Traditional Medicare vs Medicare Advantage vs Medicare Part D vs Medicare Supplement Explained

Traditional Medicare Consists of Part A for Hospital Coverage and Part B for Physician and Outpatient Services Coverage (e.g. lab, imaging).
Traditional Medicare Has a Low Premium that Must be Paid by the Beneficiary and Part B has Both a Deductible and 20% Co-Insurance with NO Out-of-Pocket Maximum.
Medicare Advantage Includes Hospital Coverage, Physician Coverage, Outpatient Services Coverage AND Prescription Coverage and Frequently Dental Coverage, Vision Coverage and Hearing Coverage.
Medicare Advantage Premiums are Low and Can Even Be $0.
However, Most Medicare Advantage Plans are Either an HMO with a Primary Care Gatekeeper or a Narrow-Network PPO Plan with Fewer Choices in Doctors and Hospitals than Traditional Medicare.
Additionally, Traditional Medicare Does Not Require a Referral to See a Specialist and There are No Prior Authorization, BUT Medicare Advantage Plans Frequently DO Require a Referral and Have Prior Authorization Requirements.
Medicare Part D Provides Prescription Drug Coverage for Beneficiaries Who are on Traditional Medicare.
Medicare Supplement Insurance is Optional Insurance that a Beneficiary Can Buy to Cover the Expenses Not Covered by Traditional Medicare, Such as the 20% Co-Insurance for Outpatient Services.
Sources:
www.medicare.gov/your-medicar...
www.healthaffairs.org/doi/10....
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[@hiyanjun]

Wow, this is by far the best video about different insurance plans I have ever seen. It clarifies so much why innovations are ripe in the MA plan world. I would double like this if I could. Thank you Dr. Bricker

[@ahealthcarez]

Thanks so much for watching and for your kind words.

[@jdean813]

Thank you so much, Dr. Bricker. This is the easiest-to-follow explanation of the differences I've heard so far!

[@ahealthcarez]

Thank you for your feedback!!

[@RaminR]

Thank you for this very broad over view -- it's great -- if you don't mind chipping away at this iceberg with more videos -- I think a deeper understanding of this is vital to physicians as insurance companies are also buying hospitals and doctor groups. Greatly appreciate all your videos and this one in particular!

[@ChadHenryPharmD]

Thanks, Dr. Bricker, this was great! Hope this racks up the viewership for you.

[@ahealthcarez]

Thank you for watching and for your comment.

[@andrewmacqueen2754]

Thanks Dr. Bricker this was so helpful. I am grateful to have you as a teacher, you have taught me so much. Stay golden!!!!

[@ahealthcarez]

Thank you for your kind comment.

[@ryanweaver962]

This is very valuable information. Many people who first enroll in Medicare and learn their first year what they should have done.

[@romanticdreamsasmr9005]

The best video that explains it succinctly while being thorough.

[@ahealthcarez]

Thank you for watching and for your positive feedback.

[@bobhea]

Thanks Dr. Bricker!

[@ahealthcarez]

Thank you for watching!!

[@elianasmith6330]

Thank you a lot for this video. This is very interesting and informative. Keep posting like those amazing videos, this is awesome.

[@ahealthcarez]

Thank you for watching and for your kind feedback.

[@lucillemargot5175]

Your videos are very useful and provide lots of information. I have received lots of help with your video, please continue to share this kind of information. Thank you.

[@ahealthcarez]

Thank you so much for watching and for your comment!!

[@vertigohan]

Eric Bricker thanks for the video. Great explanation. I can see your passion.
2 questions:
Do you have a video explaining the "doughnut hole"? "
You said that in Traditional M. patients pay 20% of the bill. Is this not the same with Advantage?
Thanks again

[@ahealthcarez]

No video on donut hole. Good suggestion.
Correct. Not the same as Medicare Advantage. Medicare Advantage typically only has copays that are much less than 20%.

[@ericklou2013]

Awesome high level explanation. Thank you

[@ahealthcarez]

Thank you for watching and for your feedback.

[@ishraqalhamdani6428]

in other video you said MA is a fixed amount per person per month not FFS ? could you please explain this to me. thank you.

[@micahdriver2985]

Thanks Dr. Bricker. Do you have an article that you have written (or recommend) on Medicare Supplemental policies? For example, in my experience almost every supplemental plan will cover the 20% (unless the plan has a unique deductible or something that makes a portion of the payment patient responsibility), but Medicaid usually denies coverage of the 20%. Why?

[@georgie9854]

Medicaid or medicare denies it?

[@jackdolphy8965]

Your explanation towards the beginning about the trend being Advantage - you made the percentages between Trad Medicare and Advantage accounting 100%. Methinks you left out Medigap aka Supplemental plans.

[@ahealthcarez]

Thank you for your comment. Medigap would go along with Traditional.

[@giangnguyenthanh4712]

Thank you, very informative video :)

[@ahealthcarez]

Thank you for watching and for your comment.

[@mjmjmj28]

Maddening that they focus on restricting access so they can increase profits.

[@ahealthcarez]

Thank you for watching and for sharing your thoughts.

[@suemilkbone4868]

Not just maddening, it is actually dangerous. By limiting your ability to free choice, you are then under their complete control. You can then be assigned to the least educated and least experienced health care provider.

[@michaelwallace2219]

@@suemilkbone4868 The choice is in not choosing an Advantage plan if this restriction is a concern.

[@suemilkbone4868]

@@michaelwallace2219 Absolutely, but the problem is that people in Advantage plans don't understand the ramifications of limited choice until it is too late. Personally, I've chosen a Direct Primary Care physician for my care.

[@ryanweaver962]

Think about this… what if commercial, ACA plans, Medicare, self insured, etc… what if all of those stake hinders and investors in all of those plans AND those investing in insurance investments… all made heakthcare interoperability a non-negotiable in their plans?
The government needs to protect rights of people and groups. Privacy, transparency and proper oversight.
FYI… this very good explanations… there’s a lot of various subsidies. And, the various levels of government already contributes to health care and Research over and over. The reality that health systems and insurance companies do NOT own patient data… is more and more obvious.
The government needs to protect rights and this will also enable far better connections with community. It’s very workable.

[@rkeefemax]

Outstanding as usual!

[@ahealthcarez]

Thank you for your feedback.

[@rodneyavery3537]

You didn't mention that if you go the advantage plan C route and have low or zero monthly fee you still pay the part B fee every month. You also have to stay in your network so if you travel or visit family out of your area and require hospital care you are screwed, no coverage!

[@ahealthcarez]

Thank you for watching and for the info.

[@poojapatwal6525]

Thank you so much !!!

[@ahealthcarez]

Thank YOU for watching.

[@ryanweaver962]

Share of costs and overdraft fees in banks.. fascinating rationalizing.
So many things.

[@drdarrylglover]

Fantastic explanation!

[@ahealthcarez]

Thank you for watching and for your feedback.

[@willypal5431]

Thank you.

[@ahealthcarez]

You are welcome. Thank you for watching!

[@ryanweaver962]

The regional systems of health, climate and tools can help with improvement process…

[@TFhello-world]

Does that $1.6K MA per member profit estimate include operating expenses or just Medical Expense?

[@ahealthcarez]

Great question. I believe includes operating expenses as well.

[@14thSun]

Its sounds like if we could just get GE to buy every in healthcare and have them try their best to profit off of it that would fix healthcare spending.

[@ahealthcarez]

Genius! 🤣🤣

[@free9g]

Can you post more video on topic medical health insurance

[@ahealthcarez]

Thank you for watching and for your suggestion.

[@sreelakshmig8968]

if I took a advantage plan with a commercial , do I need to pay the premium for Medicare and Advantage plan insurance .

[@ahealthcarez]

Just the Advantage Plan.

[@sreelakshmig8968]

@@ahealthcarez Thank you for the quick reply , can I have your contact number

[@MaryBethMcCoy]

@Sree Lakshmi You still have to pay the Medicare Part B premium even when on a Medicare Advantage plan.

[@emeraldkimble7602]

You forgot to mention those like me Medicare without Medicaid part b deductible covered by Medicaid provider gets stiffed 117 u bucks sone try to collect it to qualify fi4. Medicaid one had to spend down a hundred grand out of pi jet I won’t do it

[@ahealthcarez]

Thank you for comment.

[@bobbielynnbinner7587]

Can you talk about ACO please?

[@ahealthcarez]

Here is a video on Medicare ACOs: czcams.com/video/YEqtpCNwzSg/video.html

[@StephenWhalen-uw5vr]

I thought MA was just over 50% now, traditional Medicare around 49%?

[@ahealthcarez]

That is correct.

[@StephenWhalen-uw5vr]

Thanks, missed that this was 2 years ago! Your videos are great, thank you!

[@healthcarenewz]

HR3 bill has entered the chat

[@pmfishing1151]

So which is better 💀

[@ahealthcarez]

Thank you for watching and for your question.
Depends. Traditional Medicare costs more, but gives more choice. Medicare Advantage costs less, but gives less choice.

[@sonusen1520]

Hi doc could you tell me why medicare advantage plans have high risk score and how normalization factor affects it???

[@rahulzagade8696]

I am thankful to my country where Healthcare cost is Cheapest in the World :D 90% living life without insurance.

[@ahealthcarez]

Appreciate you watching and sharing your perspective.

[@stellarinsurancebrokerstel1485]

There are some insurance FMO's that are initiating the 'Medicare Advantage' title be reworded. Those plans are not Medicare at all, and many Clients/patients that have been on the MA plans are not finding them an Advantage at all. And for many Clients/patients to return to Origininal Medicare can't for various reasons.
I'm grateful my mother has Original Medicare A & B and is on a supplement, and I've strongly encouraged her to not ever swithch no matter how much any TV or mailer ads make an Advantage sound affordable, i.e. zero monthly premium.
Medicaid is a better secondary payor to Original Medicare if people struggle with finances. Always do what's right for the client/patient, always.
This industry is saturated with unethical non-transparent 'sellers'.
Crackdown on Scam Medicare Ads Dec. 14, 2022
www.usnews.com/news/health-news/articles/2022-12-14/biden-administration-proposes-crackdown-on-scam-medicare-ads?fbclid=IwAR1AshPD3Hmy4b2LA7S8NUtpo-t4qnNKbAhNi0iupN42-XREG-uIstFrM2U
Always do what's right for the client/patient, always.

[@ahealthcarez]

Thank you for sharing your knowledge.