Medicare Advantage vs Supplement Plans | How Do They Work With Drug Coverage?
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- čas přidán 30. 06. 2024
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Erik@TheRetirementNerds.com
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The Retirement Nerds is the no-cost educational platform and serves to offer information around Medicare, Social Security, Financial Planning, and Estate Planning.
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Erik@TheRetirementNerds.com
⏰ TIME CODES ⏰
0:00 Introduction
0:55 Similarities
1:05 Structure & Phase
3:49 Making Changes During AEP
4:46 Differences
4:56 Premiums
5:36 Deductibles
7:33 Changing Plans
10:21 Biggest Takeaway
11:26 Wrapping Up
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#medicare #90daysfromretirement #medicareexplained #prescriptiondrugs #medicareadvantage #medicaresupplement
Federal Disclaimer:
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all your options.
One thing to note - Someone is allowed to switch to a 5-star Medicare Advantage plan at any time during the year.
We mentioned that unless someone qualifies for certain events, they can only switch during AEP. This is correct... UNLESS... they want to switch TO a 5-star Medicare Advantage plan. Then, they can do so at any time of the year.
Thank you for watching!
We need healthcare that’s Not For profit. Different than Non profit. Not for profit makes profits, but it goes back into the care, facilities and lower costs for people. If well regulated. We need a not for profit model that’s open to all.
So this week I go to my heart doctor for the yearly visit. Once you go the first time they suck you in but it does give me peace of mind when the doctor gives me the thumbs up as patient of the day as he did last year. I am going to ask for the insurance lady when I go and see if she has a recommendation on carriers. Not sure if she would. I might be better off asking other patients lol. I see you mention 5 star advantage plans. I would think the Stand Alone Drug Plans would have ratings too. It's just so much to remember and I barely remember yesterday sometimes. I know you stress to not use these videos as the sole guide in making these important decisions, but these videos help so much in guiding us all. You keep doing them and we will surely keep watching. And when that time comes sooner than later I will be contacting you. Great Job!
Thank you so much!
Thanks for the great explanation! I have drug cover through my group medicare advantage plan. The state negotiates with the insurance company on the drug plan, and it has been working great for me.
So glad to hear you are happy with your plan! Thank you for watching!
My Humana H5216-304 PPO Advantage plan has for Drugs: 0$ deductible for the initial phase, gap phase and limit of 5% for catastrophic phase. All generics have $0 copay. That is quite different from a Part D insurance plan.
Thank you for watching!
If I'm understanding your comment correctly, your plan has no deductible and you start in initial coverage. Then you would work through initial coverage and the coverage gap until you reach catastrophic coverage, at which point you have the 5% coinsurance. Am I understanding correctly?
@bab008 yeah I'm trying to disadvantage plan for the first time this year some older people tried talking me into it for that zero copay yeah that's where they get you and then they don't even pay for one of my medications I got paid for it out of my own pocket then if you ain't on regular Medicare if you ever get really sick you need to pre-authorization from Humana so when you got them people running your health care that's not good I'll go back to Medicare ... but if it works for you good luck cuz I found out this year I'm going back on mine that advanced plan it be called a disadvantage plan and it should be fraud there should be no private insurance company buying our insurance.. The older people have to deal with changing every year they do that for a reason they'll suck you in one way or another GREED but like he said one size don't fit also good luck with that sir..
Thanks so much for the helpful info.
Thank you for watching!
Thank you for the clear explanation.
Thank you for watching!
Very informative and helpful video!
Thank you so much!
Excellent balanced presentation. Thanks.
Thank you so much!
Excellent advice
Thank you!
Thanks for all the videos. They are very helpful. Somethings I am still not clear on. 1) Can you change from a plan G to plan G because the insurance is too high? Plan G high deductible to low deductible. Or plan N to plan G? Does each change require a medical examination? Thanks
Hi Ray,
The hard part to that question is the answer is, it depends.
Depends on where you live and depends on when you are wanting to change.
In some states (only a few), you can switch - no problem. In most states, the answer is - you can switch, but you are subject to medical underwriting where you may be either denied or face even higher premiums.
Some Insurance companies welcome it, others are more strict.
This video addresses a little more about it - more specific to Advantage and Supplement, but a bit around your question:
czcams.com/video/djuGeI829M4/video.html
What happens if you do not have the money to pay the hosp. bill?
if someone signs up for a supplement plan and after a month or two, feels they may want to change to a different supp plan with another company (with same agent) that’s less expensive, isn’t there a period of time they can do this w/o any penalty? i know the already paid amount is not refundable of course.
Hi there! Great question!
Supplement plan enrollment periods revolve around your Part B effective date. So, you have 6 months from your Part B effective date to switch those plans if you'd like without penalty. After that 6-month window, you wouldn't have penalties, you'd just become subject to medical underwriting where you could be denied a plan or see higher premiums.
Thank you for watching!
@90 DaysFromRetirement , Excellent presentation. I have a question: as of this year I am paying $9.50 for stand-alone part D premium, and I have $505 deductible a year AND , LET US ASSUME that we are in the year 2025. As you presented in another video, in 2025 maximum out of pocket expense will be $2,000 a year. Will this $2,000 include $9.50 premium a month and $505 deductible a year? Thanks in advance for your answer.
Great question. The deductible counts towards the $2,000 number. Your monthly premiums do not.
In 2025, the deductible will be $540.
I hope I'm wrong, but my guess is that premiums will go up substantially to offset this max out of pocket.
This video goes over the changes coming in 2024 and 2025:
czcams.com/video/eWy6y77cYBM/video.html
Thank you for watching!
@@Theretirementnerds Thank you much.
Main disadvantage of Medicare advantage plans is limited network Supplement plan G is much more expensive in most of the states and close to $200 only with high deductible . But anyways Classic Medicare in combination with supplemental plan is much better option
Im going to ask my agent but if I get a part C and a separate part D I can change the D and keep the C right since one has nothing to do with the other (unless I get both from the same co)
So this gets a little complicated.
They make Medicare Advantage plans that DO NOT have Part D coverage, but these are geared for Veterans.
Most Medicare Advantage plans have Part D coverage included in the plan. You would not be able to get a separate Part D plan that is apart from your Advantage plan. Does that make sense?
@@TheretirementnerdsShoot! The part C drug plan is expensive thats why I need to lower the tier on my meds. *sigh*
Great videos as always, Thank You.
I am curious though, (not drug related, but got me thinking with regards to separate plans), most advantage plans that offer dental coverage tend to be pretty bare bones, no extraction, crowns etc. If you decided to choose a stand-alone dental plan, how is that administered? Is the stand-alone your primary, or basically your only dental plan?
Thank you for watching!
Standalone dental plans are your only plan, or are you asking about if you get an Advantage plan with dental as well as a standalone dental plan?
Dental benefits vary a lot. Stand alone plans range from minimal coverage to decent, but rarely are they even close to what you may be experiencing with a company insurance plan through work.
To clarify... If I choose a Part C Advantage plan, that only provides basic dental (no extractions, crowns etc). Can I then purchase a stand-alone dental plan that provides the additional services I'm looking for? I would assume that that insurance company would be my dental provider, and I could change that independent dental insurer each year if I so chose? Thanks Again
@margievanhandel259 yes, you can purchase a standalone dental plan on top of your Advantage plan if you'd like and find one with stronger coverage than your Advantage plan. Does that help?
I’ll be 65 next year April 4, I live in the Bay Area and I need help in Medicare selection, I’ll continue to work till I can, I’m divorced
Happy to help in any way we can. My email is erik@90daysfromretirement.com
Feel free to send me a message and we can figure out what your next steps are.
Can you compare supplemental v.s. advantage v.s. 5 star advantage ?
When it comes to drug coverage, Advantage and 5-star advantage still handle it the same. It will all mimic what's in this video here :)
I am new to your channel as of today and I love how you give detailed examples. I will most likely be going on Medicare next October 2024. I currently take a medication that will be required for the reast of my life that is not covered on my marketplace plan and is $1200 per month that the manufacturer is helping out with due to the extreme cost and I am extremely greatful for. Unfortunately it is my understanding that it will be coming to an end as of Jan 2024 and I don't know what to do. I also have other medications that I pay cash for because it is lower than my marketplace plan copay cost. Unfortunatley those medicaitons do not go towards my deductable or MOP because of this and overall it may actually be costing me more per year but I am not sure. Can you give examples of the cost on the different plans. The whole donut hole thing really concerns me. Besides 7-8 annual specialist visits, I also will be having a major surgery within the next 2-3 years with an average estimated cost of $200K and $40K my portion (80/20) which would be a financial disaster if I took just medicare only. I am trying to budget my next few years expenses since I just recently retired at 62 due to medical reasons. Can you do a video that discusses the pros and cons of each plan and how paying cash helps or hurts the overall annual costs. If I understand you right, I would be paying more than my max out of pocket due to the dount hole. If you already have video on this, let me know as I have not yet went through all of them.
Hi Matt, thank you for watching!
Due to federal regulations, we can't discuss specific plans with specific carriers and their benefits, which is why we keep things general and use averages. Having said that, there are a few videos that I think would be helpful for you.
1. How Part D is changing in 2024 and again in 2025. This video has good news for your situation if I understand correctly from your comment.
czcams.com/video/eWy6y77cYBM/video.html
2. A comparison of Advantage vs Supplement: czcams.com/video/yxXuGQYJ-ug/video.html
This goes through how these two plans work and the pros and cons of each.
Not sure where you live, but in general, if you know you have high-cost medical procedures coming, supplement plans offer excellent coverage.
3. Medicare Cost Comparison: czcams.com/video/oiaI72qqWFY/video.html
This is for 2023, and 2024 numbers aren't out yet, but it is still a helpful video for those approaching this decision.
Once 2024 numbers are released, we'll do a similar video.
Hope this helps!
@@Theretirementnerds
Thank you very much for your reply. I watched your link#1 multiple times and stopped it a dozen times to write down figures that gives me some rough estmates for my situation which were more than I expected but allows plan which was my goal. Most people have no idea and are surprised by the numbers once on Medicare especially if you have high cost medication. keep up the great videos.
@@mattroslawski4534 so glad it was helpful!
If you change drug plans do you have a penalty or medical exam ?
No. No penalty or exams for Part D, but you can only change during specific times of the year, not any time you want.
They only cover cheap drugs that don’t work and have a lot of side effects!