*Real Cost Example* Medicare Supplement Plan G vs High Deductible Plan G vs Medicare Advantage Plan
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- čas přidán 8. 09. 2024
- We used a real-world, high-cost claim to show how a Medicare Supplement Plan G, a High Deductible Medigap Plan G, and a $0 Medicare Advantage plan would cover this particular example. The results may surprise you.
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Erik@TheRetirementNerds.com
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I am sure you covered this in another video, but to me the big difference is the ease in which you can get care. With Original Medicare, if your doctor says you need a procedure, you get the procedure. With Advantage, the insurance company can override the doctor's opinion and force you to try some alternative lower cost techniques first, and perhaps only regardless of what your doctor says you need.
Thank you for watching!
You are correct, and we have a few videos that cover those points.
This one: czcams.com/video/yxXuGQYJ-ug/video.html
And this one: czcams.com/video/AlCJwhqZE0s/video.html
Both try to tackle that.
Appreciate you!
@JBoy340a…yep like i said too before i saw your comment 👍
@@Theretirementnerds Wow, not good not to explain the difference (the restrictions) in your options for care???? Some people will only follow the money. My friends mother was denied skilled nursing that the doctor felt would give her more time and so the insurance sent her home to die (hospice). I am only 61, but that convinced me that I will go with N or G.
@@dpayne1943 Even with original Medicare (with or without Supplement), skilled nursing care is extremely limited. You have to have spent three days ADMITTED to a hospital to qualify. "Admitted" is important, because many times you are "in" the hospital, even for several days, without being "admitted". They may call it "observation" or something else. Same bed, same nurses, same care. But you have not been admitted. It is covered under Part B instead of Part A. Just paperwork, but can disqualify you from skilled nursing care under Medicare. Even if you were admitted for at least three days and qualify for skilled nursing care, it is limited to just a couple of weeks (some Supplement Plans extend this somewhat). Long term nursing care is never covered by Medicare. Long term skilled nursing care can cost thousands per month and is one of the quickest paths to family bankruptcy.
As a healthcare provider, I have never had a patient complain or have concerns with their original Medicare. I can’t begin to list the numerous and various complaints I hear from patients on their advantage plans. It’s always a battle for me to get imaging completed on patients. I often end up doing a peer to peer review to get approval. Last week I had one peer to peer that was triggered simply because the insurance company entered the order twice. Their mistake. It added another week to getting approval and wasted a lot of everyone’s time.
With original Medicare, if your doctor says it is medically necessary, both Medicare and the second payer must cover it no questions asked. With Medicare Advantage, the for-profit insurance company can veto the doctor and deny your surgery or tests, etc. Original Medicare may cost more, but at least you have control over your health decisions and not a for=profit insurance company.
Mostly true, yes. If the doctor says it is medically necessary - and it is something covered by Medicare - yes, Medicare and the supplement plan will cover it, no questions asked. Just something that people need to be sure is clear and that is that Medicare does not cover everything, but for what it does cover, the administration of Original Medicare and a supplement plan is more straightforward.
Thank you for watching!
There have been multiple providers in our area that have stopped accepting certain Medicare Advantage plans, leaving those people left in the lurch. For me, original Medicare + supplement plan is a more stable choice and I've no regrets.
Supplements are more stable from a provider and claims perspective, absolutely. Not everyone can afford them and in some areas, advantage plans have solid commitments from providers. A lot of variability across the country with those. Super happy you are happy with your supplement!
I heard the mayo clinic is not accepting any advantage plans anymore. That is scary.
@@hummingbird7713 correct. If you plan on using Mayo, Advantage plans likely aren't the way to go
Always a lively discussion on MAYO. If you did not have a previous relationship with them here in Florida forget about Medicare anything with MAYO.
I agree with you. Plus living in a rural area you have to travel so far just to get services with an Advantage plan, which then is an disadvantage ✅✅✅. So I did an HD-G Plan with original Medicare and a plan D drug plan.
The only fly in the ointment that I can see is you have to get preauthorization for the Advantage plan, so there is a possibility that you cannot even get the surgery if your plan says no and/or requires other treatments before resorting to surgery. I'm happy to pay the extra premiums to ensure that I can see who I want to see, and avail myself of the treatments we agree are necessary without interference.
Yes, prior authorizations are a thing to consider. We will do more of these videos with different scenarios to show when supplements are strongest as well. Thank you for watching!
@@Theretirementnerds Thank you for the great video. I’m 3 months away from starting Medicare (submitted my application with SSA online on the first day I was able to), and it’s always great to make an informed decision, factoring all of the variables. I’m in Massachusetts where Plan 1A is the same as G.
@@MsSkymom always smart to be informed. Massachusetts is different than the rest of the country for sure. A couple other states have their own nuances as well. Would still recommend you find an agent there who can help you. Even if it's not us, have an agent look over your situation and confirm your thoughts
Appreciate you watching and commenting!
Make sure to first google advantage plan complaints. It is more of an illusion of coverage that has left people scared, vulnerable and suffering without any help or recourse. When a serious illness happens the door gets shut and patients are often denied. I seen it first hand as it happened to my mother-in-law after a bad fall and broken bones they would not even reset her shoulder socket, leaving her arm in pain and useless and no PT...refused and sent her home with tylenol! An appeal only went back to the same place that denied her. As POA I tried to help her get back on medicare so she could get treatment. But the advantage plan had to approve releasing her back to medicare, but conveniently couldn't find our request...repeatedly. It basically ended her quality of life and started a rapid deterioration, locked into a hopeless plan that would not provide care, she eventually passed away just a few years later.
The advantage plan saves medicare money by handing you off to someone else...and they make money by refusing treatment. The gov is well aware of the problem, but it saves them money so advocates are unable to change the system.
When it came to deciding on a supplement plan, my choice hung between Plan G and Plan HDG.
The difference in the premium between the two plans is roughly $2,000 in premium cost.
In my mind, with the Plan G, I would have to pay the $,2000 increased premium regardless of whether I use medical services or not.
Whereas, with the Plan HDG, I would pay up to the $2,700 deductible, only if I actually use medical services that year.
If I have a healthy year, without major medical expenses, I set aside the $2,000 in premium savings, for years when I can apply that money to the deductible in not so healthy years.
Well said, and this is a good way of looking at it. The problem many people have is the actual saving part in good years. The intention is to save, but it gets easy for people to spend that unused money. If you can stay disciplined, you'll be in a good spot!
I think the big question for some people is, "How often (if ever) will the knowledge that your doctor visit or procedure is going to be out of pocket (because of the deductible) are you going to put off going to the doctor?" For many, they won't bat an eye. For skinflints like me? I have original Medicare and a G Supplement. My only cost is the two hundred and some odd dollar Part B deductible. My wife has to brow beat me to get me to spend that! I can't imagine having a $2,700.00 deductible! I would NEVER go to the doctor! It's just psychological, I know! I pay more in premiums, but they are pulled automatically every month. I never see that money, so I never miss it! Crazy? Yeah! But I'll bet I'm not the only one! Also, it's only an "annual" deductible if you pay it in January. If you pay it in December, you could end up paying it again a month later!
I'm 68. I pay $78/mo for Mut of Omaha Plan N and $8/mo for my Part D drug plan (Wellcare). All drugs are tier 1 - I pay $0 for 6 meds. Can't beat it.
Sounds like a great setup!
$78/month...impossible for plan N at age 68 unless you are getting help from medicaid or some other agency.
I use a HDG plan for a couple reasons. My wife and I split our time between 2 homes so the flexibility of a Medicare plan without network limitations gives us great peace of mind. I like the cost savings of a high deductible plan vs the standard G plan for the years I have no major claims which is more often than not. There is no doubt that when a major claim is incurred, the Advantage of low deductible plan will be the better option but I’m willing to take the long term risk and flexibility offered by my HDG plan.
HDG is a great option for cases like yours. Premium savings, network (or lack thereof) flexibility. They are great plans. Not necessarily available everywhere, but for those who understand the tradeoff with the high deductible, these can work really well.
Thank you for watching and taking the time to share your experience!
I’m leaning toward regular G; just because the premiums are (other than the $226 per year part B deductible) all you are going to pay. However, a high deductible G does make sense, as in addition to not so much out-of-pocket during your earlier (and healthiest) years, you can keep that in your IRA and keep it growing for the years you get stung. So, with 2 1/2 years to go until 65, I’m still on the fence.
“Advantage” plans, in my opinion, are the most threatening in terms of you being denied treatment. Also, I plan to travel a lot in the US, which makes the advantage plan….er…disadvantageous.
I’d be interested in a video that discusses the different options and coverage for overseas travel with these three options.
Thanks a lot!
What if I plan with my wife to leave the US for travel . Should I get the G plan and live abroad for an extended period of time ?
@@skeller61If you travel overseas, you should always get travel insurance that includes medical. Medicare only works in the US.
The statistics show that only about 4% of people with a high deductible plan EVER make use of it. In other words , you pay the premiums and also pay all of your medical costs yourself. So, 96% of people with those plans are simply throwing money away.
This is interesting, I signed up for an Advantage plan and so glad I did. I'm presently on BCBS HMO plan, so I am used to getting approvals and referrals to see specialists. And the fact that I can go to any facility on a true life threatening emergency, and be covered as In Network, makes this plan a no brainer for me. Thanks for all that you do for us with your invaluable information. God bless.
Appreciate you watching! Stay tuned for more examples we'll be doing of where the results turn out a bit differently.
Medicare Advantage tend to require referrals and pre authorizations. The video did a great job explaining how claims work. The max out of pocket can be high with in hospital stays. Each person has a personal need. Unfortunately most states do not allow people to guarantee issue after their initial enrollments. Each person needs to look at their health and perhaps their family health. Great video
My mother is on advantage plans as she gets older it seems that it is harder to get approvals and some of the simplest things
@Hummingbird77 that is how my current (before retirement) plan is. My Dr tells me it is so much easier to get needed procedures on Medicare.
@@aananimity they wouldn’t let her get a simple stress test done. That she needed . Now mayo clinic will not even except any advantage plans now they sent a letter out stating this.
Plan G premiums will cost a lot more depending on age and medical issues. My husband has Original Medicare and
Plan G. He has heart disease, macular degeneration, diabetes, and is 89 years old, and the cost of his United Healthcare premium is $416 a month.
Thank you for sharing! Yes, premium increases are a real thing to consider.
I am 54 and was quoted a similar rate as the least expensive option. (I also have a heart condition). I am looking into which states offer QMB without an asset limit, in which case there will be no copay or premiums for standard medicare.
It is not so expensive for his age and health issues he has.
I am a few years before Medicare, but I am leaning toward the HD. Looking at my current healthcare with HSA, those the High Deductible does not look as daunting as my current normal insurance.
Thank you so much of your very detailed video. I learn more and more about original Medicare, Medicare Supplement and Advantage plan. And thank you of using the white board in that way we/I can see the figures you’re comparing of the three kind of health insurance plan which makes me understand more. Very helpful.❤
Thank YOU for watching and for commenting with ideas around what videos we need to make. Appreciate you!
I appreciate this video. I too was surprised by the result in this one example scenario.
I look at all this, this way. What is the purpose of health insurance in the first place and in the long view?
It is to cover you for the Worst Case medical care scenario(s) over the length of time of your remaining years.
You will probably have on average more good years than bad, especially from Age 65 to 75, then Age 75 to 85. This argues for “pay as you go”.
But in bad years, you gonna pay dearly if the pay-as-you is MA, especially if they keep upping their Max/out-of-pocket. (I myself am inclined to go HDG, with a much smaller Max.)
But the worst case(s) could and would be a lot worse for anyone than this example here in this video.
There is going to be much more pre-surgery work up, alternative treatments etc before a worse case surgery or even multiple surgeries. In other words, lots more MA co-pays.
Moreover, over 10 years, MAs are gonna “change” their plans every year, increasing their co-pays, deductibles and Max/out-of-pockets, and dropping perks, cancelling gym memberships and dental plans, and even adding premiums.
(If you think MAs are gonna “add” more freebie perks every year, think again. They find hidden ways to “pay” for their perks by upping co-pays, deductibles and Max/out-of-pockets.)
Also, any procedure that you and your doc could want might be denied flat out under MA pre-authorization denials vs. original Medicare.
You ain’t in control of your health decision, but a nameless, faceless bureaucrat in a profit-making company.
And then there are worst case “chronic conditions” that require on-going, repeated multiple doctor and specialist visits, triggering MA co-pay after co-pay (examples such as cancer, diabetes, heart disease, blood and lung diseases, long COVID, etc etc).
Looked at from Birds Eye view over the span of many years and even decades, MA might not look so sweet.
Just my 2 cents.
Appreciate you watching and adding your thoughts. We will have a few more of these where the outcome is different, going along with a few things you mentioned (chronic conditions, higher cost procedures).
Over the past few years, Advantage plans, at least in our surrounding states, have been getting stronger, not weaker. Lower copays. Lower MOOPs. More other perks. To your point, that could all change, but right now, it is the opposite.
Now, if your 10 follow-up visits roll into the next calendar year if you are on a supplement plan the $260 deductible would reset, increasing your costs. Thank you for this example. There is so much bashing of Medicare Advantage plans, it's nice to see them put in a good light. In addition, on Medicare Advantage you may also have some coverage for vision, dental and prescription drugs that you do not get on a supplement plan.
Thank you for watching! We try to let everyone know that Medicare is not a one size fits all approach. Supplement plans are great for a lot of people, but not everyone. Advantage plans are great for a lot of people, but not everyone.
@Daniel - thank you for taking the time to shine a bright light on the (unfairly) much-maligned Medicare Advantage plans - I wish there was a celebrity out there willing to promote on TV these awesome plans and be disabused of the assumption that the Advantage plans are administered by large for-profit publicly traded companies that exist only to produce earnings and dividends for their shareholders. I guess celebrities are all busy doing reverse mortgage commercials. As we all have seen here, in this enthusiastically unbiased presentation, Advantage plans are superior to Original Medicare and only a confused Alzheimer patient would not choose Advantage. Finally, in addition to Rx, and comprehensive dental/vision coverage that you mentioned, they offer free gym membership and occasional gift cards for being good boys and girls and eating all our vegetables.
I heard that Dental and Vision, are very basic and do not pay for important work that a senior may need.
@Gracie M thank you for watching.
This is highly dependent on where you live and the company you go with. Some plans have very strong dental and vision plans, and others do not.
Some have traditional deductibles, copays/coinsurance, others will give you a certain dollar amount per year you can use.
Better for a $260.00 deductible to reset than for a $1,500.00 deductible PLUS a $6,000.00 MOOP to reset!
Thank you...I've done all this research but it is great to have it all verified
Thank you for watching!
Love the color coding on the white board. I'm slowly absorbing medicare info with video's like yours!
Thank you for watching! So glad it is helpful!
Well heck, this kinda throws a wrench in my thinking plan G , HDG, and N are the way to go, except for one big thing, and thats the whole " In network " situation. If you are out of network on vacation, or just traveling for whatever reason, then you could be in trouble if you are denied coverage for needed medical care .
I do not like needing approvals or seeing doctors the insurance company wants.
I like my Plan G and piece of mind.
Plan G is amazing for those who can afford it. Thank you for watching!
Thank you for the video. It is very informative and kind of surprising to me. I enjoy actual examples like this one.
Thank you for watching Jimmy! We may make this a series to show some other examples. Had a request for how cancer is handled. Thank you for commenting and if you have any other questions, happy to make a video about it!
I like advantage plans they work for me here in Puerto Rico 🇵🇷 🇺🇸🏝, and if you have medicaid, but I don't use the plan too much
I like GHD ($34 in CA) for the incentive to stay healthy to avoid the medical industry and no networks.
I also save and invest $300 minimum of income per month for future medical costs.
Smart! Many don't do the save/investing part. They know it's wise and a good idea, but it is easy to take those savings and spend them on something fun.
My Advantage plan has not worked out for me. It wasn't a cost issue, but an access to doctors. My Advantage plan gave me a list of doctors who supposedly accepted my insurance. Not a single doctor would take my insurance. I'm switching to a supplement plan G for 2023. Even if my out of pocket cost are higher, I look forward to having ACCESS !!!
It's an important part of the decision, no doubt. Thank you for adding your perspective!
This is something folks really need to do their homework and research. I live in a rural area, which is challenging due to locality, so access is Key. I have chosen the HD-G Plan for me.
@@sharoneh8929 solid choice! Especially in rural areas.
I'm in Ohio and started Plan G with Anthem in 2019 at $135/month and I turned 70 on Sept of 2019. I've had increases each July. This past June of 2022, I was up to about $175/month, and in July it increased up to $194 a month. In 7 years, by the time I reach 80, my payment will be over $300 if the same increase pattern holds true. The 'High G' plan WAS NOT presented to me as a choice by RetireMed because 'they don't advise people taking a High G' plan. How nice of them! My wife is younger and still works and have an HSA where we could have contributed $3000 or more year to cover the High G deductible of $2700. In the past 3 years, Anthem has only paid out a couple of hundred dollars on me and I sure could have used a High G plan for $65/month! Now, I have stage 3A chronic kidney disease and can't pass underwriting to switch to High G.
Supplement coverage is fantastic. We need to state that first. But your story is what a lot of people who love Supplements gloss over and do not bring attention to as often as it probably deserves. Supplement plan rates increase often and, we are seeing it more with Plan G, rather aggressively at times.
Now, HD G does have drawbacks. Some people love them. Some people, after being on them during a bad year, don't like them and want to go to a regular G. Everyone is different, but there are options out there for people to balance monthly premiums with coverage.
Thank you for sharing your experience.
My heart goes out to you! After having 3 people in my circle of friends with kidney problems, the one near stage 4 went to visit a chiropractor friend in another state. He asked her what diet did her kidney specialist put her on. She said he never mentioned what to not eat. I asked my other friends if their specialist mentioned a diet, both said none. Back in the late 90’s, my father-in-law had kidney problems and was given a list of foods to not eat. You can look online and get a list, but why are doctors not telling patients in this day and age. Fortunately my friend knew of a highly recommended naturopath and her numbers have improved greatly and she feels so much better. Hope this is of some help!
@bigtex2852 for some reason, we weren't notified of your comme t. Sorry for the super late reply!
Issue age policies most definitely increase, ot just isn't based on your age. Each year, the insurance companies will reassess and give increases, stay the same, or go down. The VAST majority of the time, it is minot increases.
Attained age policies can in rease twice per year. Once as described above for the annual renewal, and once when you get one year older.
Fantastic explanation, so much better than doom and gloom anti Advantage plans.
Thank you Jimbo!
Great breakdown! I'm still a couple years away before retiring however I do believe that the GHD plan would be best for me since I'm in Florida and the costs there appear to be higher than in most other states. I'm thinking because not every year will be a surgery requirement, the high deductible won't be met for most years. I do not want an Advantage plan and I was originally thinking about Plan G until I found out the high costs in Florida. I've learned so much from all these videos so thanks for the great explanations!
Thank you for watching! HD G is very popular in Florida. Find an agent you trust and work with him or her as you get about 90 days away 🙂
I chose the HD-G for the same reason. It made sense when considering my overall budget💯 I enrolled in a plan D drug plan with no deductible, and lastly I still need to find a dental plan...
My wife and I have been on a G HD in Florida for 2 years and have saved over $4000 so far compared to plan G.
@DavidBeede HD G is very popular in Florida. Glad you are happy with your plan!
Thank you. Please, next time keep costs on the same lines.....it's easier to see the difference....once again,. Great point. Keep up the good work.
Thank you for watching!
Thank you for this clear presentation! We haven’t had any health issues in the few years we’re been on Kaiser Senior Advantage, Los Angeles, so, so far, so good. I am concerned about the potential for being denied coverage, but Kaiser here is rated 5 stars. My understanding is that if coverage were denied, you can ask for the credentials of the person who made the decision and it it usually not an MD, so you can get it overturned on the basis, but I am NO expert on that. I wish I had details on what they have denied but I’m sure that is nowhere to be found. We are ok financially and frequently “self-insure” but of course a serious diagnosis could be half a million which I would rather not spend.
People either love or hate Kaiser. The good news with Kaiser is denials happen less frequently because it is all one cohesive system. The doctors and staff seem to know how to navigate their own system and insurance rather than other entities needing to know how to comply with MANY systems.
@@Theretirementnerds We did a fair amount of research (limited without insider info) and have a robust, 15k member local Facebook page where a number of members praised their Kaiser experience, and if there were any negatives, which people love to share, they were not worrisome. We appreciate what you note, the seamlessness. No worries about who is in network, no paperwork, no copays either. Every year, so far, the benefits have improved. I am not lulled into a false sense of security and take your videos seriously. We will probably move next year while we are healthy.
I have had kaiser for many years thru my job and turning 65 soon I'm going to switch to a different Insurance and Plan G because they are not good for serious diseases. As long you are super healthy and young Kaiser is perfect but ones you get sick, they are not so good, and you cannot see the best doctors in the nation in case you need it. As I'm getting older, I'm not sure about my future so I prefer to pay more and have all the options. My boyfriend has medicare Advantage and he likes it, but he is not picky with doctors, and he doesn't care very much about his health either he wants to pay little.
I would add Kidney Dialysis as a way to hit the MOOP on a Medicare Advantage plan as well. Nice job!
Agreed! Thank you Mark!
Very good video,i also have the va and a 40% rating luckily.This is sooo confusing.I turn 65 end of Dec. And have pmr but want to remain with my va doctors primarily.
Thank you for watching and sharing your thoughts!
Thank you for these.
You need to look at the whole picture. That is what you do
Thank you for watching!
Excellent fair coverage Thanks 15:27 . Ps in NYS if health goes bad l will immediately contact you
Thank you so much! Happy to help in any way we can!
The charts that you draw for us are so very helpful. Thank you doing that. I have a question. I have not heard you talk about N plan, which is similar to G, but there are differences. I would love to hear your comments on N.
Thank you for watching!
We have lots on Plan N. I'll include the two most here:
czcams.com/video/9Lx3BntZWkU/video.htmlsi=KQ1LKW1KR2krfOuS
czcams.com/video/Yf_LRloXmSo/video.htmlsi=EpkH1idtEKy0TfwG
Thank you Erik! I wonder how many times I am going to have to watch this video to finally get it! :-) Cheers
Haha, it isn't the easiest thing to deal with. A lot of moving parts!
everyone listening to this must realize that the advantage plans regulate whether you get the surgery or not. They can and do deny surgery many and multiple times!
Your videos have done SO MUCH to help me navigate this often confusing system and I thank you for it! In general terms, and without a change in health status, how difficult is it to switch from G-HD this year to G in subsequent years? Also, is it wise to take advantage of an issue age premium now, at 65 and healthy - even though it is 32-62% higher (G-HD & G, respectively) than the most economical premiums in these plans? Thanks again - you do an incredible job of explaining things!
I'm so glad to know it is helpful! Unfortunately, the answers to your questions are... "it depends." I wish Medicare was more standardized, but the answers to your question will depend on where you live, the plans available in your area, and the insurance companies that offer those plans. If you want, you can send an email with your zip code to erik@90daysfromretirement.com and we can dig into that a bit deeper.
Thank you so much for watching!
I would take an Issue-age HDG in a heartbeat. Put your premium differential in a Savings account called “Medicare” (like a Christmas Club) and use it in your less healthy years. You will be ahead when at 80 the G premium has sky-rocketed just when you need and use it.
A 10% increase on a $60 premium is a lot less than a 10% increase on a $300 premium.
Excellent breakdown.
Thank you!
This is one of the most useful of all 150-200 hours of vids I have seen. It might well leave me with more questions than answers. I do get a lot of hate on Advantage plans, but are pretty much anecdotal and opinion without a whole lot of hard facts. I am coming up on 65 (5 months until X day). I have brewing problens, including at least one hip, kidney stones, and borderline A1C that wobbles from 5.6 to around 6 for no apparent reason). I also plan to relocate out of state, which I understand creates issuse with coverage territories. I also despise paperwork. With this package of risks and preferences I find standard G to look good, and HG to look second best... but this presentation on Advantage stirred up a bit of doubt. I do like the permanence, portability and lack of paperwork with G/HG.
For the "set it and forget it," nothing is better than a supplement plan G, as long as you can afford the costs that will grow each year. If there is concern around high-cost medical problems in the future, supplements are great.
Advantage plans have benefits too, just need to be aware of what you're getting.
Thank you for watching and your kind words!
You have done a fabulous job
I like your videos. Very useful. Please continue! I observe 1 thing in this video and please help clarify. According to this video (a year a go from August 2024), for the ADVANTAGE plan in your table, I thought the client needed to satisfy the MOOP obligation (like 7 - 8K) out of this bill total? I did not see this MOOP was mentioned in the column! Thank you.
Advantage plans have a MOOP. I think you are mixing that up with a deductible.
A deductible is the dollar amount you must pay 1st before insurance helps. Most advantage plans have $0 deductibles, so coverage starts immediately. Only 3-5% of people on Advantage plans hit the MOOP.
Very informative and somewhat surprising to me. White board examples always help with information. Thank you for this video.
Appreciate you watching. We will have more with different results coming!
The way I see it, if you’re healthy and don’t need doctors visit regularly, take GHD, pocket the difference $1800-$670 as self insurance for the bad year such as this example, otherwise you’re out of pocket every $1800. Advantage is simply too restrictive, what you don’t know is how much hassle you have to go through to get all the treatments approved.
Solid reasoning. A lot of people go that route. Where you lolive and plans available make a big difference.
Thank you for watching!
Thanks for using a real life example. Can you please add a column to compare Plan N as well using this same "case study"? Thanks.
We have one we're putting together around Cancer and we can put Plan N in there. This video is more general, but has a comparison with N:
czcams.com/video/LmpaQdZxyl4/video.html
This was very informative and actually was surprising to me, since most of the information I have seen indicates that MA plans will cost more than Med Sup plan G when major medical expenses occur. I think it should be pointed out, however, that in many if not most cases surgery for a joint replacement (apparently the case you explained) will follow a series of doctor visits, physical therapy visits, imaging and possibly alternative therapy prior to the surgery event. In my case for a hip replacement, there was an initial visit with the primary care doc to report the symptoms, followed by X-ray and follow up visit with PCP to receive diagnosis and discuss treatment options. Physical therapy was the first alternative we agreed on (24 sessions) with some minor improvement in my pain level. Next step was a corticosteroid injection in the hip, which often provides weeks or months of relief. I got about a week of improvement. THEN the sequence you described began for the surgery. So in my case the total expenses were considerably larger. There is also medical equipment cost for rehab to take into account. I believe this sequence is fairly typical for joint replacements.
First - thank you for watching and adding your perspective 🙏
Second - Depending on what the Max out of pocket is on the plan, for covered services, an Advantage plan is often less expensive when premiums are factored in. This is assuming a few things like the procedure is covered and has not been denied by the Advantage plan and it is performed in-network. The big drivers to high costs with Advantage plans come from multiple, multi-day stays in a hospital (Part A) and major issues like cancer, heart conditions, diabetes, kidney failure and others. We have this video here that goes into those a bit:
czcams.com/video/cgo5luXwDqI/video.html
We're making other videos with different examples to show when supplements are more cost-effective.
@@Theretirementnerds --Thank you for your prompt reply! I think the basic point I was trying to convey was that surgery is often the last step in a treatment plan, as mine was. The additional costs for these services leading up to surgery would not increase the total MedSup out-of-pocket costs, but would add significant cost to the MA out-of-pocket costs, narrowing the cost gap between MedSup and MA plans significantly. I also agree completely that the primary advantage of MedSup Plan G is realized with a major, prolonged illness as you stated. The channel is great and I appreciate your presentations.
@@DanMiller-rk4wo Appreciate you watching! We can try and recreate the services you mentioned with the average copays we see in our area with Advantage plans and see how big or small that gap would be.
IT DID surprize me-and I think I'm better off keeping what I have--- or get PLAN G.. none of the advantage crap- or whatever.. THANKS.
This is an interesting video. I just recently signed up for an advantage plan with a maximum out of pocket cost of $8,300 (so I can pay much less in monthly medicare premiums). If I stay healthy, maybe I did pick a good choice for me, after all. The $8,300 number scares me, but from watching the numbers in the last column of your whiteboard, maybe I have been needlessly worrying that MOOP is exactly like a *deductible* , when it actually is not.
I'm new to your channel but it seems you left out the impact of the quite sizable difference in the premiums. I live in Florida where part G is closer to $200/month and our Ghd is $50/month. It's true that in high utilization years the out of pocket max gets hit. In our case $3300 - which would require using approx $14k of care. (Works out to around $40/mo more than Plan G but only for high use years) So, in relatively healthy years there is a substantial savings. In the two years my wife and I have been on a Ghd we've saved over $4000 over plan G. I was on a very popular advantage plan for only 3 months and was denied a drug I'd been on for decades and required to use a cheaper injectable form of it before they might approve of the original drug! Original Medicare seems motivated to help us pay for healthcare while Advantage plans goal is to maximize profit which can only be achieved by minimizing care or putting barriers between patients and access to timely care. My only concern about Ghd is that the future amount of the deductible is unknown. When we started it was $2400 and is now $2700. Everyone needs to run the numbers to make their decision. Your analysis of a high use year is helpful, but do you have a video that shows G vs Ghd in low use years?
Thank you for watching! This one was definitely more around a bad year than a good year. Florida is a state that has very high regular G premiums, which is why HD G is very popular there.
I'm glad you are happy with your plan. That makes us happy. We have lots of comparisons out there and then we are in the process of making more so keep an eye out for those 😊
Same is true about premiums. The future is a big unknown to all of us.
Oh, please regard my second comments. I still need your clarification of the ADVANTAGE column for my first comment. Thanks.
Thank you for your prompt action in pulling down the previous version of this video. As I watched it, I could not believe you were making these comments. Before I could comment to you, the whole thing disappeared. Thanks. As a follow up to this new version, can you come up with scenario where G HD and/or G is the lower total cost? Seems like that would be in line with not pushing one plan or another unless there are no scenarios where the other plans would ever come out lower. Thanks again for your rapid response to the errors in the previous version of this video. By the way, nobody cares how much it costs Medicare even if they should.
Of course! We just lumped in Original Medicare with Supplement but that wasn't clear enough.
Yes, we are going to have a little series of sorts where we do this similar thing with a few different examples. The one favoring supplements will be next.
The big tipping point in favor of supplement plans *strictly from a cost perspective* will be Advantage plans with higher out of pocket maximums than the deductible and premium costs of supplement plans. This is assuming the person stays in-network and procedures are approved, which is a whole other topic. So, if someone is on an Advantage plan with a high out of pocket maximum and they have a lot of health issues (cancer, multiple inpatient hospital stays, diabetes, kidney failure, heart issues, etc.), supplement plans will come out on top. Or if someone on an Advantage plan goes out of network.
Thank you for watching!
The difference between G and high G premiums in NY is over 220 a month in premium. Over 2,500 a year. And with advantage no guarantee insurance will approve surgery or testing. Or would have to wait pending approval. And you have to use their facilities.
In certain parts of the country, New York being one of them, Regular Plan G is very expensive and difficult for most to afford. Great points!
Thanks for info, some insights. As to Advantage Plan 'paying' tha much, ok, lets say they do, but against that is how much the Federal Gov't via Medicare is paying the Advantage plan 'on your behalf'. In reality its more like the advantage plan will get the total for orig medicare paid to it, and then presumably, so they 'can make a reasonable profit' not pay the providers as much as Medicare paid them. Be it in a lump sum as I suspect it is, or via monthly premium payments paid to service you for Medicare. As far as most folks watching this, consumers of medical services, all that matters is the how much for a year to 'you' for each column. Orig Medicare leaves YOU paying 20%, some 5 G, and Advantage needs a big caveat, and that is IF THEY APPROVE YOU GETTING ALL THESE TREATMENTS. If they don't you will have to pay.
I listened to the video again. You meant to compared with the ORIGINAL Medicare, but in the your table you labeled the Original Medicare as ADVANTAGE.
It's a no-brainer when you're broke you have two nickels in your pocket you give them one nickel where everybody wants your soul but it doesn't last forever because there's a lot of people don't have any money anyway
More than Medicare Supplement or Advantage plans, I like facts. I would still rather pay the extra cost of Part G than get approval from an insurance company. Can you go from a High Deductible Part G to a G without underweighting during open enrollment?
Hi Mark, that'll depend on the state you're in and the insurance company policies they choose. But, the general answer is "No... with exceptions."
Good video. It's a roll of the dice in a way to guess how healthy we will be as we age. I still like t he G-HD because I'm thinking (me at age 60 right now) I will not have chronic, expensive issues each and every year. There's probably a break-even point where G-HD really saves money, if you have an expensive year 1 out of 5, say. As it's open-enrollment time on my prior employers' retiree site, I looked -just for giggles - on their only option for 65+, it's a crafted UHC Advantage Plan. It sounds all too good to be true. I'd be dubious of that tho. The company basically self-insures and they have the insurance company administer it. And the company has a history of peeling back benefits, so a year or two down the road that plan may not be so good. I'd like to see the G-HD be qualified to use with an HSA, that'd be great - in that, we could still contribute to our HSA's after age 65-beyond Medicare age, so we'd get the tax break on the deductible - that'd be a no-brainer all day :)
We're with you on the HSA idea. We wish it was an option for seniors. Thank you for watching and sharing!
Great video, yes Advantage plans do get a bad rap but they have alot of good points especially with the yearly out of pocket cost max. You could have a million $$$ medical bill and you would only be liable for the yearly out of pocket which run even under $3,000. in alot of advantage plans. And something people should know is that the advantage plans will and must cover anything regular medicare would cover.
I had a 5 star Advantage plan and my total out of pocket was 7500. Now, if I had cancer I would also be paying for the cancer drugs and most are tier 3 or 4 and you would have to pay all those copays of 30%. With supplement cancer is cheaper.
@@judithholleran6423 I believe you would not pay any more than your out of pocket yearly maximum, 7,500 is high, was that your out of pocket yearly max? I see alot of them at apx 2000, 2800, once its met no more paying orders co-pays for the year, its good protection.
Thank you for this helpful breakdown.
Thank you for watching and for taking the time to comment. We appreciate it so much!
I'm confused now. I thought the supplement/advantage plans also require you to pay Plan B premiums!? So plan G costs the 1980 + 1800 + 226 = 4006!? The GHD costs 1980+670+2700=5350 and the advantage plan 1980+820 = 2800. Not least to mention you need a Plan D to go with the Original/G's and to get a true apples to apples comparison with the advantage plan you need to price private dental and vision plans.
You are correct. You would still have Part B premiums regardless of which route you take - supplement or advantage.
Here in NJ it seems that most advantage plans have a high MOOP. I'm on my employer's PPO plan at this time, it has a $5,700 MOOP and it's "the best" plan my employer offers ... I am grandfathered into it - the other plans are high deductible plans. Without taking premiums into it, as things happen in life it has cost a lot to maintain my health as I have hit that MOOP twice in 4 years. Personally I can't wait to get onto a plan where my MOOP is just premiums and whatever copay I need to pay, so for me it'll be original Medicare + Supplemental.
The question though should it be Plan G or N, I am leaning toward G. I tend to think as time goes on it's possible more doctors will start charging that 15% excess charge but who knows!
Advantage plan MOOPs are highly variable across the country. It's important to note that an Advantage plan works differently that your employer plan, and we outline that in this video: czcams.com/video/woHUBw0THdM/video.html
In regards to G vs N, meeting with an agent licensed in your area would be wise and they can look at premium differences, check your providers and frequency of visits and point you in the right direction.
If you have someone, use them.
If not, happy to help. My email is erik@90daysfromretirement.com. I have a few partners licensed in NJ.
@@Theretirementnerds Thanks! I just watched the video and understand!! I appreciate the info
Thank you for watching!
If you purchase a hospital indemnity plan with an outpatient surgery rider and rider for therapy that covers the out of pocket costs of the advantage plan
Hi Gina, check out this video we made on that :)
czcams.com/video/cgo5luXwDqI/video.html
You made the video longer than it needed to be. Putting in costs to Medicare system, muddies the waters, we are simply try to find out the cost comparison for the individual. You are on the right track with the comparison videos, they are valuable, but you could make them simpler and get to the real point. I would also have made it very CLEAR what the final total cost is. You had several costs underlined, making it not so clear. Thank you!
Thank you for your feedback! This video was made after someone asked us the costs to OM, which is why that's in there. In most of our other cost comparisons, we keep that out. Thank you for watching!
Thanks again. Your comparison videos are very good for the most part - a real service to us seniors.@@Theretirementnerds
A very good video and I admit I was surprised!
Thank you!
Be sure to watch this one because there is more to it than just this cost example 🙂
czcams.com/video/yxXuGQYJ-ug/video.html
I was suprised the advantage plan came out costing less. It was a good explanation of a complicated system, Thanks
Thank you for watching. It doesn't always work this way, and we'll have videos showing the other way around.
We're gambling. The networks, pre-authorizations & lower out of pocket won't harm us in the long run. Spin the wheel & hope our color comes up.
It's definitely a "do you want to pay now (supplement) or pay later (advantage) situation.
My mother is 80. She has RA and is deformed from it. At this point, she is going to likely need a skilled nursing facility or home care. She has problems with her hip. I suspect they want to do a replacement. She is on an Advantage plan. She asked for my help to make a decision during open enrollment about her Medicare. I am willing to pay her premiums for a supplemental plan. It seems to me the kind of coverage she will need will be better covered with that. I understand she will have to go through medical underwriting if we go that direction. I do not understand that process. Can you help?
Happy to help in any way we can. Want to send me an email to erik@90daysfromretirement.com with the state your mom is in?
In California we have a maximum out of pocket deductible amount of $3399 for Medicare Advantage plan…
There are some areas that are $500! Lots of variability in those max out of pockets. Thank you for sharing!
Your bottom number shows MAPDP is the best but you omitted one important factor which is, on MA plans, the insurance decides what medical procedure deemed necessary for you and when you can have it. That is we call “referral and prior authorization.” In one word, you’re not in charge of your health when you need medical attention and treatment. This could cause red tape resulting in treatment being delayed. With that being said, MA plan is cost sharing program, naturally it focuses on prevention. Keep you away from hospital and being sick as long as possible, therefore, it’s designed to prevent rather than treat sickness.
Hi there, please watch some more videos on our channel 🙂 we cover all this in great detail
Never, ever in a million years, would I have the Advantage plan. It's very bad and they deny you everything, you have to do what your family doctor tells you. I prefer PPO and choose my specialist doctors. I'd rather deprive myself of going to restaurants and buying clothes but have the best health insurance. I will go for Plan G.
Probably need to see this video
czcams.com/video/sA9EzoiHjEM/video.html
Thank you very clear very helpful
So glad it was helpful! Thank you for watching!
i realize you are using averages, so not criticizing, but where i live (IL) my quote from BCBS for plan G is $315/mo, HDG is $113/mo as of today's date (65 soon, perfectly healthy etc). Haven't checked other providers, but my guess is they are all similar. I hope there are more affordable plans. If not, I may just have to move! lol. (update - uhc is much less, for me👍)
Yes, where you live has a big impact on those costs. In general (not always) states with more flexible switching laws have higher premiums costs, and Illinois has a birthday rule around supplement plans where people can switch around their birthday without underwriting to certain plans. We have a video on that coming out soon :)
This is the first year that I've gotten anything other than regular medicare. Luckily, I haven't had to be in the hospital or have any surgeries. I just paid my doctors whatever Medicare didn't cover. This year I took an advantage plan. There is no cost to see my primary care Dr and my co-pay for a specialist is $40. That's a big savings. Also, I'm learning about co-pays for other things too; $15 for x-rays and some blood work cost an extra $5. But recently, when I had to go to an urgent care center, the co-pay was $60. That was a deal. It included the x-rays of my ankle, the Dr time & him looking at the xrays, as well as crutches and an immobilizer boot. He did say I should see an orthopedic or podiatrist and what will be involved is a concern.
Thank you for sharing your perspective!
I'll be 65 next year. I want to get the best plan and I'm willing to pay more to get that. So I think I'm going with the G plan and planning to get Plan D for my prescription. I just want a peace of mind.
Smart. For those who can afford them, Plan G is an amazing way to go and gives exactly what you mentioned - peace of mind.
Elephant……. When do supplement and advantage plans go into effect when you sign up?
Hi Sharon, thank you for watching!
When they go into effect depends on when you are signing up for them.
If you are signing up 1-3 months before your 65th birthday, they go into effect on the 1st day of your 65th birthday month.
If you sign up during your 65th birthday month, it is the 1st of the next month.
If you are switching plans during the Annual Enrollment Period (October 15 - December 7th), your new plan goes into effect on January 1st of the next year.
There are others, but hopefully that helps!
Just to see if I understand, regardless of advantage or supplement plan, all will pay the monthly $174ish each month for Part B? Specifically, if I choose Advantage I will pay the part B premium montly?
Correct.
There are some advantage plans that have a Part B reduction benefit where they will help pay for some of that, but those are the exception, not the rule. Those generally make up for that by reducing the benefits in other areas of the plan as compared to a similar plan with no Part B buyback.
Could you do a couple more of the real world cost 1. Heart Angioplasty with two stents and 2. Breast cancer with a mastectomy? Maybe add a N plan to the list.
We can take a look at those! We don't have actual claim information for them, so it'll be pretty loose in terms of just looking up averages, but we can give it a shot.
We did cover a different form of cancer here: czcams.com/video/2YCI8m0Ol18/video.html
@@Theretirementnerds Thanks. I watched the cancer video and it was very informative. I wish you would have added the drug cost. When my mom had breast cancer that was the most expensive part of her treatment. Having said that, I can see how quickly comparing all the costs can get overwhelming.
@almoemason we are working on some real drug videos, and you are correct, it gets pretty chaotic. We made this video about how Part D will work in 2024: czcams.com/video/KLUZJMY5QYw/video.html
It only goes through 1 medication. Once multiple high-cost drugs come into play, Part D works the same, it just moves people through the phases quicker.
What do you think about Medicare Advantage paired with a Hospital Indemnity to compete with Med Support? Seems the high hospital and SNF copays in MA can be mitigated this way.
Great way to keep fixed costs lower (premiums) with protection against the MOOP. In our area, a hospital indemnity and Cancer is around $50 a month.
There are two problems with advantage plans one is I’m pretty sure MA cost Medicare more overall than traditional Medicare not for this example or any specific situation but the upfront money is more than traditional Medicare would cost. The second and more important to the individual is the requirement for prior authorization etc. All that said I live in an area with especially high premiums for supplement plans and most people I know have MA and most are happy with it. One friend I knew just got treatment for cancer and has had excellent treatment. I don’t know if prior authorization was required but if it was he got within 48 hour maybe less. I will say the MA plan isn’t zero premium so that might have helped.
Thank you for watching Jerome.
1. If someone is healthy and not using the healthcare system, and they are on an Advantage plan, then yes, Medicare is paying an amount monthly for someone that is not using the healthcare system. Very much like all insurance models. Why the government likes it though, is because the 80% of all costs with unlimited risk is not shifted. In the insurance world, risk is an actual liability and entities are transferring risk in exchange for dollars.
2. Yes, prior authorizations do happen. Advantage plans are required to cover everything Medicare covers, just not in the same way. There are horror stories around prior authorizations. There are also a lot of great stories around Advantage plans. Where you live and which company you pick matters.
Thank you for commenting!
Great but forgot anesthesia bill
Hi Eileen, anesthesia would be in that surgery cost. Hope that helps!
I didn’t see in the video any mention of the Medicare Part B monthly premium that you have to pay no matter which options you choose, supplement or advantage.
Hi Joe, thank you for watching. You are correct. People need to pay that regardless of Advantage or Supplement. This was trying so show differences and the Part B premiums are more of a constant and the same for the individual, regardless of the plan choice. Important for people to know! Appreciate your comment!
Can you run a comparison for a cancer treatment scenario?
That's what I keep hearing about where an advantage plan will cost you...
Great idea! Will make a video around it, but the main difference is that, in many cases, there is a 20% coinsurance for cancer treatments with the Advantage plan, up to the plan's out of pocket max.
So, if you have an Advantage plan with a $5,000 out of pocket maximum and you get cancer, cancer treatments can run we've seen as high as $1M. Well, you are responsible for 20% up to the out of pocket max, which in this example is $5,000 - so you would pay $5,000 - higher than the $226 deductible with a Plan G or the $2,700 deductible with HD Plan G.
We have a video here that discusses how people on Advantage plans often deal with this:
czcams.com/video/cgo5luXwDqI/video.html
Thank you for your comment and we'll put this video in our list to make!
@@Theretirementnerds CORRECT IN SAYING THOSE NUMBERS REPEAT ANNUALLY
ALL $$$ NUMBERS ARE CONTROLLED BY STATE AND ZIP CODE
Hi @richardpiotrowski1043
We finally got to make a cancer treatment scenario video :)
czcams.com/video/2YCI8m0Ol18/video.html
What about the Part A deductible?
Hi James, each of these plan options cover the Part A deductible 🙂
👏👏👏👏Excellent presentation 💯 thank you ❤😃
Thank you!
Very honest review!!! Thanks!!
Thank you Randy!
Another great video. Very informative. Just a personal comment: “I am not too wild about the mustache and beard”.
Haha, I'm not either. Have a family thing I was asked to grow it out a little for. Will be coming off this weekend 🤞
I thought on an Advantage Plan for the 24 thousand dollar surgery don't you pay 20% and insurance pays 80% of that bill?
Not with Advantage. Most Advantage plans have a surgery copay.
Original Medicare is the 80/20 concept you outlined.
In all fairness, the drug plan premium should be included. I saw an 85 y.o. client today who has been on an expensive PDP for the last 20 years (>$85/mo) and on 12 medications. However, she has never had a supplement, and has been being treated for cancer for the last 2 years (no cap to the 20% medicare B coinsurance obligation). Cancer notwithstanding, if she was healthy and passed underwriting, plan G would cost her $300/m due to her age, and her drug plan would add another $85 plus a $300 deductible and copayments. Her Advantage PPO has no drug deductible, all her meds are $0 being tier 1&2 and her MOOP is $4900/$8950. Best I could do to mitigate her expenses.
All excellent points!
In this example, the lady had to be overpaying for her Part D by thousands of dollars over several years if she was paying an $ 85 per month premium. If she had tier 1 and 2 meds (mostly or all free to her) she surely could have found a free minimal premium Part D plan. $ 0 to $ 20 / month vs. $ 85 /month. If she had a $20/month Part D premiums that would have her saving $ 65 a month in total premiums (supplement + Part D)
It sounds like someone has let this lady over spend on her Part D plan for ages and ages. -- Esp. if she has only tier 1 & 2 meds. --- Maybe she or someone thought or was led to believe "the "best" ( more expensive) drug plan is "the best to have". -- I've known people that thought that way or could be led to think that. Someone could say, "Here's a plan for $ 0 or $ 20 a month, but here's "the best plan Company X has". They'd say, "I guess I better take the best one." (at $ 85 a month) -- All the while not needing "the best".
I'm turning $ 65 and going with "original" Medicare + a supplement. I
I agree, but she was signed up for this plan in the early 2000's when the government made part D required, and neither she nor her husband ever bothered to shop around after that because they knew they were covered and could afford it. She never got on a supplememt because she was healthy (although introduced in 2003, medicare advantage didn't really come on the scene until around 2010) and couldn't see the point of an extra $200/mo, Then she got cancer. And I got a call.
I know you have decided what direction you want to go, but talk to an agent and let them give you a breakdown of the benefits of each plan before you pull that trigger. They will also let you know of changes or if a better plan comes available to suit your needs year over year. You may be amazed, or more resolute in your decision.
I'm 68. I pay $78/mo for Mut of Omaha Plan N and $8/mo for my Part D drug plan (Wellcare). All drugs are tier 1 - I pay $0 for 6 meds. Can't beat it.
@@8thman8 My job is to find the best available plan for each of my client's unique circumstances and thoroughly explain before they commit to that plan.
Supplement premiums are age, zip code and medical history specific. My client is 85, in Florida and undergoing cancer treatment for 2 years with only traditional medicare (no supplement). With her medical history, a supplement plan is not going to accept her. Her MAPD PPO is $0 premium, $0 copay for primary visits, includes her medications and has a maximum out of pocket cap. That was the best I could do under her circumstances.
Very unexpected. But how likely would the surgery have been approved with Advantage and how much time (and discomfort) would the patient have to tolerate waiting for the approval. Cost-wise, though, I'm a bit surprised.
Hi Tim, in this example, the surgery was approved with the Advantage plan within the week. They are not all like that of course and as we mentioned in the video, this is just dollars. There are a few other videos that go over the other details to consider when deciding between the two plans. Thank you for watching!
I live in Connecticut. In the last 5 years, I have gone 5 times to the doctor (just for physicals) I am taking an advantage plan until I get a serious condition. If I do, I will switch right away to HDG. Any objections?
What are the best choices for those that move from state to state, it appears that the HDG may not be the best choice? If you have the supplemental high deductible plan G (HDG) in Florida and move to Nebraska where the HDG is not available what options are there? Also if you move from Florida to another state that does offer HDG how does your deductible factor in? If you had spent $1800 of the $2700 deductible in Florida and now move to another state and enroll in another HDG does the $1800 amount count towards the $2700 or do you have to start over with the deductible?
Hi Thiago, thank you for watching and for your question.
The short answer is that supplement plans are portable. You got your HD G in Florida, you can take it with you to Nebraska. This makes them very different than Advantage plans.
Now, there are some carriers that will see your address change and then switch you over to their same product in the state, but not all do that. Especially, as you stated, if there is not that same plan in the state to which you move, but some carriers don't care. Since Supplements cover any provider or facility that participate with Medicare, you can use your plan anywhere in the country.
Your deductible carries over. You would not need to start over on your deductible if you moved states and had to change plans.
Does that help?
Medigap plans are completely portable because they don't use networks. You only have to find a health care provider that accepts Medicare.
This is an outstanding video and visuals!
Thank you!
I am a subscriber to your channel. I love that you give examples of some of the cases with these plans, be either Supplemental or Advantage plans. On this particular example on total out of pocket of each plan, my question is on the Advantage plan; What if the total out of pocket on the Advantage plan in Network is $6400, wouldn't I need to meet this total first before my Advantage plan pay the rest?
No, out of pockets are different than deductibles.
A deductible is what you are referring to where you would need to pay the deductible before insurance helps.
Most Advantage plans do not have a deductible and start helping immediately like in this example. Once the amount you pay equals your out of pocket max, the plan covers the rest of your costs for that year.
We'll make a video about this and other examples 😊
Thank you for watching and subscribing!
@@Theretirementnerds Thanks for your quick response. God bless.
The Supplement Plans will look even worse if the same costs scenario were to occur in such a way that they straddle two plan years.
Very good point. We'll have other scenario videos. Your example is a good one to show. Thank you!
SUPPS ARE ON A CALENDAR YEAR BASIS AND START ALL OVER AGAIN. SOME COS. WILL ADJUST DEDUCTIBLES ON PRO RATA
Not really. The Advantage plan will reset, too. And the MOOP can be up to 8300 instead of $0 for the Supplement. (I pay only $78/mo for my Mutual of Omaha Plan N)
Don't you have to pay the part B deductible before Medicare pays 80% for the first two specialist visits? You had the cost for our portion for those on G and HDG at only 100.00.
Excellent video!
Thank you Susan!
Nice comparison. Now do a comparison where the person has a year where they are relatively healthy.
Great idea!
TY for the excellent video. It does bring up some interesting questions. You didn't point out that in the second surgery case the Advantage Plan would have paid out a total of $53,960 . I'm assuming this difference is mostly caused by Original Medicare paying 80%. Further assuming (sorry for all the assuming, but getting the facts in this area is very difficult, it's almost like they don't want us to know) that the beneficiaries are very similar in the medical expenses generated, how are Advantage Plans (at least ones like in the example) able to be profitable given that 20% differential? Wouldn't their only choice be to suppress medical expenses incurred by that 20%? I read the 2022 MedPac report. It states that Advantage Plans cost Medicare more per beneficiary than Original Medicare which seems inconsistent with your example. Any information or explanation you might supply would be greatly appreciated.
Of course!
All excellent questions. Let's see if we can explain well enough in a comment :)
Advantage plans are able to profit as long as the beneficiaries' costs are less than the reimbursements received. The main way they are able to profit is through healthy beneficiaries. In this example, imagine that the beneficiary is healthy and does not need anything outside routine preventive visits for medical and dental. That healthy beneficiary's costs to the plan is let's say maybe $1,000 on the high end? So the net profit in this example would be the $13,400 for the Advantage plan.
Many conversations around Supplement vs Advantage plans go "if you're healthy - Advantage. Not health - supplement."
So there is an adverse selection effect of higher-risk people who can afford the premiums going with supplement plans and lower risk people leaning to Advantage. That's at 65 y.o. though. As we age, we tend to get less healthy, not more. So, if an insurance company has more people on the plan who use the healthcare system less than their reimbursements, as a whole, the company is profitable.
I think the problem with the high level articles is the assumption that the insurance company is profitable on EVERY beneficiary. They are not. Not even close. But as with all insurance, they bet on the less-costly being able to subsidize (maybe not the best word, but only one coming to my brain right now) the more costly. So, interpreting that MedPac report without diving into a lot of details would put that if we take all of the Medicare beneficiaries across the country currently on Advantage plans, the low-cost to high-cost beneficiary number is positive.
Suppressing medical expenses is a bit strong. I know you weren't trying to be and makes sense. Managed care is the technical word and is probably most accurate. The plans try to manage care by ensuring that the services the patient is seeking is medically necessary. Some providers complain that insurance companies pay them less than Medicare, which suggests that some Advantage plans reimburse less than Medicare and are managing costs through the provider network.
There was a New York Times article that read that Advantage plans denied 13% of procedures that should've been approved. Looking into that, the conclusions were taken from 250 claims over a 1 week period in July of 2019. Of the hundreds of millions of claims that happen each year, this study left me wanting a bit stronger sample size than what they extrapolated those conclusions from. That 13% number could be high, or it could be low. However, the government has a vested interest in making sure this all runs correctly and ensuring carriers don't deny necessary care.
Complex topic for sure. Possibly the longest CZcams comment I've ever written as well.
@@Theretirementnerds that was an awesome explanation. Thank you so much for giving your time and knowledge.
@@brendahunter9134 aww thank you! Appreciate you watching and leaving such a nice comment!
one thing people should be aware of is with the Advantage plan since they are taking on all the risk, they have the option to reduce their risk by dropping you. Then you do not have the option to go back to Plan G or N and hope another provider pick you up.
This is not correct. An Advantage plan cannot drop you for no reason, nor can they drop you because you have health problems or you are high risk.
If an Advantage plan leaves your area completely by withdrawing from that area or is shut down, you would be able to go to Original Medicare and a Supplement with no underwriting.
If that happened, it is to everyone under that advantage plan, not just an individual.
@@Theretirementnerds Correct, but if you have Advantage Plan and get serious diseases like cancer or kidney disease you cannot go back to a Supplement Plan because of these health conditions.
In this video, I think the High Deductible (HD) plan out of pocket expenses would be the $2700 (for the Gap plan) plus the $226 Part B deductible, and not just the $2700. Is that correct?
Great question.
The Part B deductible you pay is included in the $2,700 HD G deductible 🙂
Great question!
My spouse has a HD supplement, and we were told that the 2700 is in addition to the 226, and our Gap online account info showing what he has paid out of pocket so far, does not include the 226, and both our agent/broker as well as the gap insurance company have said the 2 deductibles are separate....yet several online Medicare education videos say the 226 does apply toward the 2700, so I am very confused as to what to believe.
I'm looking forward to watching this, but I am about 99% sure I'm going with Plan G next year when I go on Medicare.
Just a warning - and we say this in the video - this is strictly dollars and cents on a particular, high-cost example. For many people, there is a lot more that goes into the decision outside of strictly dollars and cents. Would definitely recommend working with an agent to talk about the importance of providers, health, finances, etc.
Hope the video is helpful!
Rick, good luck when searching for the best gap plan. I went through the process this year. I found out that some insurance companies give discounted premiums depending on how many members in your household are 60 or over. You would receive a discounted premium when you sign up. When the next person reaches Medicare age and signs up with the same insurance company as you, then both of you receive discounted premiums. As some insurance companies who sell Advantage plans and gap plans, provide some of the Advantage perks to their gap plans.
Love my plan G in Ohio!!!
I thought the high deductible -G plans had a medical savings account too, but you didn't mention that. How do those work? I have an HSA and that is the only useful part of the insurance.
HSAs are great. Can't use the dollars for Supplement premiums, but great for everything else.
A video on Medicare MSAs is a good idea and we will work on that.
May be using the same words to describe 2 different things, but Medicare Medical Saving Accounts are connected to high deductible Advantage plans:
www.cms.gov › files
PDF
Your Guide to Medicare Medical Savings Account (MSA) Plans
Hello. I live in Florida. I am attracted to G High Deductible. I discovered that not all the health companies offer High Deductible. So, I am deciding between United American Insurance OR Humana.
I cant find ratings.
Your opinion about United American?
Or is there anybody here that can comment? Thank you.
Got your email 🙂 we are on it!
Just to clarify, original Medicare with a Part G will pay for any procedure, no matter how expensive, if the doctor says it's a medical necessity - no questions asked? i.e. no past supporting medical records required?
Thanks in advance.
Not the doctor. Medicare.
If Medicare deems it medically necessary and approves it.
There are lots of things Medicare will not cover.