A Look at How Medicare Advantage Plans Really Work

[@tomm7505]

Good video, as usual Erik. The one comment I would make is that you mentioned that Advantage plans are similar to employer sponsored plans that people have had before Medicare and that is correct. The only issue is that during our working lives we're in our 20s, 30s, 40s, 50s and early 60s -- when most people are relatively healthy and don't use their health insurance very much. When we retire and are in our later 60s, 70s, 80s and beyond is the time when things start to break and we'll be using our healthcare services much more. That is the time, for me anyway, that I want the security of knowing that my doctor's in charge of my healthcare and not a behemoth insurance company using a third party health advisory company and its computer algorithms to determine what care I should and shouldn't have. I don't want to be fighting some unconcerned insurance company employee or computer when I'm trying to get well from a sickness. Original Medicare and Plan N Supplement for me.

[@Theretirementnerds]

All excellent points, Tom! Thank you for your continued support! That 20-year look at Plan N is in the works 😉

[@Jody-kt9ev]

Employee plans vary all over the place. Usually, large employers with a lot of clout have better plans. As a prime example of this is an experience my wife had. She has Rheumatoid Arthritis. The doctor recommended an expensive modern treatment, but the fact that I had very good employee insurance through a large employer made this no issue for me. At the clinic, she met another person with RA. Their insurance would only cover methotrexate, a very old treatment for RA with a lot of side effects. It was obvious to my wife that this person already had a lot of joint damage.

[@theeardrafter]

Well Said Tomm!! Thank you

[@Starfish2145]

Yep!!! 👍

[@INJURYCOMP]

Agree 100%

[@janmcguire5268]

That’s great! I love my Camry, but I’m going with a supplement plan and original Medicare.

[@Theretirementnerds]

Solid choice! :)

[@mmane257]

i retired at 62 in 2021 and purchased a honda ridgeline my retirement ride. turning 65 in november 2024 and looking forward to contacting you to sign up for the medigap plan G or N.thanks for all the information you give.

[@Theretirementnerds]

Appreciate you so much! Happy to help however we can!

[@kimbowr]

I may have to listen to you several times because although I paid attention I couldn’t keep up with some details. I have the attention span as a squirrel. I pretty confused right now on what to do. Thank you for your time.

[@dianahelm4852]

Eric: you did an amazing job in explaining these plans. I’ve had both. When I was married with 2 salaries, had Medicare + Supplemental. Very expensive. As a widow now, Medicare Advantage. Works ok but I lost 2 fav docs that saved my life.

[@Theretirementnerds]

Thank you so much for taking the time to watch. Also, thank you for sharing your experience!

[@NancyGram]

My husband & I have been happy we chose the Medicare Supplement Plan F! We just wish we could have our Basset Hound included! Yes, the premiums keep going up 😢, BUT we Have been able to get our back and knee surgeries done with complete coverage. Thank you for a Very well-explained presentation!! 😊

[@Theretirementnerds]

Thank you so much for watching! 🐶

[@JCV884]

20 years on Humana MA. Very satisfied. I have had many significant health issues and never once encountered a delay or denial.

[@Theretirementnerds]

Thank you so much for sharing your experience!

[@zsigzsag]

I did my research on my beloved '92 3000GT SL. Served me well for 12 years, daily driver (and a lot of fun). Did the same with my new Advantage plan for 2024, PPO with give back of Part B premium. I'm rarely sick, take steps to remain healthy, I just one RX (cheap), I go to my doc maybe once a year. Hope this plan serves me like that car did. You have the best channel for Medicare info. Thanks so much!

[@Theretirementnerds]

Thank you so much! This comment means a lot, so we appreciate you taking the time to write it. And great car 😏

[@virginiagilmour4912]

Thanks for your comments. Which plan gives you back your Part B Premium ?

[@patriciachristiansen3800]

Several years ago I was talked into an Advantage Plan & several doctors & facilities also went on board in my rural area. Now I'm having second thoughts, but am 81, BUT in good health so far. This might all depend on what happens to the ins. market in the coming 2025. My daughter is director of a rehab center & the corporate office just this last week, stopped accepting anyone on an advantage plan. We'll see if United Health Care remains viable in my very rural community : ) Gotta fix dinner. I'm recently widowed & tend to eat like a bird. Thanks for your great presentation (though I still don't know what to do).

[@kathrynmcadams8091]

I have had an HMO Advantage plan for 20 years. Both hospitals in town and most in the nearest large town are all providers. The same for the doctors and specialist. With no copay for drugs, the grocery and over the counter plus dental and vision plans as part of my plan, it has served my purposes well.

[@Theretirementnerds]

Thank you so much for sharing your perspective! And watching 🙂

[@lindamarquez5727]

This presentation was "excellent." I now truly understand the difference btwn advantage & supplement plans. I prefer the supplement plan, I get to keep my doctors. I'm medically "low maintenance." Loved your presentation.

[@Theretirementnerds]

Thank you so much!

[@joannejohnson85]

This is a good presentation. Most agents know the numbers but not actually wht MA plans are doing to providers and whats actually happening with PA. Been in the healthcare business 30+ years and can tell u most MA plans are not good. Mcare+ supp is the way to go if u can

[@KarenJohnson-z1x]

Great information We switched to an advantage plan offered by my husband’s employer. We are relatively happy with it. Our elephant is with us!

[@Theretirementnerds]

Thank you so much! Thank you for watching and sharing your experience! 😊🐘

[@markmedley6849]

There is no way to know when you are signing up for Medicare Advantage, what care you are going to need in the future. Nobody can tell you that. You waive the coverage of a doctor's opinion and replace it with the opinion of the insurance company. Maybe it will be an issue and maybe it won't depending on what illness or procedure you need treatment for. It's a risk you take when you buy the policy not knowing what the future will bring. Nice video and explanation. Thanks for posting!

[@Theretirementnerds]

Thank you for watching Mark and adding your insights!

[@les0101s]

I think insurance companies do consider the doctor's opinion and they review diagnostic tests. If your X-Ray or CT scan says you have lung cancer, then you do. I have no reason to think that insurance companies want to deny me coverage.

[@Theretirementnerds]

@@les0101s have you seen this video yet? kzbin.info/www/bejne/qXKcdq2lnq2de68

[@DebraWagner-kj2wv]

Watched three of your videos they were awesome I’m going to refer my patients to your site to educate them and on the Advantage vs Medicare insurance

[@Theretirementnerds]

This means more than you know. Thank you for spending some time with us and would be happy to help in any way we can.

[@janetkenny4861]

My dad bought a new 1976 Ford Pinto hatchback for us to learn to drive in! It was red, white and blue and fast, and fortunately traded in for a Subaru in a few years, no accidents. 😂 seriously, I will be going with a supplemental plan, most likely G. I know I will get inundated with sales pitches, but living in MT with limited doctor and hospital choices, I don’t want to get locked into a AP network, but have all the choices of those who accept Medicare. Thanks for the clear and helpful information! Gotta go walk the corgi’s. 😊

[@Theretirementnerds]

That is awesome! Thank you for tuning in!

[@kenneim4583]

Thank you for explaining everything very clearly. I am not on Medicare yet and I'm trying to learn as much as I can before I am. Every video I have watched with Retirement Nerds has provided a lot of information. Thank you.

[@mrtriffid]

As usual, straight talk! My wife and I have Advantage plans because we are both relatively healthy, don't travel constantly, and my wife enjoys much reduced prescription costs. I listen to your vids just because it's refreshing to hear the honesty! 😊

[@Theretirementnerds]

Thank you so much! So glad you are happy with your plans!

[@johnurban7333]

I was healthy for 60 years and than out of nowhere I got something that knocked me out for 8 months. Lesson learned that you never know when it’s going to hit you. It’s a gamble

[@bigd3104]

​@@johnurban7333My exact concern also regarding Advantage plans. When we're healthy, they're great. As we age, and need more care, or heaven forbid something catastrophic happens, then Supplemental plans are a better choice. I think it's terrible that we're put in the situation of being between a rock and a hard place when having to make Medicare decisions.

[@angelwings7930]

@@johnurban7333👍

[@rickybuggsr1101]

I am so thankful that here in my resident state of PA, the Medicare Advantage plans are very good, and with proper education, my clients really like them. Plan management has not hurt them at all, to include the surgeries, therapies, tests, etc. Avoiding $300-$400 monthly premiums…a big welcome to my members. They are ok with the defined copays. Many are in their 70s & 80s and switching from a Med Sup to a MA plan. It ALL depends upon what the person needs. Great video!

[@Theretirementnerds]

Thank you! Agree 100%. Bashing Advantage plans makes for easy views. The reality is they work well for a lot of people. Not everyone of course, but they can work well.

[@threeftr3349]

Those are high premiums. Zip codes really matter.. My spouse in the southwest region was quoted an N plan around 100-110 for a 65 year old male. Healthy now, but we just don't want to deal with all those most complicated denial tiers I have ever seen in our later years of life. Seeing stories of some fighting denials for up to 2 years, or families blaming Advantage insurance for denying/delaying sensitive life saving care. Mayo Clinic is denying Advantage plans in AZ and FL. There are other healthcare groups who won't renew contracts. Some doctors office are tired of all the denials, and frankly don't have the staff to deal with them all. Also some are using AI programs in their denial cases. There's been Congress sessions about the increase in denials for care from advantage plans, where they are following the policy of the insurance company and not following Medicare rules of healthcare. Calling Advantage plans as part C of Medicare is downright wrong. People are trading their hard earned paid rights to traditional Medicare for a private for profit health insurance company, who pays the highest commissions, including the highest residual commissions to insurances reps. I wish someone who gets commissions from these plans would actually do a video clearly explaining those denial tiers, because quite frankly they are terrifying once you understand them..

[@Nrsshel2]

Florida here, so what i am hearing is that we have the highest cost supplement plans here. As a retired utilization review RN, those were the best plans to have in Michigan. Thought i had done enough homework and retired here, have been on an advantage plan. 2 downsides, the doctor pool is small for my rural location. I found a dr I really like & worry they will drop my insurance. And then what if i need real hospitaliization. Declining years, declining health. Now i face underwritihg, costs of living have soared. Seeing an insurance broker this am, hoping theres a clear answer. Thank you for all your information.

[@teresaalbin-davis4529]

I chose a Tesla plan, preparing for the future, higher upfront costs but lower over time, I picked plan g, very happy with knowing I have more choices, fewer restrictions.

[@jdenino6022]

My husband is being offered a Medicare Advantage plan by his union as part of his retirement package and while we are afraid for him to go onto it it’s way more affordable than Medicare supplement plans. Medicare supplement plans start out being at around $150 and increase every year. I’m afraid that in ten years we won’t be able to afford the premiums. My mom is on original Medicare through her NYC union and it cost very little for all her medical expenses but costs the city of New York a fortune. NYC tried to switch to Medicare Advantage but a judge threw it out of court when the retirees sued. It really is a very tough choice and you only have a 3 month window to try to make a switch back to original Medicare. It really is not fair as the ACA made this illegal for under 65 year old insurance plans for people shopping on the Marketplace.

[@jabcsmith1]

I recently had to research a specialist doctor. About 90% of the doctors I examined will not accept regular Medicare patients. I live in Florida and have an Advantage HMO plan.

[@fossett7]

Another great video. So how do I find someone trustworthy in my area to work with me on getting the right plan?

[@Theretirementnerds]

I have partners I trust who are licensed in all 50 states. If you want someone in your area, I don't know someone in every zip code, but I have a decent network where we could find someone. My email is [e-mail]

[@steveg6978]

One consideration in my advantage plan is dental. Dental after 65 ca be a huge expense.

[@Theretirementnerds]

Excellent point!

[@teresaalbin-davis4529]

It can also be very low if you've kept up with it over time and floss the teeth you want to keep, electric toothbrush a huge help ( I'm a dentist)

[@johnurban7333]

Why don’t we see supplemental policy ads with celebrities

[@Theretirementnerds]

Low hanging fruit answer: the dollars. More subtle answer: less strict regulations around bombarding people about supplement plans than Advantage plans. As long as agents just talk about supplement plans, they are calling and knocking on doors unannounced. With Advantage plans, the beneficiary is supposed to make the first intent move (phone call). There's bad on both ends, unfortunately.

[@g0989]

Only ones that sell Supplements I've seen are the ones with John Michael Higgins. I've been seeing a lot of commercials pitching Advantage plans this season, as usual. But I haven't noticed any with celebrities this year, for some reason.

[@rebeccaroach230]

Secret rhino ☺️ : if you come down with catastrophic disease say cancer, which is it better to be on Advantage or supplement. No criteria, not money or anything else. Which could you get the most help from? Is it possible to be dropped from an Advantage plan if you become too expensive? Can you go back to original Medicare and a supplement if that happens? Appreciate your video and the struggle to be fair. Thank you

[@Theretirementnerds]

Thank you :) To answer your questions... 1) Advantage or Supplement - Tough to answer. In most cases, if you have a catastrophic disease, the supplement plan will have less administrative stress. This video goes over that topic in much better detail: kzbin.info/www/bejne/m4CzaGmegrWcetU 2) No. You won't get dropped from your Advantage plan because you are too expensive. There are advantage plans that will leave an area, but that is not targeting you, it is anyone on that plan. When this happens, you would be able to get another supplement plan without any issues OR you could go back to Original Medicare and a Supplement plan with no fear of denial. Does that help?

[@loveyf853]

@@Theretirementnerds get another supplement ? Isn’t it approved by underwriters first to be accepted….who wants to insure a critical pt?

[@iraforleiter7954]

From what I observed, Advantage plans that offer $0 premiums have higher out of pocket thresholds. I compared all the Advantage plans in my area and came to the conclusion that even a small premium each month lowers my out of pocket levels noticeably. To me, that makes the most sense.

[@Theretirementnerds]

Definitely depends on location and offerings in those locations :) Usually (not always) advantage plans with a premium are offering something extra compared to those in the same area or with the same company that do not have a premium.

[@davidfolts5893]

Great video and analogy, 90 Days From Retirement! When cars were first born, they were all handmade and costly, with only the wealthy being able to afford them. When the seachange came, most went out of business because Henry Ford invented the assembly line, and only a few could compete on pricing. In addition, he could price cars so they were affordable to the everyday person. Much like the Advantage Plans versus Supplemental debate, it comes down to options and pricing. It is easier to compare plans if you are county and state-specific. One last fun fact: Henry Ford lost significant market share to other companies due to his rigidity about the paint colors of his cars. His reply when told to offer more options: They have plenty of choices: They can have it in black, black, or black.😃

[@Theretirementnerds]

Love me some car stories :) I like your additional analogy on top of the analogy :)

[@LindaC-ze5ob]

🤣😂👍

[@jerryburden4525]

Another advantage is for those of us that are Expats (I live in Mexico) and have AARP UNITED HEALTHCARE PATRIATE which covers 100% Unlimited for Urgent or Emergency care in Mexico!!

[@neninocencio9325]

Hi Erik thank you so much of your very informative video. I really like if you’re using the white board because it’s a detailed explanation and I can understand more and more❤. So far I don’t have a problem with my advantage plan.

[@Theretirementnerds]

Thank you so much for watching and your support over the years!

[@butopiatoo]

It's too bad the insurance companies don't market MA plans as a "extension of an employer plan". If they had similar summaries then it would be easier for people coming off an employer plan to compare an MA plan with the type of insurance they have had for a long time. I've been on a MA plan since May and am happy so far, but I'm in good health so the low premiums and "perks" are great. No clue what it will be like if my health situation becomes more complicated. We'll just have to see. Good even handed review. Much better than the guys BREATHLESSLY BASHING MA plans.

[@Theretirementnerds]

Thank you so much for watching and such an insightful comment!

[@jacksilver9935]

Want a clue? Compare B premium/yr plus your plan’s A/B MOOP. Compare it to B Premium/yr plus Medigap per year. The avg is 4K Original and 7.5-8K Advantage (in network). So if you develop chronic illness or experience a catastrophic event you will pay up to 4K more a year for A/B costs under Advantage.

[@Theretirementnerds]

@jacksilver9935 we have a video on this here: kzbin.info/www/bejne/inumdmemgNR-rMU The difference in reality isn't quite as large as your example, but there is a difference. Thank you for sharing!

[@butopiatoo]

@@jacksilver9935 Thanks for the math lesson. What you haven't considered is RISK, cumulative cost, AND financial ability to withstand a year of higher cost. Just like the actuarial calculations the GOVERNMENT and the INSURANCE COMPANIES do, we as individuals have to look at our circumstances, resources and health history and make a decision and choice of the plan(s) we can afford and will best work for us OVER OUR LIFETIMES. Not one year, not in isolation. So, if one has a healthy HSA from saving over a 10-15 year period and rarely ever hit their deductible on their HDHP employer plan, and can afford to pay out of current income the small medical related bills one typically has during a year (leaving the HSA to grow tax free for later in life) then choosing a MA plan with a giveback, OTC supply benefit and other helpful services like dental, vision and hearing makes a lot of sense. My MA plan is helping me to stretch my dollars spent on healthcare early in life to save for later in life. If a gap plan is the best fit for you, that's great. I may change to one later in life. You play the game as it comes to you. Good luck to you, Jack.

[@wduke582]

Not rhino v elephant but my decision which I'd rather have in my corner. Very well done thank you.

[@Theretirementnerds]

Thank you!!

[@cathyreed6983]

Dog cat bird elephant! Thank you. Great video. Clarity. Great analogy to cars!! C Reed

[@Theretirementnerds]

Thank you so much for watching! :)

[@marksivakoff]

Thanks..Eric, good session, but the elephant in the room on advantage plans and emergencies out of network is who decides if it was an emergency. If you go to the ER with chest pain and it's only heartburn will they pay that? If you go to the ER with chest pain and it's a heart attack will they cover the bypass surgery or stent placement at the out of network facility or just the ER visit? Thanks.

[@lananewman8570]

Thank you for this very informative video. You kept my attention every second. Well done. I’m a new agent and trying to learn as much as possible. I’ll also be going onto Medicare at the end of this year. I was unable to find an animal to post but know I watched every second! I’ll be following you 😊with my DOG next to me.

[@Theretirementnerds]

So glad it was helpful! Welcome to the Medicare world 🙂

[@flexjay87]

I keep coming back to your channel, because i need help, and i wanna keep as much politics and marketing out of my decision, as i can, because its not productive for new people to Medicare, to be taken advantage of by, well, anyone involved, including Insurance agents.

[@Theretirementnerds]

Appreciate you coming back. We try to keep both of those out as much as we can. Medicare is a federal program, and it is a political topic, but we try to explain how it is, not how it "should" be.

[@flexjay87]

Thats good. I always say : The Truth has No agenda :) @@Theretirementnerds

[@desilu-stage9]

In 2024 I had MA. Many specialists bc I wanted to assess my health at 68. Had knee replacement surgery and a couple of imaging procedures. My total outlay was around $2k so I didnt make the $4900 out of pocket max. I view this as a wash for ME between Supp G and MA.

[@dmoon9037]

Roughly, what are the corporate economics behind agent commissions for Adv plans? Are the Adv plans more profitable for the insurance carrier (than say Supplements) and therefore the carriers are incentivized to pass along that incentive to agents? Or more factors in play re: agent commission paid by carriers?

[@Theretirementnerds]

Commissions for Advantage plans are set by the federal government, so the insurance company itself doesn't have much say in it. The dollars received from the government to insurance companies is a bundle of coverages - hospital/medical, drugs, dental, vision, hearing, etc. So it's like getting a commission for all of them in one. Supplement plans are just the hospital/medical. If you were to add in the commissions for a standalone drug plan, dental plan, vision plan, and hearing plan, the commissions don't have nearly as big a spread. That's a quick answer. More to it, but that's a good start.

[@gailsharker5725]

Eric, very good video! My cat loved it too😘. I have an advantage plan and knock on wood, have had minimal expense, mostly hospital care. I take a lot of drugs and with the cost rising faster than we know, I can’t wrap my head around that and with the premiums going up by age, I don’t see that I can afford the difference. Drugs are a big deal as we get older and drug companies have no heart, they can charge whatever they want. Thank you for being honest!

[@Theretirementnerds]

Thank you so much for watching Gail! Your cat, too 🐱 Many people are in your same boat of the medication costs being the most important factor in their decision!

[@dan1ob]

Elephants are wise, and so are you. Both of these strategies for managing healthcare expenses come with tradeoffs, so it’s hugely important to consider what your priorities are, especially considering that later switches may or may not be available to you. The only other big decision wrinkle is High-Deductible G, which dramatically lowers the monthly supplement premium but carries a higher potential out-of-pocket cost than plain G or N. However, that out-of-pocket max ($2800 in 2024) is much less than the Advantage max in most cases. As a healthy 74yo in Texas, I pay $46/mo for my HDG, and my out-of-pocket has always been much less than full G premiums would have been.

[@Theretirementnerds]

Well said! Thank you so much for sharing your experience with HD G!

[@miguelberrios19]

The High Deductible plan G looks interesting for me as well, but the main culprit is it's deductible has been increasing every year, usually by 50 to 80 bucks. Ouch!

[@dan1ob]

@@miguelberrios19 when you do the math (20% of the Medicare-approved amount), you’d have to have a terrible medical year (multiple procedures) to ever come close to the deductible, so the rising deductible amount doesn’t really matter most years. Meanwhile, you’ve saved more than that with low premiums most typical years.

[@gailremp8389]

Pintos. Yep. I have cars. Love you..will have to watch later as have a project to complete. ,etc.

[@mohammadsaber9679]

You tried to be nice to the horrible stories about advantage Medicare ,, but it was balanced to a degree, thsnk you

[@elianasmith6330]

What a brilliant video. Great advice, simple and practical. I like your video presentation. It is informative too, at the same time. Thanks a lot for your guidance!

[@Theretirementnerds]

Appreciate you so much 🙏

[@jeffreyphillips4182]

My out of pocket is 4900$ a year. Started Chemo 6 weeks ago. 1900$ out of pocket left for this year. Guess I'm paying another 4900$ first of the year to continue Chemo ☹️

[@Theretirementnerds]

So sorry to hear you are going through Chemo. My mom is as well. Thoughts your way Jeffrey!

[@Dee--Jay]

I have original Medicare. If I need dental and vision, is it best to get Medicare advantage or what do you recommend?

[@Theretirementnerds]

That'll depend on how you approach networks and cost sharing. It'll also depend on where you are and the plans available to you. Standalone dental & vision plans will have a monthly premium and work similarly to what you've likely experienced with a work plan. You may have a waiting period if you haven't had a dental plan. The Advantage plan route typically comes included with the plan, no waiting period, and works a little differently. Many have a dental benefit number. Let's call it $1500. They will cover $1500 in dental throughout the year and anything over that, you cover, still getting access to the plan's negotiated rates. Hope that helps!

[@eduardooramaeddie4006]

Thank you for the Medicare information, on advantage plans Eddie

[@edrodgers4581]

Stay away from advantage plans.

[@MrWilsonbw]

My biggest gripe with advantage plans is that agents are not required to tell you how difficult it can be to switch over to a supplement plan.

[@Theretirementnerds]

Here's a video on switching if that helps :) kzbin.info/www/bejne/jJ_JZoijfsifnas Thank you for watching!

[@MrWilsonbw]

Thanks! I have really learned a lot from your channel.@@Theretirementnerds

[@teams3345]

I will take a Supplement Plan any day. I am really shocked with this video. You have done so many that agreed that a Supplement Plan G is the best and most flexible. It is also best if you are hospitalized 2 or more times in a single year.

[@Theretirementnerds]

Supplement plans are great! We have a similar video on Supplement plans here: kzbin.info/www/bejne/aWK3an1-jLZ9gLM We cover them both :)

[@teams3345]

@@Theretirementnerds So depending on which product you are speaking about they are both the best. That sounds like you’re being political and all you want to do is sell. That sounds too car salesman like to me. I had liked you until that video on the Advantage Plan. Oh well.

[@Theretirementnerds]

@teams3345 we don't believe there is such thing as the best plan. Based on our past interactions, a Supplement plan sounds like it suits you very well. There are others who cannot afford them. Still others that live in areas that have Advantage plans that make it hard to ignore. We were meeting with some doctors this week that, without knowing them, they asked which they should get. We told them it's like me coming to them, without explaining what hurts, and just asking which surgery should we get? Knee surgery or shoulder surgery? But they can't ask us any follow-up questions. Same here. We don't think any agent should recommend "knee surgery" (supplement) when someone doesn't have a hurt knee and instead, has a hurt neck (financial limitations). Also, half of everyone who watches our channel already has an advantage plan. So our videos aren't to convince one way or another, rather explain how they work for those approaching the decision and those who have already made the decision. Hopefully that helps. We love supplement plans for the right situation. We love Advantage plans in different situations. Both are better than our current employer coverage.

[@teams3345]

@@Theretirementnerds Unsubscribed. Thanks.

[@bigmargie]

If I were hospitalized 2-3 times a year, I would go with Traditional Medicare and supplemental.

[@marinaarch2132]

Excellent video! Thank you.

[@Theretirementnerds]

Thank you!

[@danvance9113]

Erik, It may be helpfull to let people know yhat Rx costs don't count to MOOP.😊

[@Theretirementnerds]

Great point! We usually do mention that but just spaced on it for this one. Thank you!

[@keith6872]

I reached my max out of pocket of $7500.00 and all my drugs are covered in full , I pay zero for my drugs and Healthcare until the end of year.

[@WhittyPics]

I am fed up with paying high premiums for insurance with high deductibles that don't pay for anything. I am going with a medigap plan

[@July.4.1776]

For the majority of people their employer provided health insurance was most likely a PPO. A good MA advantage plan is very similar to your employer plan in some cases.

[@markcowart6887]

Are things changing as to the coverage concerns and advantages of advantage plans?

[@Theretirementnerds]

2025 has a lot of potential impacts, mostly because of drug coverage changes. Haven't released 2025 plan info yet, but we're all bracing for changes. Supplement plans are looking at double-digit premium bumps. Drug plans potentially having big premium jumps and drug tiering changing. Advantage plans potentially reducing the extras like dental and other benefits... we'll see and keep you posted!

[@markcowart6887]

Thank you.

[@JustinBrock]

I absolutely love your videos dude. I will do my best not to steal your references haha, but they're too good.

[@Theretirementnerds]

Thank you Justin! I think we run in similar circles. I've heard your name come up quite often. Would love to meet the man, the myth, the legend for real sometime. There are a couple channels that copy our stuff almost verbatim, which doesn't feel quite right, haha. Just change it up a little bit :) [e-mail] if you ever want to connect.

[@peterbedford2610]

I live in a Kaiser MA area. People speak pretty well of Kaiser , in general. Are there "user groups" of certain plans where you can communicate with people about their experiences?

[@Theretirementnerds]

Not that we know of, but a great idea!

[@judykiernan9477]

I'm looking. into a new plan because I received a letter stating that my Humana PPO is being discontinued at the end of this year (2024). I have.had this plan for 11 years and was very happy with it. I had full coverage in NY, NC and FL. The same low co-pays so apparently all in plan. I thought for sure there would be significant costs for removal of half my thyroid and one ovary. Two separate surgeries in two states (NC & NY) in the same year. I was very happy with the $244(?) charge for each. They were both out patient but it seemed like lots of docs, techs, etc involved. Where do I find a good agent to help me find a replacement plan? My husband, dog and I would appreciate any help. Thanks.

[@Theretirementnerds]

Thank you for watching! Send me an email to [e-mail] and we can see what we can do

[@kimkramer2511]

Great Presentation. Loved the rhino and elephant.

[@Theretirementnerds]

Thank you so much! 🐘🦏

[@Squddle]

Which is better, an issue age medigap plan, or a community based medigap plan?

[@Theretirementnerds]

There isn't really a way to answer which is better. It'll depend on where you live and the companies available to you. Here's a video that goes into it a bit: kzbin.info/www/bejne/rqHSl5Kpr91-eMU

[@rickyusa1000]

The ads at each end of this video weren't in your favor. The first ad was for Marvin's agency, and at the end of the video was one of those "you need to call" advantage plan commercials.

[@Theretirementnerds]

Thank you for letting us know. Unfortunately, we have zero control over the ads played before and after our videos and companies can target their ads to play before and after certain channels. Wish we had some say in that. Thank you for watching!

[@theeardrafter]

@@Theretirementnerds I can't help thinking it is a targeted placement of these ads on true and caring sales agents of real health policies by big insurance companies trying to muscle in on consumers on the fence because that's just how they roll.

[@Kathleen67.]

Thanks

[@fredk9999]

Nicely done. Learned a lot

[@Theretirementnerds]

Thank you!

[@deborahstickney314]

Hello, getting ready to be an information Tiger regarding the differences of med advantage and regular medical insurance. I have heard that if it sounds too good 2 b true it probably is. This is why so many people over 65 is one of fastest groups claiming bankruptcy or their credit going into the toilet because they did not realize with Medicare Advantage that they are responsible for the other 30 percent not covered by zmed advantage. So glad that my husband took original Medicare instead. Yes u pay 4 more premium but, should you have major surgery, I find that it is better to pay a bit more monthly and owe less for major surgery at the end. My husband has original Medicare so after paying deductibles he has only paid out less than $1 00.00 as he has supplemental insurance. It pays to figure out monthly pay a little more each month and nothing at end or pay nothing and pay 20% at end which financially hurts senior citizens as well as credit!!!

[@deborahstickney314]

30 percent should be 20 percent just a typo.

[@Theretirementnerds]

Remember, there is a Max Out of Pocket. So the 20% on an Advantage plan is a whole lot less risky than 20% on Original Medicare Only (Not taking a supplement plan). Appreciate you watching!

[@tomeauburn]

The other thing about advantage plans was they were supposed to save the government money while providing as good of coverage as traditional. Neither one is true. Insurance companies charge an average of 106 percent more than traditional. And coverage just is not as good. What is true is it's the most profitable policies sold for insurance companies. Lots of politicians get money from these companies. Depending on who gets elected may determine if traditional Medicare gets replaced or not within the next 4 years. It will be done to save the government money but we already know has been costing the government more.

[@julieplumb3427]

So far I hate my advantage plan! I plan to get out of it and never go back!😡

[@Theretirementnerds]

Oh no! Sorry you're having issues. Are you within the window to switch to a supplement? What issues have you been seeing?

[@eduardooramaeddie4006]

Very well explained, thank you, great information

[@Theretirementnerds]

Thank you Eddie!

[@eduardooramaeddie4006]

@@Theretirementnerds your welcome

[@fredk9999]

Remember the Ford Pinto well

[@Theretirementnerds]

Fondly?🙂

[@StephenARettig]

i like the elephant; Roll Tide! You fail to include the cost of prescription drugs in your analysis! For many, prescription drug cost is their largest monthly medical expense. And, the current trend favors Advantage plans because the Stage 1 deductible phase is eliminated on most Advantage plans for 2024, which lowers the RX cost when compared to the stand-alone drug plan cost. Stand alone Prescription drug costs can not be ignored in this analysis.

[@UriLev-nj3qu]

Great presentation, even my dog listened

[@Theretirementnerds]

Thank you so much! 😊🐶

[@miguelberrios19]

Hi Erik, I have never asked, are you licensed in Texas?

[@Theretirementnerds]

Just sent you an email :)

[@zemelya1980]

Hello Eric, first of all I am really shocked that you are replying to literally each comment. I am on KZbin for quite a few years, mostly cooking recipes😊😊 but I will be retiring in a 2-3 years, turning 65 this coming May and just had a meeting with one of the local agents( I am from small town in NC) and got educated about these plans but only after watching your videos several times, I think I finally understand the difference. Quite frankly, I am leaning towards Advantage Plan. Paying total of nearly $500.00 for all these plans including Supplement plan seems way too much. It seems like a gamble really. My BCBS Health insurance from employer is not cheap, around $230.00 a month including Dental and $1300.00 for deductible and out of pocket($2300.00 total) per year and I had nearly 4 years that I had to pay 100% of those $2300.00. But last year I didn't and nothing this year so far. My SS benefits will be $2300.00 per month at FRA and paying nearly $445.00-500.00 per month(if I am not mistaken), that's close to 40% of my SS Benefits. If I remember correctly, in NC Advantage out of pocket is $3600 annually. I have no mortgage, no car payments, no credit card debts but still. I think unless you try and see what will work for you, it's really hard to determine which plan is better, it all depends. Anyway, one more time, thank you for replying to each comment, that's really impressive. If you were really close to my location, I would ask you to be my agent in a heartbeat.

[@Theretirementnerds]

Appreciate you watching and taking the time to write this 🙏 I can't get to 100% of them, but I try to respond to as many as possible 😅 I wish we lived closer to each other as well!

[@reklovjj]

Seems like South Fla has good or better Advantage plans than other States! Full Giveback, max OOP $3,800, good if not great network, and more... Cant see the needs going to N or G!

[@Theretirementnerds]

Some of the best plans in the country there...

[@denabrett]

61 and beginning to think I need to pay attention to what my 69 year old hubs is going to do when he retires to help us come out on top of the health cost and standard of living, as well as to help me decide what is best for us later. Medicare is on an individual basis right? I mean powerful rhinos and wise elephants are very different animals.

[@Theretirementnerds]

Correct, Medicare is an individual plan. Thank you for watching. Here to help if you need. 🦏🐘

[@catherineparkerdouglas4114]

My current Advantage plan has their customer service team based outside of the U.S.A. Customer service is terrible. I'm ditching Advantage plans for this reason alone. (Thumbs up on the info.)

[@Theretirementnerds]

Thank you for watching and sharing your experience!

[@johnurban7333]

To go to a supplemental plan they have to approve you and they can decline.

[@joannasisemore7184]

may i ask which company you have?

[@woofinu]

Was there data on how long it took insurance companies to review and decide whether to approve or deny? I think sometimes it's not the denial but the additional step and delay in choosing a course of treatment, especially for a patient already in the hospital waiting for the next treatment. Do they still need authorization in those cases, and is it in hours or a day, not several days or weeks?

[@Theretirementnerds]

We agree. We bring that up in this video: kzbin.info/www/bejne/qXKcdq2lnq2de68 Trying to find data around the length of time between receipt and approval/denial for a video.

[@woofinu]

@@Theretirementnerds That was a good video. Actually I hope there are decisions and situations that are exempt from review and pre-approval. Sometimes time is critical and I hope that doctors are given the freedom and flexibility to do what's needed without second-guessing afterwards.

[@Theretirementnerds]

@@woofinu agreed!!

[@joedehitta2903]

I'm getting ready to get my Medicare next month. Since I'm healthy and not on any medication, I'll take MA for now. Can I switch later to Supplement if my health goes bad?

[@Theretirementnerds]

@@joedehitta2903 hi Joe. The answer is... "It depends." We have a video all about switching here: kzbin.info/www/bejne/jJ_JZoijfsifnas Hope that helps, and thank you for watching!

[@johng4093]

Love my MA with yearly maximum out of pocket and lifetime maximum out of pocket. 😊

[@Theretirementnerds]

Thank you for watching and sharing!

[@weaseldragon]

Having all my doctors, labs, pharmacies, etc. under the same roof has advantages. I've been in the Kaiser system for 10+ years, and I'd rate my experience 4 out 5 stars. I compare that to the PPOs I had in my 20s and 30s... having to drive all over town to get a blood draw, an x-ray, and a face-to-face with a doctor, and then dealing with the bills. While I'm fortunate to have no serious illness at present, I understand my opinion could change if faced with a complex disease. That said, I've seen friends and family with cancer or other devastating illnesses spend their last days burning time and cash latching on to the hope of some cutting edge or even experimental treatment (not to mention the pure b.s. pseudo-scientific scams). This is why I tend to prefer managed care, assuming it's data-driven in covering the treatments most likely to work for the most people. This is why I'm leaning toward the Kaiser Advantage plan. It could cost a bit more -- Kaiser offers a $0 premium basic plan and an "enhanced" plan for about $70/month with a lower MOOP, plus an add-on package of optional benefits (full dental, gym, hearing aids, etc.).

[@Michelle-gi9jv]

I drove my boyfriends baby blue pinto😁. I liked it

[@Theretirementnerds]

Haha! Thank you for sharing! My sister liked hers, as long as it wasn't crashed into anything :)

[@loridwornik1355]

Nice, honest description. I have advantage plan through my state plan happy so far but if I wanted to change to suplemnt when and how do I do that

[@Theretirementnerds]

Thank you so much for watching! Here's a quick video on switching. kzbin.info/www/bejne/jJ_JZoijfsifnas

[@EliCurran-g6k]

Giffaffes … in keeping w your safari animal theme…

[@danlindquist5222]

Of course we know what a Ford Pinto is. We’re watching a Medicare video.

[@Theretirementnerds]

Haha touché

[@rhyslud]

Pintos got a bad rap. The explosion thing was related to the tube to put gas into the car and the fix was easy. Otherwise they were pretty decent cars (for mid-70s Fords) and I bought several over the years because nobody wanted them. Chevy Nova was much worse.

[@Theretirementnerds]

Haha! Thank you for watching! Great add to the Pinto discussion!

[@PeterZareski]

Total honey Bee. Really worth watching.

[@Theretirementnerds]

Thank you so much for watching!

[@andi2234]

Thank you. new sub!

[@Theretirementnerds]

Appreciate you so much!

[@tomeauburn]

You didn't mention the under the table payments advance plans give to agents. It's not just that they turn down treatments but they delay it often when someone is trying to get care in a hospital or aftercare. Often AI turns down care without humans. I have heard quite a bit different opinions on what percentage they turn down but turning people down for scans who get cancer or delays of treatment can be critical. Even my doctor doesn't take a lot of the plans. When I signed up Mayo Clinic sent me a letter saying they do not take Advantage plans. The one thing about supplement plans is you do not worry about who you see, if it's covered or what it will cost. You know all of that up front. I hope my money hold out and I don't have to do an advantage plan but if I do I heard it's best to add a cancer plan with it. Our first drug plans were 85 for us, but we're going up to 150 so we switched to a zero dollar wellcare drug plan. It's been better than the first year but of course depends on your drugs.

[@masterlee4370]

What an awesome analogy of vehicles to medicare insurance companies. I honestly had no idea there were that many and I truly do not understand why there are so many. Vehicles are available to us from age 16 until we are no longer able to drive. Medicare Insurance doesn't start until age 65 and I can't help but wonder if that might change one day in the later future as people live longer, just a thought since they will one day raise the social security full retirement age which I totally do not agree with them doing. I am always like a sponge watching these videos trying to absorb all the knowledge I can. I could say I just watch the videos for the pictures, but I would be lying.

[@Theretirementnerds]

Your ongoing support over the years is unmatched. Thank you for not only watching, but always sharing well thought-out comments as well. Your son's videos pop up on my feed quite often. Hope all is well!

[@-moses-6898]

Help ! I am 73 & have Medicare A & b. I never enrolled in part “d”. Can I switch to medicare advantage- a b & c & have no penalty for not having had - medicade part “d” for last 10 yrs? I just never took it out. Please help

[@Theretirementnerds]

Unfortunately, you would still have a penalty, even if you went on a Medicare Advantage plan. Now, that penalty wouldn't feel as bad, because you wouldn't have any other Part D premiums on top of the penalty with an Advantage plan, but the penalty would still show up.

[@-moses-6898]

O my ! how high the penalty would be ? In the hundreds ? I have been without a part d since 2015

[@-moses-6898]

Could you even ball park imagine - for me- what that penalty might look like? For about 10 yrs - no part b . Mayb 200.00? Instead of Zero ? O my!

[@Theretirementnerds]

@@-moses-6898 looking at about a $41-$42 per month penalty if it has been exactly 10 years.

[@-moses-6898]

O thank you ! You are the best! Appreciate you- God bless

[@bobby-e9t]

realistically show how medicare would work for i senior living on social security receiving 1500 dollars a moth and how they can afford to live and pay for medicare

[@sailorssailing1643]

Unfortunately we can’t afford a medi gap plan.

[@Theretirementnerds]

It is an important consideration, for sure. Thank you for watching!

[@lenashanahan5829]

Love elephants & rhinos Loved the video

[@Theretirementnerds]

Thank you so much!!

[@miguelberrios19]

Another well presented and specific video, thanks for that Erik. I have one worry, and it's not so much about denials in medical care, but more about the fact that some of that doctor's and hospitals are beginning to not accept some of the Advantage plans, due mainly to higher costs in healthcare, versus lower payments from managed care. Sooner or later, managed care will start charging premiums again on its Advantage plans as it once was about 12 years ago. God bless you and your family.

[@Theretirementnerds]

Agree with you my friend! It'll be interesting to see how everything shifts over the next few years. 2025's introduction of the $2,000 MOOP for prescriptions will have ripples as well. Appreciate your support!

[@janetdavis4724]

I have had a advantage plan. For years, and have never had any problems. My husband was in and out of the hospital and in 2021/ 2022 . I had 2 knee Replacements and a hip. I never had one problem. What he said with the copay. Is wrong. . It wasn’t that much. They make me sick When they try to put the advantage plan. Down si you will get what they w@nt you too… they will probably take this. down as they have before

[@Theretirementnerds]

Hi Janet, so glad to hear your plan has been working well for you. Not entirely sure where we disagree here. Sounds like your plan works great, and we are not anti-advantage plans. We don't put it down at all, just explain how they work. The fact that you do not have an outpatient copay for knee replacements and hip replacements is very rare. Most Advantage plans (remember the car analogy) do have copays of some form if you have an outpatient surgery. Thank you for watching!

[@coopermurphy6422]

I believe what you are describing as your experience with an advantage plan is true, but not all advantage plans have the same coverage and not everyone has available to them the type of plan you and your husband enjoy. I believe location is a big determining factor in the availability of advantage plans. I sincerely hope you and your husband are doing well and enjoying good health. Cheers.

[@heidiswinson1445]

I lived in India for sometime and was charged at by a Rhino and rode an Elephant !!

[@Theretirementnerds]

That's wild! 🐘🦏

[@jwalker6446]

82% of appealed denials are overturned (or partial). Seems like the lion’s” share of denials are pushbacks either hope the client won’t appeal. My father was denied 6 times for post surgery nursing care. Without the persistence of a healthcare provide in the family, he would not have got that care. On top of that he was denied care shorter than the MD recommended and ended up with a staph infection. Insurance companies should be on the hook not the doctors and patient just because an incorrect code or misspelled word.

[@sandrawood1644]

Thank you for your information it did help me to know what is going on and I think I've seen a white rhino once on the discovery channel

[@Theretirementnerds]

Thank you so much for watching! 🦏

[@Joey-fs7ro]

Who paid for those "independent studies"???...if someone paid for them, they are not independent studies!!

[@ranman1959]

What’s the max out of pocket if you have to go out of network because the only doctors in-network are hacks? And what’s the max out of pocket if you have a procedure that is not pre-authorized? And what about the discrepancy between skilled-nursing care coverage under most Advantage plans vs traditional Medicare? BTW, I know seniors that have Advantage plans that don’t even realize it due to the excellent salesmanship by unscrupulous brokers.

[@steveg6978]

Where and whom the Advantage plan is associated with is a consideration.

[@joannasisemore7184]

depends on your plan. if you go out of network on an hmo they usually will not pay anything. ppo will pay a percentage depending on the company. if the doctors are hacks on one plan opt for another or regular medicare where you can go to any dr that accepts it. most companies require the doctors and hospitals to get preauthorization not the patient. it will still be a battle for you though. had this happen when i was on ambetter aca. the hospital did not authorize an emergency service in the correct time frame. my ambetter rep helped me fight the hospital billing department. as for nursing care at the moment you get what you sign up for but there have been government hearings that may someday correct those issues. i am not an expert i just do a lot of research!!!!!

[@MicheleZaborowske]

Our max out of pocket is $1200 and we receive ZERO penalty for going out of network...it is called a passive PPO plan and is part of a retirement package. We can choose our doctors...so traveling is no problem.

[@RonMac08]

You couldn't pay me to have an advantage plan.

[@jcyensen1236]

Supplements are very expensive for they go up ever year and you can be paying out of pocket up to $800 because you pay out of pocket for dental, or a plan which has monthly premium so does and eye exams and glasses and another premium for pharmacy. Constant switching for one supplement plan to another is outrageous cause it eventually does the same. Had Supplement for years. Take G its cheaper and it was for a few years, now its N is cheaper and on it goes. For seniors on a fixed income which often need all these protection its unaffordable and the going to Advantage is the great Plan D which sucks cause the cost of drugs is outrageous. None of this matters cause they got it all figured out you are going to pay pay pay or owe owe owe. None of these plans fit for the majority of the Americans and especially not seniors. Supplements are suckers for those who don't need it which is when you are 20,30, 40 and 50 and even 60 for some. For seniors Supplements will eat up your savings the same as Advantage plans. There is no really good plan for seniors.

[@pattycake1939]

I remember the Pinto😩

[@Theretirementnerds]

It was something, wasn't it? :)

[@tpark4444]

Mine was baby blue. traded it for a Chevy Impala. Loved that car.