Here's How Much We Paid With Medicare | Medicare Supplement vs Advantage

[@diannalocke997]

Big shout out for helping everyone understand this Medicare nightmare!

[@Theretirementnerds]

Thank you for tuning in! A lot to deal with 😬

[@luisespineira9882]

Anecdote. I’m the red pill. I just joined Medicare Plan A and B and also use a supplemental plan N. Two reasons why I decided to go with the supplemental plan. I had some bad experiences using New York State sponsored health plans. I was also advised by my doctor to go with the supplemental rather than the advantage because its restrictions with their plan and approvals. So far I’m happy with them.

[@lindabunce5133]

Red Pill: Here is what just occurred with my friend on Advantage. She had a stroke caused by a clot. On discharge, her neurologist insisted she take a med called Eliquis. Her Advantage said they wanted her on Coumadin with blood draws every few days as the cost of Eliquis was too high. She does not have transportation now as her driving has been revoked. The neurologist felt she needed the Eliquis, so the cost was theirs to bear. I've had another friend with a different company repeat the same scenario with her husband. It's not designed for patient convenience, it's not designed for better effectiveness....it's based on cost of the medication.

[@threeftr3349]

Blue Pill...💙.....Almost 80% of Advantage healthcare must be pre-approved, it's always about the cost. Its a private for profit insurance company. It's about how much can they keep for their profits, that the gov gives them every month for each person in an Advantage plan. Some even use an AI program to determine pre-approval

[@ChrisSadowski-pp1np]

​@@threeftr3349everyone loves their Advantage plans, until they have to use them....

[@barreloffun10]

Your friend is dealing with a cost containment feature called step therapy, and all Medicare Part D plans have it, whether a standalone Part D plan you get to go with a Medicare supplement, or the Part D plan that comes bundled with a Medicare Advantage plan. All Part D plans have this. The good news is that Part D step therapy (or other cost containment decisions) can be appealed. Your friend's doctor can submit the appeal to the company saying she needs Eliquis first because of clinical reasons x, y, and z, and also because frequent trips to a clinic for blood draws are not feasible because now she can't drive and doesn't have alternate transportation. About that last part, some MA plans have a routine transportation benefit, so check and see if that's in her plan.

[@Theretirementnerds]

Well said. Catching up on comments :)

[@samthompson1270]

Red Pill. Your information is SO helpful for those of us that don't understand this rabbit hole tunnel system. My frustration is how they've turned this into such a shell game for all of us to figure out. Thank God for folks like you that help us navigate this mess.

[@Theretirementnerds]

Thank you so much for watching! 💊 It is a mess, isn't it?!

[@garywhite2050]

Excellent, as always. Thank you!

[@Theretirementnerds]

Appreciate you!

[@samkeino6810]

Blue Pill: I have been told by friends that I should start my Medicare coverage with a Supplement Plan ( in this case G) over an Advantage Plan, hands down. What percentage of people get. Supplemental Plan vs. Advantage Plan and do you have a video on this? Love your channel!

[@Theretirementnerds]

Thank you so much for watching! 🔵 So... I went on a 48-state road trip this summer and went through that exact figure in each state :) They call it the penetration rate. How many people choose supplement vs advantage vs something else. I'm still releasing the videos. I think I've released about 35 of them or so. What state are you in? Nationally, the numbers are: Supplement: 21% Advantage: 50% But this varies by state.

[@mikelyons70]

Thank You

[@tomm7505]

I'm on the Part D plan from W that costs $0.50 per month (going to $0 per month in Texas for 2025 per my ANOC). My two Tier 1 drugs are $0 copay at a preferred pharmacy and Tier 1 will remain $0 in 2025. Just waiting to see the Formulary in October for next year to see if any of the Tiers are changing in the plan. I agree with you that you just need to shop for a Part D plan that fits your needs as they stand now and deal with any unforeseen circumstances if or when they arise. I take a tiny pink (or light red) pill for my cholesterol now so I'll go with light red.🙃

[@Theretirementnerds]

Haha! Love it! The industry was shocked by another year of $0.50 or $0 premiums from them. Great option for people to still have after all the chaos. 💊

[@tomm7505]

@@Theretirementnerds I was shocked as well. I guess by not paying broker commissions and getting a little more $ from CMS, W figured they can keep their market share of Part D.

[@wendyneal4900]

Definitely Red Pill! Thanks for the link!

[@Theretirementnerds]

Thank you so much for watching! 💊

[@briankowald6465]

Red pill: based on the and you other videos, I’m leaning toward a supplement plan when I get there in a few years

[@Theretirementnerds]

Thank you so much for watching! If you can afford them, supplement plans are amazing! 💊

[@nowofficial2853]

Blue pill. I have watched a number of your videos. Not only is the information very helpful and different from even the channels you admire (for example I think the Medicare school guy thinks any of us on an advantage plan is an idiot) but you speak clearly and distinctly even on those state videos where you're talking so fast. I'm on an egwp MA plan (from my national church's pension plan--they pay a premium with money that wouldn't be available to me otherwise) and it's been great for the 2 years I've had it. The max out of pocket is low the drug copays are low (no coinsurance even on the highest tier) and everytime you mention an expensive drug I look it up on my formulary and it's always been there. Brilinta $40 for 60 days mail order. Given that it's hard to know if I'm living in a fool's paradise. Thanks for your work.

[@Theretirementnerds]

Thank you so much for tuning in! Appreciate your kind words. Everyone has their own personal feelings and perspective on the whole advantage vs supplement conversation. We try to just present how each works with any data we can find and trust that you're smart enough to know which sounds best for you :)

[@pdodwell1575]

My Medicare anecdote is that I had Plan F+ for nine years without knowing it. I did like the convenience of not having to worry about any kind of co-pays or deductibles. But last year when I realized how much I was paying my supplement company for the privilege of them paying my Part B annual deductible I switched to Plan G and had the help of a broker to find the lowest cost plan in my area for my age. Now, I am giving serious consideration to tolerating having to deal with co-pay bills in order to save additional premium by switching to a Plan N.

[@dgs8011]

Are there more state rules videos to come? Still waiting in Missouri. Happy to not be taking any red or blue pills currently, so it's the cheapo plan for me for now. I'll risk the 2K maximum on a new condition popping up. Hope your relative continues to do great with her ongoing recovery.

[@Theretirementnerds]

Yes! They are still coming 🙂 trying to edit them all haha

[@dalev7391]

Always the Red Pill! So, I'm 73 and I don't take any medication. I have for some conditions that are gone now, but for years , none. I have Medicare and a supplement plan. My agent found me a part D plan with zero cost. But I'm wondering, if something happens mid year, and I need expensive drugs, how good would a zero dollar plan be?

[@Theretirementnerds]

It will depend on the medications. The $0 plan could still cover them effectively. Regardless, there is a $2,000 Max Out Of Pocket for Part D drug costs, so the most you would see is $2,000.

[@bethesda1146]

You take the blue pill and the story ends, you take the red pill- you stay in wonderland, the question remains which pill should I take? Thanks for helping me decide which pill to take!

[@Theretirementnerds]

Such a great movie! 🙂

[@cherylalmstrom7301]

Red pill or blue pill….its a tough choice. I always learn so much from your videos. Question: have you will you address the purchase of medications outside of the insurance arena? We are currently buying one medication for my husband, privately via a company that sells drugs, via prescription at a lower cost. (I would mention the company, but not sure that is allowed here). The drug and company is approved by our doctor, and costs us less then what we would pay via our Advantage plan. What information can you share about this route of action? Thanks.

[@Theretirementnerds]

Thank you for watching! 💊 I've touched on it briefly in other videos. It's not our greatest expertise outside of knowing how those purchases do (or don't) work with Part D plans.

[@ph5915]

I'm not clear on something Re: Part D plans. Suppose you choose a particular Part D plan when first going on Medicare, and it was a plan recommended by an agent and everything went well. But during the course of the first year, you came down with an unforeseen major issue, stroke, cardiac, cancer, etc., and the medications, say, blue pill or red pill, were expensive. Does the current Part D have to cover them (or an appropriate substitute), and do they have to keep the same premium rates for the rest of that year? And what happens during the following year if you still need to take those meds?

[@yy4uman]

You can apply to the insurance company for an exception (for you only and for the remainder of the year only). If they approve it: joy reigns throughout the kingdom. If they don't: you cry into your beer (and probably get another prescription for high blood pressure due to the excess salt intake).

[@ph5915]

@@yy4uman Ah, thank you!

[@Theretirementnerds]

Haha! Well said. And you would be able to change Part D plans during the Annual Enrollment Period from October 15th - December 7th every year, which would go into effect on January 1st of the next year :)

[@joghog]

To complicate things, this antiplatelet drug (will refer to it as red pill since I like red) could be stopped 6 months to one year after stent placement. Maybe your family member could get the physician's advice for her during open season so that she can make a better decision. Hope she is doing well.

[@Theretirementnerds]

Thank you so much! She is doing great considering the circumstances :) 💊

[@karinhart489]

Thanks for another great video. This past year I did one of those low cost planes that was 40¢ a month, down from $8.30mo the year before. But I wasn’t currently prescribed anything. For next year I decided to wait until after the October 15th date to ship drug plans because I see my PCP a week later, and I want to ask her what the chances I’ll end up with an Rx for any of those blue pills or red pills.

[@Theretirementnerds]

Thank you for tuning in! Did you get your Annual Notice of Change letter?

[@karinhart489]

@@Theretirementnerds I did the other day. I think they are saying next year will be $17 and some change each month. That doesn’t seem so bad when I think how much other plans cost when I was comparing them. I noticed a bit of a bump up on the copay of tier one and 2, but a drop in % of the most expensive one.

[@markaustin5269]

Red pill. Thanks

[@Theretirementnerds]

Thank you so much! 💊

[@jimhoyt49]

Red Pill: taste better?

[@Theretirementnerds]

Good question...

[@MelodieKunz-vf1fl]

Don’t know if I want red or blue pill

[@Theretirementnerds]

It's a difficult choice 😕

[@LottieTopacio]

Red pill … Blue pill

[@Theretirementnerds]

Thank you! 💊

[@douglasmiller1036]

Blue pills look more pleasing. My broker no longer will review Part D coverage since many companies are eliminating commissions on such plans. Both my wife and I have part d plans with premiums in the 80 to100 dollar range. This is due to a few high priced medications that we take. The plans with higher premiums tend to be more "kind" with the cost of expensive medications. Note: The broker does show you how to review part d plans yourself.

[@Theretirementnerds]

Many brokers are going this route because they just can't handle the volume of drug plan service needs. I'll be putting together the tutorial for Medicare.gov as soon as plans are released.

[@laurie6332]

I had different 2 agents/brokers who told me right up front they would not help with Part D. That's the most confusing part (for me) and I just didn't give them my business. Brokers are mad about not getting as much commission (or any at all for Part D). Well they may regret that once people start NOT recommending them for help in all the other areas that are so confusing.

[@douglasmiller1036]

@laurie6332 Look for a good Part D video on KZbin. They explain how to shop for a Part D plan by using the government medicare site (you need to set up an account there). My broker initially helped us do this. Once I learned the process, I did it myself and chose a different Part D plan than the broker arrived at.

[@kevinbell1785]

Red Pill, Blue Pill

[@Theretirementnerds]

Thank you! 💊

[@marykelley5182]

Red pill.

[@Theretirementnerds]

Thank you! 💊

[@myth-n-m4yhem]

red pill or blue pill? why not purple!

[@Theretirementnerds]

Haha! Great question! We can throw purple in there too :)

[@SomebodySaid...]

Okay, I'm only a couple of minutes in and my jaw has dropped to the floor ... 92 million people taking Drug #1. 82 million people taking Drug #2. 65 million people taking Drug #3. These numbers are mind blowing. According to the 2020 U.S. Census there were 331,449,281 people living in America. I've always wondered why there are so many drug commercials on TV and now I know why.

[@Theretirementnerds]

Pretty wild, right?! Those are low cost generics, so not a lot of profit in them, but still... if the profit is even $0.01 per pill, that's still $920,000 for 92 million people with 1 pill. Multiply that by 30 days in a month... $27,600,000... multiply that by 12 months... $331,200,000...

[@SomebodySaid...]

@@Theretirementnerds These calculations are mind blowing too! I'm just floored that there seems to be a LOT of unhealthy people in America!

[@laurie6332]

@@SomebodySaid... We are the sickest country in the world! Fact! Thailand is #6 for being the healthiest and having the best health care system in the world. The United States thinks they are so great? Yes, we have some great doctors, but our healthcare system is so broken. We rank #28. Thai people also pay little to nothing for their healthcare and they have some beautiful, very modern hospitals. I would even dare to say they are even more advanced than the USA in Bangkok. I believe it is their diet. They do not eat meat, nor dairy. They do not have many desserts at all. They make them for the tourists but they are not sugar addicted. They eat tons and tons of vegetables (without chemical sprayed on them), chicken and lots of fish. The American diet is the problem imo

[@SomebodySaid...]

@@laurie6332 I agree. Other countries eat food while we eat "edible product" created in a lab. There's a reason you can't eat just one Lays potato chip. I just never realized before how rampant poor health is here.

[@laurie6332]

@@SomebodySaid... When food comes in a box and you just add water and call it nutrition that’s a big problem. The ingredient list is 30 ingredients that we can’t even pronounce. That is not food. Such vitamin and mineral deficient bodies are not healthy. Sometimes it feels like a government plan. Sick get sicker and Big Pharma is drowning in money.