selling points. When my parents became Medicare eligible, I advised them the same way. Stay with traditional.
Why? Doesn’t that mean you don’t get part D or C the prescription drug cost and more? I’m confused and new to this
@@kiaraosorio7276 part C is Advantage. Part D is drug. You can get drug coverage with your supplemental insurance. Or you can buy a stand alone Part D coverage.
The problem with brokers are they make their $$$ by selling insurance and insurance plans. One insurance plan pays them more $$$ than the other one, example, if they sell plan G they get paid more by the insurance company so, who do you trust 🤷♀️.
@@10speed4 Who do you trust? I trusted my doctor's Financial Office workers' opinions. They deal with Original Medicare, Medicare Advantage programs and supplemental coverages on a daily basis. I used their advice as a guide to help me find an insurance broker. That person told me the same as this speaker has related.
Medicare is backed by the government. If your Dr decides you need a test, procedure, or surgery, you get it with original Medicare, no questions, no refusals. The amount Medicare does not cover is paid for by your supplemental insurance, no questioning. But, if you have Medicare Advantage, it is run by private insurance companies who:
- can refuse coverage, even though your Dr has prescribed the test, procedure or surgery.
- they (insurance companies that run Advantage plans) can go out of business, leaving you with no coverage.
- The private insurance company that runs your Medicare Advantage plan can significantly increase your cost of coverage by increasing your premiums & deductibles, as much as they want, as many times as they want. Medicare does have increases in cost & deductibles, but not as much, or as often as Advantage Medicare's increases.
- Original Medicare is the same coverage, no matter where you live in the US. If you have Medicare Advantage, the coverage can vary, depending on which state you are in. Private insurance companies do not have the same coverage in each state. So, if you move to another state, you may not get the same coverage that you had in the state you moved from.
This experience shaped my decisions on choosing my Medicare coverage.
Years ago, I was very ill (not on Medicare then, had private insurance policy). It was a long, serious illness. Long story short: though I had an insurance policy that was supposed to cover the care I needed- the insurance company continually refused tests, procedures, and surgery needed to save my life. They refused to pay for things that were supposed to be covered under my policy- that I continued to pay each month. They were trying to save money- at the risk of my life. Obviously, I survived. But- due to my previous experience with insurance companies, I was not about to go with Medicare Advantage when they could do the same thing to me again- deny coverage they had promised.
This is my experience, my opinions & my conclusions from the info I was given.
I suggest you research the differences in Medicare & Medicare Advantage carefully before you decide which to choose.
Thanks, I hope many stay with regular Medicare. That way those of us getting all the extras at no cost will continue to reap the rewards. If everyone went with the Advantage plans they would take away our great benefits. I also tell some folks to stay with Medicare. As for my wife and myself, we have had the Medicare Advantage plans for 17 years and they have saved us hundreds of thousands of dollars. We never see a medical bill and pay NOTHING for our plan. Our plan pays us back what is taken out of our Social Security checks plus gives us a grocery card for 50 dollars each for groceries. We also get 75 dollars each for OTC products. We have comprehensive dental and vision included at NO COST. And of course it includes prescriptions at no cost. Oh, yes, they have a nice minivan to take us to our appointments or pharmacy. We do our grocery shopping while at our Walmart pharmacy . But, PLEASE , folks stay with regular Medicare! You are paying for our extra benefits! Our doctor's office even pay us to see the doctor and to get our flu shots. Our Doctors office ALSO has a van to take us to and from appointments . So PLEASE folks stay with the old Medicare.
I really like my Advantage plan!
Haven't had any problems, never denied coverage never any monthly output, always had complete coverage.
Have you been really sick yet? The kind of sick that cost over a $100K I have..Thats when you will hate that advantage plan...Did you buy that advantage plan because Donald Trump and the GOP supports them?
Wellcare was not accepted at enough facilities and they refused to cover scripts and diagnostics ordered by Doctors not in their plan
Check out Cigna, I really like it, Cigna advantage plan..
3.000 a year dental, nothing is not covered, like a blank check!
Broke my back in several places a year ago this October, no exaggeration, Ive had every diagnostic procedure there is plus any doctor, any hospital therapy, Chiropractor, braces medicine, never a copay yet, much more..
I'm sorry I didnt check this out years ago..
I've had Viva (can't be trusted), used my ss plan when I first started ss which is zero helpful! 😅
I don’t know which Advantage plan you have but I’m a physical therapist and every patient that has an advantage plan have consistently been cut short on coverage for services! Every Advantage plan cuts services!
@@meditation6054 That's the plan advantage (for them)
I'm an insurance agent, been selling med supps and advantage plans for years. The right thing to do is explain the pros and cons for each and let the client decide which is best for them. Be honest and learn how to present in such a way that they understand and CAN make an informed decision. There ARE cons to med supps. The price increases throughout the years can become more than a person on a fixed income can handle. And scaring them with tales of not getting service/approval is not helpful. I have hundreds of clients on mapds, and rarely get complaints about rejected services. HMOs are so different now than even 5 years ago, max out of pockets are better, networks are better, we even have plans with national networks.... There's a lot of advantages to mapds. I'll be honest, I didn't listen to the presentation, mostly because I've been doing this for years, and I know the details, but I had to comment because it's disengenuos to say one should "never" get an mapd. That's just as bad as saying mapds are the best option. Everyone is different and we need different solutions.
His advice is predicated entirely on the need for expensive supplement insurance, which assumes that you’re going to have a pricey hospitalization every year if the insurance is going to pay for itself. I have a relative who paid (5 yrs ago) over 10,000 a year in various premiums for him and his wife. They’re wealthy so afford the 20% for rare illness so it’s a stupid decision in my opinion. We switched to an Advantage plan because it provided a maximum out of pocket for protection in the event of a expensive illness. He also said out of network doctors can charge whatever they want because there’s no negotiated price but that’s not true in practice. There are usual and customary charges (a range) that doctors charge. I don’t agree with most of what he says.
I very much agree with you!
Thank you Windi for your answer that both Advantage and Supplement plans need to be presented with pros and cons--we don't need someone telling us NOT to buy one or the other. I have been on an Advantage plan for years and have never experienced some of the things said in the video. I am a healthy person so far, so maybe that's why I've been happy. I love all the extras I get on my plan, most of all the GYM membership. I am on a PPO plan and all hospitals and doctors in my area are on the plan so that is not an issue. However, Most of my friends are on a supplement plan so I have been thinking about changing mainly due to my high out of pocket maximum if I would have to go out of network. But I weighed my costs and this video says your cost for a Medicare supplement is only the $233 deductible. That is false. In our area, the supplement plans are at least $100/month, so that has to be added to the $233 along with $10-$25/month for a pharmacy plan. My premiums are $0.00 and I get all those extra benefits, so a supplement plan for me is going to be way more expensive. BUT, it's like rolling the dice--if you do have a catastrophic illness, then a supplement is going to be better than the out of pocket maximum. VERY hard choice to make since we can't see whaT WILL happen in our future. Thanks for all the comments and the video.
My mother has been on a Medicare advantage plan and has never had a problem getting medical care.
I'm an agent myself and his presentation is so one-sided it's ridiculous. He is not doing any of the consumers any favors by not providing all options.
I spent the last half of my career working in the billing office for a medical specialist group. I dealt with everything from private insurance, worker's compensation, medicare, medicaid, etc. By a large margin, the problems I encountered with payment denials came from Medicare Advantage plans. And most of those happened because people did not understand the rules of their plans. Thanks for the informative video.
Exactly!
Although, it would seem as though a lot of the issue is with provider groups not confirming Advantage plan coverage prior to treatment. It seems like pre-auths are needed - I’m not sure how most patients would even know how to communicate with insurance carrier or have the relevant information. Stuff only the provider could know.
I'm seeing the payment denials because of in proper billing to the insurance company (using the wrong code) I'm showing that on one of my claims in my portal.
So, who at Medicare is working on weekends, holidays, and evenings? I worked for Medicaid and we never worked those hours.
@@Melanie-ix4nq That is common but it is often the nurse's fault.
I’ve had a Medicare advantage plan for about ten years, and never had a problem even though I had a stroke, rheumatoid arthritis, and pneumonia.
I take nine Rx a month and this past month, February,I paid out 37.00. thanks for your input I’ve had the same doctors for many years.
What insurance did you have
Wow - I pay a fortune for RX
Agree. Me2 ZERO PROBLEMS
❤️KELSEY-SEBOLD HOUSTON TX
Get em Joy you don’t need the supplement plans my Mom paid $179.00 a month for G and never used it $6000.00 down the drain
Joy, that's great to know. I stayed on the original Medicare for a few years but finally switched to Medicare Advantage and am very pleased with it thus far. Seems much easier to me all the way around. I like my docs and the network.
For regular folk the Medi-gap premium can get really high as you get older. Best option is to research and educate yourself the difference between Medi-Gap vs Medicare Advantage. The entry rate for Medi-gap may be great but increases rapidly. The competition in the Medicare advantage is really providing great benefit but remember to alway look at the Medical Group you choose. The Medical Group make all the difference in the quality of your care.
You are correct. there are thousands upon thousands of us out here that survive on Social Security only and we simply can afford nothing other than the zero premium medicare advantage. I dont know what you mean by medical "Group"
I don't care what medical group I get. You can change every month. Very few care about your health, they only want that free Medicare money! If they are good doctor and have a good practice they don't want to deal with Medicare. In Florida very few actually understand English. They can say English words but have no idea what you are really saying. You HAVE TO. E YOUR OWN ADVOCATE!
@johnsonpaul1914 ALL the MA plan are owned by groups then bought out by a major company like Anthem. Those owned by those big broker houses are the o es that give you trouble. You MUST know what your plan pays for and what they don't. ALL must cover EVERYTHING that original Medicare does. Most cover some type of Dental but many don't ACTUALLY have dental offices that will honor their plan. These EXTRA services are proctored by other companies that care NOTHING about you. There actually is NO OVERSIGHT over any of these plans except Congress itself. CMS just turns your complaint back to your plan. That's like letting a fox guard your chickens. CMS is like a union for the Medicare Advantage plans. They protect the MA plan NOT YOU! CONGRESS does have control over all these plans so make certain you know your congressman. IF you are lucky he is a Democrat, the Republicans won't help you.
What you say may be true, but people don't know one group from another. There's no information to make an informed decision.
My husband and I were paying over $700 a month for premiums alone with Medicare and a Supplement plan, so we changed to Medicare advantage plan Preferred Care with UHC and here in Miami it works fairly well. We never had any issues to go to specialists. Even though my husband takes a lot of medications, at the end of the year we end up saving money.
Thank you. These dummies never consider $700 per month or $8400 a year for supplement insurance. Have had Advantage plan so have saved nearly $90000.
@@domerbuz3813 I agree with you. For me a Medicare Advantage Plan works great.
@@domerbuz3813 How many times have you been hospitalized ?
@@danielhurley2894 I have an Advantage plan. I’m raising a red flag but doubt that our representatives in Congress will. They receive massive donations from the healthcare and pharmaceutical industry who also spend massive amounts on lobbyists. My doctor and physical therapist recommended further treatment, but after the initial 90 days (which included only ~16 visits because my copay was $35), request for authorization was sent to a contractor for Aetna who did not respond to phone calls, voicemails, or emails-so no further treatment. I filed a grievance w Aetna; their response 2 months later was that I had treatment and they had no further request for authorization. Phone calls to Aetna- rep said there was no request w Aetna, didn’t know anything about the contractor but admitted they do use outside contractors. I had a previous experience with an insurer who also contracted with outside companies whose job it is to deny claims. My neurosurgeon received a payment of $150 months following my 6 hour surgery. There is no good health insurance company or plan in this country.
@@domerbuz3813 Stay healthy!!
As a physician I wholeheartedly agree with the points you made in this video. The worst I deal with is prior auth for rehab or SNF that are denied after many days being in the hospital waiting for auth, and then the peer to peer is rejected- the patient is not safe to go home but we must discharge them home because their insurance stopped paying for them to be in the hospital days prior and our ER is full of patients boarding waiting for beds in the hospital. Then they are readmitted in a few days/weeks from complications post discharge because they did not go to rehab.
Prior authorization and SNF issues are rampant with plain Medicare. I have seen this both as a provider (retired) and as Medicare adjudicator.
Medicare Advantage has to start at the exact same place as Traditional (Original) Medicare. Then, MA plans add extra benefits for example vision, hearing, no health deductible, gym membership, etc. The fact that a network is utilized mimics private under 65 health insurance. Medicare Advantage plans help the patient afford hospital stays so they don't get stuck with 20% of the total cost of staying in the hospital.
@@juliemills6716 Why are you telling me this? Not only am I a retired provider (and nearly all of my patients were on a Medicare Advantage plan), I have been on one myself for years now and am very satisfied.
This exact thing happened to my mother this past March! Every three days they reviewed her case, and about four times we had to appeal - soooo stressful living in limbo... At the 4th time, we lost the appeal. This is despite the recommendation of the doctor/therapists at her in-patient rehab ... However, Ive always been under the impression the Medicare + supplement route was for richer people who could pay a lot each month up front, and hence, the better coverage for the bigger on-going things down the road when they happen .... My mom was a life time social worker for the state until she retired -- an honorable job but not high paying (even with her Masters Degree, sigh).
Been on Medicare + AARP/United Plan F for 7 years. Never needed a referral or had a problem with authorizations. Have paid zero for medical co-pays and minimal co-pays for drugs. Compared to my Medicare Advantage friends who are restricted to certain doctors, need referrals and pay co-pays for every doctor visit and hospital stay. One friend and I were both having problems after cataract surgery. I made an appointment for a second opinion at UM medical school. She couldn’t get approval from her Advantage plan. Yes, the supplement isn’t cheap but I budget for it and have complete control.
After working in healthcare (I'm a psychologist) through the heyday of managed care, and knowing how important it is to me to be able to choose my own doctor (they aren't all the same!), I went straight to Traditional Medicare. I know that there are some great Medicare Advantage plans that people really like. But people often love their plan until they get very sick. Then the claims start getting denied.
My best friend and I were seeing the same physical therapist. I could get as many sessions as my doctor would recommend. She had to beg for more sessions, haggle for a reasonable cost due to confusing payments from her Medicare Advantage plan, and end PT before she was better. It was appalling!
You may believe you are saving money with a MA plan. But if you have to pay for physical therapy or some other service that isn't covered, you'll send up spending more. And God forbid you need prior authorization for something before getting much-needed treatment! There are horror stories of people who have died waiting for that prior authorization.
Ever notice how many ads there are for MA plans? Guess where they get that money? It comes out of the premiums they collect. That's money that won't go to healthcare. This is just wrong.
Most of these stories are made up by those selling those supplement plans. The MA plans MUST cover EVERYTHING that original Medicare does BY LAW! In more than 15 years on a MA plan we have NEVER been turned down for ANY care covered by Medicare or the .A plan! There are rules these plans MUST go by. Several times my MA plan has even gone out of network for me and paid the ENTIRE cost even though I would have had a copay in network. If you can't read your plan, please have someone else read a d explain it to you. I call CMS first if I expect a problem. If my MA plan doesn't have a supplier within a reasonable distance, they have gone out of network. At one point Walmart optical refused to sell me the transition lens for the plans agreed upon price so I purchased the glasses anyway but complained vigorously and they sent me out of network to purchase another complete glasses both frames and lenses and paid the entire 420 dollars!
@@GAderly-fn5ly Nobody should to have to complain that much to get what they need. Very glad that it worked out for you but it may be denied for another.
@glw5166 You have to be your own person when it comes to your health! NO one can speak for you better than yourself. Those on original Medicare are much more at risk than those on an MA plan. MA plan personal and doctors help you oversee your health plan. They want you to stay healthy. Original Medicare folks want you to come as often as possible to see all kinds of doctors as that's where they make the big bucks. With MA plans your primary care doctor gets your referrals for you. They KNOW if you really need a specialist and they willingly refer you to a specialist if needed. It's not the MA plan that gives you the referrals but your PCP. IT'S NOT the MA plan that gets you the referrals, it's your PCP. It doesn't cost your PCP for your referrals and even your MA plan has specialists on contract so referrals are NOT a problem. With original Medicare doctors get paid from each other for referrals so they will give you referrals even if they know you don't need that specialist. They will pass you around from one specialist to another just for the money. With MA it doesn't work like that. You have no advocate with original Medicare, you are on your own. You can go bankrupt on original Medicare. MA plans protect you with max out of pocket expenses. If you need lots of Healthcare and many doctors you reach your max early and then there's no charge after that. Even you prescription drugs have a max out of pocket, then it's all free. This doesn't happen with original Medicare even with those super expensive supplements. My wife had both knees replaced, at different times of course. The first cost us 295.00 and the second cost us 195.00 TOTAL! That INCLUDED aftercare and rehab! Her second knee replacement, they gave her a sw
Totally agree ALL the ads are for advantage plans , and 0 dollars for the premium 🙄, you don’t get something for nothing… never Advantage for me
@@Rnjeepshoelver Right. They are making money off of those plans, and that's money that just doesn't go to healthcare. Plain and simple.
Unfortunately, many of us can’t afford anything else. We have had a Medicare Advantage plan for the last 10 years and it has delivered excellent care for us. It all depends on which plan you choose. Do some research and compare the different companies for their customer satisfaction ratings, and get input from friends who have these plans.
Until you have something catastrophic go wrong and you aren't in your coverage area.
@@rhondarowley6705 My UHC advantage plan documentation says it covers emergencies no matter where I am or what hospital I go to. Are they lying?
Is it possible to switch back to original Medicare, having no medical scenario?
@@km4hr They won't cover emergencies 100%...you will be left with what ever the doctor charges that your plan C won't cover. Read the fine print and NEVER believe an insurance company.
Very slated and MIs information by this you tuber..but what do u expect from You tube! LOL’s
I worked both for a HMO and medical biller in my working life. Yes, traditional Medicare AND a supplement are the way to go. HMOs ALWAYS had lots of customer service calls regarding problems- especially when a person was traveling and had a medical emergency and could not use a network provider. I remember one time the HMO denied paying ambulance service saying it was not "medically necessary". The person died IN the ambulance. That was nuts- the family got the bill after denial. They were livid.
I have heard that as well
I don't believe that at all!
There is much more money to be made selling these supplement plan so they make up lots of stories.
Not true -agents selling Medicare advantage plans usually get paid 3x as much commissions as original Medicare
I'm sure the logic was, "Well, they died enroute; they could have died just as easily at-scene and saved the ambulance call; so, obviously, the ambulance was not Medically Necessary!"
Jerks!
I am a licensed agent since 2006 and have clients on both Medigaps and Advantage Plans. It's our duty and obligation to give each client to do a thorough presentation and give them their options. Medigap plans are excellent but not all can budget a Medigap plan which increase every year and when it's a husband and wife the expense can really be a hardship. Then they have to pay separate for their part D and separate for dental insurance and so on. On the other hand, my parents and in-laws with medical issues like cancer and diabetes have done very well with advantage plans and still continue up to this day. Not to mention some clients may also qualify for Low-income Subsidies and Medicaid programs from their state so truly they are covered even 100% for all Medicare costs. Although they are managed care plans there are many professional physicians who participate in these advantage plans and the referral process is not a headache. There are not a one size fits all plan. Every client has unique situations, lifestyles, income and so forth. So, at the end of the day give your clients the option because if you don't do a good job explaining their options as discussed on Medicare and You handbook, another agent will come along and enroll them in a managed care plan.
Spoken like a true insurance salesman!
@@rodbutler4054 and how do insurance salesmen make money?
Everything you said is spot on! I I don’t understand how this guy can generalize something as broad as a medicare into a little 16 minute video. There’s so many other reasons why somebody would choose a Medicare Advantage plan as opposed to a supplement plan. Aside from your part B why would you pay a monthly premium for some thing that keeps going up for the most part every single year plus pay a separate premium for your part D drug plan plus pay copayment on top of that.You mentioned low income subsidy there’s also state Medicaid and that comes along with a bunch of other benefits.
I too sell both and agree with you 110%.
Would you recommend an advantage plan to someone who is really sick like a quadriplegic, cancer patient, heart patient, chronically ill, etc?
I’ve been on Medicare Advantage for eight years. Nobody “sold” me anything; I just researched my options online. There are no additional premiums for Medigap or drugs. The network includes every provider I’ve ever heard of except one. Co-pays are reasonable. It’s probably the best insurance I’ve ever had.
Wait till you get seriously ill or are hospitalized. You might change your mind.
Copays for some are $50. For specialists. If you see cardiologist, podiatrist, urologist, etc couple times a year it adds up.
Just don't get seriously.
Bob Pickering: Was your father in the Air Force? (My dad was and my folks were very close to “The Pickerings!”) I even think his first name was…Bob!
It was the same thing for my parents. Then my father actually got sick at the age of 83 and he has been severely impacted by having a Medicare advantage plan limiting the amount of care that he could receive - which could be life-changing. Everyone is healthy until they aren’t.
I have a PPO advantage plan and I have never been denied anything, and I've had many MRIs and expensive cardiac tests. Pre-approval for one test was done within 24 hours. However, my mother was on a supplemental plan and they denied her a life-saving surgery after already approving it. They didn't deny it until she was in the hospital, being prepped for surgery. She had no choice but to have the surgery and ended up paying THOUSANDS out of pocket. We had to sue that company to recoup her losses. Plus, supplemental plans cost so much in FL that as someone with low income, I could never afford them. You can push these plans all you want, but they are just as bad as any advantage plan. All insurance companies are crooked.
Most of our friends have a PPO and no issues so far
Yep!
@gk_filer That is because it is probably. You must live in a fairly wealthy area. That is why plans depend on your zip code. Average and lower income persons would not be offered plans offered in wealthy areas. They cannot afford them. So they get hmo plans. At least with Medicare it always pays 80% . Get reliable secondary insurance. With scripts if possible.
@patriciaberry4630 You are wrong in so many ways. Original Medicare does NOT pay 80%! Figure it out! With what you pay for Medicare and with ALL the deductibles and no guarantee on max out of pocket, they pay no where near 80%! But please stay with Medicare.....you are one of those paying for my great MA plan. I live in a low income area.....where it's all a service area. With my MA plan I feel like I'm wealthy with them giving me money for groceries and OTC supplies and now even paying my utilitiy bills. Please folks STAY with original Medicare. I don't want ANY more folks going with MA plans as if too many go with MA we will lose our great benefits. I like hearing this guy tell you all those lies, he sounds like trump splaining! Just like trump telling folks how bad off they are. We've never had it so good in reality. Under trump the cost of Medicare went up every year but with our real President Biden everyone's Medicare costs have gone DOWN. I'm happy so many of you believe all these lies as it makes it so much better for the rest of us.
@@GAderly-fn5ly Sorry you are the one that is wrong. I have had medicare since 2009. I have never paid a Co pay. A couple times paid small amounts. My secondary picks up what medicare does not pay. You are not very bright calling someone a liar. Opinions are okay. But not accusations. I have also done medical billing and coding and knowledge of patients imput. What do you have?
Being a Utilization management RN for a Florida based hospital for over 15 years, I totally agree with you. So often patients experience medical emergencies while on vacation and are limited to choices for care while away from home and “out of network.” I advise my friends and family to always invest in supplements and keep Medicare, steering them away from advantage or replacement plans. I think it’s a crime when I have to argue with advantage plans to authorize physician directed care after the acute health emergency has been addressed. Most folks don’t realize that once a patient is determined to be stable, their care is limited to what their advantage plan will allow, even while they remain hospitalized. Often their choices decrease significantly when they are discharged. Those who require home health or rehabilitation services post-hospitalization can be severely restricted and are usually required to return home to their local area for coverage. You are providing a great service with your videos. Keep it up!
Sure wish everyone could read your comment!
Again, you have to consider your situation and many older people don’t travel so this would not be a problem. There are many things to consider on a personal level, it’s not one size fits all.
What you do is choose a provider that is ubiquitous. Meaning, they are everywhere. Kaiser, for example.
@@TheCheryl57 I heard Advantage plans are more costly in the long run especially if you need a lot of medical care.
Also, that those plans are more costly for the government, because those Advantage plans charge more for services because the middlemen/women and the in those companies need to make a profit.
Thank you for this valuable information.
Just went through this with my 96 year old mother. Advantage plan fought with doctors recommend care and we had to go to arbitration. It worked out but if we were not available to help her , she would not have understood what was going on.
Easy way to understand difference. Regular Medicare , doctors control your health care. Medicare advantage , underwriting controls your health care.
Hi Richard,
Unfortunately I've heard that story too many times. Happy that it worked out for her but many times it does not. Hope she is doing better.
@@MedicareonVideo thanks yes she is at 96 still very alert and on the mend.
I am 76 and my phone has been ringing all day since last Thanksgiving with different people from different states trying to.sell me Medicare Advantage.
I am happy to hear what you've said.
@@riadanabtawi5880 It really is a shame that it has to be that way
Medicare doesn’t always pay for what doctors recommend. I had to have minor oral surgery to remove a growth from my pallet for biopsy and Medicare refused to pay anything. Never got an explanation why. Because Medicare refused to cover the biopsy my supplemental insurance refused to pay anything. I got stuck for the entire cost. Submitted Medicare a review petition. Called several times after the date Medicare was obligated to respond. I was repeatedly told my petition was still under review. Medicare never responded to my petition. It just disappeared. Never rely on Medicare.
I agree with you 100%.. As my wife and I grow older, We have had serious medical issues. My wife had a heart murmer all her life, and at age 76 it turned into a valve replacement and a bypass all done at the same time. Within 30 days I was advised to have a pacemaker and it was done within a week. NO HMO for us, not ever!!!
Many advantage plans have PPO’s too. He failed to mention that!
@@roberthoeller5516 PPO are NOT advantage plan and outside the scope of his comments.
@@roberthoeller5516 PPO costs can rack up in the thousands for serious health problems. There is little advantage to "Medicare Advantage".
@@landiserla3668 I had surgery in June, my bill was $21,794. I paid $464 out of that amount with my Advantage plan.
@@roberthoeller5516 Medicare paid most of that. You would have paid $0 with a Medigap plan instead of advantage after meeting deductible.
I am a Medicare Advantage Survivor. After many issues that convinced me of their intention to deny all claims they possibly could, I went back to Original Medicare with a G Supplement. You cannot qualify for this if you have certain medical conditions. Fortunately I did not wait to make the change.
I’m in the process of getting back to regular Medicare and going on plan F… praying I’ll get back to my red white and blue card🙏🙏
@@debhelms4106 Plan F is no longer available since January 1 ,2020. My husband had signed up for Plan F in October 2019.
so how much are your payments for plan G
I'm going to try the same, I didn't know there was a difference, Medicare Original V Medicare Advantage.
Odd you say these things! MA plans have to cover EVERYTHING STANDARD MEDICARE does! BY LAW! So when those saying MA plans DENIED something , original Medicare would ALSO have denied it. I'm NIT in ANY kind of sales but you all must get educated so you can know when someone is lying to you. If you never learn ANYTHING else....just know the MA plans have to cover EVERYTHING that original Medicare does! BY LAW!
My mother just passed at 96 1/2 & regular Medicare paid for literally all of her end-of-life care. I was amazed that we never got any medical bills. They even covered the helicopter transport to a larger hospital after a heart attack.
When your mom was enrolled in Medicare it was a whole different plan than what is offered today. Her plan doesn’t exist anymore. I’m sorry for your loss.
If she was low income and medical everything would be free to her
Sorry for your loss, but so great she had a long life, a blessing from God.
@@MrElby100 I'm finding that also. It seems all of this - insurance plans and medicare - keep cutting coverage and charging more. And refusing services to stall medical treatment.
I tend to agree with most of your points. However it is truly scary that many people on Medicare and paying for a supplement are completely unaware that their care is still being "managed" by providers who are in ACO/Shared Savings/Direct Contracting arrangements. So, the beneficiary is getting the worst of both worlds. They are paying for a supplement but unknowingly have providers "managing" their care behind the scenes to line their own pockets.
traditional medicare plans with supplemental plans are not managed by anyone but the patients Dr's. That is a false statement
Very true! Ask questions, Be informed, Get informed and then decide!
I don't know what you are talking about and I dont think you do either. When I get sick I can go to any big city hospital in any state I happen to be in without having to call and check to see if I am in a network...Any Hospital that takes medicare will also have to take your supplement period...You do not have to get permission for your care. You are not managed. Thats a lie.
All health care is managed for profit and business. People are so used. People are taught to be sick. And big money is made. This country rips people off more than any other country.
Undisputedly “Beneficiaries” are definitely managing their care
I totally agree! I was a RN case manager for 5 years & frequently after a hospitalization the Medicare Advantage plans would not pay for skilled nursing facilities or long term care facilities. Everyone would talk about the great “dental & vision benefits”, but if you’re 85 & break your hip & can’t go to skilled nursing, you’re hosed.
I broke my hip at 50and went home. What do they do at skilled nursing? I had a pt and my family helping. Did have pain sleeping on that side for years.
@@melindalicht6699 my friend that is 70 just had hip replacement and she didn't have anyone at home to help. Because she has a supplemental plan she was able to go to a rehab hospital for two weeks and then had home pt for a few weeks.
@@MrDONTEATUS It's not because she had a supplemental plan! She had original medicare along with a supplemental plan (which picks up the 20% medicare doesn't). Medicare Disadvantage is a ripoff.
well maybe the nurses were not skilled at the facility😂😂😂😂
I know for a fact this stuff is untrue! My brother broke his hip when he was 89 and he lives in a very small town and they transported him to Sayre Pennsylvania to have the hip replacement and took care of all expenses including aftercare!
I had very different experience with HMO plan. I think ( correct me if I am wrong ) all the long waiting of referral and complaint are really depending which Medical Group that you Choice, For my 40 years with HMO and the same Family doctor and Medical Group, I had no issues being on HMO. I even got sent to USC to treat my Bone Tumor under HMO, my ISP authorize a biopsy in 24 hours, and to see a spec list. because my ISP was willing to sign special contract to send me since at that time only 1 Doctor in the West Coast can save my life.... I don't think private insurance compamy has anything to do with you., It is your Dcotor and ISP are or are not willing to treat ( manage ) you fast and well, PICK A GOOD ISA AND PRIMAY DOCTOR
This advice is good for those that can afford the Medicare option. Couple of years ago I was climbing up out of homelessness. And I should the age where I had to either go on Medicare or Medicare advantage. I had no choice but to pick the best possible Medicare advantage plan that I could. Still don’t have sufficient money for month-to-month living expenses. But I’m not on the street anymore. Every situation is different and specific. Is he saying something good? Yes. Is it the best advice for everyone? Not by a long shot.
Why didn’t u apply for Medicaid? Even cheaper!
As an MPH I so appreciate your open honesty. Corporate medicine is unconcerned with their patient outcomes. Their top priority is making management and shareholders happy- at any dire cost of life or quality of life for the patient.
I worked for one of the biggest 4 profit corporations in the United States and abroad and I can attest to what you're saying it wasn't about patient care , it was about the profits and the stack holders.
And of course I've also done some work for non profits and the same old thing there too!
That is sad, but true! The big medical insurance companies like bcbs are notorious for this! These companies open a book when someone gets sick, with price tags next to the illness! If it's kidneys or liver issues, there is a price next to it!!!!😢😢😢😢
I agree! I had a HMO and they sent me to a
Surgeon who was training to learn how to remove my top lung. He didn't get it right and 3 days later had to open me back up for lung surgery #2. He left an air leak. I returned to work 2 months later, could not breathe. Xrays were taken twice. I worked for a year like that.No one said a word to me. I changed Insurance immediately found out my lung was collapsed and glued to my chest wall. Cedar Sinai fixed me as good as possible. My current lung Dr. said you can't leave a lung collapsed for a year. Now I'm stuck with 33% lung function. Get the best Doctor available. Don't let them send you to a surgeon in training.
No HMO for me....
Sorry you had that experience :(
I've been on Medicare and Plan F since 2008.
It's worth the peace of mind.
@@alysewitt3729 I am so sorry to hear you went through such a horrible experience, and am glad you have a good supplement plan. I also have Original Medicare and a Plan N and you are absolutely right! The peace of mind is worth the cost.
You do realize that can happen no matter what insurance you have. Sorry for health problems.
@@TheCheryl57 I found out later that if I had gone to Cedar-Sinai to a true lung surgeon they would have made two tiny cuts instead of the 16 inch cut across my back that went into my breast. They would have got it right the first time. I would not have stayed one month in the hospital. You are right that anything can go wrong and it sure did. Leaving me with a collapsed lung knowing it was collapsed, is my biggest concern. I worked that way for an entire year.
Nobody would choose Medicare advantage plan....but people can barely pay to live now, and the price of supplements plus Medicare B cost is just too much for most per month
You also have to ask yourself " How much does peace of mind mean to me?" For me, it means a great deal. For that reason...and all the points Keith made, I choose original Medicare and Plan G and a drug plan. Thanks, Keith. Awesome explanation.
Thanks Joe!
Couldn't agree more. (I picked Plan N) :)
How much does that cost you?
@@local_treasures815 I’d like to know as well.
@@local_treasures815 couple hundred a month.
Went on Medicare last year and went to a couple of advantage presentations and the sales pitch was a hard one. Kind of felt like I was talking to a car salesman. Being a retired RN I was already somewhat aware of the advantage problems and stuck with original Medicare plus a supplement. Your presentation is spot on and I think the clearest explanation of the differences I have heard thus far. Thank you so much for this great informative video!!!
I dub them used people salesmen, and they have NO biz handling the medicare generation imho.
I see the Medicare advantage commercials on TV everyday and how they are misrepresented. They only point out the pros and never explain the cons. Being a past Chartered Life Underwriter, I am surprised the Insurance commissioner lets this slide.
To me they are a scam. Just look at how many tv commercials they run. (just like aspca, shriners, save the elephants, etc)
Advantage plans make the insurance companies who write them a TON of profit. There’s a reason there are so many ads for them.
I am suspicious of any product that advertises so heavily, but I was leaning to an advantage plan because of the limit on out-of-pocket. I now think I'll stick with Medicare and a supplement. Thanks for you comment. I like to hear from people who are not selling anything.
7 years on a Med Advantage plan (for several years was on United Healthcare, but have since switched to Aetna), and I've had virtually no problems, with perhaps the one exception of sometimes having to wait a bit extra for an appointment with my PCP. No problems at all when having to visit specialists. Super and I mean super low cost - in fact, virtually no cost to Advantage. Not arguing with this gentleman, but I'm fine with my plan.
When you’re younger it’s OK, but when you need to get post Acute services they suck. They denied Acute rehab for a patient of mine who had a hip fracture. They also denied skilled nursing for her. She ended up going home with home PT twice a week.
Sure, Medicare Advantage employee, but I think I'll pass.
@@MerkinMuffly What are you in high school? Who gives AF what medical plan you choose.
I enroll people in Medicare advantage plans. 95% of the people I deal with survive just on their ssn, ssi, or ssdi benefits. If you can afford a Supplemental plan, I highly recommend it but you will have to purchase a standalone dental, vision, and/or hearing plan which could run another $100/mo. 75% of the people I help are C-SNP or D-SNP eligible.
Club Mogambo...agree..I have a lot of health issues. No problem at all with my Advantage plan. Even had 3 surgeries...I do have some med co pays but not bad...can see any Dr as well!
I have a Medicare advantage plan and I wouldn’t ever think of leaving unless there was some dramatic change. This coverage has gotten me through two bouts of cancer, and they have never caused me any grief or delays. Also, I had rotator cuff surgery recently, and I was shocked at how little I had to come out of my own pocket, really, really shocked!
Thank you for sharing your positive experience with Medicare Advantage! It's wonderful to hear that you've received excellent coverage and support during your health challenges. Medicare Advantage plans can be a great option for many individuals, especially when it comes to providing comprehensive care and minimizing out-of-pocket expenses. It's important to find a plan that suits your specific healthcare needs, and we're glad you have found one that works well for you. Thank you for watching and for your valuable feedback! 🙌🏼
I get so confused with all these variety suggestions and warnings,
I’m about to start Medicare and have been told to always go with advantage plan.
This is stressful and so very confusing shouldn’t be.
@@debbieklose8776 I remember being in your shoes and I will agree at first it is incredibly confusing. However, the supplemental plan comes with a monthly premium that you must pay. With a Medicare advantage plan there’s no cost ….you just select if you want an HMO or PPO plan, and confirm that your providers are included in the network. Good luck
Go by proof of experience? takes one to make a video.@@debbieklose8776
What is the name of your medicare advantage plan? Sounds good!!
I would say there are a few glaring omissions in this presentation.
First is that the premium prices for Medicare Supplements differ GREATLY by state and demographics. It is in your best interest to get an OBJECTIVE view of what best suits your particular situation by comparing Original Medicare with a Supplement and Medicare Advantage in your area. It may be that in your area MAPD plans are few or are not competitive. However, I live in an area where the annual premiums for Medicare Supplements are more than the out-of-pocket maximums for the HMO plans.
There was also no mention of ancillary benefits like; Vision, Dental, Chiropractic, Fitness, Acupuncture, quarterly coupons for Vitamins, etc. Medicare Advantage DOES cover and Original Medicare does not. I have clients in two states and they could not be more different. It is great that you love Original Medicare but if you do the analysis Medicare Advantage can be much better for people depending on their health and finances.
If you life in a rural area Original Medicare is usually the best option if the Supplement and Drug plan are not cost prohibitive. Providers are fewer so networks are more restrictive. In an Urban area the opposite tends to be true. Hundreds of providers and many Medicare Advantage Carriers are competing for business and that brings loads of benefits and LOW out of pockets costs. Yes, you are restricted to the Plan’s network, and on most plans will need referrals, but Referrals should take the same amount of time as it take for your doctor to send a script to the pharmacy. For man things you can also see the Primary Dr virtually to obtain a referral. A broker will show you comparable options available in your area, not just the one they like…
There are plenty of highly rated PPO Advantage plans which do not require referrals.
I have just started PPO Blue Cross advantage . So far so good. Under $8 month. Do you know any drawbacks.?
@@barbaracruisemartin9806 that is not a generic question as the plans differ in different states and counties. I enroll in Blue and have 6 states and no two plans are exactly a like. My best advice is find an agent you can trust and go over your concerns with them. Just so you know, there are multi PPO plans under Blue.
Daniel, I completely agree!!! As a licensed independent health insurance agent for almost 15 years, I can tell you there is some serious "truth twisting" in this video. He is basically taking the worst HMO product and the worst MA features and casting a blanket about all MA's across the county. In our area, we have highly rated PPO (Non-referral) plans with huge premium savings and extra benefits compared to Medigap plans. If you want the absolute best coverage and are willing to pay the huge premiums, go ahead and get a Medicare Supplement plan but if you are healthy and want to act as your own insurance company (by keeping those premium savings in your pocket) the MA plans are a VERY good option!
@@mattgreen267 i bet he used the same type of presentation when he was selling hmo. not downloading his book but i wonder what's getting sold i will say my mom had the ppo advantage from fl blue, and the one the corrupt aarp pushes . and i had fl blue hmo 2 yrs with o care, 2 yrs advantage hno, this year they offered ppo
same cost but i estimate it will cost me about 150 ded on meds . all but 1 of dr my mom used and hes a very specialize eye dr. he takes ppo . at most took 2 days to get appt with specialist . fl blues a not for profit i recommend it . if you have one home a person like who spend all winter in fl it would not be good
I was paying $235 a month for my medicare supplement. I am relatively healthy, take no prescription drugs, pay out of pocket for dental and eye care. I just cancelled my supplement and signed on to a highly rated medicare advantage program. I think this was a good move for me.
I'm weighing that too. Though I guess it is kind of a gamble. If I continue as I am, it would be the best option. But if fall into depression or something and regain my previous weight and get cancer or something, it would start costing me a lot. I have to decide.
There are many Good Advantage Plans, and Good Supplement Plan G or Plan N.
They are both good,depending on your situation! GET THE FACTS! You have 1yr from the time to change your Supplement Plan G to go back if you do not like the Advantage Plan without any medical questions.
I have plan N which is $96 monthly. I was very healthy, just a wellness check by-yearly. I slide in the bathroom and broke the tibia in 4 places, the fibula and ankle, along with damaged tendons. I did not owe anything.
Ouch, @@judymoore7469! Hope you're doing better. Though when I put myself in that situation, I calculate five years of $96/month is $5760. But with no medigap at all, I would have had to meet the deductibles and 20% on much of the remainder. So, if I remained otherwise healthy for five years, I wonder which would have been the better deal.
@@judymoore7469 My plan was F which was discontinued. I was grandfathered so they couldn’t drop me. But they kept raising the monthly premium. I went with a very highly rated plan. I have friends who have this plan and they are all very pleased with it. I just learned that I will have to pay a monthly penalty because I wasn’t previously enrolled in prescription coverage. It’s not a lot but it is for life.
With Med Supp you have 3 premiums; medicare part B, the cost of the supplement and the cost of your part D premium. The deterrent to joining a Med supp plan is the large monthly premium. United Healthcare and Aetna have the best Medicare Advantage plans hands down.
It all depends on how much peace of mind is worth to you. Basically, in many ways, it's a "pay me now (with controlled, known premium payments), or pay me later, (with unknown amounts looming). I know exactly how much my premiums are (yes, like everything else, they go up a little every year). I can budget for them. But if you have an advantage plan with big deductibles, copays and unknowns, you can take a big hit all at once.
My mother has AARP United Healthcare, Medicare advantage PPO, and so far its been great, I know someone else who has the same plan and he loves it too, I turn 65 this year so I plan on getting thd same plan three months ahead of my birthday.
@@Gwen-joyful-light good plan! My parents are both on med advantage and love it, same with my Medicare clients. Advantage isn't for everyone, and I have some clients on supplements because that is their preference and they can afford the premiums, but the vast majority are happily on advantage PPOs with huge networks & solid care. I have also seen older folks paying $700 plus total monthly for part B, med supplement, and drug plan because they're stuck in an obsolete med supplement and can't qualify for another one, and are scared to move because of videos like this.
In my area Humana’s is best. My deductible is thousands less than either of these two. However since being on MA now for my third year I would NOT suggest to anyone to take a med advantage plan. If you are in the hospital you will end up paying it out of pocket.
Yeah, and when there is 2 of you it is even more expensive.
I have Medicare Advantage and love it! No monthly premium, no co-pays except $25 co pay for a specialist. Nothing for my monthly meds. I’ve had countless tests, a few surgical procedures and have had incredible care and the best of the best drs. I chose my specialists which are all 5 star in the Houston area. I’ve never been happier with my healthcare. Everything is amazing and I’ll never have anything else. Nothing in here you’re speaking of happened to me.
What Medicare advantage plan are you on
His out of pocket of 7,500 is very rare. I am now debating on going with Summacare where the max. out of pocket is 3,800
Hello Dee how are you doing today?
@@patriciaguzman3996 Which Insurance company are you with?
It's an individual choice on Medicare supplement or Medicare advantage plan. He's getting payed as an actor for promoting Supplement plan.
Not being able to go back to Medicare Part A&B after moving to an Advantage plan makes it clear to me which is the best decision. I will stick with the original and get a supplement so I can have health care choices. Thank you for the very informative video.
You can drop the Advantage during open enrollment, if you move, and if you get Extra Help, at any time.
You can go back but getting a supplement may be harder. They now can ask health questions to see if they will approve you.
@@kathyneichoy9384 Depends on where you live. Some states have no underwriting.
You are so wrong about EVERYTHING you posted! You can ALWAYS go back to original Medicare at the end of each month! Why would you post such lies?
One can choose to go back to Traditional Medicare during open enrollment if they do not like the Advantage Plan program.
Why I think you are a crummy agent:
1) Supplement plans in my state go for $220 per month, plus the drug card at $35 per month. That's over $3,000 per year paid in premium WITHOUT FAIL!
2) Most Advantage plans have a $0 premium with reasonable co-pays and no deductibles.
3) Although extremely unlikely, the maximum out of pocket could be as low at $4,500. This compares favorably to the fixed out of pocket cost for a supplement of $3,060.
4) Catch up with the times! Many Advantage plans are PPOs, which allow the enrollee to see any provider who takes Medicare.
5) You have to carry around only one card....only one party to call when there is an issue. With the supplement, you have to handle your Medicare card, the supplement card, and the drug card. Good luck getting to the right people.
6) Advantage plans offer extra stuff that isn't covered by Medicare nor its supplement. Dental, eye care, hearing aids, fitness memberships, Over the Counter items, flex cards to augment the Dental/Vision/Hearing, etc.
7) Even some HMOs, like Aetna, do not require a referral to an "in network" provider. BTW, I have been a Medicare agent for 10 years and have NEVER received a call from one of my clients complaining about a lack of a qualified specialist in the area.
So, Mr. Expert, be careful the next time you say the word "NEVER". In the vast majority of situations, an Advantage plan is a much better deal to the consumer. About the only time a supplement is preferred is when the enrollee is on a Part B medication.....very rare.
Many high end hospitals in California will not take advantage plans C supplemental coverage plans anymore they only accept A@B with D prescription coverage and G supplemental. Never get supplemental C advantage plans you will be denied medical care at many hospitals.
If Original Medicare would just cover dental, vision, and hearing services, there would be no need for Medicare Advantage plans at all. It would also help to lower the eligibility age to 60.
It would also help if they gave free medical, dental, vision, transportation, food, clothing and entertainment free. Why not lower the eligibility to 30? That is called socialism. Medicare does cover some vision if it is medically necessary. I had cataract surgeries and macular pucker surgery, all covered by Medicare. In the video above, the agent mentions that Medicare gives the MA plan company about $1000 a month for them taking on the responsibility of and managing of your health needs. Think about that. That's $12,000 each year for each enrollee. That is a lot of money given to these companies. How can they do it? If the income is, for example, 100 enrollees x $12,000 equals $1,200,000. If you only have routine preventative services, then the MA company reaps big bucks profit. If you have serious health issues in a year, with the MA plans, then you could be out the MOOP (Maximum Out Of Pocket) for that plan, which could be $5-10,000 potentially and that could be done a nickel and a dime at a time, driving you mad trying to figure out what you have to pay and when you have to pay because of Co-pays, Co-insurance and deductibles, etc. You get some additional benefits with MA plans, but the trade offs are there lurking and you may or may not be ok with them when they jump out at you. The dental benefits included in the zero premium MA plans are typically preventative dental, not comprehensive. The vision would sometimes provide one or two eye exams annually, and typically included a set amount towards a frame (sometimes only every other year) and the prices on some of those frames were jacked up to make it look like you were getting a bargain. But remember there are tradeoffs. i.e. Friend of mine had main residence in Denver, part-time home in AZ. His MAPD, as all are, was geographically defined to the Denver metro area. Unless an emergency, when he needed medical care while in AZ, he had to fly back to Denver to get it or pay 100% out of his own pocket. And because his medical situation was such as it was, in Denver he could not switch to a Supplement, he wasn't medically eligible. But when he moved permanently to AZ, he was eligible with a guaranteed issue to get a supplement. But if he had only talked to a MA agent or the MA company, or just another MA company, I doubt they would have informed him that the Med Sup option was even available to him. The MA companies want to keep their enrollees, that's $12,000 a year for each one they sign up and keep. Not every agent is out there for you best interests, but it sounds like the gentleman above is. Having Original Medicare, a Med Sup and a stand-alone Part D isn't for everyone, neither is a MAPD plan for everyone. But before a person talks about specific plans, they should first understand concepts, options and choices.
They don't actually cover those things. You get a discount program.
Your lifetime contributions and after 65 premiums do not cover the costs of healthcare. Taxpayers subsidize about $100,000 per person until they die. Adding more coverages means more subsidies by taxpayers.
Yeah. Insurance for old people that doesn't cover dental, vision, and hearing - three of the most common problem areas for the elderly - is like car insurance that doesn't cover collisions. It's nuts. Lowering the age of eligibility would do two good things - it would remove the oldest population from private insurance (the age group that has the most health issues and makes the most claims) thus lowering private insurance costs for everyone else, and move them to Medicare, where they would be the youngest population, the age group that has the fewest health issues and makes the fewest claims, lowering Medicare costs for everyone. It would be a win-win. Gradually lowering the eligibility age to 50 (over say, a ten or fifteen year period) would make the transition easier for everyone.
@@thomasdreyer2389 Nobody said anything about free transportation, food, clothing, or entertainment. Why did you? I think it's because you have no actual argument against Medicare covering dental, vision, and hearing services other than _Something something _*_SOCIALISM!!!_* It wouldn't be socialism, of course, but even if it were - so what? Three of the most common health problems older people have are with their teeth, their vision, and their hearing. Of course Medicare should cover these. Medicare covers *_maternity_* costs, for crying out loud. Why doesn't it pay for hearing aids?
I am a utilization management nurse, been doing this since 2008. There are Medicare PPO that don't require referrals. There are Medicare HMOs that require referrals. Most require pre authorizations for many types of services up unless you have a fee for service plan. Also Medicare Advantage plans constantly call members asking if they are doing all the preventative testing.
You are 100% correct. I have plan F, which I chose because I had a serious illness shortly before I became Medicare eligible. It was an easy decision because I knew I was going to be seeing specialists, having tests, procedures etc. and did not want to be in a network. Also, the benefits for each Medicare supplements are clearly spelled out , while the Advantage plans are murky. I have had tons of imaging, bloodwork, see lots of specialists (who I did not have to get a referral to see), have had surgeries and have NEVER got a bill. I know that not everything is covered , and eventually I might need something Medicare does not fully cover. But I ALWAYS ask if it’s covered by Medicare, and so far have never found anything a doctor ordered to not be covered. So, the supplement picks up the rest. Plan F is excellent.
I’m going on plan F he said I would have copays every time I go to the dr!! Wonder why you don’t have copayments?
@@debhelms4106 You need to check your plan. Plan F cover all deductible copay.
@@debhelms4106 Plan F and Plan G have no office visit or ER fees at all. Ever. Make sure of what you are signing up for. You want a Medigap Supplement, not Medicare Advantage.
Plant F is very very expensive. If you have a pre-existing condition such as cancer, they won’t even ensure you.
Mcare covers pretty much everthing with no preauthoriztion required. There are only about 30+ procedures they started requiring PA for about 3-4 yrs ago
I worked for doctors for a vvvery long time. And everyone of them told me “if you can afford it, never give up your Medicare”.
He is not taking about giving up Medicare, Medicare advantage isn't Medicare. its a supplement if its a zero plan its worthless.
@@ozarksfarmerhansen8782 I understand. I was agreeing with him.
because Drs make more that wy
@@mwconservative Not really. It’s much more complex than that.
I've read that Medicare covers only 80% of medical costs, so if you have a very expensive hospitalization or medical condition, the 20% you pay can go into multiple thousands of dollars. I've always had either a Medicare PPO or Advantage plan in order to avoid these costs, and now I hear that this course of action isn't the best way to go. As a senior on a fixed income, I get Medicaid Extra Help from the state of Colorado, which pays my Medicare premium, and also helps pay other expenses. I've been happy with it so far. How can I be on just regular Medicare, without paying extra for the supplement programs you mentioned? With inflation climbing more every day, and with the new rent increase from my landlord, I can't pay a penny more for my health coverage. I live in a small town in Otero county, Colorado, 68 miles away from Pueblo, the nearest big city, where the medical specialists are located.
I am in agreement with you 100%. The problem also is that many people get fooled by MedAdvantage plans with the little perks that are thrown at them. For example, free travel to and from doctors, some minor eyeglass coverage or even dental. But they do not realize that if anything
Catastrophic happens to them that it becomes a waiting game for approvals and in one instance in my family we lost a uncle due to this. It’s crazy how they put a dollar value on someone’s life. Thank You for spreading the truth!
They also don't realize the "free" is for a very small portion of low - no income folks.
@@MedicareonVideo fact check. It’s “free” for rich people, too. I’m a working physician and on Humana Gold I pay nothing a month. I had a $20 copay for my ophthalmologist referral but the cataract surgery is 100% covered. Oh, by the way, latest info-Medicare Advantage now has 47% of Medicare enrollees. Are these people all stupid, or they on to something?
I enroll people in Medicare advantage plans. 95% of the people I deal with survive just on their ssn, ssi, or ssdi benefits. If you can afford a Supplemental plan, I highly recommend it but you will have to purchase a standalone dental, vision, and/or hearing plan which could run another $100/mo. 75% of the people I help are C-SNP or D-SNP eligible.
Problems is a great many retired people have limited income. Need more equitable coverage & price.
What a STORY! DID you make this up by yourself?
I am 85 and had cancer at 61, had good insurance where I worked, was off work for a full year, and returned to work and retired at 67, got medicare and full supplement and the cancer returned 12 years later, got treatment and the cancer returned 7 years later and again 3 years later and still in treatments. I am not restricted anywhere or by any doctor or hospital. Where would I be on an ADVANTAGE PLAN??? I know I have indeed been blessed. I can pay my premiums, thanks goodness. I don't have any co-pays!
I’ve had Advantage Plans with three different companies, never had any problems with any of them. All my medical needs have been met with very low out-of-pocket costs. Maybe I’ve been really lucky with the insurance companies I’ve dealt with, but I’m sticking with my current plan.
That's great.
I have an advantage plan and I get more for my money. I find the extra supplement you have to buy with original medicare is too expensive for me. Look that I dont have to buy a drug plan too. My meds are $0. Just love the extras and my deductible is 4900
Which is cheaper than original medicare! I'm happy with mine.
@@carolynwheeler2739 $4,900??? Is that annually? So you have to pay that until they pay for anything? Maybe I'm not understanding. Is our country so brainwashed that they think thousands to pay is okay? I wish everyone would start protesting and learning that we are the only country that does this, the rest of the civilized world believes healthcare is a right and not a profit system. I always thought Medicare was great and virtually free for disabled and seniors since we pay into it for so long. Never realized what a scam it is! Wow! I wish I never became sick! Ugh!
Thank you so much for speaking out about this! I’m 75 yrs old & I’m so tired of Medicare trying to push this Advantage down my throat! It is a rip off & the care is terrible!
Thank you so much for speaking up about the travesty of Medicare Advantage!
Glad it was helpful!
It's not a rip off and the care is fantastic. I've had advantage for 5 years now, and absolutely love it.
@@Rickm505 Yep I agree, great plan. I don't get the complaint this guy has in the least.
They have gotten excellent- someone who has trouble affording 200/300 a month for a supplement living on 1500 social security or less need to use the advantage plan and they are good! Do your own research with someone who has both options
@@carieyounginsurance Yes................ Just don't get sick.
I’m on an advantage plan now for 8 years. I’m very grateful for my plan.
When you went back to original Medicare did you go thru the medical underwriting (as this man claims?)
Evidently you have not have had to use it. When you have to use it you will be in for a big surprise and will be ungrateful for your plan. Hope that you own a bank because you are going to need a lot of money in the end. Sad part is you are stuck and cannot go back to the original Medicare.
@@kellikelli4413 this person cannot go back to original Medicare once they choose Medicare Advantage. Their situation is very sad.
@@JohnDavis-yz9nq
The original Medicare was RUINED anyway by the Bush43 regime when it passed that "forced" PART-D.
The current (not the real original) Medicare system is a Rockefeller big pharmakea scam.
Original Medicare is the only way to go unless you choose the Advantage and then you cannot go back to the original. Agree with you that Bush was a bad president as he tried to destroy social security. He was born with a silver spoon in his mouth and he doesn’t have a clue what the average American faces in everyday life. Other presidents born poor have forgotten where they came from. Even at best the original Medicare is not a good deal but it is the only thing that we have. The doctors that we have nowadays are awful. They are owned and controlled by the pharmaceutical companies and do not care about your well-being. What is sad is that some third world countries take better medical care of their people than the United States does. This man in this video is only telling part of the truth. For me he is a wolf at your back door just like the rest of them. Watch doctor David Belk on his videos the truth about Medicare supplements. That will surely wake you up. Good luck and I hope that you didn’t sign up with Medicare Advantage.
Advantage plans have PPOs that do not require you to see your primary care first to get to a specialist.
I'm an agent and I enjoyed watching your video. I advise my clients in much the same way you do Keith. Go with a supplement out of the gate and stay with until it hurts. I laughinly say that I wish Broadway Joe and JJ had invested their money better back when they were bringing in the bucks and not having to pitch MA plans in their golden years. Bill Shatner sure doesn't need the dough.
My very first doubts came when I heard the name "Medicare ADVANTAGE!" Sadly, in our (1984) culture, terms are often designed to trick the buyer by using a name that is the exact opposite of what your going to get. These HMOs should be called "Medicare DISadvantage."
Well, it is an advantage to those selling them, lol.
Typical corporate speak. Any terms around the subject usually mean the reality is the exact opposite. Advantage. Value. Quality. Trust. Integrity.
there are advantage plans that ae not HMO
@@bethdavis7812 and they are PPO, or Preferred Provider Organization. Yes, you can use doctors, etc not on the preferred list, but you'll pay more to do so. Also premiums, and out of pocket expenses are higher.
@@markwilson4315 Those are good points ... thanks for taking the time to further explain Medicare Advantage.
What you say may be true for some, but if you have a Kaiser HMO everything is different. I love Kaiser. I worked at Kaiser for years and I know it from the inside and out. When I hit 65 I opted for Kaiser‘s Medicare Senior Advantage. Nothing has changed for me except that I have more durable medical equipment options and things extended care and like that. My office visits cost $5 instead of $25. I did have to sign up for Plan B which I wouldn’t have had to if I just continued Kaiser, but I could see that it could become a big cost saver down the road when I get really old. But who knows what the future will bring? That’s the thing with any kind of insurance. It’s a crapshoot. And let’s face it, with medical care, the less you need it, the better. It’s much better to pay into it not use it then not have it when you do need it. And my Kaiser Senior Advantage is always there if I need it, something that as I get older is going to become more important.
A lot of people like to bash Kaiser, but it’s the best HMO out there. I can tell you that if you need something, you will get it. For-profit insurance plans make money by doling expensive care. Kaiser is a not-for-profit and their goal is to keep you healthy so you don’t need the expensive care down the road. But if you do, it is there. My husband needed a heart transplant. He checked into Stanford Hospital and was billed the Kaiser hospital admission co-pay of $250. He walked out with no more charges. Zero. He had a heart transplant, something that cost anywhere from a $half million to over $1 million for $250. And despite the huge cost of the immunosuppressive drugs, he has only a $20 co-pay with no cap. Kaiser decided that there’s no point in paying for a heart transplant if they won’t pay for the drugs that you need to keep yourself alive. Most people can’t afford a couple thousand dollars a month for medicines.
So we’re fans of Kaiser and I’m a fan of Senior Advantage. I kept my original benefits except that they’ve been expanded now.
Yes - glad you're happy. Unfortunately the vast majority are on plans that don't function very well.
@@MedicareonVideo I have a dim view of most for-profit medical insurance, so that doesn’t surprise me.
Sorry, but that is the Insurance plan I was on. They never told me my lung was collapsed....They took x rays twice. Never said a word after 2 surgeries.
Changed insurance Companys and my new Dr. Sent me for an x ray and sent me straight to the hospital. I had to have a 3rd surgery at Cedar Sanai to fix the other 2 botched surgeries.
@@alysewitt3729 Are we talking Senior Advantage or Kaiser here? I’ll just say that anyone can have a bad experience at any hospital with any health plan. It’s always the luck of the draw. Because Kaiser is a good deal. You get a lot of value for your money. They don’t ration or withhold care. Mistakes can happen and things can be missed. I’m glad you got your problem taken care of.
My dad was on that plan and had a lot of health issues. It was the worst plan for him. His out of pocket monthly drug cost was $500 a month. A ER visit was $75 per visit. He had 25 ER visits in one year. His doctors had no clue how to help him and instead wasted our time in the ER. He was in assisted living and per the CA law had to call an ambulance in certain situations. It drove me crazy. My take was if you are healthy you’ll be fine if not it is harder. I had no idea there was original medicare.
I have advantage in TN. I Don't understand what you're talking about. Max out of pocket 4.5K. Next year 3.5 K. I have Humana, which is accepted by most of the practices. Deasent cooayments. I had multiple procedures this year. Cooayments for outpatient surgeries and labs in a range of $30 to $200. Very low meds cooayments.
Very satisfied.
The biggest problem with Medicare Advantage plans are that people don't understand that they, unlike Medicare Supplement Plans, are all DIFFERENT, from one plan to the next, and certainly different in quality, too. That is why, unlike Medicare Supplement Plans, CMS rated each one every year. But people continue to lump them all together, and assume that if they had problems with one, there must be problems with all of them. NOPE. But look at the star rating for each, because that is the most important factor. Steer clear of a 3 star or below.
I've had my Medicare Advantage Plan for 5 years now and I like it! But it's a 5 star plan (top rated by CMS) and ratings matter more than anything else when considering these plans.. And yes, it's an HMO that has been in existence now since 1982. I was also covered under the same HMO as a state worker years ago, so I was somewhat familiar. I've had doctors tell me my insurance was excellent!
Sounds like a lot of common sense!
what plan do you have? I was thinking of Humana Gold.
Hubby has CalPERS insurance. We have Kaiser now. Thinking of Kaiser Senior Advantage. I’m 64, so I need to educate myself.
My mom has UnitedHealth and has never had any issues.
How much have used your health care plan? Do you have a chronic condition like diabetes or high blood pressure?
Wow! An insurance salesman with a conscience. Kudos to you for doing what's right for your clients, even though you could be making more money.
Thanks Leland - best to believe in what you sell!
He’s doing just fine on money. Those supplements he’s selling make him just as much as Advantage plans.
@@Jess_2025 Hi G2 - I have just about everything Medicare on my channel. If you look in the description of this video you can download my book and sign up for my Medicare Mini Course. All free. And yes - Medicare supplements are what I do. Feel free to give a call when time. 877-885-3484
AMEN....
not
I guess it depends where you live and what Advantage or Medigap policies are offered. My 75 year old sister-in-law has a United Healthcare Advantage policy and it is paying great for her now that she has really been using it.
And you get a food benefit and over the counter items free
@@christineplaton3048- she may, but when we go from our insanely expensive under 65 Presbyterian insurance to an offered Advantage policy next year when we are 65, it won't include these nice perks.
What a great informative video. I just retired and had to dig through what you are describing without help. It can be so overwhelming hoping you are making the correct choice. I am 61 so I had to find insurance on the marketplace for myself. My wife is 70 so I had to figure out Medicare for her. Luckily, I chose original Medicare B with a Medigap (G) for her. Sounds like I made the right call. Wish I had found you before I went through all of the headaches. Thanks so much for this information!!
Good job!
I enroll people in Medicare advantage plans. 95% of the people I deal with survive just on their ssn, ssi, or ssdi benefits. If you can afford a Supplemental plan, I highly recommend it but you will have to purchase a standalone dental, vision, and/or hearing plan which could run another $100/mo. 75% of the people I help are C-SNP or D-SNP eligible.
My personal physician also suggested that I not choose an Advantage Plan when I retired at 65 but she didn't go into detail. Your video is very informational and is articulated well. Now I can pass on what I've learned from you when someone younger asks my opinion about this medical insurance issue. Thank you so much!
Thanks Keith!
Don’t listen to him/ look at all your options and DO THE MATH- be smart with your money because insurance carriers will experience inflation next and the rates will become astronomical. Especially when part B is now 170 a month! Think about what it will be in 5 years...if you are that worried get an indemnity plan that pays you back the copays and get a heart/cancer stroke plan...much better spend of your money than paying 1200/1500 a year with no added benefits except the medical coverage (dental and vision and hearing all extra where as an advantage plan includes them...) he’s really doing most of the population a disservice with this video when most can’t afford a supplement over 70 when you probably could use it! By that time you could save thousands!!
@@carieyounginsurance exactly! You have to go with what you can afford!
@@TheCheryl57 I agree with you have to go with what you can afford. Everyone. Just be selective if you ever need major surgery like heart or Lung. My sister just had hip replacement on an Advantage plan and the surgeon did a good job. He did however break 1 of her ribs during the surgery....that was painful for her. Her hip works good though.
@@alysewitt3729 Huh
Amazing. Going on Medicare at 65 was incredibly confusing with tremendous conflicting statements. Could not understand the big picture. Now all the bs fed me makes sense. Clear presentation. Thanks
Thanks CT!
A lot of doctors don't acceot original Medicare insurance .
Doctors prefer Medicare advantage or PPO. Ask. Specialist they prefer Medicare advantage. Rather than original Medicare.
@@carollabutay4654 Emm... I think you have this completely backwards.
It is a maze and it is subject to changes...so try to keep on what is going on.
@@carollabutay4654 It depends...
What medical insurance we choose (Advantage or suppliment) starts with us d3ciding what is most important to use, i.e., monthly/yearly cost, choice of provider, catastrophic coverage, deductible, bells and whistles, etc.
You will not make the best decision if not clear about what is most important to you.
Each of us should be able to explain why we chose X rather than Y.
Hi Sheila, how's your day going with you?
My husband and I are on original Medicare with a supplemental plan and love it. My husband had major surgery last year and was back in the hospital multiple times due to complications. Our out-of-pocket costs were minimal, and did not have to fight with an insurance company.
Sounds great!
@@MedicareonVideo Again, if you can afford the extra premiums.
Would love to see a video talking about 2 or 4 scenarios of different couples, different medical needs and different financial situations and a detailed decision process based on example benefits, costs, and availability; and maybe show a Decision matrix about when Advantage might be better vs straight medicare... Maybe in a liberal state like MN, where it seems the HMO's have a good reputation for good coverage... GREAT video by the way Thank you.
It really depends on the client’s health situation. I only recommend Medicare supplements if the clients has a lot medical health issue. Not all MAPD require referral to see specialist.
When you are a senior, health issues pop up out of no where. It's better to have good coverage when you get sick. I went with Medicare and a good supplement that pays hospitalization 100%. Eventually, all of us seniors end up in the hospital.
Can you please comment on Advantage PPO. Do you have the same concerns? Also, I was told that I can start Advantage, then switch within first year if I do not like, OR switch to traditional during enrollment period without a need for review due to using my one time first application for traditional. Accurate?
I have saved almost $20,000 in premiums in 10 years by switching to Medicare Advantage from other Medicare supplements. And each year, it seems Medicare Advantage offers more benefits at no charge. My Medicare Advantage medical only policy costs nothing. This year, dental coverage was added, and I also got a card with which I can purchase $400 in medical supplies, drugs, etc., again at no cost to me.
Wow! I like my 5 star rated Advantage plan, which also comes this year with a $410 debit freebie card, which I used for dental, though itcosts me $34 per month It has not gone up in price even as much overall as $1 per month per year in the 5 years I have had it. My HMO also has a freebie plan, but no debit card, and the drugformulary is different than on my plan. No deductibles for medical or drugs, and medical OOP is only $4,400 or less. I almost chose the freebie Advantage plan, as I rarely need prescription drugs. All area hospitals and doctors participate in mine. Good deal.
Yes my mother has one too and it has saved her a lot of money over the last 3+ years. I guess this guy talking can pay his 20% coinsurance of traditional Medicare if he wants to. To each their own or whatever floats your boat I guess is the saying goes? Because my mother‘s plan has dental, vision, even has OTC built into it or she can go to CVS and get $360 worth of merchandise every quarter. That comes in handy. I don’t know what he’s talking about. She had a surgery done all she paid was her co-pay.
And he is saying that they’re all HMOs which is totally not true they do have PPOs and it takes you off of original Medicare which is not true you always have your original Medicare it’s just that it is idol in the background and your Medicare advantage plan pays instead of Medicare but you still keep your Medicare. I sell Medicare advantage plans that’s how I know this by the way
@@wisheduknew294you're just flat out wrong. And you sell this? You don't even know how it works. You are not in the medicare system with an advantage plan...period. medicare no longer pays you health care costs. The for profit insurance company pays your health costs.
Which MA are you on?
Some responses seem to indicate that their MA's are an extreme disadvantage and costly..
Even with Medicare no dentist here will take it. And the vision/eyeglass place dropped Medicare.
We have been on a 5 star Advantage plan since turning 65 12 years ago. Our plan is a non profit coop managed by medical professionals. Even though we had one major surgery, I find this plan to provide great coverage at a modest cost. Highly recommend our Martin's Point plan which is only available in the state of Maine. If you can find a similar plan in you area it will save you a bundle. The only way I can see that the supplement plans will pay is if you have multiple severe morbidities where you are spending most of your time in the hospital or doctor's office with a lot of expensive drugs. For the average normal person the advantage plans are a good alternative.
The average normal person is about 50% of the public that rarely see a doc and the other half who are in the doctors office quite often.
I was in a unique situation because I got Medicare at age 64 due to disability. I chose a Medicare Advantage plan (Anthem). I had 2 surgeries, another procedure at the hospital that required general anesthesia and a lot of hospital based tests plus I am on several RX's. I paid nothing up front but by the end of the year, I had paid over $5000 in co-pays etc not counting RX copays. Plus it was a pain to followup on bills they disallowed. Thank goodness I found out I could change back to regular Medicare with a supplement at age 65 with no underwriter requirement or extra costs. This year has been a breeze compared to last year! I have had one surgery that required numerous trips to a wound care doctor specialist, an ER visit, starting PT and stopping PT several times, lots of expensive RX's, etc. I am going to have another major surgery next month too and know I will need one or 2 more next year. My uncovered medical costs out of pocket have been $150 for this year for a specialized medical device that Medicare will not cover. My RX cost have been a lot less too. The nice thing is I can go to any doctor that accepts Medicare!!! My first surgery this year was done in a Bon Secour hospital and the next surgery will be in a Riverside hospital. All covered!!!! I can research and find the best doctors in my area and not be restricted to one group. I also travel so no worried about being out of network. Last year while out of state, I ended up with a simple eye infection and it cost me over $250 for the doctor visit and RX that was not covered out of network. Yes, I pay extra but at $190.29 a month (supplement policy, a drug plan and a dental plan) I am still way ahead of last year. I need to say I got a high end drug plan because it equals less out of pocket for my drugs over the year. I also chose to do a dental plan with the dentist I have used for over 30 years at $29 a month. The Anthem plan only had dentist an hour away from me. I get my glasses at Costco or Sams so the cost is reasonable so no insurance needed. So $190.29 X 12 = $2283.48 for the year......a lot less than the over $5000 from last year. Even if I add the $150 that none of the insurances would cover I am less than the $5000! I am a retired math teacher so the numbers are my thing and I researched a lot of plans before I chose the right supplement plan for me. After months of searching I picked Mutual of Omaha for me. Then when I was almost confident in my research I stumbled on a EXCELLENT group that does it all for you and even helps you if problems come up. BOOMER BENEFITS. They were wonderful even months later when there was an issue with my drug plan. I was always informed during the process. I even did not have to run the figures to find the best drug plan, I just sent them a list of my regular RX's. Save yourself a lot of work and money and call them. No, I am not a rep or am I paid to say this. Just someone who put a lot of time and effort to get the best cost plan for myself only to find a free phone call could have saved me A LOT of time and work. And yes they do advise you on the Advantage plans if that is what you want. They take the time to find THE best plan for their clients and it is all FREE!
Great if you have the income to afford the supplement. But why have Medicare coverage for only those who have been able to save thousands of $ for premiums? System needs to work for all income levels.
If you live in NY State the rules for going onto a supplemental plan after an Advantage plan are different than most other states.
So we are on Aetna’s Medicare Advantage. Thought we were dealing with an honest guy but he never mentioned what you said about Supplement plans. We are in Texas. How do we move from the advantage plan to a supplement plan and know which supplement plan is best? My wife takes about 12 different types of meds also and two inhalers (regular one and an “emergency” one). She is on 02. She was in hospital 4 times since Jan 20204. The first 2 times was at one we prefer. Then they had a contract dispute with Aetna and so the next 2 times forced to go to another one. Now the 1st one is back in the network and the 2nd one is no longer. We are tired if this shell game, especially when our lives on the line. Just want to do what is best for us and more affordable. She is the only one on Medicare. I am not at this time since not 65 yet. Thanks.
Hi Lynn- When did you wife turn 65? It may be a little tricky if she needs to go through underwriting, but we can look into the details. Send me an email at Keith@MedicareOnVideo.com
As a retiree Medicare eligible soon, I've been swamped with offers of Medicare Advantage plans for nearly a year. Not fully understanding the options, your video enlightened me plenty. Am glad to see you doing the right thing now.
That's great! You'll get a lot more mail and phone calls the closer to 65 :(
Wonderful it works in your favor.
I'm of the opinion that Kaiser can be great if your medical problems are not complicated and things are stable.
And it also depends on the choice of practitioners at the particular Kaiser you join. I've seen top notch physicians, specialists and nurses at some Kaisers, and other Kaisers where I wouldn't send my Yorkie to.
@@catbee1452 my mom had Kaiser thru her union, it was fine until they said she needed a pacemaker. Then she subjected her to 3 surgeries installing faulty pacemakers. In her area, Kaiser was a teaching hospital and she was the guinea pig. I got IN THEIR FACE and said enough I don't want these experimental new contraptions. I did research and DEMANDED a well known unit and she FINALLY was fine. But then I knew how to navigate the broken system as a LICENSED AGENT and I went to the insurance commissioner and demanded they stop experimenting on her. I was an advocate as well having volunteered in hospital for decades. I knew the cages to rattle to get results, and I went after them ALL like a pit bull and got my mom the care she deserved. Kaiser can be good or seriously iffy.
@@savannahsmiles1797 As a nurse for 43 years, I've seen a lot of "iffy" in different health care settings.
To navigate the "iffy", one must know enough about the system to jump through the required hoops.
@@catbee1452 I used to work at Kaiser. If you have minimial health problems. Kaiser will work for you. I always caution people that if you have expensive chronic medical problems, then there system is not so good. You have to learn how to work their system to get what you want/need.
He is selling supplemental so take that with a grain of salt. Supplemental is going to cost you hundreds-maybe a few hundred, maybe many hundreds-a month extra. I have ACA Marketplace insurance with Kaiser Permanente (an excellent healthcare system) which has generally served me well except for the high deductible. About to turn 65 and I can choose a Kaiser Advantage plan that COSTS NOTHING EXTRA, and continue with the same coverage as I had before. No brainer? Pretty much.
Fortunately you never had to get an authorization for a treatment that your doctor prescribed. I have worked in medical offices and would need to get these authorization. So here I am talking to some kid that was selling bicycles last week, trying to explain why it’s necessary. Finally, the doctor would ask for a peer to peer. After waiting sometimes a week to be able speak with the company’s doctor and convince him/her, that it is necessary.. (wait time) and often they would make you try different treatments that were less expensive before granting the authorization. Advantage plans do work for some... but, sadly not all
He is telling the truth about Medicare DIS-Advantage ! The proof is that the very BEST (Ivy League) physicians and state of the art, cutting edge hospitals are no longer accepting Medicare DIS-Advantage Plans. UNLESS that Medicare DIS-Advantage Plans are issued from a EMPLOYER'S GROUP Plans (patient's fromer employer provided medical coverage).
Medicare DIS-Advantage Plans have become a NIGHTMARE and ENDLESS approvals, and increasing patient co-payments, and splitting up single visit lab tests into separate charges to force the patient to pay for co-payments for EACH lab test during a single visit ! Also, they are REDUCING the lifetime limit of hospital visits to force patients to go back to straight Medicare. Manage Care plans offer to drive you to doctor's visits, pay your gym membership, and fluff your pillows, BUT HIDE THE FACT THAT THEY ARE REDUCING COVERAGE ON THE MOST EXPENSIVE MEDICAL COSTS, LIKE SURGERIES, HOSPITAL VISITS & REHAB STAYS ! They even offer plans that pay your Medicare Premium, but HIDE the fact that these very plans that return your Medicare Premium, pay for LESS MEDICAL SERVICES ! The ones that claim to pay for your prescriptions will only do so for GENERIC drugs, but refuse to pay for drugs that have no generic option ! Then if your physician prescribes a drug that has no generic, these plans will only pay a "PORTION" of the drug price. But you can get that same non generic expensive prescription FROM CANADA FOR LESS than what the Medicare Advantage Plan is paying ! If you talk to a Medicare Advantage "agent" who helps you to find a plan during open enrollment, give him/her THE ZIP CODE of WHERE you WANT TO RECEIVE MEDICAL TREATMENT. You will find that the BEST PHYSICIANS & HOSPITALS IN THE MOST EXCLUSIVE NEIGHBORHOODS DO NOT ACCEPT MEDICARE ADVANTAGE PLANS !!! UNLESS that Medicare Advantage Plan is issued by.the patient's EMPLOYER GROUP POLICY! Then if you give them a zip code from a WORKING CLASS OR POOR NEIGHBORHOOD, YOU WILL FIND LOTS OF PHYSICIANS that WILL accept Medicare Advantage, and also WEEKS TO MONTHS TO GET AN APPT !!! EVEN LONG WAIT TIMES FOR EXISTING PATIENTS !!!
Btw, IVY LEAGUE DOCTORS DO NOT WORK FOR KAISER !!! ALSO, RICH PEOPLE NEVER GO TO KAISER, FOR A REASON ! Kaiser IS NOT & NEVER HAS OFFERED, "CADILLAC MEDICAL CARE !" KAISER HAS ENOUGH HORROR STORIES, TO FILL A HALLOWEEN MOVIE THEATER FOR THE NEXT CENTURY !
Rich people, go to Johns-Hopkins, Mayo Clinic, UCLA, Cleveland Clinic, St John's Providence (Santa Monica CA), etc.
@@kitcatmeowpurr745 I have had Kaiser Permanente for three years. Kaiser is one of the best health organizations in the US. Although my ACA coverage had a fairly high yearly deductible ($6,000) that’s not unusual anymore. Next month I switch to Kaiser’s Medicare Advantage plan. The coverage and cost is nearly identical.
@@Nicksonian kaisers attitude towards high cost populations is questionable. Oncology, premature babies and elder populations disproportionately cost more. Look closely at how these populations are treated by Kaiser before signing up with them.
My elderly mom is covered by my late father's Advantage plan through Aetna and Express Scripts as part of his pension. I take her to doctor's visits and manage bills and her costs are not higher than when she was on regular Medicare. Obviously his pension happened to include great coverage and terms and perhaps is atypical. Her primary care doctor sends her to specialists of his choice and she's never been refused any specialist or treatment. To continue to be covered by his pension she had to switch to Medicare Advantage a year ago but it has been no problem.
The problem comes when ur diagnose with cancer. You have to pay that 20%co insurance for chemo/radiation and cancer medication, is when it can eat up all your life savings.Medicare Advantage is only good if you don’t end up sick with major illnesses!
@@fatimagross1956 Dear me ! I will have to look into this!
No mapd has a moop
@@cherylstade3614 Please don't worry! She's in good hands with good coverage with a reputable carrier. There's nothing wrong with managed care and shared medical expenses. Just differences of opinion, that's all. Your mother won't lose her life savings, as ALL of these plans have an out of pocket maximum. I sell these plans and nearly all of my customers have no complaints and for many years.
Agree with you. Thanks for information 👍
I have the ARRP United healthcare plan and have zero complaints. In fact, if I have a complaint, it is they are constantly calling me to offer services which I do not need. Like a home health nurse visit. I have used it when working out of state and my out of pocket costs have been minimal. I have never had a doctor refuse to take me as a patient with this coverage. Recently I had a mild heart attack. I went to our local ER who had me transported to the regional medical center. I had a hearth cath and stent implanted. 3 days in the hospital total, 2 ER visits, transportation, my out of pocket was $315. A deal in my book.
Thank you SOOOO much. You have answered questions for me that I have been asking for years! You made the information about choice of doctors and coverage area simple to understand without double talk that confused me. After listening to you I now understand the difference and I will always stay with Medicare.
Thanks for the thorough explanation. I’ve been asking Medicare questions well before the requirement age of 65. And now 6 years later. I am just as confused. To top it off, I worked at an agency that did not pay into social security. Which means I have to pay a larger Medicare premium. Nobody has given an explanation like this about the differences in this Overwhelmingly confusing process. I subscribed.
Thanks Connie! Sorry you'll have to pay more than you should.
@@MedicareonVideo
ka n
There are some employers (read school districts) that don't contribute to Social Security, however, there is a separate line item for Medicare. I would check you paystub. If there is a medicare line with a dollar amount, and it has been paid for 40 quarters or more then you will get no premium Part A. Part B cost $170.10/month for most middle class
Its so uneccesarily difficult to understand. I still don't know what to do!! I live in Manhattan, NY , just got approved for disability and I feel there are no options that I can afford .
I’m a Medicare agent, and there is definitely good argument to go with original Medicare and a supplement, but only about half of what you say is true about the Medicare advantage plan. Just saying!
I agree. Im an agent that handles every Medicare plan thats offered. MAPD, Supplements, and PDP. MAPD plans can work great for some people. Every single person is different and this video is misleading.
@@codydriver6413 Cody
MEDADV is "Dubya" scam in an attempt to Privatize all of Medicare
like prefunding the Postal Workers Pension for 75 years in '06 was a plan to torpedo the Postal Service prematurely. Privatyze! Cody
@@marya4717 I don't have any hassles with my MADP with Humana. I have a really good Medicare agent who looks for the best plan for me with the least costs and most benefits. I don't pay anything for them and pay very little for my meds and Dr. I get $200/yr for vision and $1000/yr for dental. I have the Humana app on my phone and get $220/3 months for OTC items that would have cost me to buy them in a store. That has been a major help. Please talk to an agent and check out an advantage plan to save you those monthly costs you are paying.
What is NOT true...just asking.
@@codydriver6413 I agree, my first year I went with Original, just fine. Second year I decided to try an Advantage. With the one I was leaning towards all my current docs are in network, my two meds are covered at $2 per refill, and in addition they also give me $40 quarterly in over the counter meds, a paid in full annual vision exam, $100 towards frames, 2 annual dental exams, and if needed it they will pay some towards hearing aides. All this for the (current)
$170 Pt B premium. Now, I am healthy and the situation might change if something medical occurs. But so far (second year in) I'm very satisfied with my Advantage plan.
I sell both Supplement and Advantage plans. There is no one-size-fits-all. And in terms of the network size, if you live in a metro area (I live in San Diego) there are tons of doctors available, even on Advantage plans. My clients rarely, if ever, have a hard time getting the medical support they need. But you're right...the choice and simplicity of Supplement plans is very attractive. $0 premiums on Advantage plans are also attractive. Depends on the situation and need.
My sister just sent me your link and I'm so glad she did. I handled all of my mother's medical affairs, though I know nothing about the world of Medicare. I know that she would get very frustrated with Medicare Advantage and being required to keep going to her PCP over and over, which meant paying him over and over. You are correct - ultimately, it ended up costing her more to be on Medicare Advantage. Now that my sister and I are about to be at the age where we need to make informed decisions, your video has helped us tremendously. Thank you for taking the time to do this.
Happy to help!
Usually you don't pay anything to go to your PCP in a Medicare Advantage Plan.
I'm 75 and don't need medication or doctors very often, But I'm glad you explained all of this. Thanks
So what plan do you have now sir?
I am a medicare insurance specialist as well and I agree with the video with some exceptions. Not everyone can afford a supplement plan or qualifies for one. The idea that it is a Supplement or nothing leaves some in society medically vulnerable.
My question is if they can't afford a supplement plan, how are they going to afford a $7500 out of pocket expense each year? I guess the Doctor's and Hospitals can always write off the uncollectable debt.
@@bobbycoln5626 Glad you asked...Not all Medicare Advantage Plans are created equal. The first thing to understand is that it is NOT a $7500 expense incurred every year, known as Max Out of Pocket (MOOP).
It could happen if you get sick and incur major expenses. You could hit what is commonly known as the donut hole or coverage gap in Medicare. For some plans, it is not $7500, it varies according to the plan, and some are $3500 (MOOP) it depends on the Advantage plan.
How it works is, you get hospitalized and need drugs and medicine:
You pay 100% percent of the drug cost until the deductible is met
You pay copays or coinsurance for your coverage drug determined by your part D plan
The donut hole-You pay a percentage of the cost of gen. drugs & brand name drugs until you reach the MOOP
Catastrophic Coverage Period- You pay $3 for generic and $8 for brand drugs until Jan. 1 and the calendar resets.
Most states have programs for those who are could face MOOP during a year.
If a person has chronic illness i.e. diabetes, blind, etc. they may qualify for Dual Special Needs Plan and Low Income Subsidy (Dual/LIS). Medicare and Medicaid are utilized.
These are in place because the individuals that I have described above are NOT eligible for Medigap insurance (Medigap is not a medical plan).
I could go on describing other scenarios that some of my clients have faced and I have guided them through. The moral of the story is: One Size Does Not Fit All
Having said that, Medigap is still the Flagship!
The idea is to Privatise all of Medicare and failing that a handfull of Republican Cronies can get Billionaire status. Done and Done.
@@barnardcarbajal8506 Medicare Advantage, paid for by our government, is the next best thing to Medicare for all.
@@bobbycoln5626 My plan has a $2000 out of pocket and there is no way to come close to that in my experience. In 17 years I have never had anywhere near that and my husband has heart disease, on lots of meds with several hospitalizations. The most we've ever been out of pocket per year in those 17 years may be $300 or $400, for specialist visits. The plan we have now has no co-pays at all. As far as drugs, there is one that costs us $20 a month. Seven other drugs $0. So I guess you can say for the 2 years we've had this plan, it does cost us $20 a month for that one drug.
If you’re on an advantage plan and switch to a different state, can you then go on a supplement plan without medical underwriting?
Following...I have the same question.
This is a great explanation. Signing up for Medicare was one of the most confusing things I have ever done. Based on this info, however, it seems I made the right choice to go with original Medicare.
You are right. Almost ALL Doctors and Hospital accept Medicare and the Supplements pay the same no matter which company you buy it from. Unless your primary care Physician, Hospital or specialists is in the Advantage network you pay out of network charges.
Laura, if you ONLY have Medicare, you will have to pay the 20% that Medicare doesn’t cover. A $100,000 hospital bill will cost you $20,000. You still keep Medicare whether you chose to use a supplement or a Medicare advantage plan. But they each cover that 20% for you to some degree.
Call and ask an insurance agent that sells Medicare Supplements and Medicare Advantage plans to educate you about your choices. I sold both about 12 years ago. I took my dad off a supplement and put him on a MAPD, medicare advantage plan with prescription drug coverage. He saved $150/month by switching to the MAPD. Over the 10 years, he has saved over $9,000 in premiums to his supplement company.
If the insurance person can’t explain everything and answer all your questions, find another one. It will cost you nothing to speak to someone.
@@yeppers7225 It is my understanding when you go to a Medicare Advantage plan, you go entirely to the plan. In other words the insurance company covers ALL of your medical expenses not just the 20%. That's why the Fed. Gov. pays them at least a $1,000 a month for every Senior they sign up. One can always go back to Medicare from an advantage plan for the 80% they pay but they would have to be underwritten for a Supplement plan and can be turned down and then have to pay that 20% themselves.
@@bobbycoln5626 that is incorrect. Medicare advantage participants and Medicare supplement participants still pay their part B premium. Most don’t know that because it comes out of their social security checks automatically. If either of these groups were “entirely on the plan” that would not be the case.
Also, if you check Medicare.gov, it clearly explains both groups remain on original Medicare. That’s why these plans are called “gap” plans, both Medicare supplements and advantage plans fill the “gaps” original Medicare doesn’t cover.
As a side note, I sold both supplements and advantage plans many years ago. I was able to write policies with any company in the US. In order to get the same coverage with most advantage plans, you must pick one of the most expensive plans in the supplements. That used to be plan F, as it was the most comprehensive coverage available for supplements. Plan N is fairly close as well, but doesn’t cover everything plan F does.
Regardless of which option you choose, the worst thing to do is choose neither and have no extra coverage since original Medicare only covers 80% of the costs which leaves you paying the remaining 20%.
@@yeppers7225 Yes, you continue to pay the part B premium but the Federal Government pays the Insurance company a monthly costs of around $1,000 to cover ALL of the insured's claims. The Federal Gov. or Medicare pays nothing if you own an Advantage plan. Some companies even refund the part B premium when you purchase a Advantage plan.
It doesn’t have to be complicated. My pcp gives me all the referrals I need in the beginning of the year. All my doctors are in network my premium is $0. I am keeping it simple. Love mecicsre advantage. Everyone’s experience is different
Glad it's working for you!
Yup- but you have 7500 out of pocket!
It can work if you have good medical coverage available in your county, unfortunately it isn't across the board the same for all.
@@debbiemoore5945 MOOP can hurt a LOT and so can copays...every situation is different
I'm sure it works great ... until you get really sick.
I am a retired RN on original Medicare and a supplement. I chose this over an Advantage plan based on my experience working in a cardiology clinic where we had to get pre-approval for various diagnostics and procedures from Advantage plans. It was sometimes a drawn out procedure, resulting in delays or denials from these insurance companies who are not in a good position to make these determinations. One time, an agent from one Advantage plan sent a message to one of our cardiologists asking why he thought he should do a particular test. The exasperated cardiologist said to tell her “because I am a cardiologist and you are not.” I will say that it is also true that some doctors have stopped accepting original Medicare because their reimbursement is lower, not sure if that is regional or by specialty or what, and I don’t know how widespread that is. But those doctors may then have the added expense of a larger staff to deal with pre-approvals. All I know is there is no one between you and your doctor, slowing or stopping your care with original Medicare, and you have a network wherever you go.
Hi Merry! That is what I hear most. Thanks for commenting!
That's crazy they stopped accepting Medicare! I do billing for outpatient practice and in our region, MC pays the 2nd highest rate. Aetna, UHC, BCBS rates are always lower than MC.
That’s awesome! Must have been a great doctor to work with 😉
@@poisonivy745 I enjoy hearing from billing...y'all are who I call to get the true picture. Just know as an agent, I appreciate what you do!!!
@@savannahsmiles1797 thank you for the kind words!
I subscribed to "Blue Advantage" because they offered better coverage on drugs. Now they are imposing more restrictions on what they cover, regardless of your medical needs. I want to go back to Medicare, but can't afford to lose the drug coverage. Any suggestions?
I worked as a case manager for a Medicare Advantage company for many years and the only real benefit from an Advantage program I could see was a reduced hospital readmission rate. The reason for the difference was identified as Advantage programs having case managers to coordinate care and assist patients in navigating through the health care system.
The only advantage you get is to call to check your zip code.
Of course, utilization of Home Health, SNF if needed, PT/OT all at $0 copay with the usual covered transportation costs. Our plan also provides free meal service to the home post operatively....which of course helps patients recover more fully....hence avoiding the need for readmission. Shoot, neither my mom or I were in the hospital, and we both just received boxes of fresh fruits and veggies from our Advantage health plan. There are a lot of perks to some Advantage plans that are in place for the right reasons, and yet they haven't been spoken about. What a shame.
@@Charlie9165 I have yet to be denied something yet on my Advantage plan.
@@Charlie9165 Until those theoretical regulations are put in place you're paying monthly premiums for a traditional plan. Those regulations may never come but you pay anyway. I prefer the MA approach, pay for service as needed.
I was the sole caregiver for both of my parents. Each year I checked the information about Medicare & Medicare Advantage to make sure that they got the best plan. I could not explain it like this video explains but to me Medicare Advantage was just like the healthcare plan I have today. I decided long ago that I will enroll in the original Medicare when I'm eligible in a few years. Medicare is a lot easier to maneuver.
Hello 👋 Pamela how are you doing today?
I stayed on original Medicare. Had an HMO before and wasn't into an Advantage Plans as I realized the limits of HMOs. Recently had a stroke and the expenses have been minimal so far.
Most Advantage Plans are PPO's. I don't know why he doesn't acknowledge that. You should consider a PPO.
@@DeanCF1 You're correct. This was a key omission on his part. Could be he just doesn't know. I had a knowledgeable agent who took me through it. And, even though all of our doctors and medical situations are "in network" locally, that was not our complete reason for selecting an Advantage Plan. UHC offered four different options when we switch Advantage carriers; three were HMO with four being PPO. It was the best for us. That doesn't mean the best period.
Thanks!
When we first got on medicare we got a part G for 150 for me and 175 (and it went up every year after 3 years was paying over 225) for my husband a month plus RX another 50 for both and app $5 per RX (another 20 a month plus and one time ). Yearly just under $6000 even if we never see a doctor. We are now on an advantage plan 0 per month RX 0. Last year my husband started bleeding internally...was taken to the hospital by ambulance spent 15 hours in ER given 5 liters of blood 5 days in hospital and given more test than I can count...total cost 225!!! Out of pocket for the 2 of us last year was right around 1100. Our plan does cover dr all over the US. We pay 0 for our RX and 0 to see our pc doctor and 20 to see a specialist. And we get over the counter ...cold , pain reliver ect... of 50 a month. Our doctors are great and I really do feel we have much better coverage than when I was working and paying insurance. We had part G for almost 5 years because we didn't know better and our agent use the same scare tactic on us. Been on Kelsey Advantage for 3 years and it is great. AND NO WAITING IN DOCTORS OFFICES!
No waiting? I do not believe that. Wait times even for appointments is weeks to months. I've never seen a doctor without waiting up front or, worse, in an exam room. Never.
Hello 👋 Pamela how are you doing today?
@@craigharris702 great...thank you!
@@virginiamoss7045 We are still on KCA and still love it. It could take weeks to get an appointment for routine appointments but emergency right away. They even have Home visits for just $25 (not the once a year wellness exam that most plans do) if you feel to sick to go in that usually takes 24-48 to see, video anointment within 2hours and only 20 to go to urgent care. We do a lot of traveling and have used it in most part of the country (to be honest most parts are Oh NJ and FL are the only states we had to use it) with no problems. I'm sure my plan is NOT the only one out there. When looking start with 5star plans in your state.
Thanks for the comment, it is VERY helpful. I will take Advantage plan !!
Thank you so much for this video. I started with regular Medicare eight years ago and have stayed with it. Advantage plans sound so good and some family members were taken in by that and with all the "free" stuff they receive. It just didn't sound right to me. I didn't know why but now after this video I know why. I hope anyone looking at Medicare sees this video. Again thank you.
I enroll people in Medicare advantage plans. 95% of the people I deal with survive just on their ssn, ssi, or ssdi benefits. If you can afford a Supplemental plan, I highly recommend it but you will have to purchase a standalone dental, vision, and/or hearing plan which could run another $100/mo. 75% of the people I help are C-SNP or D-SNP eligible.
@@roberthoeller5516What do these folks do when they have surgery and have to pay their $6000 max out of pocket?
Not been my experience with Medicare Advantage Plan. No referral needed for specialist. All of my doctors are in the plan. Most hospital stays limited to paying 3 days at $300. I haven't had to use the traveling across the US benefit, but I think I would want the emergency treated and then return home for the ongoing care.
We are on Blue Medicare Advantage PPO plan G and love it. We still have our eyes and ears open for better suggestions. Thanks
Advantage is great if you don't get real sick or have a medical emergency and have to stay in the hospital for an extended stay. Most advantage plans have that max out of pocket for the year from around $3500 to $7550 depending on the plan. Keep in mind drug costs are not included in that max either. Here is an example, on an advantage plan, if you have to go to the hospital for an inpatient stay. Your first 5 or 6 days depending on the plan, you have to pay a co-pay anywhere from $295 to $345 a day. That is $1770 that you would pay out of your pocket for being in the hospital for those 5 or 6 days. That cost alone for one hospital stay is more than most peoples Supplement plan costs including the Part B Deductible for an entire year. Now keep in mind with Supplement plans as well, you can shop them around once the rates start increasing but you will be subject to medical underwriting. I am a licensed agent in the states of NC and SC and I help people save money by keeping them on the same plan but switching them to a different insurance carrier. Another thing about supplement plans is that they are identical from carrier to carrier and all pay out the same. So that is why it is best to shop around your supplement plans once they start increasing in price. That is as long as you haven't had major medical issues in the past two or three years due to the underwriting process.
Sounds about right.
Most people pay more than $100.00 per month for a med supplement. Once you include the separate cost for prescription drug plan, dental, and hearing Med supplements you are paying atleast $2400. a year. All good agents know you can get a hospital indemnity plan for $25 to $35 a month along with your advantage plan to cover the hospital stay and still pay less than a med supplement. Not to mention the benefits that someone with Medicaid can get with a Medicare advantage plan. Overall the Medicare advantage plan helps both the well off and those in need. Once someone who has been paying $200 a month with a med supplement changes to a Medicare Advantage plan and now have a 0 monthly premium. They love the fact that they have extra money each month. Medicare advantage plans save seniors thousands of dollars on dental. You can get a Medicare advantage plan and get free dentures.
I’m in N.C. I have Unitedhealthcare hmo/ppo plan. I’m ok with them.
In my Medicare Advantage Plan, the co-pay is $0 per day for the first 90 days. After 90 days, your out of pocket maximum kicks in, which is $2000 for my plan. You've got to research your benefits to get the right plan. Most drugs are $0. The higher tier (Eliquis) is $20 a month.
@@jjbud3124 I am in know way telling people what to do. So glad you found a plan that suits you. Some people Advantage is great for and some not. It just depends on the plan and that persons medical needs.
I have been a health insurance agent several times in my career and did not understand the cost structure of advantage plans. When I started my part B coverage I went with a traditional supplement plan because I understood who was paying for what. If you don't pay for it you may get just what you pay for. Thanks for the explanation.
So all in sll..a supplemental plan..N..for example..is a great choice...
@@jeffhoffmann3620 yes , at least you know what the policy will or will not pay for.
I sure am glad I didn't see your presentation 12 years ago when I retired.
I'm with Senior Advantage and a member of Kaiser Permante here in CA.
KP is consistently rated the best health plan in the state, and I can affirm that the health care is excellent.
I moved to AZ from CA where I was on Kaiser senior. I sure miss it here in AZ. Kaiser was constantly urging me to keep up proactive services. They don't do that with my Humana plan.
Kaiser isn’t available to anyone not in CA. Lucky you
Having Kaiser for many years I wouldn't say it's good insurance. It is cheaper and it's insurance but but I don't feel that most of the Drs I've seen there are very good. There are a few that are,but not many it's ok if you're never sick.
Problems with Medicare private insurance, it is a multi billion dollar business of roll-over business. First, no matter your health condition, there will always be a company that doesn't ask health questions and at a competitive price (shop the mkt.). 2nd. Private Medicare insurance policyholders endure a never ending price increase, and eventually for lots of folks there back shopping in the private medicare insurance market looking for same coverage with less premium and should not be a problem. Health questions today are mainly yes and no questions. Experience from June 1984-1998 acting as an Managing General Agent or MGA with 33+ broker/agents. In my day, we were referred to by the state as Master General Agents.
There is lots of money in the medicare day workers mkt. Be ware of the excess MGA's and, private insurance brokers sell what pays them the most commission..
And, medicare programs offered through the mail, we referred to as less sophisticated med sups.
We LOVE our Medicare Advantage PPO Plan! So many extra benefits, too.
Which one do you have? If you don’t mind me asking. I have two elderly parents and I’m having a hard time deciding which one to enroll them with
@@Summersunshinemylove AARP
@@Summersunshinemylove Now both my husband and I started with AARP right away at 65 - so we did enter at a good rate. It might be that the rate goes up depending on what age your parents start the Advantage Plan.
But I really did my research and multiple phone calls, etc. and this was the best plan that covered everything we needed. Along with peace of mind. Highly recommend calling AARP for more information.
Please feel free to ask any other questions if I'm able to help. I understand how daunting this process can be. 🍃
@@nottthereyet4872 thanks a million. I’ll check it out
We are full time RVers who are retired and travel the country in our motorhome. We have a Medicare Advantage PPO plan in our state of Domicile, Louisiana, which we haven't visited in over 2 years. We have used network doctors from AZ to NC and haven't had to go out of network yet. We paid $100 out of pocket last year for the initial visit at a dermatologist. That was it, for the entire year. However, we save $130 every month as a give back from our Medicare part B premiums. That's $1,560 a year in savings! Even with the $100 out of pocket last year (nothing the year before) we still saved $1,460. That's huge for us retirees.
Thank you. I was directed to Medicare Advantage by my doctor when I retired. Fortunately I live in Washington State and I do not have a pre existing condition so I was able (after jumping through a million hoops) to get on traditional medicare Phew. I wish I had heard this video before.
Sounds like you're al good going forward.
@@barnardcarbajal8506 Wha????
@@pravinasings8254 if you want off Advantage call SS and tell them you vant to change your RX plan....
I'm the youngest in my family and having older siblings really helped me understand the difference between Advantage and original Medicare with a Supplemental plan. By the way, F has been phased out for new enrollees. I've got G and it runs $150. per month (note that the premium goes up every year as you age). Also, if you were to get Advantage initially and wanted to change to original Medicare/Supplemental, you may not qualify, as preexisting conditions are taken into account during the approval process for the Supplemental. The only time preexisting is not a factor, is when you already have health insurance and are applying for Medicare/Supplemental for the first time.
Depending on your income, some people can't afford original Medicare/Supplemental and have to go with Advantage. Lucky for me, the employer I retired from reimburses me monthly for my Medicare/Supplemental premiums, but even if they didn't, I would still go with original Medicare/Supplemental. I retired in a rural area (it was originally my secondary home) and have heard many horror stories about the lack of coverage, denial for treatment, hidden costs and the scarcity of doctors who accept Advantage in rural areas.
Also if you are under 65, and qualify for disability, it is my understanding that you can only get Medicare Advantage plans.
@@pattyeverett2826 Individuals who qualify for Medicare based on a disability (under 65) can be enrolled in the traditional/original Medicare plan. It depends on which state they live in, if there is a supplemental plan offered to this type of Medicare enrollee. If there is a supplemental plan for individuals who are disabled, it maybe more costly for this group of Medicare beneficiaries, than those who purchase supplemental plans at age 65, or when they are first enrolled in Medicare Part A and B (after age 65).
Other options are, If they have a spouse or family member they can be covered under a large employer group health plan (100 or more employees). If they qualify for state assistance; Medicaid/Medical and the Medicare Savings Programs. Otherwise; their choices are original/traditional Medicare (without a supplemental plan for most) or a Medicare Advantage Plan. Not to forget the Part D plans--they would be included. This is just a snapshot of information in trying to answer your question. Every state has a program to help people of all ages on Medicare called, State Health Insurance Benefit Advisers (SHIBA) who help people navigate through insurance issues. They usually work under the State Office of the Insurance Commissioner. Many of the people who make up this awesome group of individuals are volunteers.
Many Plan F that stopped taking new enrollees a few years back causing the premiums to sky rocket got moved into Plan G, which is causing those premiums to increase. I went with Plan N as Medicare is phasing out plans that do not have a co-pay for office visits. The co-pay is minimal but it does deter some patients to run to the doctor for nothing because it's free. I would definitely recommend new Medicare Enrollees to consider Plan N. It wouldn't surprise me at all if Medicare phases out Plan G in the future.