Why I Would Never Choose Medicare Advantage - YouTube

when you come into medicare your first decision is  which way you're going to go are you going to stay  

with original medicare are you going to choose a  medicare advantage plan and it's a huge decision  

one you absolutely need to understand i'm going  to tell you right now why i would never choose a  

medicare advantage plan i'll show you exactly why  and the difference between the two and i'm keith  

armbruck i'm founder of medicare on video and  i help people across the country make the right  

medicare choices i can absolutely help you as well  if you've watched any of my other videos you know  

i am not a fan of medicare advantage i'm going  to tell you exactly why i personally would never  

choose a medicare advantage plan so first we need  to understand what is a medicare advantage plan  

and it really should be called medicare managed  care because that's exactly what it is so if you  

choose a medicare advantage plan and these are  all the tv commercials that you see especially  

at the end of the year during medicare's open  enrollment plan primarily all medicare advantage  

plans so what a medicare advantage plan is is if  you choose to go on to a medicare advantage plan  

it takes you off of original medicare and put you  into a private insurance carrier's managed care  

plan now how does that work and why does the cost  not reflect that to you medicare actually pays a  

managed care plan to take responsibility  of all your medical claims so they pay  

it's generally upwards of about a thousand dollars  a month per member to the medicare advantage  

company to take your claim responsibility  away from medicare so good for medicare  

and good for the medicare advantage company  because they want as many as possible that's why  

you see so many commercials and why they sell  so hard because for each member that they get  

they get a significant monthly premium that goes  along with it so when you go into a medicare  

advantage plan again it ought to be called managed  care used to be called in the old days an hmo  

health maintenance organization which you  don't hear that term that much anymore  

but that is essentially what most of these  plans are and it takes the decision making away  

from medicare to the medicare advantage company  so my experience with managed care plans in my  

younger days i actually worked for four different  managed care companies i was an account executive  

and i did manage care sales primarily to large  employers so if you work for a large employer your  

group health plan was typically an hmo and you may  have had some other options but that was typically  

what your primary choice was at a large employer  and i was the one that would go in every year and  

explain the benefits and tell them how much their  costs have increased and their benefits decreased  

it really was a miserable job it was not enjoyable  i happen to be good at it which worked out okay  

but it just was not something that was in a  place of feel good so i have made the transition  

since then about 10 years ago into medicare  medicare is absolutely a feel-good position  

and it's very enjoyable when you do it correctly  because it does exactly what it's supposed to do  

medicare is probably possibly the only government  program that does exactly what it's supposed to  

do and does it very well and that's why it's  confusing to me why anyone would want to choose  

to leave medicare and go to a medicare advantage  plan unless it's kind of a sales situation where  

somebody's selling you into that scenario so i'm  going to tell you exactly why i would never choose  

that and there's a couple of main reasons let's  first talk about the cost differences between a  

medicare advantage plan and staying on original  medicare so if you stay on original medicare a  

and b you'd likely have a medicare supplement plan  that covers the pieces that a and b do not a has a  

deductible that's kind of big b has a deductible  that's pretty small and then there's some 20  

co-insurance also that you wouldn't want to be  responsible for so you get a medicare supplement  

plan that covers most of all of that and a  medicare supplement plan generally for the  

folks that we deal with runs pretty close to about  a hundred bucks a month so it's not by any means  

prohibitive in a cost standpoint now something to  understand whether you're on original medicare or  

on a medicare advantage plan you're always going  to have your medicare part b premium so your part  

b premium which is also a couple hundred bucks  a month is going to be paid regardless of which  

avenue you choose so that really negates the  difference between the choice because that's  

always there the difference after that is the  medicare supplement plan and then on original  

medicare you'd also probably get a medicare  drug plan so your medicare drug plan can run  

as low as 10 a month up to about 20 25 a month  depends on how complicated of prescription drug  

regimen that you have now a medicare advantage  plan can have zero additional premium or it can  

have 50 a month or it could be higher than that  it also generally will include medicare drug plan  

as part of the medicare advantage part of it  now something to understand if you are looking  

at medicare advantage plans the lower that cost  is generally the more restrictive it will be or  

the smaller network of doctors and hospitals so  kind of get what you pay for without a doubt so  

when you go to use either original medicare  with a supplement or medicare advantage plan  

significantly less expensive with original  medicare and a supplement when you have  

a supplement let's say you have plan g with  your a and b you're out of pocket for the year  

is a couple hundred bucks and that's it for the  entire year once you're out of pocket a couple  

hundred bucks which is generally just the medicare  part b deductible it pays a hundred percent the  

rest of the year without any out-of-pocket expense  on medicare advantage it's kind of a pay-as-you-go  

and your out-of-pocket maximum for the year if  you had a really significant year medically can  

be as high as 7 500 for the year so absolutely  something to keep in mind can be a little bit  

less expensive on the front medicare advantage  but can be significantly more expensive as you  

use it so if you never use it it's terrific and  that's generally where you hear the good things  

about medicare advantage is people that  haven't had a lot of experience using them  

if you go on to google and you pick a medicare  advantage company and you look for reviews  

on that company i mean you'll find books  and books of reviews on medicare advantage  

medicare supplement there's really no interaction  with an insurance company you go to the doctor  

you give them your medicare card you give them  your supplement card the doctor bills medicare  

medicare pays their part and sends it then to  the medicare supplement company the medicare  

supplement company has no decision to make  on whether they cover or whether they don't  

cover if medicare covers it they have to cover  it so there's literally no interaction between  

you and the insurance company or any  pre-authorizations or any referrals  

or anything of that nature with original  medicare that's the primary reason  

that i would absolutely choose original medicare  would never choose medicare advantage is because i  

want control over what i do and medicare original  gives you that control it's absolutely terrific  

it's basically autonomous if it's medically  necessary and your doctor says you need it  

medicare covers it and then your supplement has  to cover it because they have to cover whatever  

medicare covers so there's literally no decision  made on a medicare advantage plan different story  

there's pre-authorizations where if you're going  to have something significant generally they have  

to get it pre-approved before you can do it and  that can cause wait times of weeks even months  

to have whatever procedure you need to have done  done and especially in these days where things  

get a little more complicated with wait times also  authorizations and referrals so referrals from a  

primary to a specialist that's probably the number  one complaint with a medicare advantage company is  

if you need to go to a specialist first you have  to go to a primary care ask them if it's okay they  

give a referral then you make an appointment with  a specialist it can add weeks to the time that you  

get to actually see that specialist because you  had to make extra trips to a primary care first  

original medicare you don't need any of that now  sometimes a specialist may require that you see a  

family doctor before you come to see  them that's very possible if it's a  

neurologist or something like that they want  you to make sure you know why you're coming  

but you don't have to do it it's not a requirement  so it's much easier to get through things and to  

choose what you want to have done and leads me to  the next point of networks and networks probably  

the number two complaint on medicare advantage  when you join a medicare advantage plan you  

primarily have to use a network of doctors and a  network of hospitals that are based generally in  

your local area so and again can be cost related  so if it's a zero dollar plan that you're in you  

probably have a much smaller choice of doctors a  much smaller choice of hospitals if you're paying  

fifty dollars a month or eighty dollars a month in  premium you might have a bigger network of doctors  

and a bigger network of hospitals but  in your local area again it does not  

go outside of your area for the most part on  a medicare advantage plan if you are traveling  

and you run into a medicare or medical scenario  and it's an emergency it's going to be covered  

and then generally if it's going to require  continued care they're going to require you to  

come back within the service area another reason  that i would never join a medicare advantage  

plan with original medicare you can go to any  doctor any hospital anywhere in the country any  

50 states that accepts medicare without asking  if it's okay to go so if you want to choose to go  

to a specialist for your very unique situation  in new york or in california or in nevada  

you simply make the appointment and do it you  don't have to get authorization on a medicare  

advantage plan you cannot do that now there  are medicare advantage plans that will have  

out of network benefits we have out of  network benefits that allow you to go  

other places the issue with that is cost and  generally with any out of network benefit you  

will find that it is cost prohibitive meaning it's  super expensive to go out of network number one  

the out of network doctor can charge  whatever they want to charge they have no  

pre-negotiated rates with an insurance company  and then the medicare advantage plan would pay  

based on usual and customary which could be far  less than what that doctor actually is charging  

and therefore you will pay that balance bill  after the usual and customary part of it is taken  

care of and it can get super complicated with  medicare original none of that it's all already  

pre-negotiated doctors that accept medicare agree  they have to accept medicare approved charges  

and that's how they get paid and then again your  supplement again doesn't play any part in the  

decision factor you go to the doctor you give  them your medicare card they send the claims to  

medicare medicare then sends the balance to  the supplement that they're supposed to pay  

and that's it there's no questions asked i have  thousands of clients on medicare supplements  

i get zero customer service calls literally  zero if if i get a call it's about a lost  

card or something like that but never i mean i  can't recall last time that somebody said hey  

this didn't get paid and this is a problem it  just doesn't happen and to be perfectly clear  

and transparent i sell medicare supplements  i'm an insurance broker that's what i do  

i could absolutely easily sell medicare advantage  plans medicare advantage plans actually pay a much  

higher commission than medicare supplement plans  but i i completely uncomfortable with selling  

something to somebody that's super important  in something that i just don't believe in so  

that's generally why i focus solely on  medicare supplements because it's terrific  

it's easy it's great for me too because i don't  get a bunch of angry customers and it does exactly  

what it's supposed to do i get calls all the time  from friends that i know that my sister's on this  

medicare advantage plan and now there's an issue  and we need to get her off how do we get her off  

you can't get her off you once once you're in a  medical scenario and you're already in medicare  

in most states you'd have to go through medical  underwriting to get a medicare supplement plan so  

it's not the way it is now if you're on a medicare  supplement for some crazy reason you wanted to go  

to a medicare advantage plan you can do that  anytime at the end of the year during medicare  

open enrollment but you can't go from a medicare  advantage plan back to a medicare supplement  

in most states there are a handful of states that  allow you to do it but in most states you have to  

go through medical underwriting so you don't want  to wait until there is a medical scenario where  

you need to go to see a certain cancer doctor  in north carolina or a certain cardiologist in  

arizona you just don't want to be in that position  and then have your hands tied because you can't do  

it with original medicare you can do it you can  go anywhere you want you can do anything you want  

and there's no questions asked on why do you  want to go there and that again is a main reason  

that i would choose always original medicare  and i would never choose medicare advantage so  

i hope you found this helpful and by all means  leave comments i'm sure i'll get comments that  

people who love their medicare advantage plans  generally people that haven't used them a lot but  

if you have let me know uh it's rare but it does  happen that that people you know if you had one  

specific doctor and that's the one you were gonna  go to and they're in that medicare advantage plan  

you know that that might work out very well but  everything else cost access freedom flexibility  

all goes on the original medicare side without any  doubt whatsoever so hope you found this helpful  

i'm gonna show you right now how to download my  book for free medicare made clear i explain a  

whole bunch of everything in my medicare book i  hope you found it helpful have a fantastic day  

thank you for taking the time to watch my video i  hope you found it very helpful here are a couple  

other things that you'll also find helpful as  you go through medicare the first one is a copy  

of my book medicare made clear you can download  it right now for free i put a lot of time and  

effort into this book and you'll see i cover just  about every piece of medicare and i've written it  

in a way that makes it pretty easy to understand  now i also have videos throughout the book so if  

you don't want to read through all the information  click on the video and i'll explain it all to you  

right there you'll also find all the links that  you need to either sign up for medicare or things  

that you're going to need now or in the future  when things come up related to medicare so take  

just a minute go to medicareonvideo.com forward  slash free book and you can download it right now  

now also make sure once you're in medicare that  every year you come back and visit medicare  

price check this is my other website where  i make it super easy for us to compare  

our current coverage against new plans that may  be less expensive and remember that medicare  

supplements are standardized so it doesn't matter  which insurance company we use we'll still have  

the same plan g or the plan n that we have now  but hopefully we can get it at a lower price  

so visit medicarepricecheck.com real  easy we'll email you the quote if it  

makes sense then we'll do it from there so hope  you found all this helpful have a fantastic day