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Crooks, lies, treason against America, against dignity, against truths.. there should be NO AGENT, NO COMMISSION - NO RESIDUAL ANYTHING ! OH MY GOD WHAT DISGUSTING PEOPLE: AGENTS/INSURAMCE AGENCYS - POLITICAL HACKS -jAp. PS- I have spent a lifetime succeeding to earn a secure older age. Now. I'll invest every penny in Spring these American vultures put out of business. HHS- IS A JOKE - MANIPUKATED BY HEALTH INDUSTRY - NO, NONE INSURANCE COMPANY , ANY - SHOULD HAVE ANY SAY IN OUR, MY CARE--- NO MEDICAL DOCTOR, CLINIC SHOULD PERSCRIBE ANY UNNECESSARY PROCEEDURE -- American politicians have betrayed every America. - jAp
This presentation was so informative. I have never understood the difference between traditional Medicare and Advantage plans. The Advantage plans look very attractive, with lots of perks. After watching your video, I feel very grateful for not getting sucked into one of those Advantage plans. Thank for this presentation. It completely settles the issue for me.
I was a medical biller for over 25 years. I have seen first hand the problems patients have encountered with advantage plans, especially with the prior authorization problem.
I was on an Advantage plan for my first 2 Years on Medicare. First Year was fine, since I didn't use much health care, but on Year 2, when I needed to see GI specialist, I hit a brick wall. My insurance list of providers was completely invented. NONE, not a single doctor would take my insurance. How can they get away with making up a list of "in network" doctors. Being wrong about one or two providers is one thing, but lying about over 50 providers. The whole MA concept is flawed. I've since moved to original Medicare + a Supplemental plan and the peace of mind about access is priceless. It's not just about costs folks, it's about access to care.
These videos made me decide to not do a MA plan this year. I am going on original Medicare and have been approved for both a Part G plan and a Part D Plan. It isn't going to be cheap but I am at an age where I have to worry about paying big medical bills. I want that Part G Plan to help pay big medical expenses if needed, and a Part D plan to help pay for medications I might need.
@@jleechadwick I was warned against the Advantage Plans (I was told insurance companies could refuse care and that you had to choose drs in their network.) Boy, am I glad I listened! I'm on original Medicare with a "G" supplemental plan, and part D (drug) coverage. I have had no problems with coverage and can see any Dr I wish. My supplemental has picked up whatever portion of a bill that Medicare did not pay. The cost is not cheap, but I have peace of mind that I won't be turned down for coverage. Prior to getting on Medicare, the insurance company backing my insurance coverage refused to cover many proceedures, tests, and surgery (that they were supposed to, according to my coverage package). I was in the position of paying the monthly premium on a policy, plus paying for the things they refused to cover. When I became eligible for Medicare, I was not about to be in that situation again with a Medicare Advantage plan. I figure original Medicare is cheaper in the long run because it does cover all it's supposed to. I have not been refused any service and I can choose my drs. with no pre-approvals needed. There is no way to anticipate what medical needs one might have in the future, or the costs. I feel secure in the knowledge that original Medicare lives up to it's promises. I am told that Medicare Advantage plans do not. That is the one- and very important- reason I chose original Medicare. I don't have to worry about going bankrupt due to medical bills with original Medicare.
This is the reason they are pushing the Medicare Advantage plans. Private insurance is in business to make money. When you need serious medical attention, you are better off with a Medicare Supplement plan. As you get older, stop saying you don't need it, you are healthy. You could be in the hospital tomorrow.
@@les0101s No, they don't. That's the problem with Medicare Advantage plans- insurance companies can do whatever they want. If you live in a small town, there aren't many drs. to choose from without traveling. If you live in a big city, there are more options, but the drs listed may have stopped accepting the MA plans. If you are a dr., you do have the option to stop accepting Medicare Advantage plans- which many drs. have done. I bet the list of "in network" drs. he was given was not an up-to-date list. Customers are at the mercy of the insurance companies to be truthful in advertising their services & providing their customers with current information. Many do not meet that standard. What can you do? Wait until the "Enrollment/Disenrollment period", (which comes around once a year) so you can switch plans. In addition to waiting, there's usually a penalty charged to switch, and sometimes a physical can be required (for switching from one Advantage plan to another). If your ailment is serious, you will be spending time, money and energy to sue. If you are really ill, you may not survive long enough to sue. Insurance companies know this- they don't care. They will tell you anything to get you to sign up, then renig on their promises when you need coverage.
For me original Medicare plus a supplemental plan G works best. I can go to any provider that accepts Medicare assignment without a referral. The supplemental plan pays the 20 percent that Medicare does not cover. Once I pay my deductible of $226, I do not have to keep track of any further covered costs. I sleep well at night. I know what my risk is.
I attended a Marvin seminar locally a couple of years ago.His guidance was so helpful. Original Medicare with a supplement was the way to go for us. Advantage might be OK if your healthy, as we age we are more likely to face major health issues. We don't want any additional difficulties. Less likely to cope once we are 80 or 90. A huge thanks to Marvin, you were so helpful and kind.
I was diagnosed with two benign brain tumors a few years before I retired. They couldn’t get all of one of the tumors even after two surgeries. I learned all I could about Medicare and went with a supplemental plan. I wanted no part of pre authorization. If my Neurosurgeon recommends I do XYZ I’m doing XYZ and don’t want anyone to be able to deny me that treatment. That was 10 years ago. I’ve never regretted that decision. What I say to those who tout the $0 premiums is that you never get anything for nothing so before you enroll in one of those plans you need to really understand what you’re giving up to get that $0 premium.
Despite being quite healthy when I first retired, I have since developed a number of serious medical conditions. When first deciding whether to go Medicare Advantage or traditional Medicare plus supplement, I looked at nearly all of the points raised in this video. I consulted with the Medicare advisor recommended by my company. I talked with friends and family, some of whom had chosen MA and some of whom had chosen traditional Medicare. I ultimately chose Medicare Advantage. That was nearly seven years ago. I have not experienced any of the MA horror stories described in the video. Only once have I gone out of network and that was for a specialized genetic test. My available PPO network is extensive and essentially nationwide. When I add all of my costs (all premiums, actual out-of-pocket costs, dental, vision, prescriptions) I have still paid less over nearly seven years using MA than the premiums would have been for Part B, Part D, Supplemental F or G). My wife’s cost differential has been quite substantial. I am sure there are Medical Advantage plans that are poor. Mine has not been one of them.
Agreed. I've talked to a lot of folk that have the Advantage PPO plan that I will have available to me and they all love it. I've talked to several folk familiar with it on the hospital and provider end and they praise it also. I think that for the most part these insurance salesmen make more money selling traditional Medicare plans versus Advantage Plans.
@@DLTJR1959 My experience was the opposite and I found most insurance agents were pushing Advantage plans. In fact, the insurance companies pay them more for doing so and why they're so heavily advertised on TV. I have a number of friends on Adv plans and they had no idea that they had turned over their original Medicare to a private insurance company. They didn't even know the differences between the plans. The dental/vision coverage that enticed them at the start turned out to be minimal, at best. My husband is a cancer patient at the Mayo Clinic. He recently retired and went on Medicare. I spoke directly with their billing people who deal with insurance companies every day and asked what they would do when it comes to Advantage or Supplemental plans. They said it was a no-brainer and go with a Sup plan. They had too many stories about insurance companies dragging their feet, requiring referrals/prior auths. or denying coverage for Adv plan patients. In fact, many health care providers in our area are no longer accepting certain Adv plans, Humana being one of them. Mayo Clinic came very close to dropping UHC. As long as a provider accepts original Medicare, your supplement plan is good anywhere in the country. An Adv plan may work out just fine, as long you remain healthy.
@@gloriataruc8371 They want to collect that 22% commission for the rest of your life. In your 80s, the supplement G plan is probably $300-$400 a month. That comes out to 800 to 900 a year to the broker.
To me a supplement plan is what I call an "affordable luxury". Very affordable. Any other luxury as good as this normally would cost a lot more. Health care has the potential to completely devastate peoples personal funds like no other expense. I appreciate your careful explanation and I pay close attention to the little things you say. I know people on advantage plans. They don't know the truth. They have even said that the things you said in this video can't be true because the federal government would not allow it. They just don't understand and sadly it's likely going to be to late, ?If you have ever, ever had to wait for a prior authorization for anything serious it will straighten you right out. Insurance people sleep at night just fine while you paperwork sits in their IN BOX waiting for them to get to it while you suffer and maybe even die. Truly not an exaggeration. You guys are awesome. Marvin, do not underestimate your personal impact on your company. It's amazing that you personally train all of your agents and that is a huge deal. The single most important thing you can do is to sit in on consultations. Thanks for all you do!
A Medicare Advantage plan probably won't devastate your personal funds because there are out-of-pocket limits for each plan. Also, whether you have regular Medicare or Medicare Advantage, the cost for care (like surgery) is much lower than the cost for people who aren't on Medicare. So, most people don't reach their out-of-pocket limits each year.
Had a advantage plan for 13 years. Regular Medicare you have to pay big deductible before Medicare kicked in then only 80% then you should buy supplemental which will cost you. Then drug plan which will cost you. My plan cost me nothing other then what they takeout of my social security. I pay nothing to see my family doctor. I pay nothing for my prescription drugs. Just had my 6 month dental checkup paid nothing. Very happy with my plan.
And obviously you have not encountered any health problems during this time, good for you! Can't wait to see you change your tune once you do start having problems, good luck!
This is an excellent video, very clear instruction and easy to understand. I chose the Traditional Medicare and the Supplemental Plan. It has been excellent. I am getting excellent care and not having to take out a bank loan to pay medical expenses or do without certain services. Thank you Medicare School for the awesome presentation!
I disliked Advantage plans after dealing with them for my mother. I was routinely frustrated with changing plan coverages and changes. When it came time for me to choose, I went with original Medicare plus the add-ons. It's not cheap, but it is manageable.
Advantage plans are run by companies that have to make a profit. Keep this in mind. The money has to come from somewhere. Yes you can have a great one but like he said in the video, that can change every year. I've been traditional for 8 years and every time I looked at Advantage plans, they looked good but the more I went in to details there was always a "gotcha" someplace so I stayed in place. Especially if your happy with your current specialists. Good luck everyone, researching Advantage is about as exciting as keeping up with new IRS tax laws every year. :)
My wife and I will start year 4 on our Advantage Plan and could not be more pleased. What would the monthly premium be for us at age 88 if we had a Supplement Plan? No - will stick with Advantage Plan.
I agree. I started out with a Supplemental Plan and after watching the premiums go up for 4 years, I also couldn't imagine what the premium would be as a I aged. I switched to Medicare Advantage and have been happy with it for the past 6 years. I've used a couple of companies and they were fine.
My team would be happy to assist you with setting up your Medicare coverage correctly. Give us a call at 800-864-8890 or schedule an appointment at www.medicareschool.com
That’s exactly the reason I didn’t go with Medicare Advantage plan! My mom was on the Advantage Plan and we ended up after she passed away, when we had to sell her house, we had to pay Medicare back almost $20,000 after the sell of her house. I learned that choosing my own plan which was and is the best plan for me! I’m so glad I didn’t go for the Medicare Advantage because otherwise I would be in big trouble financially. Now I am a recent widow, but I am debt free as far as you can be debt free in this world! When my husband was in ER for a few hours before he passed of a massive heart attack, I was billed over $1000 but my Insurance paid every cent and I didn’t owe a dime. So for me going with a non Medicare plan was for me the best option financially.
I went with a MA plan earlier this year. I had no health issues at age 65. In May I experienced a health problem that required a CT scan of my head and neck. It was weeks later I got a call from my clinic that they had me schedule! When I asked why this had taken so long, I was told the MA " had to approve" the test!!!! I was in horror about that. Thinking my clinic was dragging their feet on this, but instead it was the very ppl that are supposed to help me stay healthy? I am dropping MA and choosing to go back to original Medicare and supplements.
great presentation, but there are a few more things - MA Advantage (at least in this area) shifts ou off to physician extenders as primary care - you may never see a doctor! Also the care is not of equal quality - they may take out a cataract using an older and cheaper procedure (and riskier) - a few years ago I had prostate cancer (without obvious spread) and had an overnight robotic prostatectomy. My friend developed localized prostate cancer about a year later and had an MC Advantage HMO. He was told that the robotic procedure was "experimental" and was told to have the open prostatectomy. He looked into the robotic procedure and was told he was a candidate. but since his HMO didn't cover it it would cost about $40,000 out of pocket. He chose to have his insurance with the older and riskier procedure and had a much longer recovery and some complications associated with the older procedure. Also I don't believe you emphasized how locked into the Advantage plan if you develop a serious chronic condition after the first year in an Advantage plan.
I am a senior who is disabled and I love Humana Medicare Advantage PPO. All the doctors on their list are in network. I pay $5 for an office visit and $45 for a specialist whom I can choose. I have prescription coverage also with them. Never use a HMO plan as you have to get permission from your assigned physician to see a specialist for anything. I do have to pay $250 co-pay for an MRI. The drug coverage covers most of my fees and I pay about $4.00 for a 90 day supply for my meds. Also, if you are living on social security only you qualify for Extra Help thru social security to help pay for your prescriptions. I use this and they keep my prescription drug costs down. I do have dental coverage also.
This gentleman is right on. Anyone who is considering an advantage plan needs to watch this video. Personally I would never consider an advantage plan especially an HMO. I've worked in health care for many yrs and battled along with physicians trying to get necessary tests approved. Many were not approved unfortunately. Many of us when first getting on or researching the best plans have no or very few health issues but unfortunately as we age this changes. I believe having regular Medicare is the way to go.
You are absolutely right! I took Medicare with supplement plan because I did my homework on Advantage plans. They aren't worth the so called cheaper price.
Advantage plans give you rides to doctors appointments, extra cash for your everyday bills, etc. When they try to sign you up for Advantage plans, ask them "If I go to the hospital, how much deducible will I have to pay". They don't like that question!
I would be scared to death if I was on an Advantage plan. Having known someone who passed away from cancer two years ago, and his frustrations and dealings with a well known MA plan was enough for me. Hard pass.
I have Anthem Medicare Advantage Preferred (PPO). I had no option, I had Medicare AB and Anthem PPO which was funneled into the above plan, as part of my retirement. I receive a health subsidy of $494.67 + $164.90 Medicare reimbursement monthly and am charged $23.14 for the plan. I net $636.43 monthly. There are small co-pays, $10 for Rx and office visits, $25 for ER visits.
Sounds like a good plan with the reimbursement for Medicare patient b premiums which are always going up. I don’t know how the government expects senior citizens to afford all of this. It’s very expensive. My husband’s union used to reimburse the members for Medicare part b premiums but they stopped doing that around the time they switched over to Medicare Advantage through UHC.
You are 100% spot on. The article you read, and the reference to skilled nursing, accurately exemplifies the significant disadvantage of Advantage plans. I’m currently helping my parents navigate their way through this nightmare. In an effort to triangulate information, I leveraged UA-cam content in my research, and have consistently found yours to be most accurate and informative. Thank you for your diligence in providing good content.
As we are watching this I am helping my parents also. UA-cam has been my favorite source of information on multiple subjects since 2010! Gotta love free lectures. All you gotta do is comment and hit like to support, it is wonderful.
I found you first as a UA-cam ad. I so glad I clicked. Literally the first UA-cam ad that was for something I needed. The education you are providing is so important. I’m still on my husband’s plan for healthcare (I’m 68), but when he retires I will need this info. One question. I had cataract surgery and had to pay the anesthesiologist $500 not covered by insurance. I honestly don’t know if Medicare or the private insurance paid. Is there something I could be doing to avoid this type of charges?
I'm on an advantage plan and would like traditional medicare BUT can't afford the dental and drug plans and all the other costs with it. My plan has been great
Sure. Choose your plan carefully. If the Supp costs was out of reach then presumably your budget cannot carry high C premiums. A number of carriers will offer very low copays; they’re not just HMOs they’re HMOs on steroids! Teeny tiny networks of providers which may be manageable if you’re in an urban area, less so in rural areas.
Thank you! I am preparing for retirement- several yearz from now- gathering info and knowledge and will continue to do so. This vid and your others are invaluable.
I worked as a service rep for advantage plans, I won’t tell which one but it was a very big company. I was already knowledgeable about their problems before I worked there. I mainly took calls from Florida and the east coast. These plans caused so many heart breaking problems. I would sometimes come across someone who thought their plan was wonderful, but those were usually seniors with few health concerns. In Florida, seniors had a hard time finding doctors who took the plan and if they did, it could be months before they could get an appointment. Health plans in general are very confusing and add that to people who are older and may not understand things as well. I was over 65 when I did this work, so I knew how much better it could be with a supplement plan. I will say, I did talk to seniors who could not afford a supplement, but they still could make these advantage plans better.
I've been a Medicare agent for over 10 years. Like you, I heard a host of heart breaking issues related to Medicare Advantage plans. I offer both. For 80% of my clients, MA plans work just fine. But, I do my best to screen those who have significant health issues or concerns when they are turning 65 and therefore have a guaranteed issue for a MedSupp. The thing is, MedSupp eventually will price members out of the plan due to age. So eventually, MedSupp won't make any sense. The interesting thing is that looking at my clients who were on Medicare very much caused me to be very aware and focused on my own health. I started to realize that I needed to take care of my body so that I wouldn't have the medical issues that so many of my clients had. I would say diabetes is the most likely chronic disease. But it's one that is both reversable (not curable) and within a persons control. But medical practitioners are told not to talk about the root causes of the disease, which is diet and weight. A Medical Director at a local large hospital system stated during a speech that he gave, and which I attended that: "90% of health care problems are lifestyle related."
@@jdenino6022 LOL....No. Our approach is to do a needs analysis to figure out, using our software, which avenue (traditional Medicare with a Supp, PDP and some ancillary coverage; Or MAPD with ancillary coverage) makes the most sense at the time for the client. We're more interested in building long term relationships with our happy clients then turning over our client list every year like call centers do.
Advantage plans are NO Advantage, and will only get worse with big insurance companies setting the prices and care given. They don't care about your health.
Noting that the advantage plans are merchandising to people with both government Medicare AND Medicaid, it would be interesting to know how much taxpayer money goes to pay for Medicare Advantage Plan. An ER nurse once told me that Medicare Advantage Plans DON'T PAY for every needed medical care that basic Medicare does pay.
Thank you for providing this information! I am only 60 but starting to plan ahead. At this time I am planning on a plan similar to the United Health Medicare Supplement Insurance Plan Extended Basic 2020 Plan, and when it is time for me to sign up I am planning to have gone through all the details, and your videos will help with that.
My team would be happy to assist you with setting up your Medicare coverage correctly. Give us a call at 800-864-8890 or schedule an appointment at www.medicareschool.com
No one gets out of the B premium, so what is the point? $200+ per month is also a "pay as you go cost. My wife and I are both 76 and have had zero premium advantage plans from the time of Medicare signup. Heart bypass, knee replacement, cataracts for both of us, stent in a leg, several sets of eyeglasses, two sets of hearing aids, one of us had several afib sessions in a hospital and I don't think total out of pocket has been over $5000 total for both of us. Do you care to figure out $200 per month for each of us over an 11 year period. Doesn't matter anyway because as social security only retirees we cant afford the supplements anyway.
What all the TV Doctor shows fail to mention is that money is the lubricant needed to gain good medical care. The Hippocratic Oath died many years ago when avarice replaced it and the government got involved. Medicine is a business, indeed a very big business!
Your statement is hyperbole at best and you do a disservice to physicians to generalize as if you do know them all. The Hippocratic Oath is taken by physicians, not insurance companies. All the physicians who have taken care me - YES ALL - fight/fought with insurance companies to ensure I had what I needed.
Marvin, this is your best video yet! Clearly spells it out, the clear winner is a supplement plan if you can afford it. Being a former State employee I see they offer MA plans as well as supplemental plans once I'm 65. I fully plan to go the supplement route! My questions are, do I save anything with them being a former employee and signing up with the State of NJ supplemental plan or, should I shop around? Second, I have the rates for these supplemental plans, can I compare them with your company suggestions by calling? Thanks.
My team would be happy to assist you with setting up your Medicare coverage correctly. Give us a call at 800-864-8890 or schedule an appointment at www.medicareschool.com
Thank you for such an honest assessment. We are currently weighing out options for my dad (81 years old with afib, high BP and wet AMD) and he has had a supplemental plan since he started on Medicare. The premium increases this year are going to be painful and we took at look at the Advantage plans to see if they might work for him. I have to anticipate that Dad will have increasing health concerns as he ages and while the premiums can be a struggle, his care is going to be better than if he had an advantage plan. My mom had a supplemental and after her cancer diagnosis, she needed repeated hospitalizations and expensive care before she died. We barely paid anything out of pocket except for a few copays. While I'd certainly rather not have to deal with the ever increasing premiums, I won't risk Dad's health, so we will seriously tighten out belts and sleep with some security that I will never have to worry about Dad not getting the care he needed because we can't afford it or because some bean counter denies it.
We're glad that we could be of some help in making this decision. If you ever have any questions for us please don't hesitate to give us a call. 800-864-8890.
Thanks Marvin, Unfortunately this is true, After Cataract Surgery I developed a vision impairment and needed a in office laser procedure maybe 5 minutes. But no, Access Denied. Our wonderful Politicians made deals with these BIG INSURANCE company's to do this to Seniors. The word Medicare shouldn't have been allowed to these Advantage plans. Its just a private plan that skimpy on whats IMPORTANT to your HEALTH. It's like the the Insurance Co. Is your Doctor.🧐
This is one of two UA-cam channels that has educated me the most on Medicare etc. Turning 65 in 6 months and want to understand all this and make the correct choices. Thank you sir!
My team would be happy to assist you with setting up your Medicare coverage correctly. Give us a call at 800-864-8890 or schedule an appointment at www.medicareschool.com
Thank you for this information. My ex husband passed in 2021. He thought he was "required" to sign on to an advantage plan. His coverage was excellent before he did so. I always thought he was ushered off of his original health care coverage. My health care coverage has been trying to encourage me into an advantage plan. I keep refusing because of what I saw my ex go through. Personally I believe the insurance companies don't want seniors on their plans because we are considered too expensive. I just refused my health care company from trying to usher me into a prescription drug plan when I already HAVE prescription drug coverage with them. I see this as an effort to try to dump me into an advantage plan just like my ex husband's health care company did to him.
What an awesome video and that article was so eye opening. The letter from that lady was spot on in the first five sentences. Those last 3 sentences I could not help but tear up thinking of what she went through losing her husband. It's "G" for me! Hope this site continues grow and eventually hits a million followers. "The Cajun Ninja's Dad"
I could never afford the g plan, even though thats my preface. Really sad that those of us that have low checks and are in bad health will suffer so badly do to costs
Along with Medicare School there are a lot of great providers of Medicare information on the web when it comes time for you to decide on what type of Medicare you'll be on starting at 65. I started about 9 months prior to my 65th birthday, and doing all the research, plus these video sites, was very helpful. I'd also suggest asking the staff at your doctors office about plans (both supplemental and Advantage) and see what their experiences are; even if you're going with Advantage, see which ones they like to work with. Also ask at the local hospitals and see what their staffs like to work with (and if the even accept Advantage plans - more and more do not!). Yeah, the hospitals' insurance staffs thought me coming in was a little bit odd, but once I explained what I was trying to find out they were very interested in why I was researching Medicare.
A Medigap policy is something you obtain when you keep original Medicare. This insurance pays for the 20% that Medicare doesn’t pay on billing. Depending on the state you live in there is usually 5 to 7 policy’s you can choose from. I personally have one through AARP UnitedHealthCare. These policies can range in price from $175 to $300 a month depending on the extra coverage your looking for. Now, Advantage Plans are all together a different ball of wax. They are Insurance Companies that sell a complete coverage plan as long as you abide by the rules. They get a set amount of money from Medicare for you annually. From there, they more or less guide your spending. everything is well and good when you really don’t need a lot of services when you’re younger I just happen to be a healthy individual. But once you start needing tests and everything else repeatedly, they want you to get approvals and you have to wait usually to get them. You have to remember that insurance companies are there to make money. You have to go to the selected group of doctors hospitals. There might be large co-pays for ambulatory services and such. It is a personal choice.
Because the alternatives being used in other countries (many with populations only around 10, a couple around 80 million) are virtually unworkable in a country of some 350 million people in which less than half of the population doesn't pay any income tax. The UK is dealing with nonstop funding issues and seriously restricted access to care (including doctors, nurses and ambulances going on strike this year alone) and German friends say it's much more difficult to access care as the foreign population has increased. Better plans require serious discussions of costs and how to pay for them.
Thank you for all the valuable information, but I would like to add one more thing if I may. When someone has a MA PPO plan and are able to go out of network, that doesn’t mean a doctor out of their network has to accept that Insurance. I have been in the Medical field for decades and some of the offices I worked at would not accept an OON MA plan because getting a PA for some procedures can be difficult and time consuming. Also, sometimes we had to fight the insurance in order to get paid. So the doctors just felt it better to not accept them. JM
I’m sure the Advantage plans are fine for some, but I never want to have to hear about pre-authorizations and maximum out-of-pocket costs again. I hated dealing with insurance companies when I was still employed, and so happy to be on original Medicare with a supplemental plan.
Exactly right: Anyone who’s ever experienced the nightmare of battling a health insurer to obtain coverage for needed medical treatment or surgery will opt for a supplemental plan (assuming they can afford one).
Been disabled since 2008. And still in original Medicare. I don’t want advantage plan. Basically think of it is private insurance companies getting the OK from Medicare to take over. You don’t have Medicare you got private insurance One private insurance company got paid by Medicare despite denying claims or not approving pre-authorization. It should not be allowed but it happens. One company got paid over $7 billion last year and did not service the clients they made money out of telling people NO. THATS why I KEPT ORIGINAL Medicare despite some good “extra perks “. Not worth the headache and possible denial of care
Do you care to share the Advantage Name? This is overwhelming to me. I'm going back and forth supplemental/ advantage So far I'm very healthy. At the moment I have an Advantage plan with Cigna. I'd appreciate your help. Thanks! please
If expenses are relatively low, you can save a lot of money. I have a supplemental hospital plan to my Advantage plan that costs $75/month. I am paying about $140/month less than regular Medicare plus supplemental plus RX for similar coverage. Yes, it's a bit of a gamble to stay relatively healthy, but all my doctors are in my Advantage plan, meds are 100% covered, and my annual copays are minimal. The hospital plan was set up to fill the gaps in Advantage to Medicare coverage. My RX plan plus cost of meds under Medicare was over $25/month and is now $0
Supplemental plans are NOT cheap and they go up every year. My Advantage plan has a zero monthly premium, with an OOP max of $999. After three surgeries and months of physical therapy, my costs were only about $100.
Not all Advantage plans are horrible. Fact is that some folks simply cannot afford a Supplement plan. Best advice to them would be to really shop around. Talk to people, especially doctors, medical case managers, friends on the plan you are considering if possible. The biggest complaints about Advantage plans are needed preauthorization, doctors being told they have to do x before they can do y, because it's cheaper, or denying coverage; hidden charges and charges when out of network...maybe you need a specialist not available in network or you are traveling; requiring referrals before you can see a specialist. Those are the things you want to ask about.
@@carmenpalenske6685 I was misdiagnosed multiple times with Kaiser's HMO. I actually paid outside doctors for treatment of a bacterial infection. Every time I hear a MA commercial, I flash on Kaiser.
I am a very healthy male 66. I recently had aspiration /pneumonia. It went undiagnosed for several weeks. I started having AFIB and it went on for a few days. I was hospitalized twice in less than a week. left the hospital without a diagnosis or know cause for the fluid buildup in my lungs. It wasn't till i remembered chocking of food, getting it up but some went into the bronchia. Anyways. I paid about $100.00 of copay on meds. Not one dime for each hospital stays or the paramedics who saved my life because I did suffer pulmonary arrest and heart failure. woke up 26 hours later intubated in ICU. Still just saying I have A-B-and Medicare advantage. The 5K Dental was used, the 1K for prescription glasses was used. And it pays for my gym membership. I don't see a downside.
I live in Tampa, Florida, where senior citizens make up a large majority of population, and therefore, medical options abound. I find the Medicare Advantage plans work very well for me and my friends. I highly recommend them. Maybe they aren’t ideal for other places in the country, I don’t know.
Again... Very informative and Truthful.... BUT YOU need to make a whole video about the Company most Ins. Cos. use for Prior Authorizations... EviCore. This company approves or denies approval... The Insurance company just follows their decision. a Whole Video on the evils of EviCore would be very informative. Thank you for your service!
I'm a licensed agent as well and that is specifically the message I always try to convey to members!...if you are healthy MA might be great!...but once you have a major medical condition, long inpatient stay or procedure; then is when the out of pocket will be sky high...😢
You dramatically overgeneralize. I went the Medicare Advantage route when I retired. So did my wife. Over those seven years, I have had several outpatient procedures, been under general anesthetic four times, and was in hospital after surgery for three nights followed by nearly three weeks in a skilled nursing facility. My wife has had four outpatient surgeries. Our total out of pocket costs, including insurance premiums for our MA plans have been several thousand dollars less than the combined premiums for Part B, Part D, and Supplement G would have been. We have had no problems with doctors or hospitals being outside our PPO network.
@@lbalsiger Did you actually read my comment? Your reply seems to imply that I have been healthy throughout the last seven years, whereas my comment clearly says I have had multiple serious medical issues, despite which my MA premiums plus all out of pocket costs are still lower than the premiums alone for Part B, Part D, and Plan G. I have no criticism of those who choose traditional Medicare. Some MA plans are doubtless more restrictive than mine. Would I have been satisfied going the traditional Medicare route? Almost certainly, because I would have gone to the same doctors and the same hospitals as I actually did with my MA plan. I am just saying that given the alternatives when I retired, MA seemed to be better for me then, and I have not regretted the decision since.
@@RichardIILionheart i hope my husband has the same experience with good coverage because his union is offering him United Healthcare PPO through his benefits package and he has a preexisting condition. I worry about him every day so your comment makes me feel better ♥️
I'll go with Original Medicare if Mr. Musick will come up with $230+ every month to cover the premium and cover my dental and vision care. Come to think of it, I probably wouldn't anyway. Where I live, the major clinics and hospitals all accept MA plans. They even list on their websites which ones. Very helpful! Someone on a social media app said her husband went to 4 urgent care facilities in one night looking for care, and all of them refused his Medicare plan F! Here in SW WA state our providers are mostly affiliated with the Oregon State University Hospital system. I get excellent care with my MA.
I was able to switch to a supplement from advantage with two chronic conditions. I got the usual discount price. AARP UHC supplemental plan. The biggest reason I switched was to get rid of prior authorizations. I don’t want to be at the mercy of an insurance company. Before going on Medicare, I had to wait a long time to get prior authorization to treat a painful condition. It was awful.
Did you have a 6 month waiting period for a preexisting condition when you went on the supplemental plan? Because I read that if you have something like a heart issue they can deny your claims for six months. This would be a huge problem....I have a chronic condition myself. I take thyroid medication for hypothyroidism. that's not such a big deal but my husband has a heart issue and is on an expensive drug a PCSK9 drug to lower LDL cholesterol though his BCBS policy from his union. He has to go on Medicare early next year. Was looking into a supplemental plan to compare to his UHC PPO PLAN offered by his union but the agent never called us back!
For 2024, I tried to switch from advantage plan to supplement Plan G and 2 of the plans available said that I have to wait 2 years before they will even consider selling me a plan since I had cancer surgery this year and one plan is making me wait 3 years before they will sell me a plan. Were you within the 6 months of starting Medicare which is the open window to switch back to original Medicare + supplement? They also told me that I would pay more for my premium. I also have hypothyroidism and I don't know if that will count against me when applying.
I don’t have any of the expenses or issues you are speaking of. I don’t even have to pay part B. No co-pays. Excellent drug coverage. I always tell people to look into an advantage plan when I hear them crying about all the things they still have to pay for with their Medicare plans. Good luck everyone. If you have any questions you can always Medicare directly. Tell them what you are looking for and they will go over the various plans available for the best one to choose for you. The reason I don’t pay the part B is because I qualify for it based on what I receive financially. Not many people are aware of this but make sure you ask your representative about plans that will pay that for you. There are several. I also get OTC benefits that includes a grocery stipend, dental, eye exams etc.
Ty for this video and reading the article. I recently asked you to comment on the high rate of denials on more expensive treatments. You answered my questions. Thanks again
Right now I’m trying to get my mom in a rehab facility after she fell and broke her hip. I can tell you it’s not easy to find a facility with an open bed, but those that do ask about insurance. When they find out she’s on Medicare with supplement, there’s no issue. Thank goodness! I’m not even asking about cost, only trying to find a bed!
Your thorough, very informative presentation cuts down on Advantage vs Supplement confusion. It reveals that Advantage plans are not the great deal they appear to be. Thank you for sharing the facts with us!🎉
Some specialists will see patients on a referral basis-only, regardless of what kind of insurance the patient has. It's just the way they operate. I guess they don't want to waste their time with patients who could be treated by a PCP or other provider.
My advantage plan has been top notch. No pre authorizations and everything has been smooth sailing. Yet to find a hospital or doctor that doesnt accept. We saved money last year with all the perks we didnt pay for
I’m a pharmacy technician and the number of people who have no idea what their Medicare Advantage plan does is terrifying. They assume that having MA means that their medications will be free or at least cheap, and then I hit them with the $500+ copay for Eliquis and they start screaming. Please do your research before you sign up for insurance, and NEVER pick insurance based on an advertisement.
Prior authorization is horrible. I am on Cardiology. Non-medical staff deny lifesaving tests, meds and procedures. All based on algorithms. I agree with cost effective care. But appears so many of the denials are for costs. I would never recommend an advantage plan because of this.
Happened to my husband when he was on a regular BCBS Plan through his union, they said a stent was medically unnecessary for a 90% blockage, the doctor/hospital put in the stent anyway and it took the hospital a year and a half to collect payment from the insurance company which was a regular policy from an employer (his union). Their letter of denial was mailed after the procedure was already done. His doctor was shaking his head when we told him they said it wasn't medically necessary. Well BCBS ended up paying for it and we paid about $300 or something from what I remember. insurance companies. On the other hand they paid no questions asked in full for an inguinal hernia operation and an operation I had to remove a cyst from inside my abdomen which was benign and I also had a few other surgeries. No cancer surgery thank God.
Your info is certainly very helpful. Its so very confusing and complicated. So many scenarios and cost to consider. Its very overwhelming. I'm not very confident make a choice since I'm very healthy now. But I must concider the unknow health issues that could arise.... Wheww !
Great video. Just wanted to add that i have been on Aetna Advantage for 3 years. Prior to that was on original Medicare with supplement for 7 years. I just switched back to Medicare and supplement. I had to go thru underwriting for past Stroke and AFib16 years ago. Still have AFib and on Eliquis. Live in Nevada.
Essentially every negative described for MA plans also applies to most employer plans, which are increasingly high deductible plans. That means that many people entering Medicare for the first time and deciding between traditional Medicare + Supplement and MA plans have experience with MA type employer plans.
Had a HDHP employer plan for 15 years. built a 45k HSA balance and only paid my $3k deductible once. Had 2 colonoscopies in that 15 year period paid about $1500 total for both (average $750 each). Super happy with that experience, My current MA plan is actually cheaper out of pocket than my employer plan was including my current Part B premium. Now I have a healthcare nest egg, and If I manage it well it can provide a buffer going forward. People have to focus early in life to be in the best possible situation.
@@butopiatoo Good for you. Building up HSA funds before retirement provides a cushion for paying post-retirement premiums, deductibles, co-pays, and co-insurance.
@@butopiatoo Nice. Ideally, if you have a Medicare Advantage plan and you could save the $3-4,000 you would spend annually on Supplemental Plan premiums, you would have a nest egg after a few years to spend on co-pays if you did end up needing surgery or other expensive treatment.
@@RichardIILionheart Yes I was VERY LUCKY to have pushed for the adoption of an HDHP as a plan option with my small employer. And VERY LUCKY that I had the discipline to have saved what I did. It could all be gone if I have a catastrophic medical condition, but hey, it gives me options.
Exactly right: I’m healthy as a horse but in the past have had to battle with a health insurer over coverage for treatment when my ankle was crushed. Took over a year! Anyone who’s experienced that kind of nightmare will decline an MA plan. Like most things in life, you get what you pay for!
I dispute several points in this presentation, but especially that regarding point #2. In calendar year 2023, I left an advantage plan for original Medicare. The latter imposed more out-of-pocket costs, so I enrolled in a different advantage plan than my original plan. The new advantage plan had just launched in 2023, and was a shambles. I went back to my original advantage plan. How did I make all these changes? I picked up my mobile and called Medicare. Their agents answer their phones in real time. No brokers and no paperwork and no commercial insurance companies involved. Also, I have never had a referral to a specialist or rehab care declined under an advantage plan. With respect, health insurers, Big Pharma, and processed “foods” corporations, AARP and US Chamber of Commerce are all in it for profit only. I am French-American, and have never eaten the Standard American Diet (SAD), so have none of the typical health problems as most Americans: morbid obesity, diabetes Types 1, 2, or 3, high BP, cancers and heart disease. The American healthcare system is obscenely expensive with very poor outcomes, and absolute and nearly-exclusive focus on profitability.
The fact that you're in good health gives you a leg up with your MAP. The problems start when the medical problems start. Aging, accidents and hidden environmental dangers are just three complications of future health that never go away. Just because you believe your lifestyle gives you immunity to future health problems or that your MAP will approve treatments you and your doctor may need or want in the future, doesn't mean you'll get access to those services or get them in a timely manner. Unless you're uber wealthy, that decision is out of your hands and it comes at your most inopportune time, when you're not healthy.
Before I decide whether to change Advantage plan it would be very helpful to know which Advantage providers have the highest prior authorization events. In other word, which is causing the most harm to patients.
You can check CMS star ratings…Center for Medicare/Medicaid awards stars from 1-5 (best). Also some plans do not require prior approvals…ask your agent. Annual Enrollment starts 10/15-12/7 so this is your chance to go over coverage & change if necessary for January 😊
@@cynthiakozikowski1765 I'm understanding that. Although my super expensive drug got covered this year and (maybe) part of next year, Wellcare doesn't cover it at all and it is 100,000/yr plus. I'm looking for something else. Because I'm in Maine I can get off Advantage so more options to pick from.
My team would be happy to assist you with setting up your Medicare coverage. Give us a call at 800-864-8890 or schedule an appointment at www.medicareschool.com
I had a PPO all my days working that covered us both we never had any issues. Our insurance transfers over to a MA PPO that is the same 400 dollar deductible and 2,000 dollar total out of pocket . We should be all set….
I am a recruiter for a supplement carrier and you would not believe how many agents are out there that do not know a thing about what they are even selling when it comes to advantage. If by chance they do, the vast majority of them dont let you have a word. The problem isn’t necessarily Advantage by itself, but mostly the agent you are working with.
I chose an advantage plan because the insurance company that operates it is owned by the three largest hospitals and doctors locally in my city. It was the same insurer for employees while I was still working. They’ve been first rate top notch with my and my wife’s health care. We have zero problems with them, the customer service is amazing and I’m glad we are with them. I’ve been in it for 6 years and my wife for four years. Because it is locally owned and operated, it functions better than many advantage plans.
@@steveg6978 The insurer is owned and operated by the three major hospital systems in my city. They cover approximately 11 counties surrounding us. The three hospital have multiple branches throughout these counties and all are served by our plan. Our 2024 plan will be even better than the 2023 plan as more coverage is provided, and it works extremely well. There are over 1300 physician providers, nurse providers, specialists and even chiropractic, plus comprehensive dental with over 500 dentists and vision provision.
Advantage is good for my friend, who’s income is low, doesn’t travel, and who practically never sees a doctor - not because she’s healthy (she’s already had two strokes), but she hates doctors, won’t comply with their instructions, and won’t take medicine. Yes, that’s a bad approach to health care, but she’s stubborn, doesn’t t care if she dies, and that’s that. I have a good income, have some chronic health problems, see specialists, and have prescriptions I take daily. I get expensive Botox shots for chronic migraines. Also looking at surgery in the future. I plan to travel, and may move to a different part of the country. When I retire, i intend to get the most comprehensive supplement(s) available. Tw very different approaches for two very different people.
Why all the gloom and doom about Advantage plans when the plain fact is it’s all many of us can afford? There’s no way I could afford a supplement even if it is better. My Advantage plan has been fine thankfully, even if it weren’t what could I do?
Exactly. It's mostly about how much money you can afford to pay or throw away on Supplemental Plans that go up year after year, as well as higher prescription costs. One of the best things we can do is keep our weight down and get some exercise.
Thats a total lie. Medicate advantage has a set copay for surgeries usually between $200-300 a piece. Thats far from breaking the bank and better than most group or individual plans@@Hugh_Manitee
I have 2 family members that are on an Advantage plan. I have tried to tell them they need to be on a supplement but since they don’t have any health issues as of now they think it’s ok. They are all about the 0 premium or low premium. I’m afraid if their health changes they won’t get the treatment they need. My husband and I have a supplement plan. Yes the cost is more but worth the peace of mind. As of now I don’t have health issues but my husband does and to know that are medical bills are taken care of is a load off my mind.
I have an advantage program and from my experience it has been wonderful. My drugs cost me zero. My surgery to remove a lump was a whopping $270 for everything (hospital, surgeon and anesthesiologist). I also get free membership to a health club, $2k in dental (my dentist was in network), $40 per quarter in OTC. All of my doctors are in network 😊. Maybe I am biased but you seem to be presenting that advantage plans aren’t good which isn’t our experience
I'm wondering if you go out of state does Medicare Advantage plan pay for all your hospital expenses and zero co-pay for your prescription haven't listened to the video yet but that's my experience
@@deiadraper6358 we have used our as a plan multiple time at urgent care out of state. Without an issue. Not sure about hospitals. It would depend on which plan and if they are in network. We discussed this with our insurance agent when we selected our plan as we travel frequently
Thanks for making this very informative video! You did an excellent job showing all situations and options that are currently happening with Medicare for those of us about to be part of it!
Glad it was helpful! ✅ Watch the Internet's #1 Online Medicare Educational Workshop for FREE: get.medicareschool.com/3Fp0KZv ✅ To get 1 on 1 Help from our Team, Schedule a Call Here: get.medicareschool.com/3PP0kjW
For years I've been getting routine low dose CT scans to check for lung cancer; since Medicare made them available for lifelong smokers. On my new Advantage Plan it took constant phone calls and Dr. re-submissions over four months to get it approved. My United PPO did not allude to this prior authorization anywhere in plain English.
You really explain ma, I am on ma, however after watching your videos, i realize we don't know if we will be healthy as we get older, thank God I am healthy and I plan to change to original Medicare. When I chose ma my Agent never explained the difference in ma and original Medicare. I have been on Ma 5 years so hope I can go back to medicare and supplement. Thanks to your informative videos
My team would be happy to assist you with setting up your Medicare coverage correctly. Give us a call at 800-864-8890 or schedule an appointment at www.medicareschool.com
I've been on an advantage plan for a few years and all my doctors accept the plan and I have zero monthly payments. Lot's of great benefits including dental, vision, free gym membership. All my prescriptions are covered with no copays. I can't justify the monthly premium for the supplemental plan in addition to part B and D. I also live in Massachusetts so can switch to a supplemental anytime.i did get a supplemental with a 15% discount the first year I went on Medicare but didnt need any care so basically wasted a couple hundred dollars a month for premiums.
I live in Minnesota, and subsequently have no choice. I have to be on an Advantage plan. I hate the whole idea of networks. I should be able to choose any doctor I want. Because of networks and the fact that my dentist is not a part of my network, I haven’t been to the dentist in three years.
The harping on MA plans and PA’s always leaves out one HUGE variable- the actual cost of care. You can eliminate PA’s and get all the care you need.. and when you see your insurance premiums you’ll have some serious sticker shock. The underlying issue is the black box cost of care. Insurance company margins are in all in the single digits. This ranting is masking the real issue.
As long as your MA is a PPO you are fine. Never go with a HMO MA. I have saved so much in premiums with my MA I could have five years of max out of pocket in a row and still be ahead. Remember supplement plan premiums rise each year as you get older.. This guy has to make money selling supplemental plans. Medicare would not allow MA plans to exist if they were so crappy.
My team would be happy to assist you with setting up your Medicare coverage correctly. Give us a call at 800-864-8890 or schedule an appointment at www.medicareschool.com
I have similar issues with my insurance and it is not an advantage plan. Most of these insurance companies are scammers. Every step of the way they try to think of of ways to slow down or not pay a claim. It is like a full-time job to try and keep them straight and honest.
With the supplement plans, they bill Origibal Medicare & Medicare bills the Plan G insurance company - who HAS to pay if it is covered by Medicare. Don’t even have to get involved.
I have a feeling that ppl that like their MA plan are ones that didn’t have to hit the out-of-pocket max. I’m in the $6,700 max too, but luckily I haven’t had to get near that. I’m in NY, so I just might switch to traditional Medicare. I have been bitten by the PO nonsense.
Awesome video. THIS resonates with me. I have SOOO much distrust of any managed care system. I'll be going overseas. Basic A/B/G makes sense. for me. Would like to consult when I'm almost there (3 more years); hope to talk w/ you then!
✅ Watch the Internet's #1 Online Medicare Educational Workshop for FREE: get.medicareschool.com/3tvHPdb
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yes i agree with you there called advantage where they take advantage of you
Crooks, lies, treason against America, against dignity, against truths.. there should be NO AGENT, NO COMMISSION - NO RESIDUAL ANYTHING ! OH MY GOD WHAT DISGUSTING PEOPLE: AGENTS/INSURAMCE AGENCYS - POLITICAL HACKS -jAp.
PS- I have spent a lifetime succeeding to earn a secure older age. Now. I'll invest every penny in Spring these American vultures put out of business.
HHS- IS A JOKE - MANIPUKATED BY HEALTH INDUSTRY - NO, NONE INSURANCE COMPANY , ANY - SHOULD HAVE ANY SAY IN OUR, MY CARE--- NO MEDICAL DOCTOR, CLINIC SHOULD PERSCRIBE ANY UNNECESSARY PROCEEDURE --
American politicians have betrayed every America. - jAp
This presentation was so informative. I have never understood the difference between traditional Medicare and Advantage plans. The Advantage plans look very attractive, with lots of perks. After watching your video, I feel very grateful for not getting sucked into one of those Advantage plans. Thank for this presentation. It completely settles the issue for me.
I tried to finish and set up the appointment on line, and the screen would not move up to do so😠😡
Your website has a serious glitch.
🤷🏼♀️
Thanks so much for your truth - it means a lot and you are appreciated.😊
I was a medical biller for over 25 years. I have seen first hand the problems patients have encountered with advantage plans, especially with the prior authorization problem.
They also have to go to certain doctors that are in the Medicare Advantage plan.
I was on an Advantage plan for my first 2 Years on Medicare. First Year was fine, since I didn't use much health care, but on Year 2, when I needed to see GI specialist, I hit a brick wall. My insurance list of providers was completely invented. NONE, not a single doctor would take my insurance. How can they get away with making up a list of "in network" doctors. Being wrong about one or two providers is one thing, but lying about over 50 providers. The whole MA concept is flawed. I've since moved to original Medicare + a Supplemental plan and the peace of mind about access is priceless. It's not just about costs folks, it's about access to care.
These videos made me decide to not do a MA plan this year. I am going on original Medicare and have been approved for both a Part G plan and a Part D Plan. It isn't going to be cheap but I am at an age where I have to worry about paying big medical bills. I want that Part G Plan to help pay big medical expenses if needed, and a Part D plan to help pay for medications I might need.
@@jleechadwick I was warned against the Advantage Plans (I was told insurance companies could refuse care and that you had to choose drs in their network.)
Boy, am I glad I listened!
I'm on original Medicare with a "G" supplemental plan, and part D (drug) coverage. I have had no problems with coverage and can see any Dr I wish. My supplemental has picked up whatever portion of a bill that Medicare did not pay.
The cost is not cheap, but I have peace of mind that I won't be turned down for coverage.
Prior to getting on Medicare, the insurance company backing my insurance coverage refused to cover many proceedures, tests, and surgery (that they were supposed to, according to my coverage package). I was in the position of paying the monthly premium on a policy, plus paying for the things they refused to cover.
When I became eligible for Medicare, I was not about to be in that situation again with a Medicare Advantage plan.
I figure original Medicare is cheaper in the long run because it does cover all it's supposed to. I have not been refused any service and I can choose my drs. with no pre-approvals needed.
There is no way to anticipate what medical needs one might have in the future, or the costs.
I feel secure in the knowledge that original Medicare lives up to it's promises. I am told that Medicare Advantage plans do not. That is the one- and very important- reason I chose original Medicare. I don't have to worry about going bankrupt due to medical bills with original Medicare.
This is the reason they are pushing the Medicare Advantage plans. Private insurance is in business to make money. When you need serious medical attention, you are better off with a Medicare Supplement plan. As you get older, stop saying you don't need it, you are healthy. You could be in the hospital tomorrow.
Where do you live? That's a lot of GI doctors in one place. If there's no one on panel, they have to let you see someone else.
@@les0101s No, they don't. That's the problem with Medicare Advantage plans- insurance companies can do whatever they want.
If you live in a small town, there aren't many drs. to choose from without traveling. If you live in a big city, there are more options, but the drs listed may have stopped accepting the MA plans.
If you are a dr., you do have the option to stop accepting Medicare Advantage plans- which many drs. have done.
I bet the list of "in network" drs. he was given was not an up-to-date list. Customers are at the mercy of the insurance companies to be truthful in advertising their services & providing their customers with current information. Many do not meet that standard.
What can you do? Wait until the "Enrollment/Disenrollment period", (which comes around once a year) so you can switch plans. In addition to waiting, there's usually a penalty charged to switch, and sometimes a physical can be required (for switching from one Advantage plan to another).
If your ailment is serious, you will be spending time, money and energy to sue. If you are really ill, you may not survive long enough to sue.
Insurance companies know this- they don't care. They will tell you anything to get you to sign up, then renig on their promises when you need coverage.
Those perks aren’t worth giving up your hard earned Medicare!
I’m a broker and I’m definitely getting a supplement this January for myself.
For me original Medicare plus a supplemental plan G works best. I can go to any provider that accepts Medicare assignment without a referral. The supplemental plan pays the 20 percent that Medicare does not cover. Once I pay my deductible of $226, I do not have to keep track of any further covered costs. I sleep well at night. I know what my risk is.
I attended a Marvin seminar locally a couple of years ago.His guidance was so helpful. Original Medicare with a supplement was the way to go for us. Advantage might be OK if your healthy, as we age we are more likely to face major health issues. We don't want any additional difficulties. Less likely to cope once we are 80 or 90. A huge thanks to Marvin, you were so helpful and kind.
I was diagnosed with two benign brain tumors a few years before I retired. They couldn’t get all of one of the tumors even after two surgeries. I learned all I could about Medicare and went with a supplemental plan. I wanted no part of pre authorization. If my Neurosurgeon recommends I do XYZ I’m doing XYZ and don’t want anyone to be able to deny me that treatment. That was 10 years ago. I’ve never regretted that decision. What I say to those who tout the $0 premiums is that you never get anything for nothing so before you enroll in one of those plans you need to really understand what you’re giving up to get that $0 premium.
Despite being quite healthy when I first retired, I have since developed a number of serious medical conditions. When first deciding whether to go Medicare Advantage or traditional Medicare plus supplement, I looked at nearly all of the points raised in this video. I consulted with the Medicare advisor recommended by my company. I talked with friends and family, some of whom had chosen MA and some of whom had chosen traditional Medicare. I ultimately chose Medicare Advantage. That was nearly seven years ago. I have not experienced any of the MA horror stories described in the video. Only once have I gone out of network and that was for a specialized genetic test. My available PPO network is extensive and essentially nationwide. When I add all of my costs (all premiums, actual out-of-pocket costs, dental, vision, prescriptions) I have still paid less over nearly seven years using MA than the premiums would have been for Part B, Part D, Supplemental F or G). My wife’s cost differential has been quite substantial.
I am sure there are Medical Advantage plans that are poor. Mine has not been one of them.
Thank you! I don’t know why most agents bash Medicare Advantage!
Agreed. I've talked to a lot of folk that have the Advantage PPO plan that I will have available to me and they all love it. I've talked to several folk familiar with it on the hospital and provider end and they praise it also. I think that for the most part these insurance salesmen make more money selling traditional Medicare plans versus Advantage Plans.
Very cool story! Good luck to you going forward. Hope you are doing well.
@@DLTJR1959 My experience was the opposite and I found most insurance agents were pushing Advantage plans. In fact, the insurance companies pay them more for doing so and why they're so heavily advertised on TV. I have a number of friends on Adv plans and they had no idea that they had turned over their original Medicare to a private insurance company. They didn't even know the differences between the plans. The dental/vision coverage that enticed them at the start turned out to be minimal, at best.
My husband is a cancer patient at the Mayo Clinic. He recently retired and went on Medicare. I spoke directly with their billing people who deal with insurance companies every day and asked what they would do when it comes to Advantage or Supplemental plans. They said it was a no-brainer and go with a Sup plan. They had too many stories about insurance companies dragging their feet, requiring referrals/prior auths. or denying coverage for Adv plan patients. In fact, many health care providers in our area are no longer accepting certain Adv plans, Humana being one of them. Mayo Clinic came very close to dropping UHC.
As long as a provider accepts original Medicare, your supplement plan is good anywhere in the country. An Adv plan may work out just fine, as long you remain healthy.
@@gloriataruc8371 They want to collect that 22% commission for the rest of your life. In your 80s, the supplement G plan is probably $300-$400 a month. That comes out to 800 to 900 a year to the broker.
To me a supplement plan is what I call an "affordable luxury". Very affordable. Any other luxury as good as this normally would cost a lot more. Health care has the potential to completely devastate peoples personal funds like no other expense. I appreciate your careful explanation and I pay close attention to the little things you say. I know people on advantage plans. They don't know the truth. They have even said that the things you said in this video can't be true because the federal government would not allow it. They just don't understand and sadly it's likely going to be to late, ?If you have ever, ever had to wait for a prior authorization for anything serious it will straighten you right out. Insurance people sleep at night just fine while you paperwork sits in their IN BOX waiting for them to get to it while you suffer and maybe even die. Truly not an exaggeration. You guys are awesome. Marvin, do not underestimate your personal impact on your company. It's amazing that you personally train all of your agents and that is a huge deal. The single most important thing you can do is to sit in on consultations. Thanks for all you do!
A Medicare Advantage plan probably won't devastate your personal funds because there are out-of-pocket limits for each plan. Also, whether you have regular Medicare or Medicare Advantage, the cost for care (like surgery) is much lower than the cost for people who aren't on Medicare. So, most people don't reach their out-of-pocket limits each year.
Had a advantage plan for 13 years. Regular Medicare you have to pay big deductible before Medicare kicked in then only 80% then you should buy supplemental which will cost you. Then drug plan which will cost you. My plan cost me nothing other then what they takeout of my social security. I pay nothing to see my family doctor. I pay nothing for my prescription drugs. Just had my 6 month dental checkup paid nothing. Very happy with my plan.
And obviously you have not encountered any health problems during this time, good for you! Can't wait to see you change your tune once you do start having problems, good luck!
This is an excellent video, very clear instruction and easy to understand. I chose the Traditional Medicare and the Supplemental Plan. It has been excellent. I am getting excellent care and not having to take out a bank loan to pay medical expenses or do without certain services. Thank you Medicare School for the awesome presentation!
I disliked Advantage plans after dealing with them for my mother. I was routinely frustrated with changing plan coverages and changes. When it came time for me to choose, I went with original Medicare plus the add-ons. It's not cheap, but it is manageable.
I have traditional Medicare. When you add up all the co pays and deductible on an Advantage plan. Traditional Medicare is cheaper is the way I see it.
Advantage plans are run by companies that have to make a profit. Keep this in mind. The money has to come from somewhere. Yes you can have a great one but like he said in the video, that can change every year. I've been traditional for 8 years and every time I looked at Advantage plans, they looked good but the more I went in to details there was always a "gotcha" someplace so I stayed in place. Especially if your happy with your current specialists. Good luck everyone, researching Advantage is about as exciting as keeping up with new IRS tax laws every year. :)
Exactly
Oh, and Supplement plans do not have to make a profit?
My wife and I will start year 4 on our Advantage Plan and could not be more pleased. What would the monthly premium be for us at age 88 if we had a Supplement Plan? No - will stick with Advantage Plan.
I agree. I started out with a Supplemental Plan and after watching the premiums go up for 4 years, I also couldn't imagine what the premium would be as a I aged. I switched to Medicare Advantage and have been happy with it for the past 6 years. I've used a couple of companies and they were fine.
My team would be happy to assist you with setting up your Medicare coverage correctly. Give us a call at 800-864-8890 or schedule an appointment at www.medicareschool.com
That’s exactly the reason I didn’t go with Medicare Advantage plan! My mom was on the Advantage Plan and we ended up after she passed away, when we had to sell her house, we had to pay Medicare back almost $20,000 after the sell of her house. I learned that choosing my own plan which was and is the best plan for me! I’m so glad I didn’t go for the Medicare Advantage because otherwise I would be in big trouble financially. Now I am a recent widow, but I am debt free as far as you can be debt free in this world! When my husband was in ER for a few hours before he passed of a massive heart attack, I was billed over $1000 but my Insurance paid every cent and I didn’t owe a dime. So for me going with a non Medicare plan was for me the best option financially.
Wouldn't touch Advantage Plan with a 10 foot pole. Happy to pay my supplemental premiums. N has worked very well for me.
I went with a MA plan earlier this year. I had no health issues at age 65. In May I experienced a health problem that required a CT scan of my head and neck. It was weeks later I got a call from my clinic that they had me schedule! When I asked why this had taken so long, I was told the MA " had to approve" the test!!!! I was in horror about that. Thinking my clinic was dragging their feet on this, but instead it was the very ppl that are supposed to help me stay healthy? I am dropping MA and choosing to go back to original Medicare and supplements.
My team would be happy to assist you. Give us a call at 800-864-8890 or schedule an appointment at www.medicareschool.com
WHAT IS MA? 🤔😳
@@lindalewis5222Medicare Advantage
@@lindalewis5222 Medicare Advantage
@@lindalewis5222Medicare advantage. Or Massachusetts.
great presentation, but there are a few more things - MA Advantage (at least in this area) shifts ou off to physician extenders as primary care - you may never see a doctor! Also the care is not of equal quality - they may take out a cataract using an older and cheaper procedure (and riskier) - a few years ago I had prostate cancer (without obvious spread) and had an overnight robotic prostatectomy. My friend developed localized prostate cancer about a year later and had an MC Advantage HMO. He was told that the robotic procedure was "experimental" and was told to have the open prostatectomy. He looked into the robotic procedure and was told he was a candidate. but since his HMO didn't cover it it would cost about $40,000 out of pocket. He chose to have his insurance with the older and riskier procedure and had a much longer recovery and some complications associated with the older procedure. Also I don't believe you emphasized how locked into the Advantage plan if you develop a serious chronic condition after the first year in an Advantage plan.
I am a senior who is disabled and I love Humana Medicare Advantage PPO. All the doctors on their list are in network. I pay $5 for an office visit and $45 for a specialist whom I can choose. I have prescription coverage also with them. Never use a HMO plan as you have to get permission from your assigned physician to see a specialist for anything. I do have to pay $250 co-pay for an MRI. The drug coverage covers most of my fees and I pay about $4.00 for a 90 day supply for my meds. Also, if you are living on social security only you qualify for Extra Help thru social security to help pay for your prescriptions. I use this and they keep my prescription drug costs down. I do have dental coverage also.
This gentleman is right on. Anyone who is considering an advantage plan needs to watch this video. Personally I would never consider an advantage plan especially an HMO. I've worked in health care for many yrs and battled along with physicians trying to get necessary tests approved. Many were not approved unfortunately. Many of us when first getting on or researching the best plans have no or very few health issues but unfortunately as we age this changes. I believe having regular Medicare is the way to go.
You are absolutely right! I took Medicare with supplement plan because I did my homework on Advantage plans. They aren't worth the so called cheaper price.
Advantage plans give you rides to doctors appointments, extra cash for your everyday bills, etc. When they try to sign you up for Advantage plans, ask them "If I go to the hospital, how much deducible will I have to pay". They don't like that question!
Well, it is zero deductible but you do have co pays.@@thelakeman5207
I would be scared to death if I was on an Advantage plan. Having known someone who passed away from cancer two years ago, and his frustrations and dealings with a well known MA plan was enough for me. Hard pass.
I have Anthem Medicare Advantage Preferred (PPO). I had no option, I had Medicare AB and Anthem PPO which was funneled into the above plan, as part of my retirement.
I receive a health subsidy of $494.67 + $164.90 Medicare reimbursement monthly and am charged $23.14 for the plan. I net $636.43 monthly.
There are small co-pays, $10 for Rx and office visits, $25 for ER visits.
Sounds like a good plan with the reimbursement for Medicare patient b premiums which are always going up. I don’t know how the government expects senior citizens to afford all of this. It’s very expensive. My husband’s union used to reimburse the members for Medicare part b premiums but they stopped doing that around the time they switched over to Medicare Advantage through UHC.
You are 100% spot on. The article you read, and the reference to skilled nursing, accurately exemplifies the significant disadvantage of Advantage plans. I’m currently helping my parents navigate their way through this nightmare. In an effort to triangulate information, I leveraged UA-cam content in my research, and have consistently found yours to be most accurate and informative. Thank you for your diligence in providing good content.
Thank you for your support!
As we are watching this I am helping my parents also. UA-cam has been my favorite source of information on multiple subjects since 2010! Gotta love free lectures. All you gotta do is comment and hit like to support, it is wonderful.
I found you first as a UA-cam ad. I so glad I clicked. Literally the first UA-cam ad that was for something I needed. The education you are providing is so important. I’m still on my husband’s plan for healthcare (I’m 68), but when he retires I will need this info. One question. I had cataract surgery and had to pay the anesthesiologist $500 not covered by insurance. I honestly don’t know if Medicare or the private insurance paid. Is there something I could be doing to avoid this type of charges?
I'm on an advantage plan and would like traditional medicare BUT can't afford the dental and drug plans and all the other costs with it. My plan has been great
Sure. Choose your plan carefully. If the Supp costs was out of reach then presumably your budget cannot carry high C premiums. A number of carriers will offer very low copays; they’re not just HMOs they’re HMOs on steroids! Teeny tiny networks of providers which may be manageable if you’re in an urban area, less so in rural areas.
Dental plans usually do not cover much..Any chance buying those directly and maybe that would satisfy your dental needs?
Thank you! I am preparing for retirement- several yearz from now- gathering info and knowledge and will continue to do so. This vid and your others are invaluable.
Thank you for your support.
My team would be happy to assist you. Give us a call at 800-864-8890 or schedule an appointment at www.medicareschool.com
I worked as a service rep for advantage plans, I won’t tell which one but it was a very big company. I was already knowledgeable about their problems before I worked there. I mainly took calls from Florida and the east coast. These plans caused so many heart breaking problems. I would sometimes come across someone who thought their plan was wonderful, but those were usually seniors with few health concerns. In Florida, seniors had a hard time finding doctors who took the plan and if they did, it could be months before they could get an appointment. Health plans in general are very confusing and add that to people who are older and may not understand things as well. I was over 65 when I did this work, so I knew how much better it could be with a supplement plan. I will say, I did talk to seniors who could not afford a supplement, but they still could make these advantage plans better.
I've been a Medicare agent for over 10 years. Like you, I heard a host of heart breaking issues related to Medicare Advantage plans. I offer both.
For 80% of my clients, MA plans work just fine. But, I do my best to screen those who have significant health issues or concerns when they are turning 65 and therefore have a guaranteed issue for a MedSupp.
The thing is, MedSupp eventually will price members out of the plan due to age. So eventually, MedSupp won't make any sense.
The interesting thing is that looking at my clients who were on Medicare very much caused me to be very aware and focused on my own health. I started to realize that I needed to take care of my body so that I wouldn't have the medical issues that so many of my clients had.
I would say diabetes is the most likely chronic disease. But it's one that is both reversable (not curable) and within a persons control. But medical practitioners are told not to talk about the root causes of the disease, which is diet and weight.
A Medical Director at a local large hospital system stated during a speech that he gave, and which I attended that: "90% of health care problems are lifestyle related."
Are you sworn to secrecy on which company was most problematic?
@@jdenino6022 LOL....No. Our approach is to do a needs analysis to figure out, using our software, which avenue (traditional Medicare with a Supp, PDP and some ancillary coverage; Or MAPD with ancillary coverage) makes the most sense at the time for the client.
We're more interested in building long term relationships with our happy clients then turning over our client list every year like call centers do.
@@jdenino6022 I only worked for one company and it was a major player.
Advantage plans are NO Advantage, and will only get worse with big insurance companies setting the prices and care given. They don't care about your health.
Noting that the advantage plans are merchandising to people with both government Medicare AND Medicaid, it would be interesting to know how much taxpayer money goes to pay for Medicare Advantage Plan. An ER nurse once told me that Medicare Advantage Plans DON'T PAY for every needed medical care that basic Medicare does pay.
Thank you for providing this information! I am only 60 but starting to plan ahead.
At this time I am planning on a plan similar to the United Health Medicare Supplement Insurance Plan Extended Basic 2020 Plan, and when it is time for me to sign up I am planning to have gone through all the details, and your videos will help with that.
My team would be happy to assist you with setting up your Medicare coverage correctly. Give us a call at 800-864-8890 or schedule an appointment at www.medicareschool.com
No one gets out of the B premium, so what is the point? $200+ per month is also a "pay as you go cost. My wife and I are both 76 and have had zero premium advantage plans from the time of Medicare signup. Heart bypass, knee replacement, cataracts for both of us, stent in a leg, several sets of eyeglasses, two sets of hearing aids, one of us had several afib sessions in a hospital and I don't think total out of pocket has been over $5000 total for both of us. Do you care to figure out $200 per month for each of us over an 11 year period. Doesn't matter anyway because as social security only retirees we cant afford the supplements anyway.
What all the TV Doctor shows fail to mention is that money is the lubricant needed to gain good medical care. The Hippocratic Oath died many years ago when avarice replaced it and the government got involved. Medicine is a business, indeed a very big business!
Private insurance pays more than Medicare does, no matter which plan you have, but I like to think most doctors care about all patients.
Your statement is hyperbole at best and you do a disservice to physicians to generalize as if you do know them all. The Hippocratic Oath is taken by physicians, not insurance companies. All the physicians who have taken care me - YES ALL - fight/fought with insurance companies to ensure I had what I needed.
To paraphrase Ronald Reagan: Government is not the problem, insurance companies are the problem.
Marvin, this is your best video yet! Clearly spells it out, the clear winner is a supplement plan if you can afford it. Being a former State employee I see they offer MA plans as well as supplemental plans once I'm 65. I fully plan to go the supplement route! My questions are, do I save anything with them being a former employee and signing up with the State of NJ supplemental plan or, should I shop around? Second, I have the rates for these supplemental plans, can I compare them with your company suggestions by calling? Thanks.
My team would be happy to assist you with setting up your Medicare coverage correctly. Give us a call at 800-864-8890 or schedule an appointment at www.medicareschool.com
Thank you for such an honest assessment. We are currently weighing out options for my dad (81 years old with afib, high BP and wet AMD) and he has had a supplemental plan since he started on Medicare. The premium increases this year are going to be painful and we took at look at the Advantage plans to see if they might work for him. I have to anticipate that Dad will have increasing health concerns as he ages and while the premiums can be a struggle, his care is going to be better than if he had an advantage plan. My mom had a supplemental and after her cancer diagnosis, she needed repeated hospitalizations and expensive care before she died. We barely paid anything out of pocket except for a few copays. While I'd certainly rather not have to deal with the ever increasing premiums, I won't risk Dad's health, so we will seriously tighten out belts and sleep with some security that I will never have to worry about Dad not getting the care he needed because we can't afford it or because some bean counter denies it.
We're glad that we could be of some help in making this decision. If you ever have any questions for us please don't hesitate to give us a call. 800-864-8890.
Great summary! These are the reasons why I have/will NEVER considered an Advantage plan.
Thank you for watching.
Thanks Marvin,
Unfortunately this is true, After Cataract Surgery I developed a vision impairment and needed a in office laser procedure maybe 5 minutes. But no, Access Denied.
Our wonderful Politicians made deals with these BIG INSURANCE company's to do this to Seniors. The word Medicare shouldn't have been allowed to these Advantage plans. Its just a private plan that skimpy on whats IMPORTANT to your HEALTH. It's like the the Insurance Co. Is your Doctor.🧐
This is one of two UA-cam channels that has educated me the most on Medicare etc. Turning 65 in 6 months and want to understand all this and make the correct choices.
Thank you sir!
My team would be happy to assist you with setting up your Medicare coverage correctly. Give us a call at 800-864-8890 or schedule an appointment at www.medicareschool.com
Great job!!! I an 66, still waiting, and will NOT enroll in MA plans--Mefical Disadvantage!!!
Thank you for this information. My ex husband passed in 2021. He thought he was "required" to sign on to an advantage plan. His coverage was excellent before he did so. I always thought he was ushered off of his original health care coverage.
My health care coverage has been trying to encourage me into an advantage plan. I keep refusing because of what I saw my ex go through.
Personally I believe the insurance companies don't want seniors on their plans because we are considered too expensive. I just refused my health care company from trying to usher me into a prescription drug plan when I already HAVE prescription drug coverage with them. I see this as an effort to try to dump me into an advantage plan just like my ex husband's health care company did to him.
What an awesome video and that article was so eye opening. The letter from that lady was spot on in the first five sentences. Those last 3 sentences I could not help but tear up thinking of what she went through losing her husband. It's "G" for me! Hope this site continues grow and eventually hits a million followers. "The Cajun Ninja's Dad"
Thank you for your support!
I could never afford the g plan, even though thats my preface. Really sad that those of us that have low checks and are in bad health will suffer so badly do to costs
Get a N plan. It is cheaper.
Along with Medicare School there are a lot of great providers of Medicare information on the web when it comes time for you to decide on what type of Medicare you'll be on starting at 65. I started about 9 months prior to my 65th birthday, and doing all the research, plus these video sites, was very helpful. I'd also suggest asking the staff at your doctors office about plans (both supplemental and Advantage) and see what their experiences are; even if you're going with Advantage, see which ones they like to work with. Also ask at the local hospitals and see what their staffs like to work with (and if the even accept Advantage plans - more and more do not!). Yeah, the hospitals' insurance staffs thought me coming in was a little bit odd, but once I explained what I was trying to find out they were very interested in why I was researching Medicare.
A Medigap policy is something you obtain when you keep original Medicare. This insurance pays for the 20% that Medicare doesn’t pay on billing. Depending on the state you live in there is usually 5 to 7 policy’s you can choose from. I personally have one through AARP UnitedHealthCare. These policies can range in price from $175 to $300 a month depending on the extra coverage your looking for. Now, Advantage Plans are all together a different ball of wax. They are Insurance Companies that sell a complete coverage plan as long as you abide by the rules. They get a set amount of money from Medicare for you annually. From there, they more or less guide your spending. everything is well and good when you really don’t need a lot of services when you’re younger I just happen to be a healthy individual. But once you start needing tests and everything else repeatedly, they want you to get approvals and you have to wait usually to get them. You have to remember that insurance companies are there to make money. You have to go to the selected group of doctors hospitals. There might be large co-pays for ambulatory services and such. It is a personal choice.
Why do we continue to put up with this crazy medical system in this country?
Because the alternatives being used in other countries (many with populations only around 10, a couple around 80 million) are virtually unworkable in a country of some 350 million people in which less than half of the population doesn't pay any income tax. The UK is dealing with nonstop funding issues and seriously restricted access to care (including doctors, nurses and ambulances going on strike this year alone) and German friends say it's much more difficult to access care as the foreign population has increased. Better plans require serious discussions of costs and how to pay for them.
Thank you for all the valuable information, but I would like to add one more thing if I may. When someone has a MA PPO plan and are able to go out of network, that doesn’t mean a doctor out of their network has to accept that Insurance. I have been in the Medical field for decades and some of the offices I worked at would not accept an OON MA plan because getting a PA for some procedures can be difficult and time consuming. Also, sometimes we had to fight the insurance in order to get paid. So the doctors just felt it better to not accept them. JM
Thank you for your insight!
I’m sure the Advantage plans are fine for some, but I never want to have to hear about pre-authorizations and maximum out-of-pocket costs again. I hated dealing with insurance companies when I was still employed, and so happy to be on original Medicare with a supplemental plan.
Exactly right: Anyone who’s ever experienced the nightmare of battling a health insurer to obtain coverage for needed medical treatment or surgery will opt for a supplemental plan (assuming they can afford one).
Exactly how I feel.
Been disabled since 2008. And still in original Medicare. I don’t want advantage plan. Basically think of it is private insurance companies getting the OK from Medicare to take over. You don’t have Medicare you got private insurance
One private insurance company got paid by Medicare despite denying claims or not approving pre-authorization. It should not be allowed but it happens. One company got paid over $7 billion last year and did not service the clients they made money out of telling people NO. THATS why I KEPT ORIGINAL Medicare despite some good “extra perks “. Not worth the headache and possible denial of care
I have had Advantage Plans for 16 yrs. LOVE THEM
Do you care to share the Advantage Name? This is overwhelming to me.
I'm going back and forth supplemental/ advantage
So far I'm very healthy. At the moment I have an Advantage plan with Cigna.
I'd appreciate your help. Thanks! please
If expenses are relatively low, you can save a lot of money. I have a supplemental hospital plan to my Advantage plan that costs $75/month. I am paying about $140/month less than regular Medicare plus supplemental plus RX for similar coverage. Yes, it's a bit of a gamble to stay relatively healthy, but all my doctors are in my Advantage plan, meds are 100% covered, and my annual copays are minimal. The hospital plan was set up to fill the gaps in Advantage to Medicare coverage. My RX plan plus cost of meds under Medicare was over $25/month and is now $0
Supplemental plans are NOT cheap and they go up every year. My Advantage plan has a zero monthly premium, with an OOP max of $999. After three surgeries and months of physical therapy, my costs were only about $100.
What plan is that? Who is the provider?
@@TheMarpalm Humana gold plus 056. It’s an HMO. I have been pleased with the medical care. I previously had Kaiser for about 30 years.
Most don't provide much help.
Not all Advantage plans are horrible. Fact is that some folks simply cannot afford a Supplement plan. Best advice to them would be to really shop around. Talk to people, especially doctors, medical case managers, friends on the plan you are considering if possible. The biggest complaints about Advantage plans are needed preauthorization, doctors being told they have to do x before they can do y, because it's cheaper, or denying coverage; hidden charges and charges when out of network...maybe you need a specialist not available in network or you are traveling; requiring referrals before you can see a specialist. Those are the things you want to ask about.
@@carmenpalenske6685 I was misdiagnosed multiple times with Kaiser's HMO. I actually paid outside doctors for treatment of a bacterial infection. Every time I hear a MA commercial, I flash on Kaiser.
I am a very healthy male 66. I recently had aspiration /pneumonia. It went undiagnosed for several weeks. I started having AFIB and it went on for a few days. I was hospitalized twice in less than a week. left the hospital without a diagnosis or know cause for the fluid buildup in my lungs. It wasn't till i remembered chocking of food, getting it up but some went into the bronchia. Anyways. I paid about $100.00 of copay on meds. Not one dime for each hospital stays or the paramedics who saved my life because I did suffer pulmonary arrest and heart failure. woke up 26 hours later intubated in ICU. Still just saying I have A-B-and Medicare advantage. The 5K Dental was used, the 1K for prescription glasses was used. And it pays for my gym membership. I don't see a downside.
Thank you for sharing.
Thanks for the info. What Advantage Plan do you have that does not have a copay for ER or hospital stay/out patient visits?
I live in Tampa, Florida, where senior citizens make up a large majority of population, and therefore, medical options abound. I find the Medicare Advantage plans work very well for me and my friends. I highly recommend them. Maybe they aren’t ideal for other places in the country, I don’t know.
I hear Florida has some excellent advantage plans with low MOOP, large networks. Some offer a give back that pays for part of your part B premium.
@@yeahright532 Correct on some you get your total part B premium paid back to you
I second that. Tampa has good network. Nothing has been turned down by insurer.
Love the perks.
You ALL MUST be WEALTHY! 😡! Most of US ARE NOT
Again... Very informative and Truthful.... BUT YOU need to make a whole video about the Company most Ins. Cos. use for Prior Authorizations... EviCore. This company approves or denies approval... The Insurance company just follows their decision. a Whole Video on the evils of EviCore would be very informative. Thank you for your service!
I'm a licensed agent as well and that is specifically the message I always try to convey to members!...if you are healthy MA might be great!...but once you have a major medical condition, long inpatient stay or procedure; then is when the out of pocket will be sky high...😢
You dramatically overgeneralize. I went the Medicare Advantage route when I retired. So did my wife. Over those seven years, I have had several outpatient procedures, been under general anesthetic four times, and was in hospital after surgery for three nights followed by nearly three weeks in a skilled nursing facility. My wife has had four outpatient surgeries. Our total out of pocket costs, including insurance premiums for our MA plans have been several thousand dollars less than the combined premiums for Part B, Part D, and Supplement G would have been. We have had no problems with doctors or hospitals being outside our PPO network.
@@RichardIILionheart No problem yet. You are reaching the age where more medical things happen. Our bodies get old & break down as we age.
@@lbalsiger
Did you actually read my comment? Your reply seems to imply that I have been healthy throughout the last seven years, whereas my comment clearly says I have had multiple serious medical issues, despite which my MA premiums plus all out of pocket costs are still lower than the premiums alone for Part B, Part D, and Plan G. I have no criticism of those who choose traditional Medicare. Some MA plans are doubtless more restrictive than mine. Would I have been satisfied going the traditional Medicare route? Almost certainly, because I would have gone to the same doctors and the same hospitals as I actually did with my MA plan. I am just saying that given the alternatives when I retired, MA seemed to be better for me then, and I have not regretted the decision since.
@@RichardIILionheart i hope my husband has the same experience with good coverage because his union is offering him United Healthcare PPO through his benefits package and he has a preexisting condition. I worry about him every day so your comment makes me feel better ♥️
@@jdenino6022
I wish you both well.
I'll go with Original Medicare if Mr. Musick will come up with $230+ every month to cover the premium and cover my dental and vision care. Come to think of it, I probably wouldn't anyway. Where I live, the major clinics and hospitals all accept MA plans. They even list on their websites which ones. Very helpful! Someone on a social media app said her husband went to 4 urgent care facilities in one night looking for care, and all of them refused his Medicare plan F! Here in SW WA state our providers are mostly affiliated with the Oregon State University Hospital system. I get excellent care with my MA.
I was able to switch to a supplement from advantage with two chronic conditions. I got the usual discount price. AARP UHC supplemental plan. The biggest reason I switched was to get rid of prior authorizations. I don’t want to be at the mercy of an insurance company. Before going on Medicare, I had to wait a long time to get prior authorization to treat a painful condition. It was awful.
Did you have a 6 month waiting period for a preexisting condition when you went on the supplemental plan? Because I read that if you have something like a heart issue they can deny your claims for six months. This would be a huge problem....I have a chronic condition myself. I take thyroid medication for hypothyroidism. that's not such a big deal but my husband has a heart issue and is on an expensive drug a PCSK9 drug to lower LDL cholesterol though his BCBS policy from his union. He has to go on Medicare early next year. Was looking into a supplemental plan to compare to his UHC PPO PLAN offered by his union but the agent never called us back!
For 2024, I tried to switch from advantage plan to supplement Plan G and 2 of the plans available said that I have to wait 2 years before they will even consider selling me a plan since I had cancer surgery this year and one plan is making me wait 3 years before they will sell me a plan. Were you within the 6 months of starting Medicare which is the open window to switch back to original Medicare + supplement? They also told me that I would pay more for my premium. I also have hypothyroidism and I don't know if that will count against me when applying.
I don’t have any of the expenses or issues you are speaking of. I don’t even have to pay part B. No co-pays. Excellent drug coverage. I always tell people to look into an advantage plan when I hear them crying about all the things they still have to pay for with their Medicare plans. Good luck everyone. If you have any questions you can always Medicare directly. Tell them what you are looking for and they will go over the various plans available for the best one to choose for you. The reason I don’t pay the part B is because I qualify for it based on what I receive financially. Not many people are aware of this but make sure you ask your representative about plans that will pay that for you. There are several. I also get OTC benefits that includes a grocery stipend, dental, eye exams etc.
Ty for this video and reading the article. I recently asked you to comment on the high rate of denials on more expensive treatments. You answered my questions. Thanks again
Happy we can help!
Right now I’m trying to get my mom in a rehab facility after she fell and broke her hip. I can tell you it’s not easy to find a facility with an open bed, but those that do ask about insurance. When they find out she’s on Medicare with supplement, there’s no issue. Thank goodness! I’m not even asking about cost, only trying to find a bed!
My team would be happy to assist you. Give us a call at 800-864-8890 or schedule an appointment at www.medicareschool.com
Your thorough, very informative presentation cuts down on Advantage vs Supplement confusion. It reveals that Advantage plans are not the great deal they appear to be. Thank you for sharing the facts with us!🎉
Thank you for watching!
Very good. Right on target. Dr. Greg Bowers, MD Rain Specialist
Thank you for watching!
I am on original Medicare a and b and recently, when I call a doctors office to get an appointment, I’m now required to have a referral.
Some specialists will see patients on a referral basis-only, regardless of what kind of insurance the patient has. It's just the way they operate. I guess they don't want to waste their time with patients who could be treated by a PCP or other provider.
My advantage plan has been top notch. No pre authorizations and everything has been smooth sailing. Yet to find a hospital or doctor that doesnt accept. We saved money last year with all the perks we didnt pay for
Thank you for enlightening us. People like us need people like you.
Glad you like them! Thank you for watching our video.
I’m a pharmacy technician and the number of people who have no idea what their Medicare Advantage plan does is terrifying. They assume that having MA means that their medications will be free or at least cheap, and then I hit them with the $500+ copay for Eliquis and they start screaming. Please do your research before you sign up for insurance, and NEVER pick insurance based on an advertisement.
Great advice!
there are excellent Advantage plans but they cost more . Just read the list of benefits!
Prior authorization is horrible. I am on Cardiology. Non-medical staff deny lifesaving tests, meds and procedures. All based on algorithms. I agree with cost effective care. But appears so many of the denials are for costs. I would never recommend an advantage plan because of this.
Happened to my husband when he was on a regular BCBS Plan through his union, they said a stent was medically unnecessary for a 90% blockage, the doctor/hospital put in the stent anyway and it took the hospital a year and a half to collect payment from the insurance company which was a regular policy from an employer (his union). Their letter of denial was mailed after the procedure was already done. His doctor was shaking his head when we told him they said it wasn't medically necessary. Well BCBS ended up paying for it and we paid about $300 or something from what I remember. insurance companies. On the other hand they paid no questions asked in full for an inguinal hernia operation and an operation I had to remove a cyst from inside my abdomen which was benign and I also had a few other surgeries. No cancer surgery thank God.
Your info is certainly very helpful. Its so very confusing and complicated. So many scenarios and cost to consider. Its very overwhelming. I'm not very confident make a choice since I'm very healthy now. But I must concider the unknow health issues that could arise.... Wheww !
Medicare is complicated! If you need assistance, feel free to reach out
800-864-8890 or schedule an appointment at www.medicareschool.com
Great video. Just wanted to add that i have been on Aetna Advantage for 3 years. Prior to that was on original Medicare with supplement for 7 years. I just switched back to Medicare and supplement. I had to go thru underwriting for past Stroke and AFib16 years ago. Still have AFib and on Eliquis. Live in Nevada.
Why did you switch back to Medicare AB + Supplement?
Essentially every negative described for MA plans also applies to most employer plans, which are increasingly high deductible plans. That means that many people entering Medicare for the first time and deciding between traditional Medicare + Supplement and MA plans have experience with MA type employer plans.
Had a HDHP employer plan for 15 years. built a 45k HSA balance and only paid my $3k deductible once. Had 2 colonoscopies in that 15 year period paid about $1500 total for both (average $750 each). Super happy with that experience, My current MA plan is actually cheaper out of pocket than my employer plan was including my current Part B premium. Now I have a healthcare nest egg, and If I manage it well it can provide a buffer going forward. People have to focus early in life to be in the best possible situation.
@@butopiatoo
Good for you. Building up HSA funds before retirement provides a cushion for paying post-retirement premiums, deductibles, co-pays, and co-insurance.
@@butopiatoo Nice. Ideally, if you have a Medicare Advantage plan and you could save the $3-4,000 you would spend annually on Supplemental Plan premiums, you would have a nest egg after a few years to spend on co-pays if you did end up needing surgery or other expensive treatment.
@@RichardIILionheart Yes I was VERY LUCKY to have pushed for the adoption of an HDHP as a plan option with my small employer. And VERY LUCKY that I had the discipline to have saved what I did. It could all be gone if I have a catastrophic medical condition, but hey, it gives me options.
Exactly right: I’m healthy as a horse but in the past have had to battle with a health insurer over coverage for treatment when my ankle was crushed. Took over a year! Anyone who’s experienced that kind of nightmare will decline an MA plan.
Like most things in life, you get what you pay for!
I dispute several points in this presentation, but especially that regarding point #2. In calendar year 2023, I left an advantage plan for original Medicare. The latter imposed more out-of-pocket costs, so I enrolled in a different advantage plan than my original plan. The new advantage plan had just launched in 2023, and was a shambles. I went back to my original advantage plan. How did I make all these changes? I picked up my mobile and called Medicare. Their agents answer their phones in real time. No brokers and no paperwork and no commercial insurance companies involved. Also, I have never had a referral to a specialist or rehab care declined under an advantage plan.
With respect, health insurers, Big Pharma, and processed “foods” corporations, AARP and US Chamber of Commerce are all in it for profit only. I am French-American, and have never eaten the Standard American Diet (SAD), so have none of the typical health problems as most Americans: morbid obesity, diabetes Types 1, 2, or 3, high BP, cancers and heart disease. The American healthcare system is obscenely expensive with very poor outcomes, and absolute and nearly-exclusive focus on profitability.
The fact that you're in good health gives you a leg up with your MAP. The problems start when the medical problems start. Aging, accidents and hidden environmental dangers are just three complications of future health that never go away. Just because you believe your lifestyle gives you immunity to future health problems or that your MAP will approve treatments you and your doctor may need or want in the future, doesn't mean you'll get access to those services or get them in a timely manner. Unless you're uber wealthy, that decision is out of your hands and it comes at your most inopportune time, when you're not healthy.
Before I decide whether to change Advantage plan it would be very helpful to know which Advantage providers have the highest prior authorization events. In other word, which is causing the most harm to patients.
You can check CMS star ratings…Center for Medicare/Medicaid awards stars from 1-5 (best). Also some plans do not require prior approvals…ask your agent. Annual Enrollment starts 10/15-12/7 so this is your chance to go over coverage & change if necessary for January 😊
I had Wellcare. It was awful. They kept denying everything I needed. I would have to have everything appealed.
@@cynthiakozikowski1765 I'm understanding that. Although my super expensive drug got covered this year and (maybe) part of next year, Wellcare doesn't cover it at all and it is 100,000/yr plus. I'm looking for something else. Because I'm in Maine I can get off Advantage so more options to pick from.
Wellcare sucks! Awful coverage!
@@noelc2my husband’s union is offering him a United Healthcare Plan with Express Scripts.
My experience with an advantage plan has been totally lousy and unacceptable.
My team would be happy to assist you with setting up your Medicare coverage. Give us a call at 800-864-8890 or schedule an appointment at www.medicareschool.com
I was counseled by Medicare counsel at The Office for Aging I was advised to go with Advantage plan.
My Medicare advantage plan has been great. No complaints.
Glad to hear that!
I had a PPO all my days working that covered us both we never had any issues. Our insurance transfers over to a MA PPO that is the same 400 dollar deductible and 2,000 dollar total out of pocket . We should be all set….
I am a recruiter for a supplement carrier and you would not believe how many agents are out there that do not know a thing about what they are even selling when it comes to advantage. If by chance they do, the vast majority of them dont let you have a word. The problem isn’t necessarily Advantage by itself, but mostly the agent you are working with.
In turn, if your agent doesn’t offer you supplement plans, they do not have your best interest in mind- at all.
Thanks so much for great information. It can be life saving.
Glad it was helpful!
I chose an advantage plan because the insurance company that operates it is owned by the three largest hospitals and doctors locally in my city. It was the same insurer for employees while I was still working. They’ve been first rate top notch with my and my wife’s health care. We have zero problems with them, the customer service is amazing and I’m glad we are with them. I’ve been in it for 6 years and my wife for four years. Because it is locally owned and operated, it functions better than many advantage plans.
Yes, if your advantage plan is in conjunction with a teaching hospital ( center of excellence ) it really works well.
@@steveg6978 The insurer is owned and operated by the three major hospital systems in my city. They cover approximately 11 counties surrounding us. The three hospital have multiple branches throughout these counties and all are served by our plan. Our 2024 plan will be even better than the 2023 plan as more coverage is provided, and it works extremely well. There are over 1300 physician providers, nurse providers, specialists and even chiropractic, plus comprehensive dental with over 500 dentists and vision provision.
Advantage is good for my friend, who’s income is low, doesn’t travel, and who practically never sees a doctor - not because she’s healthy (she’s already had two strokes), but she hates doctors, won’t comply with their instructions, and won’t take medicine. Yes, that’s a bad approach to health care, but she’s stubborn, doesn’t t care if she dies, and that’s that.
I have a good income, have some chronic health problems, see specialists, and have prescriptions I take daily. I get expensive Botox shots for chronic migraines. Also looking at surgery in the future. I plan to travel, and may move to a different part of the country. When I retire, i intend to get the most comprehensive supplement(s) available.
Tw very different approaches for two very different people.
I'm like your friend! Good for her! I get so much grief from all my friends and family but tend to prove them wrong with herbal remedies!
Perhaps it'd time to "checkout" before those costs come up?
Why all the gloom and doom about Advantage plans when the plain fact is it’s all many of us can afford? There’s no way I could afford a supplement even if it is better. My Advantage plan has been fine thankfully, even if it weren’t what could I do?
Exactly. It's mostly about how much money you can afford to pay or throw away on Supplemental Plans that go up year after year, as well as higher prescription costs. One of the best things we can do is keep our weight down and get some exercise.
@@les0101sYes and my MA pays for my exercise classes and gives me $10 a month when I attend exercise class and/or social events.
One heart surgery could bankrupt a person on an advantage plan. With a supplement G, max out of pocket on a heart surgery?😮 $240 annual deductible
Thats a total lie. Medicate advantage has a set copay for surgeries usually between $200-300 a piece. Thats far from breaking the bank and better than most group or individual plans@@Hugh_Manitee
Thank you for all you do I like honesty.
I appreciate your support!
I have 2 family members that are on an Advantage plan. I have tried to tell them they need to be on a supplement but since they don’t have any health issues as of now they think it’s ok. They are all about the 0 premium or low premium. I’m afraid if their health changes they won’t get the treatment they need. My husband and I have a supplement plan. Yes the cost is more but worth the peace of mind. As of now I don’t have health issues but my husband does and to know that are medical bills are taken care of is a load off my mind.
Thank you so much for telling us the truth and giving us invaluable information! I truly appreciate it!!
You are so welcome
I have an advantage program and from my experience it has been wonderful. My drugs cost me zero. My surgery to remove a lump was a whopping $270 for everything (hospital, surgeon and anesthesiologist). I also get free membership to a health club, $2k in dental (my dentist was in network), $40 per quarter in OTC. All of my doctors are in network 😊. Maybe I am biased but you seem to be presenting that advantage plans aren’t good which isn’t our experience
Exactly my sentiments! I love my Medicare Advantage plan so far- I’ve been on it since 2018 and I stayed with the same company!
Agree and I think it's normally hard to reach that out of pocket, even if you have surgery.
Just curious if you get the Medicaid advantage plan or the regular premium paid. The Medicaid pays for MUCH more with no premium.
I'm wondering if you go out of state does Medicare Advantage plan pay for all your hospital expenses and zero co-pay for your prescription haven't listened to the video yet but that's my experience
@@deiadraper6358 we have used our as a plan multiple time at urgent care out of state. Without an issue. Not sure about hospitals. It would depend on which plan and if they are in network. We discussed this with our insurance agent when we selected our plan as we travel frequently
Thanks for making this very informative video! You did an excellent job showing all situations and options that are currently happening with Medicare for those of us about to be part of it!
Glad it was helpful!
So well explained. Thank you.
Glad it was helpful!
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For years I've been getting routine low dose CT scans to check for lung cancer; since Medicare made them available for lifelong smokers. On my new Advantage Plan it took constant phone calls and Dr. re-submissions over four months to get it approved. My United PPO did not allude to this prior authorization anywhere in plain English.
Medigap and a Plan G or Plan N have worked well in my family. The Part C plans were pretty lousy for our needs.
You really explain ma, I am on ma, however after watching your videos, i realize we don't know if we will be healthy as we get older, thank God I am healthy and I plan to change to original Medicare. When I chose ma my Agent never explained the difference in ma and original Medicare. I have been on Ma 5 years so hope I can go back to medicare and supplement. Thanks to your informative videos
My team would be happy to assist you with setting up your Medicare coverage correctly. Give us a call at 800-864-8890 or schedule an appointment at www.medicareschool.com
I've been on an advantage plan for a few years and all my doctors accept the plan and I have zero monthly payments. Lot's of great benefits including dental, vision, free gym membership. All my prescriptions are covered with no copays. I can't justify the monthly premium for the supplemental plan in addition to part B and D. I also live in Massachusetts so can switch to a supplemental anytime.i did get a supplemental with a 15% discount the first year I went on Medicare but didnt need any care so basically wasted a couple hundred dollars a month for premiums.
I live in Minnesota, and subsequently have no choice. I have to be on an Advantage plan. I hate the whole idea of networks. I should be able to choose any doctor I want. Because of networks and the fact that my dentist is not a part of my network, I haven’t been to the dentist in three years.
Also a Minnesotan. Have original medicare + supplement, no problem. Dental plan through my dentist. (I also hate networks!)
Geez, as the skipper on Gilligan's Island says to the Professor;"Easy for you, Difficult for me"!🤣
So how could you even sell someone an advantage plan and sleep at night?
The harping on MA plans and PA’s always leaves out one HUGE variable- the actual cost of care. You can eliminate PA’s and get all the care you need.. and when you see your insurance premiums you’ll have some serious sticker shock.
The underlying issue is the black box cost of care.
Insurance company margins are in all in the single digits. This ranting is masking the real issue.
As long as your MA is a PPO you are fine. Never go with a HMO MA. I have saved so much in premiums with my MA I could have five years of max out of pocket in a row and still be ahead. Remember supplement plan premiums rise each year as you get older.. This guy has to make money selling supplemental plans. Medicare would not allow MA plans to exist if they were so crappy.
Are we going to have to bring a lawyer with us to doctor appointments?
My team would be happy to assist you with setting up your Medicare coverage correctly. Give us a call at 800-864-8890 or schedule an appointment at www.medicareschool.com
I have similar issues with my insurance and it is not an advantage plan. Most of these insurance companies are scammers. Every step of the way they try to think of of ways to slow down or not pay a claim. It is like a full-time job to try and keep them straight and honest.
With the supplement plans, they bill Origibal Medicare & Medicare bills the Plan G insurance company - who HAS to pay if it is covered by Medicare. Don’t even have to get involved.
Excellent presentation of the facts about MA plans.
Thank you for watching!
I have a feeling that ppl that like their MA plan are ones that didn’t have to hit the out-of-pocket max. I’m in the $6,700 max too, but luckily I haven’t had to get near that. I’m in NY, so I just might switch to traditional Medicare. I have been bitten by the PO nonsense.
Awesome video.
THIS resonates with me.
I have SOOO much distrust of any managed care system.
I'll be going overseas. Basic A/B/G makes sense. for me.
Would like to consult when I'm almost there (3 more years); hope to talk w/ you then!