How Can Medicare Advantage Cost $0? | (Hint: They Aren't Free!)

Have you wondered how can Medicare Advantage plan cost $0?
In this video, we’ll explore why Medicare Advantage plans may cost less than Medigap plans, how some of them can have zero premiums, who pays for the plan then and what some of the costs are that YOU will pay if you enroll in an Advantage plan.
You will discover that while some plans have a zero premium, they are certainly NOT free.
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[@cherit.4412]

A question: Does a Medicare Advantage plan take the place of a Medigap policy? If so, how does that affect the copays and coinsurance that a Medigap policy may typically cover? I currently have a Medicare Advantage plan and will turn 65 in the near future. Thank you for your assistance!

[@BoomerBenefits]

You can't have a Medicare Advantage plan and Medigap plan at the same time. It's one of the other. A Medicare Advantage plan takes over your Part A and B coverage and usually Part D as well.

[@thienho6373]

@@BoomerBenefits Yes, I know that. I do not plan to have both Med. Advantage and Med. Supplement at the same time. I am now with Medical Supplement Plan G. And I am thinking about switching from 1 company to another, still Plan G. My question is would I be denied to switch from 1 company to another one?

[@johnsonpaul1914]

Everyone pays the medicare premium regardless of the type of plan so that is a moot point. Wife and I are both 72 and have had advantage plans from two different companies since turning 65. Both were zero premium. Three and a half years ago I Had a heart attack, 2 weeks hospital, two ambulance rides and 3x heart bypass. Total billings of over 250,000 dollars, my share was 1600 TOTAL. Less than the premium on most medigap policies for one year. Regular office calls are zero, specialists are 30, tier one drugs at Walmart are zero. Not even considering anything different. I am figuring right now after 7 years that we are at least 20,000 ahead vs medigap. I live in a tiny town of 1000 and our dr and local pharmacy are in both plans

[@nrm55]

Whose Advantage plan do you have?

[@johnsonpaul1914]

@@nrm55 Aetna, but they are not in all markets

[@donatocongialdi4811]

@@nrm55 Hi Neil, what Aetna plan do you have if you don't mind?

[@drbassface]

Why was your out of pocket so low for such an expensive total bill? What about the Max Out of pocket that’s now $7,500 plus...? How did you avoid paying 20% up to the Max out of pocket?

[@johnsonpaul1914]

@@drbassface because most settle for 33% of the asking. One hospital billed me the 1600 and the surgical hospital billed me nothing.

[@se7ensnakes]

You know we have a bad hospital care system when you need to be certified to be able to explain your benefits

[@barrydee587]

My wife pays 12x$135.=$1620. annually for her Medigap plan. My Advantage HMO Plan is zero premium and zero for Primary Care Physician and $20. copay for specialist. No referral required. Yes, her plan is more flexible in what she can do, however Im strictly surviving on SSI for my resources and this to me has been a Godsend. P.S. Your really good looking. (-:

[@rosariocampos6412]

Totally unfair to our seniors,when you have you gals having 6 kids with diffrent no good father's, they get hospital pay,all medical treatment paid,then kids get full Medicaid and other free service.

[@randyjerrett3385]

👍exactly

[@seanhenry4830]

Appreciate your insight accurate and straight to the point. Thanks

[@oveidasinclair982]

Advantage plans vary greatly on where you live, in Florida there are a lot of Zero premium plans, $4900 max out of pocket PPO's and $2750 max out of pocket HMO's with Part B give back. Chemo, dialysis and multiple hospital stays are killers on Advantage plans. The best Medigap planto look for is High Deductible G paired up with the Humana Wal-Mart PDP, you just need to get your head wrapped around High Duc G, once you fully understand it, you can't beat it. Stay health people.

[@Jenniferde2007]

I feel that is incorrect information. You want Plan N not a high deductible Plan G--it would incur too much out of pocket expense. Under Plan N You only pay up to a $20.00 copay for a doctor visit and up to $50.00 for a visit to the ER which is waived if you are admitted to the hospital. You must also pay your Part B Deductible....that is less than a high deductible plan.You must make sure that your doctors accept Medicare assignment as payment in full.

[@joshpembers]

I am so annoyed that I allowed myself to be talked into an Advantage plan by a friend. In my entire life pre-Medicare, I only had PPOs with no referrals and I didn't realize how much I would hate going to a Primacy MD to get referrals, permission, paperwork, and "approval" to go to someone who I wouldn't have even chose by myself. In other words...I hate being required to ask for "permission" to go to another doctor. Unfortunately, due to one issue I don't think I could get through underwriting to switch over to a MediGap plan. ((Result to me is that I just don't go to see a doctor for a lot of things......which is likely one of the reasons that HMOs exist (to cut usage)/

[@MikeBear1231]

Likely you already have, BUT, at the yearly open enrollment, you can CHANGE your Advantage plan for a different Advantage plan. I suggest a PPO plan. Better than an HMO, and you don't need referrals for everything.

[@sammyelliott5554]

You are always informative with how things work on each plan. Thanks again for your videos. So educational!

[@BoomerBenefits]

You're very welcome! Happy to help!

[@gooddogbelle]

Thank you so much.

[@samgarthherrington]

Great stuff thx ! I'm really liking your book as well. Finally someone gives a simple explanation. Everyone wants to know the cost annually avg, and the pitfalls. Great job

[@BoomerBenefits]

We're so happy to hear that! Thank you for your kind comment.

[@thienho6373]

Dear Stephanie, thank you very much for your videos. Your

[@Spiderveins60]

Thank you.

[@rslitman]

Born in 1952, on Medicare since 2017, chose a Medicare Advantage plan that was very similar to the health insurance I had with the employer I retired from that year. Premiums have been in mid-100s. Going up to $165 for 2022. But they are also introducing a zero premium one and one for $51. I am seriously considering a switch to the latter. $25 instead of $20 to see my podiatrist. $20 instead of $18 for a Tier 3 prescription. But many things are the same.

[@randymacpherson4689]

These are the very best , clearest, and most honest explanations of Medicare options anywhere. As a certified HIICAP volunteer in New York State for nearly 10 years I am quite knowledgeable on the subject. One further comment. Be aware that Medicare allowable expense is QUITE different from some hospital’s “list price” for your procedure and days in hospital. When the bill says $250,000??? Medicare (and you) pay SIGNIFICANTLY less.

[@paulghilino2906]

Awesome! I was wondering how Medicare Advantage Plans could not be charging a monthly premium. You answered my question!

[@BoomerBenefits]

Glad it was helpful!

[@leokim5106]

Thankyou

[@chicagomike]

Perfect thanks I am 64 so thinking I am very low income. Like very low. Social security and no savings really a small cushion.

[@sawlovesyou52]

I would like to see doctors forming their own plans ..... especially if you have a doctor and give him/her a premium for services that could cover deductable costs. Two .... I would like to see doctors charge those pill pushers and insurance companies who want them on their plan to charge them for taking up the doctors time .... like a office visit charge. Ideally, it would make more since if we made payments to a doctor rather than a insurance company.

[@stephenpolicoff292]

I have an advantage plan that has a lower out of pocket cap than the medigap policy I had previously. It has better prescription coverage and vision and demtal benefits. It's also zero premium. The main problem is the coverage can change from year to year. But you can shop for a different plan during open enrollment. If Medicare is paying the insurance company $1000 per mo th per enrollees, no wonder the insurance companies push these plans. They must be quite profitable for the insurance companies overall. Taxpayer money going to corporate profits, but I guess it may still be preferable to many Medicare recipients vs. contributing to the corporate profits made from Medigap policies. Either way, a portion of our healthcare dollars go to corporate profits.

[@rjahn3000]

The Lasso Medicare Advantage plan is somewhat unique, how about covering that...thanks?

[@leokim5106]

Ray J d

[@hemapatel7642]

Hi mam I am watching your videos. Very good information. I have a question when people have Medicare and Medicaid both, if they choose regular advantage plan but not dual. Do they need to pay copay for hospital or surgery?

[@BoomerBenefits]

Hi Hema - Medicare is primary and Medicaid is secondary. Medicaid helps will pay for your costs associated with Medicare. This includes your Medicare Part A or B premiums, deductibles and coinsurance costs. However, we do not specialize in dual-eligible plans. Therefore, we recommend contacting Medicare for more information. boomerbenefits.com/medicare-medicaid-and-extra-help-for-part-d/

[@sunetraCHI]

Do you know how much a Cataract outpatient procedure would cost ? Do I then have to pay the copay for each follow up visit or is it a package cost.

[@BoomerBenefits]

We can never tell you the exact costs of a procedure as that will depend on your doctor specifically and the type of insurance you have.

[@thienho6373]

Thank you very much for your videos. Your explanation is very informative and easy to absorb. I wish that I could find a video which explains in what situation, one person may be declined by either a Medicare Supplement Insurance Carrier or a Part D plan, when they apply for switching from one carrier to another.

[@BoomerBenefits]

We're happy to know you have found our Medicare videos helpful! :) If you were to apply for a Medigap plan outside your 6-month Medigap Open Enrollment, you will likely go through medical underwriting in most states. You potentially could be denied a Medigap plan due to pre-existing health conditions. Regarding Part D plans, you would not be denied a plan if you apply during the appropriate enrollment window. Here is more information on Medigap underwriting: boomerbenefits.com/medigap-underwriting/

[@thienho6373]

I currently have medicare. But if I like to switch during the opening during the fall oct to dec 7. Then in what situation i may be denied.

[@BoomerBenefits]

@@thienho6373 The Annual Election Period is only for those who want to drop, change, or enroll in a Medicare Advantage and Part D plan. The AEP has nothing to do with Medigap plans, since you can apply for a Medigap plan anytime throughout the year. Check out our video, Medicare Annual Election Period | 6 Things You Can Do and One Thing you Can't

[@thienho6373]

@@BoomerBenefits Oh, Really. I don't know that. I currently have Medicare and Medicare Supplement Plan G. I thought I can change the Insurance from 1 carrier to another during the AEP. My question is in what situation, one may be denied by another carrier when he/she like to change?

[@BoomerBenefits]

@@thienho6373 The AEP has nothing to do with Medigap plans, only Medicare Advantage and Part D drug plans. In most states, you will have to go through medical underwriting when changing Medigap plans/carriers. If you cannot answer "no" to the health questions on the Medigap application, you could potentially be denied a Medigap plan. Learn more about Medigap underwriting here:boomerbenefits.com/medigap-underwriting/

[@lesterpicar9815]

What is the best insurance company if we want to consider dual eligibility plans?

[@BoomerBenefits]

It depends on where you live. Feel free to give us a call and an agent in your area can help you with that answer.

[@chicagomike]

Hello. Do any of the plans cover hiv medication.

[@BoomerBenefits]

Yes, all Part D drug plans must cover at least two HIV medications on the plan's drug formulary.

[@billyrayband]

Good summary because yea, nothing is really free. Do you see any chance congress will fix the 80/20 issue with Medicare and have an out of pocket max? That is the #1 reason I hear that people buy an MA or Medigap plans.

[@BoomerBenefits]

So far there is no talk about changing the 80/20 rule nor is there any talk about adding a maximum out of pocket.

[@joshpembers]

I never thought about those 20% if ever needed Chemotherapy, radiation or dialysis. Can you advise what is the price range for those types of treatments and what 20% comes to for each? I don't know if 20% comes to $10.00 or $250.00 each treatment.

[@BoomerBenefits]

Hi there - The price for these services can vary from facility to facility across the nation. We only specialize in Medicare plans, so we are unable to provide you with this type of information. We recommend reaching out to your local doctors or hospitals for this type of information.

[@bbhihoney]

Plus, most have networks of providers you can use. That is NEVER good.

[@jamescalifornia2964]

I hear that ! You *must* use the network - _or else !_

[@luismarquez7917]

Yes, lots of restrictions with advantage plans.

[@jamescalifornia2964]

@@luismarquez7917 - Good luck getting approval for tests or special treatment. 😒💨

[@jacquesmerde3282]

I currently have a Medigap policy (Plan G) and pay for parts B and D automatically as deductions from my social security check. I recently entered the VA system and I plan to have the VA as my primary care next year. I'm thinking of getting an Advantage Plan as a backup in case VA can't see me in a reasonable amount of time. I get all my diabetes medications at no charge from the VA. Should I go with a $0 premium Advantage Plan and cancel my Part D payments? I have no income other than SS and my medical payments currently amount to over 25% of my monthly income.

[@BoomerBenefits]

That seems like a good plan for you. Since you have VA and just want to use Medicare as backup, a low cost Medicare Advantage plan definitely sounds like a perfect backup plan for you. You can call us to compare Medicare Advantage plans in your area. 855-732-9055.

[@luismarquez7917]

I suggest you check it out with an expert. Call senior savings and watch their very informative KZbin

[@bookmagicroe9553]

What is a ball park figure for a 95 year old to pay for a Medigap Plan G? She is healthy except for high blood pressure. She only takes 3 prescriptions. Would she even be accepted due to her age? She is presently on a Medicare Advantage plan with a $5000 max out of pocket.

[@BoomerBenefits]

Medigap premiums depend upon multiple factors, such as age, gender, zip code, tobacco use, carrier and more. We cannot really give you a ballpark number since it varies by person. Age does not disqualify you from being able to enroll in a Medigap plan. However, in most states, you will be subject to medical underwriting. So, if she cannot pass the health questions, then she will either be denied a plan or will be charged a higher premium. Give our team a call at 817-249-8600 and we can look into this for you.

[@sheryl318]

If kaiser offers OOP of $4900 does that mean I will pay that before they pick up the bill?

[@BoomerBenefits]

No. You're thinking of the deductible. First you meet the deductible. After that, the plan starts to help you pay. Once you total out of pocket spending hits $4900, then the plan pays 100%.

[@pankajpatel4434]

How do I compare Medicare Advantage plans for my Zip 89002 in the context of “ Medicare Part B premium reduction “ ? Thanks 🙏 HARI HARI

[@BoomerBenefits]

Hi there - Our team should be able to help you with this! Please give us a call at 817-249-8600.

[@marymelzer8412]

We have a med advantage plan and would like to change back to med sup. When can we do that. We live in Oregon and can change med sups in our birthday month. My hubby’s is in August. Should he change to a med sup then without underwriting or do we have to wait until January

[@BoomerBenefits]

To take advantage of the birthday rule, you must already be enrolled in a Medigap plan. However, you can apply for a Medigap plan anytime during the year. You will just likely have to answer health questions. You can call us at 817-249-8600 to see what we can do for you.

[@lalaser8160]

If you have health issues you may not be accepted in to a supplement or gap plan. Because you did not choose a Medicare supplement plan when you were guaranteed issue you will have to be underwritten which means you will have to answer health questions. If you are in good health and never had certain health issues you should be accepted. Also if you had med supps when you first became eligible for Medicare and it's been less than year you have a right to go back to your med supp without underwriting. If your birthdays are not until Oct you can use the annual enrollment period from October 15th thru December 7th to switch.

[@BoomerBenefits]

​@@lalaser8160 They would still have to answer health questions for Medigap plans during the annual election period. Mary is in Oregon and they have an annual Medigap open enrollment period where they can switch Medigap plans without having to answer health questions.

[@luismarquez7917]

In South Florida, United health has an advantage plan with 0 everything. Too good to be true? Anyone enrolled in this plan?

[@PeakWithUs]

Luis Marquez yea it’s true. She’s probably an agent selling sups.

[@kc5658]

Any 0 down Advantage plan is a misdirection. You have to pay Part A and Part B premium - if you have worked for 10 years - then no premium for Part A. But Part B premium is to be paid. This will be deducted from your Social Security. If ou stay with Original Medicare - which is far better - you can see any doctor who accepts Medicare with no restriction anywhere in USA. Part A deductible is about $1408 per benefit period. This is for any hospitalization and whatever be your hospital bill - you owe only $1408. Part B covers all doctor fee etc and you have to pay 20% of what Medicare approves. Normally for a family physician, medicare approves , say $60, all you owe is 20% of the $60 - which is $12. Any specialist may be bit higher. in my opinion, Original Medicare gives best coverage for senior citizen. See the video of Dr David Belk in KZbin.

[@ethanwelch9068]

What federal legislation created medicare advantage and what year did it pass govt.?

[@BoomerBenefits]

President Bill Clinton signed Medicare+Choice into law as part of the Balanced Budget Act of 1997. The name changed to Medicare Advantage in 2003.

[@sawlovesyou52]

Government only passes bills that favor corporate America and not the public (democrat .... do not liberate or republican ... conserve nothing).

[@billblack2871]

How does MA only plans work with Tricare for life. Can take advantage of the extra perks of MA only plans and file with Tricare to reimburse my copays while using Tricare for my prescription needs?

[@BoomerBenefits]

Hi there - Check out our article here where we go into detail about Tricare and Medicare Advantage plans: boomerbenefits.com/tricare-and-medicare-advantage/

[@peternguyen5097]

Is the Blue Medicare Advantage a good one to choose?

[@BoomerBenefits]

It depends on your wants, needs, and budget. You can call us and a representative can help you compare that plan with other plans.

[@luismarquez7917]

Not in Florida

[@25anishmannoor]

How Medicare supplemental Rider is working? How is the premium paid for the rider? is it monthly or a singe payment? also will there be any rate changes if I add rider to MediGap plans

[@BoomerBenefits]

If you live in a state with unique Medigap plans with riders, you would create you own custom Medigap plan and based on what plan and riders you choose, your Premium will change. Usually rates increase each year no matter what kind of plan you have.

[@25anishmannoor]

Thank you for the information...can you confirm the payment? Is it monthly or single payment for the rider

[@BoomerBenefits]

Monthly.

[@jackbankston3730]

I can't see the link to th e booklet. Please provide me with the link.

[@BoomerBenefits]

Hi Jack - click here - boomerbenefits.com/medicare-advantage-vs-medigap-guide/. You will choose "Get the Guide Now" to have this emailed to you.

[@eyezonly8593]

I have a Medicare advantage plan an I'm wondering why I haven't been charged anything for Medicines Hospital visits ? Maybe because Im low income .I was wondering if I'll get charged annually or something.

[@BoomerBenefits]

It can take several weeks or months for things to be processed after you are discharged from the hospital. However, you should be able to check your Medicare Advantage plan's portal and view your claims there. If you are a Boomer Benefits client, please give us a call at 817-249-8600 and we can look into this for you.

[@AGreaterAmerica]

I've just signed up to switch from a "high deductible Plan F" (Global Life), to a Zero $ monthly fee Advantage plan with $1,000 yearly MOOP (UnitedHealthcare). Seemed like a good plan. Is that a mistake?

[@BoomerBenefits]

It just depends on your health and what you want out of your insurance. You will have more restrictions and copays on the back end as you use your plan, but a smaller premium and MOOP.

[@johnb4183]

Have you ever dealt with a garbage HMO , that's what an Advantage plan is. I switched to a supplement only way to go...................

[@luismarquez7917]

Let us know how this change works out for you.

[@Dinngg0]

It's not free, you pay a premium deducted from Social Security.

[@gooddogbelle]

How do you qualify for Medicaid, if already on Medicare?

[@BoomerBenefits]

You must meet their income requirements and others. Contact your state's Medicaid office to see their requirements.

[@larryhanson6674]

@@BoomerBenefits My Humana Advantage plan contacted me last week about this without me asking about it.

[@jamesgraul63]

I am on a PPO medicare advantage plan with Humana that has a 6700 dollar out of pocket costs ceiling per year. But what if something bad happens and I am hospitalized for a year and have a half a million dollar bill? Is not 6700 out of pocket cost misleading? The same question for Medicare plus medigap...what would the true cost be under a worse case scenario?

[@BoomerBenefits]

If you have a million dollar bill and you use an in-network hospital, and the MA plan accepts all the charges, you will be subject to $6,700 max. If you have a Medigap plan, like Plan G, then you would only be subject to the Part B deductible ($198 in 2020). However, if Medicare doesn't accept something, nor will the Medigap plan.

[@lusciousbobby]

UNH might be the largest HMO/health insurer. Last year they took in 240 billion and paid out around 185 billion, leaving them a gross profit of 35 billion or around 15% which did NOT go towards your health benefits. Now we all know insurance is predicated on most people making small or no claims and a few making large claims. But this is a case where the insured pool is getting 15% less back then they paid in. Also you are generally obliged to stay in network, which probably means lousy doctors. No Advantage for me, thanks.

[@classic287]

I'm getting back $125 per month of the Medicare premiums. Next year it will be $148.

[@chicagomike]

Give back is based on income I understand? Am I correct? Thanks for responding.

[@booxxx2759]

What if you paid 0 for everything due to mental illness does that mean that I can receive SSI

[@BoomerBenefits]

It depends on your state. We recommend you call your SS office.

[@jackrosario9990]

Isn't a waste of money for Medicare to give an insurance all that money when they can do the same?

[@jamescalifornia2964]

To me it definitely seems that staying on a Medicare Plan supplement is much better & cheaper 👌

[@sawlovesyou52]

go ahead and keep paying ... you must have the monies to pay where others do not.

[@jamescalifornia2964]

@@sawlovesyou52 - In the end we all must pay ... 💀

[@sawlovesyou52]

@@jamescalifornia2964 In more ways than one ... more likely if one is a believer.

[@dennisj.varadesr9816]

The best by far it blows every employer-paid insurance out of the water. The last employer insurance I contributed $900 a month, Family doctors visit was $50, a specialist was $100, a 30 day supply of my medicine was $92, a 90 day supply without insurance was &64. 4 months before I was eligible for medicare I dropped out, they threatened me with not being able to buy insurance, not to mention they refused to pay for the last month of medical services that I was covered for. A local Doctor owned insurance company. Now I use a national Advantage plan much happier. The hell with supporting local businesses. Yes bitter!

[@Miguel195211]

Is that 20% and out of pocket!

[@BoomerBenefits]

Hi Miguel - We're a little confused by your question. Can you be more specific?

[@Miguel195211]

Boomer Benefits just making a comment at what can hurt the pocket if one doesn't have the right medical coverage.

[@larryhanson6674]

@@Miguel195211 It is 20% of what Medicare allows, not 20% of what the provider initially bills you, which is about 10 times more than Medicare allows.

[@abstewartful]

I AND MY WIFE HAVE MEDICARE PARTS A AND B, AND MY MILITARY RETIREE STATUS ALLOWS ME/US TRICARE FOR LIFE. DO I WANT UNITED HEALTH CARE'S MEDICARE ADVANTAGE PLAN?

[@BoomerBenefits]

No. TFL works as a supplement for your Part A and Part B. So after Part A and Part B pays, TFL will pay, leaving you with little to nothing out of pocket.

[@rosariocampos6412]

I wouldn't get any other plan.

[@mikemckeon8976]

And thank you for your time and service to our country, you deserve all the benefits you get, thank you again.

[@michaelirwin1887]

Thank you for the information, but it is one more reason to have universal healthcare.

[@commonsense7803]

Many US doctors would quit practicing under universal healthcare, as it would cost them more to treat you than the gov. pays them. (It's almost that bad under Medicare now.) And, as in other countries that have it, waiting times to be seen by a provider would be outrageous.

[@jettramel]

No what your saying is they Doctors would not lower their prices or take a cut in pay. Ever seen the billing office in a Canadian Hospital? Instead a whole floor they have one office handling billing. A Dr would be able to get rid of 3/4 of their staff that shuffle paper adding to the bottom line of said Doctor. Being a Doctor should be a calling not a get rich quick program as Americans aren't meant to be walking ATMs.

[@Jenniferde2007]

@@commonsense7803 If it was a condition of licensure, they would accept anyone.

[@commonsense7803]

@@Jenniferde2007 That would be unconstitutional in the US.

[@Jenniferde2007]

@@commonsense7803 My husband was a surgeon and I am a nurse. Requiring a doctor to see a patient would be a necessity under a universal system. That is NOT unconstitutional in the USA. Even Hillary Clinton was for it in the early days when Bill was still President.

[@vickiesantino4314]

Veterans 100% disabled, with Medicare A and B do you still need a Medicare supplement plan.

[@BoomerBenefits]

Only if you want the extra coverage when/if you see civilian doctors/hospitals.

[@BoomerBenefits]

Also, thank you for your service!

[@timberwolfpowler8747]

I am Henry the 8th I am,, Henry the 8th I am I am, I got married to the widow next door she's been married 7 times before and everyone was a Henry.. couldn't be a Willy or a Sam... I cured bad eye sight, skin cancer and balding among other things using this; Psalm 82:6 & John 12: 12-14. My God is not a liar. Is yours?