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

[@morrismonet3554]

My anecdote story is that I don't want to ask anyone's permission to receive medical care or be told where to get it. I'm happy with Medicare, and my supplemental plan G.

[@Theretirementnerds]

With that in mind, Supplement Plan G is perfect!

[@oldroscoe2590]

Anecdote ... 75 years old here. I wound up in the ER a week ago with severe abominable pain. Lots of tests and and a ERCP to clear gall stones from the gall bladder duct on the emergency day. They scheduled me for gall bladder removal surgery the next day. I called my medicare advantage and was told the surgery would need prior approval or they would NOT pay for the surgery. I told the nurse this and then the surgeon and I wound up signing an AMA ( Against Medical Advice) and came home, the surgery never happened. The bills haven't arrived yet so it will be interesting to see how it all goes. I still have my gall bladder and I feel great.

[@tioswift3676]

All You needed was a prior auth…the doctor handles this all. Why would you take it upon yourself to call? They would have approved this if it was necessary.

[@davidhill7055]

When you sign up for an Advantage Plan, you are giving permission of the insurance company (or software program they are running) to control the treatment decisions your doctor and you have agreed on. Advantage plans are in the business to make money, your treatment is interfering with their bottom line. It is an adversarial relationship that you signed up for. Probably tricked into it by the agent who sold you the plan. They get much higher commissions than sell Original Medicare supplement plans which require no approval.

[@banon7853]

So if you didn’t have Medicare advantage and just had Medicare, would they have done the surgery?

[@banon7853]

I don’t think the advantage program is worth anything if Medicare will pay for your gallbladder surgery you just have to worry about the deductible. You’d never be denied and you get the treatment.

[@davidhill7055]

@@banon7853 You can’t have Medicare Advantage unless you give up original Medicare A and B. If you leave your Medicare Advantage plan and have just Original Medicare A and B then there will be no preauthorization, but you would be on the hook for copays, and deductibles. Which might be overwhelming if you had a very serious health event. They would have done the surgery if you agreed to bare the responsibility of your share.

[@chuck3700]

It certainly is an antidote that it is this hard to figure things out. I'm on part G and I'm certainly glad that I am.

[@Theretirementnerds]

Plan G is great! Thank you so much for watching to the end :)

[@abspasadena]

Anecdote: You forgot to show what cost to patient would be with JUST Medicare.

[@Theretirementnerds]

Here's a video that does that :) kzbin.info/www/bejne/bWi8d2CKgZWhY5o

[@JCcreates927]

@@abspasadena He says what it would be without Plan G get a calculator out.

[@abspasadena]

@@JCcreates927 grrrr….

[@8aNda1d]

While they seem more expensive they are not as reliable and they can change your coverage at anytime.

[@hightide4782]

“Medicare Advantage” is a total misnomer. It should be more like “Insurance Company Shell Game.”

[@davidhill7055]

Or Medicare Disadvantage Plan.

[@ChrisSadowski-pp1np]

​@@davidhill7055exactly

[@LarryB-inFL]

Anecdote included: The thing that never seems to get discussed about healthcare billing is that amount billed versus what-insurance-will-pay difference. The hospital shrugs their shoulders and eats the $485,000 difference....and we sort of ignore that fact. But if you had no insurance, then you would quite literally be looking at a $507,000 bill. I worked in IT for a health insurance administrator for 30+ years. I remember hiring a struggling single mom who had taken the bills for her young son's appendectomy as "legit", and unquestioningly was trying to pay those bills down...she was stunned to learn that the hospital probably would have only collected 1/10th that amount if there had been insurance involved. And she had already all but put herself out on the streets paying down those bills. THIS is healthcare in America...now rated dead last in every category of healthcare, *including outcomes!*, in the top 10 developed countries: Most expensive, worst general care, worst outcomes.

[@e79422]

When you tell people from other countries about healthcare in the US, they are shocked to find out that Americans can go broke from a hospital bill. Most of the time, they don't even believe me.

[@johnscott2746]

I’m in Florida too and in my early years I didn’t have health insurance. I had to go to the hospital for surgery and the bill came to nearly 100k. When I was being discharged, they were wheeling me towards the front door and suddenly veered off and went to the business office. They were demanding some sort of payment and also wanted me to sign papers saying I would pay the entire bill. I told them that I was still medicated and under doctors orders so I couldn’t legally sign anything. My wife came in , very pissed off, and took me out of there. When they called a few days later I told them that I wanted an itemized bill. They argued with me and I told them that I knew that hospital bills are works of fiction and that I wanted the same discount that the insurance companies get. They knocked the bill down to $6,000 and I told them I would send $100 a month. After paying for 6 months I called them back and asked what it would take to pay it off. They agreed on $1,500 and I sent them a check and they marked it paid in full. Of course now I’m on Medicare and have a supplement plan but anyone who’s younger should remember that you can always negotiate.

[@freecycling6687]

But the Affordable Care Act took care of this problem.

[@joepro3562]

The anecdotal stories we hear about Advantage plans should be enough to scare people into a Plan G. The ability to seek medical care from professionals of your choice that you want treating your illness without permission from an insurance company can't be overstated.

[@oscardelta1257]

Anecdote...I'm in FL. In early summer I went to the ER and was admitted in the hospital. I spent 5 days in the hospital and was discharged. The total I was responsible for was $120. I don't remember what the hospital bill was but probably well over 100K. My plan was care plus advantage plan and paying the $174 per month premium. I didn't have any therapy afterward. I was able to change my plan about a month after the hospital visit. My Dr office recommended that I go on a chronic advantage plan and I switched to freedom health and like it even more. Yes, I was allowed to change my plan at that time because I have several chronic conditions and Medicare allows you to change your plan outside of the normal enrollment period.

[@Theretirementnerds]

Thank you for watching and sharing your experience!

[@wallacesantana9190]

Anecdote I'm in NY state and plan G is expensive. Is plan N a good substitute?

[@8aNda1d]

​@@wallacesantana9190 plan G pays for EVERYTHING after the yearly deductible is met. Plan N, while cheaper, you will be responsible for up to $20 copays to Dr and $50 for emergency rooms. I don't know for sure but there may be copays for diagnostic tests. Some Drs charge excess fees that you will be responsible for. If you are fairly healthy and don't see the Dr often plan N may be best for you, but call and find out what options you have for your situation.

[@PierresHuman]

I just wanted to thank you for your very insightful videos. I’m still a decade away from Medicare but you turn 50 you start getting inundated. Friends and family are talking about it. So I wanted to figure out what the deal was. And now I get it. I can talk intelligently about it and understand what others are saying. I am in California and a member of Kaiser and that’s probably what I will keep. But who knows what the landscapes gonna look like in a decade. Thanks so much. Anecdote.

[@Rusty6450]

I enjoyed your presentation and it is very accurate. I worked for Health insurance companies for a couple of decades back when HMO's started. The Advantage plans remind me a lot of how the HMO plans work and if your provider is within their network, you are good, but you must check every year to verify your provider is still in that network. I have been on Medicare for a couple of years and have Plan G with the High Deductible. I have my HSA since I am healthy at 70, except for my accident. Glad you are presenting options since many seniors may not understand the consequences of their decisions.

[@Theretirementnerds]

Thank you so much for watching and sharing what you are on!

[@rickarmstrong3944]

I have an anecdote to share. I was watching a video about Medicare and my favorite part was when another video was referenced with this description: The presenter seems pretty neat.

[@Theretirementnerds]

Haha! Sounds like quite the clever video :)

[@darylancrum]

It's always good to remember when listening to your very thorough explanation regarding the 2 different plans that its based on an "anecdote ". 1 persons example, 1 size does not fit all.

[@garybenhart]

While the costs of Medicare Supplement and Medicare Advantage are close in this video, I also realized the variable costs are a lot different. The variable costs are $ 240 for Medicare Supplement (the Part B Deductible) and $ 2,396 for Medicare Advantage. So for Medicare Advantage, you are paying a lot more out-of-pocket for your medical costs when the medical need arises but can save money when the medical need doesn't arise. For Medicare Supplement, on the other hand, your out-of-pocket costs are essentially limited and are going to be a lot more stable from year-to-year. The video also exemplifies the complete farce that exists today with U.S. hospital bills, because a $ 506,922.28 hospital bill gets magically "negotiated" to only $ 22,000.00 (or a whopping 95.66% discount). I simply don't understand why our politicians don't make this type of unreasonable hospital billing illegal. I simply don't understand why our politicians let our drug companies spend so much on unnecessary advertising (and then charge you $ 20 per daily pill for Jardiance). In closing, my wife and I went with a Medicare Supplement in part because I never liked the insurance "approval process", in part because we don't want to be restricted to a specific medical network. It's still a bargain because my wife and I only pay $ 7,309 annually for our Medicare medical+Supplement+prescription drug coverage. Anecdote ...

[@Jody-kt9ev]

Pretty much true. With original Medicare and a supplement, your costs are predictable. They may be more expensive than MA would have been some years, but much less other years. How would the costs of the above example have been if the person in his family required more medical care after the heart attack(same year). Then original Medcare and Supplement would essentially cost $0(he already included the premium cost of the supplement plan in his example). MA would not cost $0 in any case. As to US health care costs-everything you say is very true. The US pays the most and gets the least due to greed.

[@Theretirementnerds]

Great insights! Thank you for sharing your thoughts so clearly and making it to the end ;)

[@ChristinemSA]

This type of case study with all the numbers is extremely helpful. Seeing it side by side for this one example gives a great template for our future decision making.

[@Theretirementnerds]

So glad it was helpful! Thank you for tuning in!

[@jackieburns1566]

I always watch the entire video and then struggle to figure out a way to use the secret word in my comments. Do you have an anecdotal story for that? In any case, I have been on an advantage plan for about 10 years, mostly because I am not able to pay for a supplement and drug plan. I know I am gambling that I will stay healthy in my retirement years and that the money I saved with zero cost premiums and prescriptions over the years will outweigh what the cost would have been if I had stayed on traditional Medicare with a supplemental plan and a drug plan. Thanks for your very straightforward and informative videos.

[@Theretirementnerds]

Thank you for watching and sharing your thoughts! Saving a little in "pretend" premiums for yourself can help build a safety net to cover more expensive years.

[@SpynCycle57]

I have a anecdote story. Nothing to do with the Medicare vs Advantage debate. Back in 1977 my father had triple bypass surgery. He wasn't Medicare eligible yet, and had no health insurance, no Medicaid. The total hospital bill was under $2,000. I know this because I was reviewing his bills and helped pay it. 47 years of healthcare inflation.

[@aliannarodriguez1581]

If only our salaries had inflated at that same rate since then!

[@Theretirementnerds]

Wow! That's interesting. Looked up a quick calculator and it said that $2,000 in 1977 is the equivalent of $10,381 today 😮

[@SpynCycle57]

@@Theretirementnerds Triple bypass surgery for $10K, can you imagine?

[@rosebonner7091]

Anecdote. Thank you for your breakdown. After 2 years of being on a supplement plan N I still go back and forth if I should switch to a g. So far all is good

[@Theretirementnerds]

Plan N is great! Your state is important and the doctors you choose to visit, but Plan N can save people good money. Thank you for watching ;)

[@susanbrynt]

This is why I am moving to New Hampshire with an option of Plan G. The anecdote is that with an issue-age plan G or N this will be covered. You need to think about where to live when you are a senior citizen. It is important. Look at each state when it comes to Medicare. It matters. If you take care of yourself, I would recommend an issue-aged state to retire. If you can start Medicare age 65. and are issue-aged, that matters. You can receive the benefits of a supplement plan with the minimum cost. It all depends on where you work and what the healthcare benefit structure is. Out of Pocket matters. Know that. Don't think short-term. I plan to move to Supplement Plan G or N. They are the best if you can afford them. If you are getting close to age 60, think it through Medicare is great when used with knowledge. I support the site because they show they know what they are talking about.

[@commonsense6967]

Thank you for this easily understandable comparison. I've had my MA for 8 years now, and will likely keep it, unless something drastically changes. Other insurance agents are giving us fear-porn anecdotes about possible changes to MA plans. I appreciate your truthful presentations!

[@Theretirementnerds]

Appreciate you watching! Changes are coming to many plans. They aren't released and we can't talk publicly about them until October 1st. Some plans are experiencing big changes, others small or none, so make sure you check out your Annual Notice of Change that should have arrived or will soon :)

[@JodyFaldet]

Anecdote! So appreciate the side by side comparison, and clear explanations. Keep up the excellent content!

[@Theretirementnerds]

Thank you so much! :)

[@johnjohnson426]

I appreciate the anecdote video! I like how you break down all the costs including premiums etc.

[@Theretirementnerds]

Thank you so much! So glad it is helpful ☺

[@anonemouse3768]

Anecdote: I switched from my employer insurance plan to medicare advantage plen fron the same insurer when I turned 65 15 years ago. My bills have been small until this year. My primary detected that I had a heart murmur. The results is an echo to verify the murmur, and angiogram to tell if I could have a TAVR. Followed by a TAVR procedure. I was in the 30% of patients that needed a pacemker. 2 more echos and 2 CT scans. 9 days in the hospital, 5 for the TAVR mostly because my platelets "crashed". After release, my pulse rate dropped so it was to the ER with what turned out to be a Heart Block neccessitating the pacemaker. 4 more days in the hospital with an accompanying ambulance from the ER to the Cardiac unit. I still have 11 days of zero cost in the hospital this year. After 20 days, it will be $100 / day for an additional 80 days. I have zero copays for doctors and specialists. Also zero for labs and x-rays. I just got my August statement for the year. The hospital billed approx $300,000 and the insurer agreed to a little more than $100,000. My costs were $30 copay for the 2 CT scans. I did have to pay for parking for my wife. My meds accounting will come in a few days but most of my meds are zero copay with a few $5 copays. In addition to the medicare premium, I pay zero premium for the advantaage plan. I guess my non-profit HMO is a bargain. I must emphasize that it's a NON-PROFIT.

[@Theretirementnerds]

Thank you so much for sharing this! Would love to do a similar video on your experience if you're willing

[@corgiowner436]

No anecdotes but the minimal savings with Advantage is not worth the restrictions placed on you if it’s not an emergency.

[@Theretirementnerds]

For many people, they agree with you. For many others, they don't. I have a corgi, too :)

[@mikehenderson2039]

Erik, Thanks for sharing this extremely clear and specific anecdote! I always learn something valuable by watching your videos! Keep up the great work! Glad to hear your relative is doing okay after her heart attack! We'll keep her in our prayers!

[@margaretd7037]

Sharing anecdotes about one's experiences is a way to interact with others. I am still patiently waiting for your video on Medicare in Ohio. 😊

[@Theretirementnerds]

@@margaretd7037 it's the next one up 😀

[@diannalocke997]

Anecdote. I am so thankful that you make this videos! Keep up the good work!!!

[@Theretirementnerds]

Will do! If you ever come across actual bills, those are my favorite so people can't say I'm misleading, haha!

[@Zeker303]

Anecdote. I'll stick with my traditional Medicare and supplement plan. Thank you!

[@Theretirementnerds]

Supplements are fantastic! Thank you for watching!

[@tomm7505]

Thanks Erik. It's amazing that if someone had no insurance that the total bill for this incident would be over $500K yet with insurance it's less than $35K. Thanks again, anecdotally.

[@patty109109]

@@tomm7505 good ole’ amercia

[@miguelberrios19]

It's absurd that the hospital system will accept these extraordinary negotiated rates from Medicare, but will absolutely not assist people without insurance and high medical bills. How shameful is our Healthcare system.

[@GearMaven]

Would love you to provide our Medicare Advantage ANECDOTE from the Coachella Valley specifically just to show folks how location is everything for MA plans. With a powerful high senior population, big medical groups, three participating award-winning hospitals, and nearly all specialty groups participating in MA plans, it would be enlightening to see a top MA area just one time for people's edification. Our MOOPs this year were $699 and $800!! We have no copays except $25 for MRIs and $250 for ambulance. The hospital copays were minor as well. The significant benefits over the past 15+ years often made us feel as if we were making money on our MA plans, and that is WITH significant comorbidities such as heart disease, surgeries, autoimmune diseases, chronic illnesses, etc. We have never faced a denial of referral or service or medication even when off formulary with easy appeal. So, for THIS location, an MA plan can't be beat!

[@Theretirementnerds]

I've taken a screenshot 🙂 Thank you for sharing! Everyone reading this should understand that advantage plans are highly dependent on location and company. Yours sound amazing! Appreciate you!

[@vonlee7758]

with medicare advantage , you would have the daily copay again if you were to be hospitalized each time in the same year, with a supplement you pay the deductible and copay only once for the whole year.

[@melblacke5726]

I'll stick w the supplement plan....😊

[@GearMaven]

LOCATION is EVERYTHING with Medicare Advantage!!!!

[@GearMaven]

In which area IS the patient???

[@johng4093]

I feel like I'm in heaven with my MA plan, so cheap, get so much: vision, dental, medications, free gym membership, medical devices, etc. It seems like medications weren't considered in this example, unless I missed it.

[@Theretirementnerds]

The drug plan was mentioned. At the end of the video, there is a link to a video specifically about her drug costs :) Here is that link for you: kzbin.info/www/bejne/aJSqgoewiLKlnJY

[@Beadgcfb]

Anecdotally, I work in a medical practice. It's stunning how many patients just never cash their refund checks.

[@Theretirementnerds]

Thank you so much for being willing to share this! Any behind-the-scenes info you're willing to share on the Medical billing side is always welcome. You can always email me at [e-mail] if you want to stay anonymous :)

[@nancymartin2352]

Another great informative video. I like hearing anecdote stories when they come from reliable sources. I wish it was easier to chose a supplemental plan though. I also wish traditional Medicare offered a fitness membership. Keep up the good work. You are going to get super busy in the days ahead so be sure to eat right and rest when you can.

[@bricknercj]

These videos are so helpful. I'll be applying for Medicare next year, and will definitely be using your resources for my search. You make it so much less intimidating!

[@Ashok-travels-24]

Anecdote: ❤. Thankfully your relative is safe. Love the way you break things down with Medicare choices. I am on advantage plan for about 5 years now. My choice was before I saw your or any online advice. My calculations are exactly how you summarized and decided the maximum out of pocket cost will be my cost if I have really big expense. So far I have not had any problems even with prior authorization (no emergencies yet). As you say, permutations and combinations are different for each individual and each year. 👍keep up the good work

[@Theretirementnerds]

Thank you so much for tuning in and sharing your thought process! 🙂🙏

[@barreloffun10]

Anecdotally, Crom laughs at your billed amount. He laughs from his mountain. (Okay, name the movie reference)

[@Theretirementnerds]

Haha! Love it. I may have cheated and looked up the reference :)

[@bruceandrews7581]

Anecdote. Nice presentation. I am especially impressed with your ability to write legibly with a marker on a white board. I was even able to make out the smallest print.

[@Theretirementnerds]

Haha! Thank you! The upper left corner was tough because I couldn't stabilize with my hand for fear of smearing everything. Glad it was legible 🙂

[@happyron]

The story about how the doctor's office would have to refund you your copay that happens at 4:45 is really interesting, especially the fact that they might not do that. Perhaps in the future you could have a video "Things to double check on your medicare bill" since undoubtedly there are other of these type of situations where mistakes or a lack of knowledge might end up costing someone big time.. Great channel again, KEEP NERDING OUT!

[@garybenhart]

I'm retired now but spent many hours over the years dealing with my family's medical bills and my medical insurance companies (i.e. pre-Medicare). My personal experience is that medical billing/medical insurance is extremely complex and being involved with it is simply a headache you want to avoid. My personal experience is also that most medical providers won't automatically "refund" an overcharge. If you want to essentially get out of the medical bill paying routine, you should opt for Medicare Supplement Plan G. Why? Because your Medicare Supplement Part B annual out-of-pocket max is only $ 240 so you'll likely be personally involved in a very limited number of out-of-pocket medical payments each year. You'll simply no longer need to be an expert in medical billing/medical insurance, a fact that is rarely discussed on the internet.

[@poncho6784]

Not an anecdote: Hospitals don’t “write off” the rest. List prices in healthcare are just like any industry. It’s what ever the seller wants to put on their price tag. Not even close to what any insurers actually pay.

[@KatrinaBourne-d9b]

Anecdote- Great video! Your attention to detail is impressive. Thanks for sharing such helpful information.

[@Theretirementnerds]

Thank you, Katrina!🙂🙏

[@kathleenbrown6734]

I have medicare and med. supplement and I paid nothing on plan F!!

[@mike94560]

I had to pick what was available in my area. ie Advantage vs Supplemental.

[@ericbond5276]

Make sure you are back in Oct. when things change re Adv and Gap plans.

[@Theretirementnerds]

Bracing ourselves for that. Have a whole list of videos ready to make once final plans are made public.

[@dennislyons3095]

Very well described from this anecdote.

[@Theretirementnerds]

Appreciate you! 🙂

[@HandellInsurance]

Love this video! Certainly impressed by the density and diameter of your 🏀s. What a weedy concept to get out to people. I really enjoyed watching the hospital billing vs medicare approved amounts. I learned something for sure! As a mathy guy, I am always impressed by your breakdowns. Anyway.... always impressed! and ya Anecdote!

[@Theretirementnerds]

Appreciate you so much for tuning in... to the end! :)

[@lKnOneQ]

Anecdote . Great job!

[@Theretirementnerds]

Thank you so much! ;)

[@rileydj8764]

Had triple bypass surgery in Dec 2017, total with ambulance was 227,000. That’s open heart surgery ! (My out of pocket was a few thousand and if I remember correctly the billed amount was about 50% higher.) Can’t believe heart attack and 3 stents is now 500k+!

[@Theretirementnerds]

So glad you are still with us! Thank you for sharing!

[@freecycling6687]

(ANECDOTE) The care provider (hospital, doctor, whatever) doesn't ever "write off" a single penny of the billed amount. That amount is simply a placeholder, the amount that self-insured people would pay if they don't know how to negotiate it downward. The amount they receive from Medicare is well-known to them, and they know when they send out that bill that's the amount they're going to receive. And these days, between the ACA's healthcare exchanges and the expansion of Medicaid, if there are low-income families who don't have medical insurance it means their State is failing them and not letting people know about their options for affordable health insurance.

[@dt76sf]

Anecdote! My wife works for the city we live in. She seems to have a special city sponsored advantage plan option once she retires. Cost is approx $600 per month for both of us. Includes prescription and some vision. Dental is an add in cost. The thing is it seems like co pays and co insurance are much less (lower out of pocket for us) than what I see on “normal” advantage plans. So it seems like a better deal than what non city employee folks would get. Annual out of pocket is around $3500? I think. The $600 ($300 per person) seems like a decent cost Have you heard of special advantage plans offered by certain companies / organizations / group insurance??? I think this may be the case here

[@Theretirementnerds]

Yes, there are employer advantage plans than are all over in terms of how they work, costs, and benefits, but yes... they often have premiums and can be more of a ppo option with more network options 🙂

[@horsey8516]

Mixing $ and Healthcare was a bad idea. 🐴

[@DavidWright-sn4tu]

Anectdote,65 and plan g for me. Thanks for all the videos!!

[@masterlee4370]

Just think if they came up with an Antidote for some of these Anecdotes. Life would be so much easier. The cost of everything done versus the payment is mind blowing to me. Is the mark up that high or is the price of it all simply inflated because they know Medicare will only pay a certain amount. Since I am still on my company's insurance right now I just watch the videos and soak it in like a sponge. I am very interested in seeing what happens with the Advantage plans in 2025. Looking forward to those videos. Great Job!

[@Theretirementnerds]

It's maddening sometimes with how the system works. Appreciate you! Have lots in the works, especially once they release official plans October 1st.

[@kevinmote2369]

The write off of the difference sure is an interesting aspect of this i had not considered. By doing this i suppose a hospital could funtion well while never showing any profit and therefore never paying tax on profits.

[@Theretirementnerds]

Not a tax pro on that, but I'm sure they have their reasons for massive sticker prices and then really small negotiated rates.

[@myth-n-m4yhem]

very informative and for me using an anecdote sustains my attention.

[@Theretirementnerds]

Appreciate you making it to the end :)

[@Theretirementnerds]

Appreciate you making it to the end :)

[@LDhusky]

Anecdote: your pretty smart for a young fella 😊

[@Theretirementnerds]

Haha! Thank you :) I have a good team behind me that help me look smarter than I probably am.

[@wajobu]

Another fantastic video, clear to understand. Anecdote.

[@lobby5t]

This is an interesting anecdotal description, however I suspect it wouldn’t be so cheap for me,

[@freecycling6687]

(ANECDOTE) Forgot to mention that Advantage plans have provider networks. So unlike original Medicare, you're restricted to using only providers that are in the network. This doesn't matter too much if you're lucky enough to live in an area that has excellent and abundant medical care, usually the larger urban areas. But it matters a lot if you're in a suburban / rural area, and the better-rated providers that are a good distance from you aren't even in the network.

[@jimhoyt49]

Best Anecdote!

[@Theretirementnerds]

Thank you so much!

[@Paul-GrnHil]

Here is an interesting anecdote, if you are a snow bird and spend substantial time in different states, a supplement plan is the best option to avoid network issues.

[@freecycling6687]

(ANECDOTE) Interesting - the cardiologist "approved amount" is 60% of the billed, whereas the physical therapy "approved amount" is 80% of the billed. This explains why every hospital and large "sports medicine" practice has a huge physical therapy amount. It's clearly become a major cash cow for providers. They hire "therapists" at low salaries, and receive nearly TRIPLE the amount for a visit than a cardiologist receives. And in my experience, "physical therapy" is for the most part nothing more than "specific exercises that you could easily do at home once someone has shown them to you."

[@juniorcrandall8933]

Anecdote.... Fine Presentation

[@Theretirementnerds]

Thank you!

[@ericbond5276]

In 3 months, I'm going Anecdote with a UPMC adv plan because I'm on 4 tier 1 drugs. I did call AARP Utd HC. What a joke.

[@8aNda1d]

Yes that's a big draw back to original M'care. Some people just can't afford it. I'm on a tier 3 drug that costs $45 with advantage plan and $285 on m'care part D. Everyone has to do what's best for them.

[@ericbond5276]

@@8aNda1d You are correct. I asked AARP Utd HC about using a Goodrx plan. He said, you'd probably not meet the deductable limit. That case, get a charge card w/ no annual fee that gives ya flyer miles.

[@chrisbauer6505]

Antidoticly, your secret word reminds me of the secret word on the old TV show Peewee's Playhouse.😅 thanks for another good video.

[@Theretirementnerds]

Appreciate you sticking through to the end ;)

[@Chris_at_Home]

My wife had a triple bypass and a valve put in her heart and with her supplemental insurance costing about $250 a month we didn’t pay anything.

[@bikeny]

The anecdote of 1 heart attack surprised me (and you) as to what Medicare actually paid. What is the CliffsNotes' version of why that discrepancy is so wide (like Grand Canyon wide). Happy to hear that your relative is recovering.

[@Theretirementnerds]

Thank you for watching! Think sticker price at any store that does 75% off clearance sales... but if just 1 person doesn't know about the sale and can afford full cost, that store had a good day.

[@markaustin5269]

Anecdote. Thanks for the video.

[@ericgold3840]

Everybody should be very skeptical of drawing any conclusions about best insurance approach from a single case study. I did find it interesting though to realize that in this case, if extended out through time, it saves money to not have Part B or Supplement if the hospitalization rate is less frequent than every 4 years. If I inject my IRMAA surcharges, the breakeven happens at a hospitalization rate of every 2.5 years (not including routine outpatient charges). Which brings me to a question for Eric: can you share any insight or knowledge regarding how patients who pay out of pocket fare with negotiated payments ? I keep imagining that billing depts would be happy to accept in payment the Medicare allowed amount (since that is what they get from a Medicare patient) and then write off the remainder.

[@Theretirementnerds]

Are you referring to cash pay and negotiating that with the hospital? That can and does happen. I can't tell you how close it is to Medicare allowed amounts because that'll depend on each hospital, patient, procedure, and collection company the hospital uses, but people can and should negotiate off the sticker price.

[@commonsense6967]

My MA plan has a MOOP of less than 4K in 2024. No way could you owe more than that, unless for Outpatient meds.

[@Theretirementnerds]

Thank you for sharing!

[@sbe8544]

Why you always ignore very important facts and do not shed more light when you compare advantage to supplemental plane. Which is supplemental plane does not limit you to net work so you can go any Dr or or hospital without wary about acceptance, second in advantage plane in some procedures you need approval from your insurance company and most the this decision made by non doctor who work for the advantage plane company. For those who read this comment be aware that in supplemental plane you do not need to specific Dr or hospital and once you pay your monthly your balance is $0. Regardless how many procedures you go through. I’m not an agent but I learned this fact because I lived it. Unfortunately my wife was diagnosed with kidney cancer and other issues and if we have the advantage mis conception in this video we would paying thousand of $. However, what is more important is we were able to chose the best doctor and to go to the best hospital without wearing about net work or approval from the insurance company. Be aware that in the most of the states, once you choose advantage plane it will be very almost impossible to switch to supplement plane . Finally, many agent directly or in directly make advantage plane is better because they make more commission from advantage than supplement

[@Theretirementnerds]

Did you watch the video? We address all of these. Highly suggest watching the videos before commenting about stuff we didn't include in the videos that are actually in the videos :) Sorry to hear about your wife's cancer. Sounds like she was not on an advantage plan?

[@sbe8544]

@@Theretirementnerds yes I did watch it. You did not address the most important and crucial difference between both plane. I believe it’s morally important to explain in detail the issue of network, pre approval requirements that would be determined by non doctor who represents the interests of advantage plan’ insurance company. I can go on and on and you should know better. Do you know that there are many top hospitals that specializes in serious treatments like cancer are no longer accept the Advantage plane . Again, I am not agent but unfortunately the personal experience opened my eyes to this life and death situation. Do you know that some people dies while waiting for the approval of certain procedures. You have no excuse for not addressing all this because you represent yourself as an expert.

[@mariemondello5547]

Google says anecdote is a short interesting story. I agree.

[@auricgoldfinger8478]

Brilliant summary

[@Theretirementnerds]

Appreciate you!

[@sabio2009]

The biggest challenge with Advantage plans is finding providers that will remain in the various Advantage plans’ networks. Providers are exiting Advantage plans’ networks all across the Nation in droves due to chronic service denials. It looks as though Advantage plans will soon become a thing of the past.

[@barreloffun10]

I respectfully disagree. Not every Advantage plan company deals with Prior Authorization in the same way. Some plans forge a very good cooperation with provider groups. Other Advantage Plan companies are actually created by hospital or provider groups. And of course some Advantage plans stink with prior authorization. You can’t make such broad generalizations.

[@8aNda1d]

I think the more expensive the premiums and drug costs increase more and more people will have to get M'care advantage, unless the government can change the course of M'care and I really don't see that happening.

[@angtx]

Anecdote. Why does Medicare have to be so complicated?

[@Theretirementnerds]

Agreed. Wish it was more simple.

[@KMarik]

@@angtx Because we don’t deserve affordable healthcare.

[@tomm7505]

Erik, also a quick question: For Part D plans, can the Formulary be different in each state for the same Part D plan from the same insurance company? In other words, can a drug be Tier 1 in one state and be Tier 2 or 3 in another state under the same Part D plan and same insurer?

[@Theretirementnerds]

Hey Tom! Yes, technically they can be different. Each plan is filed independently with the state. That doesn't mean they all are different, but they technically can be different.

[@tomm7505]

@@Theretirementnerds Thanks, that's what I thought. FYI: I got my ANOC yesterday for my Part D plan from Wellcare. I'm in Texas and have the Wellcare Value Script plan. My monthly premium is going from $0.50 to $0.00. (zero). I checked the changes and the only thing I could find is the cost for Tier 1 and Tier 2 drugs are both going up $5 for non-preferred pharmacies. For their preferred pharmacies, the copays for Tier 1 and Tier 2 are not changing (still $0 and $5 respectively). They had a link for their pharmacy list and all of the ones that are currently preferred are still preferred for 2025. So no changes there either. The only thing I'll need to check is when their Formulary comes out for 2025 to see if my two Tier 1 drugs are still Tier 1.

[@freedivemd9366]

Now do a video on someone who has a rare expensive cancer with years of treatment, surgeries, in and out of hospital all the time - and compare the price of supplement vs advantage.

[@lyndayoung8761]

He can only do an accurate computation/ comparison when he can see the actual MSN. Trying to guess is impossible as evidenced by the very high billed amount compared with the Medicare contracted rate. What do hospitals do with the uninsured or under-insured? For profit hospitals write it off as unpaid expense or they refuse to admit or they bill it under charity or they bill the patient who must negotiate. It’s a stupid system.

[@threeftr3349]

Many independent agents are recommending cancer(one time pay out, or other) and hospital indemnity policies if you get an Advantage plan.

[@jeanorr3629]

I just started on Medicare so have no anecdote. I’m on an employee sponsored advantage plan supplement. An advisor told me there are other rules for employee sponsored plans so that if I hate it after more than one year I could still get a regular plan G without underwriting. Is that really true? Do you have videos on employee sponsored Medicare supplement plans?

[@danhuttinger5040]

I get to feeling sorry for myself what it cost me for my Medicare and my plan F supplement and a plan D pharmacy plan all of a sudden last year I started having a lot of health problems in and out of the hospital 2 times 5 trips to the emergency room and also some home nursing. I never had to get any approval that was worth a lot to me I have no copays so it is the choice you make.

[@jamee6]

Are these reflections accurate: 1) in this scenario (Adv vs. Plan G), the expenses for the plan g person will occur regardless of whether a medical event happens that year or not. 2) in this anecdote, the expenses paid out are roughly even. But if a second event happens, the advantage plan member would be on the hook again similar to this scenario ($$), but the plan g member would have no additional expenses for that second event? 3) both members are taking a risk: either paying yearly for coverage and possibly never needing it, OR (Adv plan) having no monthly $$ but maybe incurring higher expenses throughout the year if there are multiple or outrageous events.

[@Theretirementnerds]

1) Correct. 2) Mostly correct. Advantage plans do have Maximum Out of Pockets. In this example, with a $5,000 MOOP plan, she would've had $2,604 left to meet that, so the maximum risk on an advantage plan is definitely higher in this example. With the supplement, the could have 100 surgeries that year and, as long as they were all approved by Medicare, she wouldn't have additional expenses. 3) Very well stated. We have a video that goes over a look of 20 years worth of costs and a spreadsheet you can download to play with your own numbers here: kzbin.info/www/bejne/j5fCfYWipL2gidE Great comment!

[@lynnstone6998]

Anecdote ❤

[@Theretirementnerds]

Thank you! ☺💓

[@colemant6845]

Anecdote: Your White Board presentations are Very Clear! Best on You Tube. Now do a YT on the Medicare Services (Like Via Benefits) that off $100+ /mth (for LIFE) paid to Medicare people who use their service to sign up for Medicare. This is QUITE attractive... but misleading as in my case... I took an Advantage Plan through Via Benefits with a extensive Cancer History... and am now PAYING hugely OOP expenses that would not have happened under a G Plan. This would be a good topic.

[@lyndayoung8761]

Never heard of Via. What’s that? Is it State specific or a program?

[@timmccabe4654]

Care to offer any ANECDOTAL thoughts on whether adding a hospital indemnity plan to your MA/MAPD coverage would often increase or decrease overall patient costs in this and similar scenarios?

[@Theretirementnerds]

This is an older video that probably warrants a refresh, but indemnity plans and cancer plans work pretty well with Advantage plans: kzbin.info/www/bejne/mZjSZp-rjdx3p6s 🙂

[@bernaclischurchill4463]

Anedote: Can a person on Medicare/Medicaid get a Part D Prescription Plan?

[@Sunlight-btc]

I invested in IRA& 401k and health care now became disabled from 2020 until now "0"INCOME been Homeless

[@ph5915]

Ohh, I don't know, am i not supposed to take to heart my waiters' sisters' college roommate's aunt's dogsitters' story of her experience? Quite the better story than cold, hard, facts and numbers 😂 Isn't it preposterous that the bill starts off over $500K and actually gets chopped down to like 7% of that??? Sheesh. And once again, the US is dead last vs peer (highly developed) nations for healthcare outcomes and #1 in costs! I saw a KZbin assessment by a climate scientist today about my state (DE) Re: the effects of 2C (2 degrees Celsius) warming...It's dire. I was messaging with her and it's like "Yeah, be a good idea to relocate by about 2-3 yrs from now... Try to pick a state / area with minimal climate impact, decent services and costs, AND Medicare Supplement rates...lol...

[@yy4uman]

Any anecdotal horror stories about supplement plans?

[@Theretirementnerds]

Yes. Much MUCH fewer... but yes 🙂 Thank you for watching!

[@JettaRedIII]

Do you have an antidote for the anecdote?

[@8aNda1d]

Just subscribed

[@Theretirementnerds]

Thank you! Appreciate you!

[@jdtexas2048]

Need this example done for FEHB and us who are getting moved to PSHB …!!!!!!!!

[@jdtexas2048]

AND DO NOT HAVE MEDICARE

[@Theretirementnerds]

Do you have the PSHB plan grids with copays/coinsurance amounts? [e-mail] is my email!

[@jdtexas2048]

NO they won’t give them to us yet and we have to make a decision whether to take Medicare or not - we pay full premiums for FEHB now so it has been like Medicare but we have no idea how PSHB will be they have said it will be like FHEB - but how many times has the Govt lied to us

[@Sunlight-btc]

Is been a misinformation, that's supposed to be my plan, but then went to my mom. I am disabled and NO INCOME at all 4 years and I invested in health care. They changed her like more than half of millions.. someone need to check oni it so wrong.

[@davidmorrill2943]

What a comp!coated mess. Anacdote

[@Theretirementnerds]

Appreciate you making it to the end :) It is super complicated!

[@dannydonuts4219]

Anecdote

[@StuffyRuffy]

Almost here

[@freedivemd9366]

Congress needs to do something about the outrageous billing ($500K !!) for the uninsured. This is why people are so angry at US healthcare system.

[@barreloffun10]

No uninsured person will end up paying $500k. If you ever get a huge bill like that and you have no insurance, do the same as you would do with any major purchase like buying a house or a car-negotiate!

[@agedwiseone9220]

They bill $500K because they know they will get 15 cents on the dollar (or less) from Medicare/Congress...if they bill $22K they will only get $3,300. or so. If uninsured/cash (illegal by ACA law) then ask for the "Medicare rate".

[@davidgray1515]

Congress needs to do something about the people who choose to be uninsured who make taxpayers pay for their healthcare. That is why people are so angry at those who reuse to buy insurance. it should be mandatory like car insurance and the penalties for both should be much more harsh.

[@barreloffun10]

@@davidgray1515 Medicare does have substantial penalties for those who do not enroll in a timely manner.

[@rebeccatrono3376]

Most people wouldn't choose to be uninsured. The cost is sky high now, and the deductibles are ridiculous. Friends of mine have a $5000 deductible! What's the point of having insurance?!

[@thomasrobinson182]

Put vision and dental on there and your looking at $500 to 600 a month. This for people on retirement. We need national healthcare.

[@ChrisSadowski-pp1np]

That's an emergency event. Cancer is the real killer when it comes to Advantage. Advantage plans are simply an inferior product. With HDG there is simply no financial reason to go on an advantage plan. For the cost of cable every month, you can have access to literally the best possible healthcare. No annual changes outside of part D, no worrying about doctors going in and out of networks, No worrying about approvals for procedures, 100 verses 20 days of skilled nursing care, and of course coverage that travels with you. Without HDG that changes everything. Places like New York and Connecticut, it would simply not make sense to choose traditional Medicare. Even if it means losing out on the ability go to Mayo clinic. I believe in a video about Nevada there were Advantage plans with limits around $1,000. Of course those are outliers and usually when limits are that low they are HMO versus PPO plans.

[@barb963]

Anecote

[@Theretirementnerds]

Thank you! ;)