Two important notes not mentioned in the video: *ER Visits - Supplement* There are instances where an ER visit, once moved to inpatient, will waive the part B deductible. It would still apply to the surgery and your total costs wouldn’t be affected in this example, but the exact placement of the Part B deductible could shift. *Other Advantage Copays* There are Advantage plans that don’t have all-inclusive copays and a handful of other charges could arise while inpatient. Think Durable Medical Equipment and other various charges that would marginally increase the total cost for the Advantage plan. This is a point you'd want to discuss with your agent if you are considering one of these in your area.
My wife and I chose a supplement plan over Medicare advantage for 3 reasons... 1) Advantage plans lock you into a network and the network can change from year-to-year. 2) Advantage plans vary from company to company and coverages can change from year to year. All supplement plans, no matter the company, cover the same maladies as Medicare (though the price may vary). 3) Advantage plans have a "pre-approval" provision for medical treatment. If your Doctor thinks a procedure is necessary, advantage plans have the "right" to deny coverage for said procedure.
Plan G for anyone with medical issues. I had my aortic valve replaced last year under my employer insurance, the total for the year, surgery, rehab, etc was around 123k, my part was 5k. The doctors office received approval from Anthem (ppo) the day before the surgery, so that added a lot of stress, I was lucky that I had a great surgeon in my network who was recommended by my cardiologist. I recently signed up for part G, and don't want to be stuck with networks and preapprovals.
my mother in her later years was DENIED "some" treatments by her advantage plan , financial cost means very little if you can't get the treatment you need. One nursing home turned people away if they had certain advantage plans, advantage plans should never get to play doctor because it could cost you your life.
I knew a person who was denied specialized diabetic wound care by Medicare Advantage. Just over-ruled the doctor. They could have appealed, but this takes time, time you cannot afford when you are ill. I think everyone who can possibly afford a supplement should go with regular Medicare. You do not stay healthy forever.
I'm guessing you mean a "skilled nursing facility" for rehab and not a "nursing home" as in long term care, since neither original Medicare with a supplement plan nor any advantage plan offers any coverage for long term care costs. That being said, as a former director of nursing in a long term care facility, I spent significant time battling with advantage plans over getting "prior authorizations" for my residents for needed treatments.
@@MrHaighahatta Yes, this is what I mean. I have read many stories about skilled rehab treatment being cut short by Medicare Advantage plans. By contrast, my wife, who is on original Medicare + supplement got all the skilled rehab the doctor ordered with no hassle. Because of what you mentioned, we both have long term care insurance through a private company. Hope it pans out, with private insurance companies, you never know.
I had a heart attack in 2018. It involved all the accoutrements: Medivac helicopter flight; emergcncy surgery; etc. The helicopter flight alone was over $20,000. My total out of pocket expense: $0. Medicare and Medicare Plan N and my gap insurance covered it all. Later I developed kidney problems and am now on dialysis. It's all covered. Medicare is the best government program in existence. I'm an eyewitness.
I'm a Medicare agent in SoOrange County CA. I started in JAN 2016. You folks do a great job. THX for all your hard work... and your consistent... spot on accuracy.
I had a heart attack Thanksgiving 2022. I was in the hospital for 5 days. The put one stint in one of my arteries. The bill was $167,000 but they discounted it to $116,000. I must be going to a high line priced facility comparing to other costs that I’ve viewed on here for a similar procedure? My private insurance paid all except some small misc charges. I’m now on Medicare with a supplement N. I feel good about my insurance going forward.
Thank you for sharing David. So glad you are comfortable with your plan, that is important. And yes, hospitals will all charge much different amounts. Thank you for watching!
I'm on Plan G and something I like is the quality of service. I don't trust an Advantage Plan to give me the same. I get to pick my providers and specialists
In 2018 I got in a bike accident and crushed my index metacarpal bone in my right hand. The best hand & wrist surgeon in my area would not take my Healthnet insurance because they would not pay him what he was worth. Yet he would take Medicare Supplemental which would pay him about 40% more than a network would pay him. Regrettably, I went to an in-network orthopedic surgeon who botched my care. I ended up going to the hand & wrist specialist to pay out of pocket for surgery...to partially fix what the in-network doctor did to me. Conclusion: The best and highest paid doctors do not work for networks and agree to work for 40% less. Also, Medicare Supplement Plans will pay for the best doctors you can find. My right hand is paying the price for thinking all doctors are the same.
@@Theretirementnerds What I do not hear in these videos is that doctors who only take Medicare Supplement Plans are paid up to 40% more for the same procedure, thus attracting better, more successful doctors. The 30% of people who are willing to pay for a Supplement Plan likely learned this the hard way, like me.
Several Major Hospitals (i.e. The Mayo Clinic) will not accept Any Advantage Plan. Be Careful with Advantage Plans. Also Agents are paid much more and annual residuals for signing you up for an Advantage Plan.@@brianmueller7913
What if you are healthy and eat properly. I have had an advantage plan for about 5 years now. In my first two years, I had no plan. During those years, I did pay for a couple of Dr visits. Also, I had an ER visit. All together, that cost a few hundred dollars. So, with my current advantage plan, I have not been charged for anything. I figured by now that I have saved over $11,000 in G plan payments. That is enough to pay for a bad health situation that may occur. Eventually, I may have to pay the $5000 deductible. 72 year old.
Your experience is more common than many want to admit. If you are healthy or have an occasional medical situation, Advantage plans can save a lot of money. If you are okay to visit in-network providers and understand managed care, Advantage plans are great. Save what you would have paid in premiums for a potential max out of pocket year, or two, or three. Thank you for sharing your experience!
How about the Mayo clinic dropping Advantage Plans for lack of payment etc. as they are slow to pay and have to much paperwork. I have AARP United Healthcare and it took them 8 months to pay a approved dental procedure. Every time I got a denial I would call customer service in India and the last time I called they told me I paid to much for the procedure and I asked him why did you approve it then. Its so much fun getting the run around when your in your 70s and dealing with all of this B.S. Look at the news many other hospitals are dropping Medicare Advantage and then if you try to go back to original Medicare and a supplement plan you have to pay a penalty. So if your on Advantage good luck finding a hospital that will take you, I would suppose the Advantage SCAM companies will send you to a hospital in India or some other country in the future. United Healthcare is buying up all the clinics they can and also with the premiums we pay they are donating millions to politicians ! On the plus side accepting DEATH gets easier every day !
Another advantage to advantage plans. I would rather have the best coverage that I can find with a Plan G. I look at it as having a go anywhere prepaid card, so why would I go to the worst place when I can go to the best place of my choosing
Thank you! I'm meeting with someone who had a heart attack and they have a supplemental plan; I can use your spread sheet as an example....PS most people have no clue what they are being billed...
@ 90 DFR .. We are at different ages so my spouse was covered under my regular employer insurance while I was still employed. When I retired we could keep the regular employee insurance on myself as I am under age 65, but they pushed my spouse onto a MA PPO plan that matches my pre and post retirement PPO. It’s quite expensive with the combined premiums. The deductibles are $400 out of pocket for us both with a top expense of $2,000 for us both. When I reach age 65 the premiums will decrease as I will be pushed on to the same MA PPO plan as my wife. I feel fairly comfortable being it is a state employee plan that was excellent. Hopefully the plan is what it appears to be moving forward. I am not sure if we can move back to a traditional medicare with supplement insurance? Due to the fact that we are on a retiree plan offered by my state employment with no break in service as required in order to retain it. Thank you 90 Days From Retirement for all your effort into these post!
Yeah, so first, when you reach 65, you can get traditional Medicare and a supplement plan, no problem. Rour retiree plans are typically referred to as EGWP (Employee Group Waiver Plan - pronounced "Egg-Whip"). If your spouse is on this, should your spouse decide to come off of that, it would be a special election period and your spouse could pick up a supplement plan - no problem. Not sure where you live, but supplement plans may be around the same cost, maybe lower, maybe higher compared to your company option. Something to look at. Does that help?
Hi Randy, thank you for watching! Not sure how far you got into the video, but we state that we're covering the costs sent in by our subscriber. We have other videos that go over these copays post surgery if you want to check those out. Thank you!
Eric...as another gentleman mentioned in a post about ten months ago, I have the option of enrolling in a group MA plan because my wife is a retired teacher in the state of Georgia. It's a UHC PPO, 3,500.00 MOO, no premium, subsidized by the state. I think you mentioned that you were going to post a video on EGWP plans but I haven't seen it posted yet. I'm having difficulty deciding which way to go - MA versus supplement. If I choose a supplement, I can never go back and enroll in the state MA plan. Are group plans generally better than individual plans as far as denial rates? I saw you video on denial rates for MA plans. I would think that group plans that are subsidized by the state would be more careful about denying service to retirees on their plan due to the fear of loosing the state contract. Anyway, I enjoy you videos...thank you for all your great information!
Yes! Still working on that one. I know it's been a while, but we have that on our whiteboard of videos to make :) Similar to this video, the group EGWP plans are all over the place in terms of cost and value, so for some, it is a no-brainer. For others, they aren't that strong. In our state, it's usually 50/50 in terms of group plans being stronger/weaker than commercial options. I'm not licensed in GA, but I have a partner who is. More than happy to make an introduction via email if you'd like and he can look into that and compare. He'll know the commercial plans available to you there much better than I would. erik@90daysfromretirement.com
What you did not cover in your example are the test performed that every Dr. would want performed before any surgery. These test may be performed at a hospital or at the Dr. office and billed separately from the hospital bill. Also, there would definitely be follow up Doctor visits and possibly physical therapy as well. These things may well be outside of the example you were asked to respond to.
Thank you for this and other videos. I think you do a great job explaining the details. Maybe a little fast, but then we have pause and replay buttons don't we:) I hope your UA-cam video business is paying off because it's a valuable service for us. My college degree was in insurance, and I spent several years in insurance before moved into another life direction, but Medicare is a whole different animal. A deductible is still a deductible and same with a co-pay, but the administrative issues are quite complicated and interesting. Thanks again.
i just can't be subjected to the in or out of network restrictions of advantage plans. I would rather cut costs by enrolling in a high deductible G plan and have all my options available.
Makes a lot of sense. Network is weighed heavily by some, lightly by others. High Deductible Plan G in certain areas of the country does really well and people are quite happy with it. Thank you for watching and sharing your thoughts!
This doesn't take into account that Medicare Advantage has case managers that may limit the hospital stay, rehab, etc. So Medicare original does not have this and generally will pay for hospital, rehab, etc.
Hi there, thank you for watching. Were you able to make it to the 0:47 mark in the video? We mention these type of things and why they aren't in the video. Have lots of videos on the channel that go over what you mention though!
Great question. Once admitted, in this case it was after the surgery, that all falls under Part A and is covered as usual with the Supplement and then is covered under the daily copay of Advantage. Hope that helps!
This one might be what you're looking for? ua-cam.com/video/MWrNhZW8ZcQ/v-deo.html The Part B deductible works a little bit differently than the video describes, but the total cost is correct.
Two comments: First is that the Medicare approved amount will be much less than 39,000, secondly, how many hospital events are likely ... maybe 1 in every 5 years. During that time one would pay about 10,000 in supplement premiums.
Thank you for watching and sharing. In this video, we use actual Medicare approved amounts. Might be more helpful: ua-cam.com/video/2YCI8m0Ol18/v-deo.html
As a friend once said. I hope I dont live to regret getting the Advantage Plan. Or worse, die early, getting the Advantage Plan. Unfortunately he realized both...
If you have government Medicare, you can go to any specific doctor you want, most Medicare Advantage plan demand that you first see your general practitioner, who will then have to refer you to a specialist. Also, you don’t need approval from Medicare for almost all procedures, whereas, Medicare Advantage plans will require an evaluation before approval. Also, if you travel from state to state, or abroad, you advantage plan might not be excepted where you are at. I’m sticking with government Medicare.
yes sure you can choose you r specialist, but most of the time it's your doctor refer to you anyway. if you really need the procedure why would they not cover you?
If your Advantage plan is a PPO, you don't need a referral to see a specialist. Also, with a PPO, you do not have to select a specific PCP, although providers who do not contract with your plan may not take you, even if you are willing to pay the out-of-network copays.. Be advised that some specialists may only accept patients who are referred by a PCP or other provider, regardless of what kind of insurance plan the patient has. It's just the way some of them operate.
Other bits to this is follow up care and visits for a MI that required stents. Frequent cardiologist visits, cardiac rehab, possible home health, did this happen in December or January so new year deductions required.
How about do one on drug costs? When my mom got cancer (plan G) it was the drug copays that bankrupted her. How do the new Part D rules apply? This is way more confusing than Supplements or Advantage plans
Thanks! Although, still a crap shoot. My friend has Advantage for first year & now will switch over to Govt Medicare, she had $3,000 worth of dental work done plus cash in her account. She says she can switch one time without underwriters asking lots of questions. Is this correct?
According to your cited source, “Part A pays: Your inpatient hospital stay and all related outpatient services provided during the 3 days before your admission date.” So I still don’t think Part B is applicable to the surgery in your hypothetical case.
My mom has a supplemental plan through her city of NY retirement plan and she pays close to nothing and the city pays for her premiums too. She also gets reimbursed for her Medicare part b premium. They send her a check every year to cover her premiums.
The problem is that this video does not include what happens after the heart attack. The Medicare Advantage plan will most likely require co-pays for every visit to any medical provider needed following the heart attack (Cardiologists, re-hab, etc.). Medicare+Supplement will not. This can get very expensive and easily bring the cost above the Medicare+supplement amount. As to the part D, yes you need to pay for this in addition to your Medicare+supplement plan. However, there is an advantage. You can choose the formulary to cover the drugs your doctor recommends. This is not true of Medicare Advantage. And finally, with Medicare+ supplement, you can go to the Cardiologist you prefer as long as they take Medicare and get all the re-hab or other treatments you need. No networks. Also no pre-approval delays(you do not want these when dealing with cancer or other deadly illnesses), and very little likelyhood of treatment denials. Medicare Advantage may be cheaper(probably in the short term only), but the available care is not even close to Medicare + Supplement. The basic fact that Medicare Advantage plans have limited networks is evidence of that.
you forgot to mention if you have a medical event and you are in a out of network area like if you travel out of state is it possible that Advantage will not pay the claim?
We talk about this in several other videos. Emergency care is required to be covered as in-network with all advantage plans. If the care transitions away from emergency care, that's where the advantage plan could deny.
These are outlined in each plan's Evidence of Coverage. This is a beefy document with a lot of pages, but each plan has their own and it will outline the inclusive copay in that document. Great question and thank you for watching!
Interesting breakdown. My brother came to live here after becoming homeless and had an Adv plan once he turned 65. Recently his heart gave out. Paramedics couldn't start his heart, they took him to hospital after trying 30 mins (if they revived him he would be a vegetable but maybe that's protocol). Hospital sent a bill taking off 900.00 for insurance and billing him almost 7500 grand! Not sure how they got the 900.00 for insurance but his Adv paperwork said In network MOOP is 3,750 and combined in/out network is 8,250 which the hospital is in network. There was no breakdown (just said emerg room) and I'm not calling because he was pretty much destitute (no pension, only SS) and I'm not responsible for his bills so I really don't want to get too involved but I sent a death certificate and copies of Medicare/Adv cards I found. They can do whatever their next step is. Waiting to see what happens next.
My understanding you are still paying the 165.00 on medicare that is deduct from SSI for the Advantage Plan part you would add the 1978 to the 820.00. Im.l right?
Your videos have been outstanding & helpful. I will be turning 65 in May. My wife is a retired school teacher and I have the option of enrolling in an employer sponsored Medicare Advantage PPO Group plan subidized by the State Health Benefit Plan. I would love to see a video from you on what to be mindful of when considering an employer sponsored Medicare Advantage Plan. I am on her retiree Healthcare HRA plan and I need to enroll in Part A & B. Thanks for all you do!
We appreciate you saying that Bill. And, we are working on a video that does just what you requested concerning a retiree plan. We have a long list of videos we need to make and that one is on the list! Thank you for watching!
Eric, One of the interesting things that surfaced during my deep dive was that many Group Sponsored Medicare Advantage PPO plans are much less restrictive related to allowing out of network providers. An example is that many group plans define the plan service area as all 50 states & US territories. Individual Medicare Advantage Plans define the plan service area by particular counties within a state. As a result, if I moved across the country... I would still be a member of the group plan. I am struggling to get my head wrapped around how to process this. I understand that Medicare Advantage Plans are not portable but group plans give the impression that they are portable. You have a wonderful way of explaining complicated things in a straightforward & easily understandable manner. I am looking forward to your video on group plans and how we should try to understand them. Blessings! Bill
@@billdavis6905 Appreciate you Bill! We are working on this video :) This is one we'd like to release very soon. We've been working on a few Social Security videos for a series as well as re-shooting the videos on our website, but will have one along these lines very soon. Thank you!
Correct. It'll depend on how much the HD G premium would be. The range is between $40-90. Assuming $60, total cost for HD G in this example would be somewhere around $3,600 for that year. Thank you for watching!
@@Theretirementnerds Thank you for answering my question. Here is a recommendation for a future video if you have not already done so. Present the historic increase in premiums for the various supplemental plans and projected increases. I had heard that Plan G premium may go up considerably due to guaranteed issue rights where Plan N does not have that feature. This would make Plan N increase less in the future compared to Plan G. And Plan G HD may have low rate increases because less healthy people avoid this plan.
Robert, this is an excellent idea for a video. We'll have to limit that to a small geographic area, because that will vary quite dramatically across the country, but I like that idea for a video. It is one of the major knocks on Supplement plans, specifically G, is the rate increases. I'll get working on this!
My husband is on advantage plan and we have to pay the first 5 days of hospitalization. I'm not sure why you wrote only $1050 as opposed to the 1750 we would really pay. Can you clarify?
Medicare Advantage Plans are OK if you are in good health, and rarely go to a doctor. The premiums are zero or very low which is nice. I had a MAP and had trouble finding a doctor as my primary, who would accept it. The co-pays and deductibles are high. I was in good health, but fell and injured my back. The surgery was expensive and my co-pays were in the thousands. It hurt us financially. We now pay for a better supplement, and Part D for prescription. We are older now, see doctors 2x yearly, and dermatologist, medical eye tests (not vision). We pay just the annual Medicare deductible and nothing else. Our prescriptions are minimal for the most part. It’s easier for us to pay a higher monthly premium and not worry about huge medical bills. It’s a gamble. If you are healthy, MAP’s are great. If you have lots of money and big co-pays and deductibles are not an issue, then it’s the way to go.
Cost should obviously be a consideration. The bigger issue as one ages is quality of care. Talk to any health care administrator to get the true picture of Medicare Advantage plans shortcomings. Your limited when you need the optimal care the most. Sister in law had multiple health issues. Almost every specialist has told her that they would prefer to follow the latest protocols as far as tests, treatments, and meds but their limited to what MA will pay for unless she pays cash which she can't afford to. Off the record of course.. She recently passed which was inevitable, but it was apparent that she wasn't receiving the best care possible from every doctor. I've heard similar stories from multiple people who loved MA until they got sick.
Good video. Insurance companes do have reputations. As an example, prior to Obama's health care reform, some insurance companies were trying to find was to exclude breast cancer from their coverage. Others would try to go back in time to find ways to deny coverage. In one case the insurance company tried to use a case of acne to deny cancer coverage. Insurance companies(of any kind, not just health insurance companes), have reputations and some are better than others.
Canada here…my mother suffered a heart attack went to the hospital in an ambulance got a pace maker and left after one month care. Total cost $42 for the ambulance. The medical system in the USA is criminal!
I had a heart attack last year and went to the ER in an ambulance. I was admitted to the cardiac ward and had open heart surgery. I was in the hospital 11 days. The billed amount was $352,000. My Medicare Advantage and TFL supplement paid 100% of the negotiated amount and I paid $0. Sorry your mom got ripped for $42.
Liked the video. Understand this is for the total cost analysis on the year with heart attack, BUT no one will have heart attach every year, nor anyone will know if the heart attack will come next year before signing up the plans. It will be nice if you can also mention the ongoing cost (every year) vs one time cost for the incident on that year. If I understand it right, one could assume having heart attack or similar event once every 5 years, in that case, I am not sure if that added up premium expenses on plan G could be worth for something else.
Seems like you left out the after discharge care. There will be several close followups with tests before the 6 month or yearly followups begin. The differences between plans with copays for one of them will be substantial I think especially if the cardiac event causes major damage to the organ.
Agreed that there are charges after the fact. Our subscriber who submitted this case didn't provide us with those numbers, so we went with what we had. Thank you for watching and adding your perspective
I'm a few months away from qualifying for Medicare and watch your video with great interest trying to educate myself about these issues - and for all this I thank you! However, (always must be a however) you might want to drop the constant sarcastic comments about the “greedy evil” insurance companies - it makes you sound less impartial and more biased towards the Advantage plans but using some kind of clever reverse psychology. I know you want to sound entertaining and distinguish yourself from the rest of UA-camrs, but remember your audience, elderly, dementia prone absent-minded soon-to-be retirees unable to grasp nuances- and trust I know all about this! Good luck with your channel!
Elderly dementia prone absent minded soon to be retired unable to grasp nuances… at age 65…that’s sad! Lots of us are in good shape so please speak for yourself.
Hello Erik: Maybe it's just me, but it would be nice to just focus the camera on the worksheet while you're explaining it than to go back & forth to your handsome face and to the worksheet. Sorry, but it's just so distracting. Do you want us to see more of you or what you're talking about?
What happens if you are on a Medicare advantage plan and the heart attack happens when you are outside of your network or the ambulance takes you to a hospital that is not in your network?
That happened to me out of state-- out of network with Advantage plan. Wife took me to hospital emergency room with a heart attack in the morning had 3 stents by the evening and left the next day. $420 out of pocket. Happened in 2018.
Dang - I went to subscribe, but discovered I already was. 😉 I'm four months out from retiring and am trying to wade through all the options and implications of Medicare. In particular, I am seriously considering moving to Mexico, so am trying to figure out how to balance Medicare enrollment with the public health care system (and/or private health insurance) in Mexico. Your videos have been exceptionally useful in filtering out noise from those decisions.
Missed one cost to taxpayer on the Advantage plans - the taxpayer pays your insurance company around $700 to $900 per month to cover your health costs under their advantage plan. That is $8,400 to $10,800 per month per year. Really messes up the numbers in this article.
Hi there, thank you for watching. Were you able to make it to the 8:00 mark? We cover this, and actually have slightly higher numbers at 1,000 per month, even though the actual numbers aren't published. Hope that helps!
Hi there. Like where your mind is at, but in this instance, that is incorrect. The gentlemen had a heart attack and went to the ER. Emergency care and the subsequent surgery are Part B expenses. After the emergency surgery was performed, the patient was admitted, and all subsequent charges after admission are Part A. If the attending doctor admitted first, then yes, it could be a Part A expense, but that is not the case here, nor is it typical of emergency surgery. Medicare.gov has more clarification if you'd like in the webpage below. Hope that helps! www.medicare.gov/what-medicare-covers/what-part-a-covers/inpatient-or-outpatient-hospital-status
@@Theretirementnerds Umm, what about this (from table in linked page)?: *Part A pays* Your inpatient hospital stay and all related outpatient services provided during the 3 days before your admission date.
Thank you for watching! We get a lot of people that want to know what it would look like if they just had original Medicare and not any sort of supplement or Advantage plan.
Two important notes not mentioned in the video:
*ER Visits - Supplement*
There are instances where an ER visit, once moved to inpatient, will waive the part B deductible. It would still apply to the surgery and your total costs wouldn’t be affected in this example, but the exact placement of the Part B deductible could shift.
*Other Advantage Copays*
There are Advantage plans that don’t have all-inclusive copays and a handful of other charges could arise while inpatient. Think Durable Medical Equipment and other various charges that would marginally increase the total cost for the Advantage plan. This is a point you'd want to discuss with your agent if you are considering one of these in your area.
My wife and I chose a supplement plan over Medicare advantage for 3 reasons... 1) Advantage plans lock you into a network and the network can change from year-to-year. 2) Advantage plans vary from company to company and coverages can change from year to year. All supplement plans, no matter the company, cover the same maladies as Medicare (though the price may vary). 3) Advantage plans have a "pre-approval" provision for medical treatment. If your Doctor thinks a procedure is necessary, advantage plans have the "right" to deny coverage for said procedure.
Solid logic!
Plan G for anyone with medical issues. I had my aortic valve replaced last year under my employer insurance, the total for the year, surgery, rehab, etc was around 123k, my part was 5k. The doctors office received approval from Anthem (ppo) the day before the surgery, so that added a lot of stress, I was lucky that I had a great surgeon in my network who was recommended by my cardiologist. I recently signed up for part G, and don't want to be stuck with networks and preapprovals.
Plan G is super sold! Thank you for sharing your experience!
Smart man who wants to play Russian Roulette with your health
Were you using a Medicare advantage plan or a traditional Medicare plus a supplement to pay for your hospitalization?
my mother in her later years was DENIED "some" treatments by her advantage plan , financial cost means very little if you can't get the treatment you need. One nursing home turned people away if they had certain advantage plans, advantage plans should never get to play doctor because it could cost you your life.
Thank you for sharing!
I knew a person who was denied specialized diabetic wound care by Medicare Advantage. Just over-ruled the doctor. They could have appealed, but this takes time, time you cannot afford when you are ill. I think everyone who can possibly afford a supplement should go with regular Medicare. You do not stay healthy forever.
I'm guessing you mean a "skilled nursing facility" for rehab and not a "nursing home" as in long term care, since neither original Medicare with a supplement plan nor any advantage plan offers any coverage for long term care costs. That being said, as a former director of nursing in a long term care facility, I spent significant time battling with advantage plans over getting "prior authorizations" for my residents for needed treatments.
@@MrHaighahatta Yes, this is what I mean. I have read many stories about skilled rehab treatment being cut short by Medicare Advantage plans. By contrast, my wife, who is on original Medicare + supplement got all the skilled rehab the doctor ordered with no hassle. Because of what you mentioned, we both have long term care insurance through a private company. Hope it pans out, with private insurance companies, you never know.
Opted out of part B++,,Instead I opted to stay/lead a healthy life style....I'm now 69,,143lbs,,on no meds...
I had a heart attack in 2018. It involved all the accoutrements: Medivac helicopter flight; emergcncy surgery; etc. The helicopter flight alone was over $20,000. My total out of pocket expense: $0. Medicare and Medicare Plan N and my gap insurance covered it all. Later I developed kidney problems and am now on dialysis. It's all covered. Medicare is the best government program in existence. I'm an eyewitness.
Thank you for sharing your experience!
I'm a Medicare agent in SoOrange County CA. I started in JAN 2016. You folks do a great job. THX for all your hard work... and your consistent... spot on accuracy.
Thank you so much Larry!!
I have Kaiser Senior Advantage. Monthly cost - Part B only. Likely costs for a heart attack: ambulance $200, ER visit $190. That's it.
A lot of peace of mind knowing you are saving on premiums and don't have a lot of risk. Thank you for sharing!
what about Part A co-pays?
@@miked5106 None
I had a heart attack Thanksgiving 2022. I was in the hospital for 5 days. The put one stint in one of my arteries. The bill was $167,000 but they discounted it to $116,000. I must be going to a high line priced facility comparing to other costs that I’ve viewed on here for a similar procedure?
My private insurance paid all except some small misc charges. I’m now on Medicare with a supplement N. I feel good about my insurance going forward.
Thank you for sharing David. So glad you are comfortable with your plan, that is important. And yes, hospitals will all charge much different amounts. Thank you for watching!
I'm on Plan G and something I like is the quality of service. I don't trust an Advantage Plan to give me the same. I get to pick my providers and specialists
Many share your reasoning. It is solid. Thank you for watching and sharing!
I have KP Advantage care. I had a partial right nephrectomy and I did not have to pay anything.
That's fantastic!!
In 2018 I got in a bike accident and crushed my index metacarpal bone in my right hand. The best hand & wrist surgeon in my area would not take my Healthnet insurance because they would not pay him what he was worth. Yet he would take Medicare Supplemental which would pay him about 40% more than a network would pay him. Regrettably, I went to an in-network orthopedic surgeon who botched my care. I ended up going to the hand & wrist specialist to pay out of pocket for surgery...to partially fix what the in-network doctor did to me. Conclusion: The best and highest paid doctors do not work for networks and agree to work for 40% less. Also, Medicare Supplement Plans will pay for the best doctors you can find. My right hand is paying the price for thinking all doctors are the same.
So sorry to hear about your accident and issues! Thank you for sharing!
@@Theretirementnerds What I do not hear in these videos is that doctors who only take Medicare Supplement Plans are paid up to 40% more for the same procedure, thus attracting better, more successful doctors. The 30% of people who are willing to pay for a Supplement Plan likely learned this the hard way, like me.
Several Major Hospitals (i.e. The Mayo Clinic) will not accept Any Advantage Plan. Be Careful with Advantage Plans. Also Agents are paid much more and annual residuals for signing you up for an Advantage Plan.@@brianmueller7913
Thank you so much.
What if you are healthy and eat properly. I have had an advantage plan for about 5 years now. In my first two years, I had no plan. During those years, I did pay for a couple of Dr visits. Also, I had an ER visit. All together, that cost a few hundred dollars. So, with my current advantage plan, I have not been charged for anything. I figured by now that I have saved over $11,000 in G plan payments. That is enough to pay for a bad health situation that may occur. Eventually, I may have to pay the
$5000 deductible. 72 year old.
Your experience is more common than many want to admit. If you are healthy or have an occasional medical situation, Advantage plans can save a lot of money. If you are okay to visit in-network providers and understand managed care, Advantage plans are great. Save what you would have paid in premiums for a potential max out of pocket year, or two, or three. Thank you for sharing your experience!
How about the Mayo clinic dropping Advantage Plans for lack of payment etc. as they are slow to pay and have to much paperwork. I have AARP United Healthcare and it took them 8 months to pay a approved dental procedure. Every time I got a denial I would call customer service in India and the last time I called they told me I paid to much for the procedure and I asked him why did you approve it then. Its so much fun getting the run around when your in your 70s and dealing with all of this B.S. Look at the news many other hospitals are dropping Medicare Advantage and then if you try to go back to original Medicare and a supplement plan you have to pay a penalty. So if your on Advantage good luck finding a hospital that will take you, I would suppose the Advantage SCAM companies will send you to a hospital in India or some other country in the future. United Healthcare is buying up all the clinics they can and also with the premiums we pay they are donating millions to politicians ! On the plus side accepting DEATH gets easier every day !
Another advantage to advantage plans. I would rather have the best coverage that I can find with a Plan G. I look at it as having a go anywhere prepaid card, so why would I go to the worst place when I can go to the best place of my choosing
Thanks for the heads up .
Thank you! I'm meeting with someone who had a heart attack and they have a supplemental plan; I can use your spread sheet as an example....PS most people have no clue what they are being billed...
Agreed! And, negotiated rates end up being quite different than the "sticker price."
@ 90 DFR .. We are at different ages so my spouse was covered under my regular employer insurance while I was still employed. When I retired we could keep the regular employee insurance on myself as I am under age 65, but they pushed my spouse onto a MA PPO plan that matches my pre and post retirement PPO. It’s quite expensive with the combined premiums. The deductibles are $400 out of pocket for us both with a top expense of $2,000 for us both. When I reach age 65 the premiums will decrease as I will be pushed on to the same MA PPO plan as my wife. I feel fairly comfortable being it is a state employee plan that was excellent. Hopefully the plan is what it appears to be moving forward. I am not sure if we can move back to a traditional medicare with supplement insurance? Due to the fact that we are on a retiree plan offered by my state employment with no break in service as required in order to retain it.
Thank you 90 Days From Retirement for all your effort into these post!
Yeah, so first, when you reach 65, you can get traditional Medicare and a supplement plan, no problem.
Rour retiree plans are typically referred to as EGWP (Employee Group Waiver Plan - pronounced "Egg-Whip"). If your spouse is on this, should your spouse decide to come off of that, it would be a special election period and your spouse could pick up a supplement plan - no problem.
Not sure where you live, but supplement plans may be around the same cost, maybe lower, maybe higher compared to your company option. Something to look at.
Does that help?
maybe you should add in the co pay for all the office visits after the surgery on MA plan
Hi Randy, thank you for watching! Not sure how far you got into the video, but we state that we're covering the costs sent in by our subscriber. We have other videos that go over these copays post surgery if you want to check those out. Thank you!
Very interesting comparison, thanks.
Thank you for watching 🙂
Eric...as another gentleman mentioned in a post about ten months ago, I have the option of enrolling in a group MA plan because my wife is a retired teacher in the state of Georgia. It's a UHC PPO, 3,500.00 MOO, no premium, subsidized by the state. I think you mentioned that you were going to post a video on EGWP plans but I haven't seen it posted yet. I'm having difficulty deciding which way to go - MA versus supplement. If I choose a supplement, I can never go back and enroll in the state MA plan. Are group plans generally better than individual plans as far as denial rates? I saw you video on denial rates for MA plans. I would think that group plans that are subsidized by the state would be more careful about denying service to retirees on their plan due to the fear of loosing the state contract. Anyway, I enjoy you videos...thank you for all your great information!
Yes! Still working on that one. I know it's been a while, but we have that on our whiteboard of videos to make :) Similar to this video, the group EGWP plans are all over the place in terms of cost and value, so for some, it is a no-brainer. For others, they aren't that strong. In our state, it's usually 50/50 in terms of group plans being stronger/weaker than commercial options. I'm not licensed in GA, but I have a partner who is. More than happy to make an introduction via email if you'd like and he can look into that and compare. He'll know the commercial plans available to you there much better than I would. erik@90daysfromretirement.com
Eric...yes, please get me in contact with your partner if you don't mind!@@Theretirementnerds
What you did not cover in your example are the test performed that every Dr. would want performed before any surgery. These test may be performed at a hospital or at the Dr. office and billed separately from the hospital bill. Also, there would definitely be follow up Doctor visits and possibly physical therapy as well. These things may well be outside of the example you were asked to respond to.
Thank you for this and other videos. I think you do a great job explaining the details. Maybe a little fast, but then we have pause and replay buttons don't we:) I hope your UA-cam video business is paying off because it's a valuable service for us. My college degree was in insurance, and I spent several years in insurance before moved into another life direction, but Medicare is a whole different animal. A deductible is still a deductible and same with a co-pay, but the administrative issues are quite complicated and interesting. Thanks again.
Thank you so much for this comment. Means a lot!
i just can't be subjected to the in or out of network restrictions of advantage plans. I would rather cut costs by enrolling in a high deductible G plan and have all my options available.
Makes a lot of sense. Network is weighed heavily by some, lightly by others. High Deductible Plan G in certain areas of the country does really well and people are quite happy with it. Thank you for watching and sharing your thoughts!
This doesn't take into account that Medicare Advantage has case managers that may limit the hospital stay, rehab, etc. So Medicare original does not have this and generally will pay for hospital, rehab, etc.
Hi there, thank you for watching.
Were you able to make it to the 0:47 mark in the video? We mention these type of things and why they aren't in the video. Have lots of videos on the channel that go over what you mention though!
Question: where are all the tests that I assume were done while in the hospital? Are they covered by A or B? Thanks!
Great question. Once admitted, in this case it was after the surgery, that all falls under Part A and is covered as usual with the Supplement and then is covered under the daily copay of Advantage. Hope that helps!
I was unaware that part B charged a monthly premium? I thought it was a one time payment per year of about $174?
Unfortunately not. It is a monthly premium
Cost compare high deduct G plan to N plan
This one might be what you're looking for?
ua-cam.com/video/MWrNhZW8ZcQ/v-deo.html
The Part B deductible works a little bit differently than the video describes, but the total cost is correct.
Excellent info.!
Thank you!
Two comments: First is that the Medicare approved amount will be much less than 39,000, secondly, how many hospital events are likely ... maybe 1 in every 5 years. During that time one would pay about 10,000 in supplement premiums.
Thank you for watching and sharing.
In this video, we use actual Medicare approved amounts. Might be more helpful:
ua-cam.com/video/2YCI8m0Ol18/v-deo.html
As a friend once said. I hope I dont live to regret getting the Advantage Plan. Or worse, die early, getting the Advantage Plan. Unfortunately he realized both...
Very good information video
Thank you Mary!
Doesn't the 'Surgery' category have Part A and Part B components ?
If you have government Medicare, you can go to any specific doctor you want, most Medicare Advantage plan demand that you first see your general practitioner, who will then have to refer you to a specialist. Also, you don’t need approval from Medicare for almost all procedures, whereas, Medicare Advantage plans will require an evaluation before approval. Also, if you travel from state to state, or abroad, you advantage plan might not be excepted where you are at. I’m sticking with government Medicare.
yes sure you can choose you r specialist, but most of the time it's your doctor refer to you anyway. if you really need the procedure why would they not cover you?
If your Advantage plan is a PPO, you don't need a referral to see a specialist. Also, with a PPO, you do not have to select a specific PCP, although providers who do not contract with your plan may not take you, even if you are willing to pay the out-of-network copays..
Be advised that some specialists may only accept patients who are referred by a PCP or other provider, regardless of what kind of insurance plan the patient has. It's just the way some of them operate.
Other bits to this is follow up care and visits for a MI that required stents. Frequent cardiologist visits, cardiac rehab, possible home health, did this happen in December or January so new year deductions required.
How about do one on drug costs? When my mom got cancer (plan G) it was the drug copays that bankrupted her. How do the new Part D rules apply? This is way more confusing than Supplements or Advantage plans
This one might help:
ua-cam.com/video/eWy6y77cYBM/v-deo.html
Or this one:
ua-cam.com/video/KLUZJMY5QYw/v-deo.html
Thanks! Although, still a crap shoot. My friend has Advantage for first year & now will switch over to Govt Medicare, she had $3,000 worth of dental work done plus cash in her account. She says she can switch one time without underwriters asking lots of questions. Is this correct?
Depends on a couple things. Here's a video that might help: ua-cam.com/video/djuGeI829M4/v-deo.htmlsi=2Mn61cPpccavBAUi
According to your cited source, “Part A pays: Your inpatient hospital stay and all related outpatient services provided during the 3 days before your admission date.”
So I still don’t think Part B is applicable to the surgery in your hypothetical case.
My mom has a supplemental plan through her city of NY retirement plan and she pays close to nothing and the city pays for her premiums too. She also gets reimbursed for her Medicare part b premium. They send her a check every year to cover her premiums.
That sounds like a good way to go!
@@Theretirementnerdsit’s actually amazing.
@@jdenino6022 I agree!
The problem is that this video does not include what happens after the heart attack. The Medicare Advantage plan will most likely require co-pays for every visit to any medical provider needed following the heart attack (Cardiologists, re-hab, etc.). Medicare+Supplement will not. This can get very expensive and easily bring the cost above the Medicare+supplement amount. As to the part D, yes you need to pay for this in addition to your Medicare+supplement plan. However, there is an advantage. You can choose the formulary to cover the drugs your doctor recommends. This is not true of Medicare Advantage. And finally, with Medicare+ supplement, you can go to the Cardiologist you prefer as long as they take Medicare and get all the re-hab or other treatments you need. No networks. Also no pre-approval delays(you do not want these when dealing with cancer or other deadly illnesses), and very little likelyhood of treatment denials. Medicare Advantage may be cheaper(probably in the short term only), but the available care is not even close to Medicare + Supplement. The basic fact that Medicare Advantage plans have limited networks is evidence of that.
you forgot to mention if you have a medical event and you are in a out of network area like if you travel out of state is it possible that Advantage will not pay the claim?
We talk about this in several other videos. Emergency care is required to be covered as in-network with all advantage plans.
If the care transitions away from emergency care, that's where the advantage plan could deny.
New York does many have excess charges
Ya that'll all depend on if the facility and providers participate with Medicare or not. Thank you for watching!
well you interested in posting your commission on MA VS Medicare Supplement.I doubt it.
We have multiple videos where we do! Encourage you to watch them 🙂
Well I missed them if you would postem. Thanks
Examples don’t mean anything if you don’t know your “region” or plan provider.
Medicare Premium $171 a month.
Plan G $271 a month.
This is NYS
NY has some of the highest G rates in the country ☹️
Researched, Medicaid part a when a person has worked 40 hours or 10 or so contributing to Medicare. What does premium Medicare cost aline to?
My concern with MA plans is being limited to in-network providers. I live in a rural area with very few choices.
Valid concern. Rural areas are tough when it comes to networks. If you can afford a supplement, could work well!
when you talked about inclusive copays on his hospital stay how common are these in the advantage plans and where would it say in the plan details
These are outlined in each plan's Evidence of Coverage. This is a beefy document with a lot of pages, but each plan has their own and it will outline the inclusive copay in that document.
Great question and thank you for watching!
Can you compare plan N and plan G with this example or another example
I curious to see if dr charged excess charge
We can work on a video like that!
Its people that retire with very good work health plans, that make the rest of us feel lousy, as we have to pay our premiums
Interesting breakdown. My brother came to live here after becoming homeless and had an Adv plan once he turned 65. Recently his heart gave out. Paramedics couldn't start his heart, they took him to hospital after trying 30 mins (if they revived him he would be a vegetable but maybe that's protocol). Hospital sent a bill taking off 900.00 for insurance and billing him almost 7500 grand! Not sure how they got the 900.00 for insurance but his Adv paperwork said In network MOOP is 3,750 and combined in/out network is 8,250 which the hospital is in network. There was no breakdown (just said emerg room) and I'm not calling because he was pretty much destitute (no pension, only SS) and I'm not responsible for his bills so I really don't want to get too involved but I sent a death certificate and copies of Medicare/Adv cards I found. They can do whatever their next step is. Waiting to see what happens next.
So sorry to hear about your brother. Sounds like a tough situation all around for everyone involved.
Are you able to sell insurance for residents of Florida and/or South Carolina?
I'm not (the guy in the video) but I have a partner who is. Happy to connect you if you'd like. Erik@90daysfromretirement.com is my email.
My understanding you are still paying the 165.00 on medicare that is deduct from SSI for the Advantage Plan part you would add the 1978 to the 820.00. Im.l right?
Yes, we discuss that at about the 7:40 mark 🙂
Thank you for watching!
Oops sorry should've watched the whole thing😊
@@judiashley5818 they are long videos sometimes haha so no worries at all!
Your videos have been outstanding & helpful. I will be turning 65 in May. My wife is a retired school teacher and I have the option of enrolling in an employer sponsored Medicare Advantage PPO Group plan subidized by the State Health Benefit Plan. I would love to see a video from you on what to be mindful of when considering an employer sponsored Medicare Advantage Plan. I am on her retiree Healthcare HRA plan and I need to enroll in Part A & B. Thanks for all you do!
We appreciate you saying that Bill. And, we are working on a video that does just what you requested concerning a retiree plan. We have a long list of videos we need to make and that one is on the list! Thank you for watching!
I need to see this one too!
@@tanyafulton583 we are working on this one 🙂
Eric,
One of the interesting things that surfaced during my deep dive was that many Group Sponsored Medicare Advantage PPO plans are much less restrictive related to allowing out of network providers. An example is that many group plans define the plan service area as all 50 states & US territories. Individual Medicare Advantage Plans define the plan service area by particular counties within a state. As a result, if I moved across the country... I would still be a member of the group plan. I am struggling to get my head wrapped around how to process this. I understand that Medicare Advantage Plans are not portable but group plans give the impression that they are portable.
You have a wonderful way of explaining complicated things in a straightforward & easily understandable manner. I am looking forward to your video on group plans and how we should try to understand them. Blessings! Bill
@@billdavis6905 Appreciate you Bill! We are working on this video :) This is one we'd like to release very soon. We've been working on a few Social Security videos for a series as well as re-shooting the videos on our website, but will have one along these lines very soon. Thank you!
Great example and explanation! Thanks Erik!
Thank you Jodie!
I assume high deductible G would have come out about the same as G as the high G deductible would have been reached?
Correct. It'll depend on how much the HD G premium would be. The range is between $40-90. Assuming $60, total cost for HD G in this example would be somewhere around $3,600 for that year.
Thank you for watching!
@@Theretirementnerds Thank you for answering my question. Here is a recommendation for a future video if you have not already done so. Present the historic increase in premiums for the various supplemental plans and projected increases. I had heard that Plan G premium may go up considerably due to guaranteed issue rights where Plan N does not have that feature. This would make Plan N increase less in the future compared to Plan G. And Plan G HD may have low rate increases because less healthy people avoid this plan.
Robert, this is an excellent idea for a video. We'll have to limit that to a small geographic area, because that will vary quite dramatically across the country, but I like that idea for a video. It is one of the major knocks on Supplement plans, specifically G, is the rate increases.
I'll get working on this!
My husband is on advantage plan and we have to pay the first 5 days of hospitalization. I'm not sure why you wrote only $1050 as opposed to the 1750 we would really pay. Can you clarify?
The person who submitted this example was in the hospital for 3 days, which is why we only did $350x3.
Hope that helps!
Medicare Advantage Plans are OK if you are in good health, and rarely go to a doctor. The premiums are zero or very low which is nice. I had a MAP and had trouble finding a doctor as my primary, who would accept it. The co-pays and deductibles are high. I was in good health, but fell and injured my back. The surgery was expensive and my co-pays were in the thousands. It hurt us financially. We now pay for a better supplement, and Part D for prescription. We are older now, see doctors 2x yearly, and dermatologist, medical eye tests (not vision). We pay just the annual Medicare deductible and nothing else. Our prescriptions are minimal for the most part.
It’s easier for us to pay a higher monthly premium and not worry about huge medical bills.
It’s a gamble. If you are healthy, MAP’s are great. If you have lots of money and big co-pays and deductibles are not an issue, then it’s the way to go.
Cost should obviously be a consideration. The bigger issue as one ages is quality of care. Talk to any health care administrator to get the true picture of Medicare Advantage plans shortcomings. Your limited when you need the optimal care the most. Sister in law had multiple health issues. Almost every specialist has told her that they would prefer to follow the latest protocols as far as tests, treatments, and meds but their limited to what MA will pay for unless she pays cash which she can't afford to. Off the record of course.. She recently passed which was inevitable, but it was apparent that she wasn't receiving the best care possible from every doctor. I've heard similar stories from multiple people who loved MA until they got sick.
I’m so happy you found her I can’t even begin but you know I know how you felt when you’re with me you were
What happens when the doctors and hospital do not accept the BS advantage plan.
Networks are important when on am Advantage plan. This video might help:
ua-cam.com/video/5Tl0Ut1tTEs/v-deo.html
Good video. Insurance companes do have reputations. As an example, prior to Obama's health care reform, some insurance companies were trying to find was to exclude breast cancer from their coverage. Others would try to go back in time to find ways to deny coverage. In one case the insurance company tried to use a case of acne to deny cancer coverage. Insurance companies(of any kind, not just health insurance companes), have reputations and some are better than others.
100%. Who you choose to work with matters. Thank you for watching and sharing!
Cost comparison between HMO and N plan, knee replacement cost 😭😭
Thanks for this!
Thank you for watching!
Why are people negative about Medicare Advantage Plans?
That's a loaded question 🙂
This video might help a little:
ua-cam.com/video/AlCJwhqZE0s/v-deo.html
Great video, thank you! Knowledge empowers.❤
Thank you David! We have a series of videos in the works on Social Security. Your expertise may find those interesting as well 🙂
@@Theretirementnerds Excellent!😃
@@Theretirementnerds
Canada here…my mother suffered a heart attack went to the hospital in an ambulance got a pace maker and left after one month care. Total cost $42 for the ambulance. The medical system in the USA is criminal!
I had a heart attack last year and went to the ER in an ambulance. I was admitted to the cardiac ward and had open heart surgery. I was in the hospital 11 days. The billed amount was $352,000. My Medicare Advantage and TFL supplement paid 100% of the negotiated amount and I paid $0. Sorry your mom got ripped for $42.
Most comprehensive & informative yet concise & practical illustration. Great presentation! Thanks..
Thank you so much!
It’s called the shell and p game .
Liked the video. Understand this is for the total cost analysis on the year with heart attack, BUT no one will have heart attach every year, nor anyone will know if the heart attack will come next year before signing up the plans. It will be nice if you can also mention the ongoing cost (every year) vs one time cost for the incident on that year. If I understand it right, one could assume having heart attack or similar event once every 5 years, in that case, I am not sure if that added up premium expenses on plan G could be worth for something else.
All excellent points. Thank you for watching and sharing.
Seems like you left out the after discharge care. There will be several close followups with tests before the 6 month or yearly followups begin. The differences between plans with copays for one of them will be substantial I think especially if the cardiac event causes major damage to the organ.
Agreed that there are charges after the fact. Our subscriber who submitted this case didn't provide us with those numbers, so we went with what we had.
Thank you for watching and adding your perspective
Well if You get a hearty stay home and take 2 aspirins you will save a boat load
Thank you for another great, informative video!
Thank you for watching Jimmy!
Its just a Dollar Comparison ! Try talking about the Quality and Choice of Physician / Facility etc. That's where the Real Difference is.
Thanks for watching! Check out the other videos on our channel. We have several that talk about these things.
I'm a few months away from qualifying for Medicare and watch your video with great interest trying to educate myself about these issues - and for all this I thank you! However, (always must be a however) you might want to drop the constant sarcastic comments about the “greedy evil” insurance companies - it makes you sound less impartial and more biased towards the Advantage plans but using some kind of clever reverse psychology. I know you want to sound entertaining and distinguish yourself from the rest of UA-camrs, but remember your audience, elderly, dementia prone absent-minded soon-to-be retirees unable to grasp nuances- and trust I know all about this! Good luck with your channel!
Appreciate the feedback! Thank you for watching!
Elderly dementia prone absent minded soon to be retired unable to grasp nuances… at age 65…that’s sad! Lots of us are in good shape so please speak for yourself.
@@beecee921 - someone woke up feeling a little bee cee today!
@@beecee921right!
Love this. I’m new at offering Medicare so this helps me understand so much better thanks 🎉
So glad it is helpful! Welcome to the Medicare world :)
One comment you can die waiting for procedure approval from an advantage plan assuming the AI the insurance uses actually approves the surgery.
Another outstanding, informative and (as clear as you can make it) explanation of a complicated issue. If it was easy, agents wouldn't be necessary!
💯 a lot of exceptions and assumptions always need to be worked in there haha
Hello Erik: Maybe it's just me, but it would be nice to just focus the camera on the worksheet while you're explaining it than to go back & forth to your handsome face and to the worksheet. Sorry, but it's just so distracting. Do you want us to see more of you or what you're talking about?
Great feedback. This is an older video and I think 🤞 they have gotten better
Love your video just wish you would speak a little slower.
Thank you Regina! I am working on that 🙂
What happens if you are on a Medicare advantage plan and the heart attack happens when you are outside of your network or the ambulance takes
you to a hospital that is not in your network?
Great question. Advantage plans are required to cover emergencies as in-network.
That happened to me out of state-- out of network with Advantage plan. Wife took me to hospital emergency room with a heart attack in the morning had 3 stents by the evening and left the next day. $420 out of pocket. Happened in 2018.
Dang - I went to subscribe, but discovered I already was. 😉 I'm four months out from retiring and am trying to wade through all the options and implications of Medicare. In particular, I am seriously considering moving to Mexico, so am trying to figure out how to balance Medicare enrollment with the public health care system (and/or private health insurance) in Mexico. Your videos have been exceptionally useful in filtering out noise from those decisions.
Thank you David! Appreciate you watching and subscribing. More videos are coming...
Advantage plans deny care to make profits. Read the Office of Inspector General Reports - Advantage plans deny care.
We're coming out with a video shortly on this 🙂
Missed one cost to taxpayer on the Advantage plans - the taxpayer pays your insurance company around $700 to $900 per month to cover your health costs under their advantage plan. That is $8,400 to $10,800 per month per year. Really messes up the numbers in this article.
Hi there, thank you for watching. Were you able to make it to the 8:00 mark? We cover this, and actually have slightly higher numbers at 1,000 per month, even though the actual numbers aren't published. Hope that helps!
This guy is way off base on the surgery calculation. Inpatient surgeries are covered by Part A not Part B.
Hi there. Like where your mind is at, but in this instance, that is incorrect.
The gentlemen had a heart attack and went to the ER. Emergency care and the subsequent surgery are Part B expenses. After the emergency surgery was performed, the patient was admitted, and all subsequent charges after admission are Part A.
If the attending doctor admitted first, then yes, it could be a Part A expense, but that is not the case here, nor is it typical of emergency surgery. Medicare.gov has more clarification if you'd like in the webpage below.
Hope that helps!
www.medicare.gov/what-medicare-covers/what-part-a-covers/inpatient-or-outpatient-hospital-status
@@Theretirementnerds
Umm, what about this (from table in linked page)?:
*Part A pays*
Your inpatient hospital stay and all related outpatient services provided during the 3 days before your admission date.
Medicare does not pay the costs he is saying , ??? Why is he allowed to lie to us ... Oh he is a beaurocrat ...
I'm not sure why most of this video was focused on what Medicare is paying. I'm more concerned about what I'm paying
Thank you for watching!
We get a lot of people that want to know what it would look like if they just had original Medicare and not any sort of supplement or Advantage plan.
Insurance shill
So watch something else! Geez.