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Medicare Advantage vs Medicare Supplement | How to Choose the Best Medicare Plan - YouTube
Channel: Boomer Benefits - Medicare Expert
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are you pacing a mountain of Medicare
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mail and tended to all telemarketing
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calls about Medicare every day if so you
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are not alone and we know that all that
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confusion and overwhelmed certainly
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doesn't help you with how to choose the
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best Medicare plan for yourself
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hi there if we haven't met yet I'm
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Danielle Roberts co-founder here at
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boomer benefits where we provide free
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help to baby boomers who are turning 65
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and trying to find the right coverage in
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the 14 years that I've been working with
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Medicare insurance products my team and
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I have helped thousands of people with
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figuring out their Medicare insurance
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options and selecting suitable coverage
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in this video I'll give you some of my
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top tips for finding the best Medicare
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plan for you stay with me until the end
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and I'll tell you where you can grab our
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free guide that discusses Medicare
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Advantage plans vs. Medicare supplements
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[Music]
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there are two main ways that you can
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fill in the gaps in Medicare these two
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choices are Medicare supplements which
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are also called Medigap plans and
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Medicare Advantage plans which are also
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called Part C plans it's important to
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understand that these two types of
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coverage do not work together so you
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will never have them both at the same
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time you'll be choosing one or the other
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let's start by discussing Medigap plans
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also called Medicare supplements same
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thing Medigap plans pay after Medicare
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first pays its share your health care
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provider gives you treatment and then
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bills Medicare Medicare processes the
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bill from your health care provider and
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if it approves the service it pays what
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it's supposed to it then sends a
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remainder of the charges on to your
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Medigap plan to pay its share it's
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important to understand here that
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Medicare always decides if the claim is
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paid if Medicare approves the bill your
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Medigap plan must also pay its share of
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your deductibles co-pays and coinsurance
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here are some features that our clients
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often tell us that they like about
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Medigap plans
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first Medigap plans allow you to see any
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provider that accepts medicare doesn't
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matter if your insurance company you buy
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your Medigap plan from is one or the
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other if the doctor accepts medicare he
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will also accept your supplement second
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all new Medicare beneficiary
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are given a one-time six-month open
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enrollment window to enroll in any
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Medigap plan offered in their area with
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no health questions asked if you apply
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during this window your acceptance is
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guaranteed be sure to check our separate
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video on your one-time Medigap open
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enrollment window third you do not have
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to choose a primary care provider if you
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have a Medigap plan
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there's no referrals necessary in order
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to see a specialist either this type of
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plan gives you the most freedom of
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access when it comes to providers fourth
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Medigap plans are standardized making
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them so easy to compare for example in
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2019 the most comprehensive plan you can
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buy is Plan F a Plan F from one
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insurance company has exactly the same
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benefits as plan uh from another
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insurance company this means that you
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can shop based on price and here at
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boomer benefits we also like to look at
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the rate increase histories for each
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carrier to help our clients choose
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wisely Medigap plans have higher
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premiums upfront than Medicare Advantage
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plans but the co-pays on the back end
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are very predictable for example if you
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enroll in plan F you have zero co-pays
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on the back end whatsoever nothing out
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of pocket other than your monthly
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premium on Part A and B services in my
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experience Medigap plans work very well
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for people who travel within the US as
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well because they can see providers who
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accept Medicare in any state these plans
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also work well for people who don't like
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the hassle of networks I've also seen
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them bring great peace of mind to
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someone who is entering Medicare with a
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chronic health condition if you're a
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person with high medical usage and you
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feel worried about what kinds of co-pays
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you will encounter once you're on
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Medicare you can purchase a Medigap plan
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with pretty full coverage like a plan F
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or G and you'll know that you will have
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very little out-of-pocket later on now
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be aware that Medigap plans do not
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include drug coverage because these
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plans were created in the 60s before
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Medicare Part D was around however it's
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easy to pick up an inexpensive Part D
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drug plan to go along side your Original
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Medicare and your Medigap plan now let's
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take a look at the second type of
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coverage which is Medicare Advantage
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these plans were introduced in the late
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90s as part of the Balanced Budget Act
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they are a form of coverage that you can
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enroll in to get your benefits from a
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private insurance company instead of
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from Original Medicare Advantage plans
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cover the same services as Original
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Medicare but your cost-sharing for each
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service will be different because it's
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set by the plan instead of by Medicare
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about one-third of current Medicare
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beneficiaries are currently enrolled in
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a Medicare Advantage plan here are some
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features that are common to Medicare
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Advantage plans first most plans have a
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network of providers in your local area
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Medicare HMO plans seem to have the
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highest enrollment numbers and in these
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plans you will usually only have
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coverage within the network there's no
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coverage outside the network except in
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emergencies some HMO plans may also
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require you to choose a primary care
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provider and you may have to get a
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referral from them in order to see a
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specialist Medicare PPO plans have a bit
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more flexibility in these plans you can
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treat outside the network usually at a
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higher cost and if the out of network
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provider is willing to build a plan
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second you can purchase a Medicare
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Advantage plan that has a built in Part
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D drug plan this allows you to get your
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Medicare Part A B and D services from
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the same insurance company using one ID
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card for all three services third
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premiums for Medicare Advantage plans
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are often lower than Medigap plans in
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some areas you can find Medicare
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Advantage plans that have what we call a
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zero premium this means that the plan
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does not charge you anything to be a
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member you must still however be
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enrolled in both Medicare Parts A and B
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and you'll continue paying for Part B
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throughout your life but you won't have
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any additional premium for the Advantage
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plan on top of that this does not mean
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the insurance is free the insurance plan
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is paid by Medicare to take on your risk
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so it is simply setting a very low
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premium to attract you to enroll in the
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plan so that it can collect a paycheck
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from Medicare fourth Medicare Advantage
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plans are allowed to offer you ancillary
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benefits this means they could have some
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basic dental vision or hearing services
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included some plans offer discounted gym
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memberships as well recent legislation
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will also allow some Advantage plans to
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include things like home modifications
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for mobility and transportation to and
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from doctor appointments it doesn't mean
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that all plans will offer these things
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but they will at least be allowed if
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they so does
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fifth Medicare Advantage plans can and
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do change their benefits from year to
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year much of this depends on how much
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Uncle Sam is giving them each year to
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fund these plans and so you may see some
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years where your costs go up and others
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where your costs go down this means you
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have to be a person who's willing to
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review the coverage changes every fall
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and decide whether you wish to keep your
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current plan or change to another
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Medicare Advantage plan the next year be
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aware that if you enroll in a plan
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because you like the free gym membership
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it's entirely possible that the plan
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could drop the gym membership the
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following year that is actually
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happening this year with a major carrier
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so my advice is always to choose the
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plan that covers the health events that
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are most important to you and consider
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the rest to be gravy do you want a plan
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that will offer great coverage for a
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heart attack or stroke or cancer or do
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you want a plan that offers a great gym
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membership I think you see my point it's
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not that one type of coverage is better
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than the other it's that they are
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different and you need to thoroughly
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review all the benefits of each plan
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type before you decide on what's right
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for you now considering how differently
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these two types of coverage operate how
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can you choose the best medicare plan
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for you here are some of my tips for
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discovering the type of coverage that
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fits you best one consider your budget
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sometimes we need people who live on
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Social Security income alone and the
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cost of a Medigap plan is simply not
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possible for them Medicare Advantage
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plans can be a great option for people
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with limited and it comes to consider
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your medical usage since Medicare plans
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often require co-pays when you see a
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specialist you'll want to think about
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this carefully if you see a specialist
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twice a month will the co-pays that you
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shell out negate any of the premium
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savings you're achieving 3 ask your
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providers speak with your doctors and
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hospitals and find out what plans are
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accepted there most doctors offices
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accept Original Medicare so you'll know
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that you can use any Medigap plan if
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your doctor accepts medicare however he
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or she may or may not participate in
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Medicare Advantage plans in your area so
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if you have several important providers
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it's important to make sure all of them
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are in the network for any Medicare
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Advantage plan the
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maybe considering before you enroll in
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that plan next access to providers many
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of our clients who enjoy Medigap
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policies like the freedom of access of
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those plans
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if hassling with the network will set
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your hair on fire then you may like the
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flexibility that Medigap plans offer
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convenience some of our clients who
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enroll in Medicare Advantage plans tell
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us they like the convenience of having
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one member ID card that they use for
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both medical and drug benefits peace of
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mind you need to ask yourself which
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coverage helps you sleep at night if
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you're the type who will worry during a
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hospital say over what types of bills
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you'll get when you get home then a
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Medigap plan can help to eliminate that
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kind of worry on the other hand if
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you're the type of person who will worry
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over that Medigap premium you have to
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pay every month then perhaps you'd like
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an advantage fund better where you can
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simply pay for services as you go along
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backend costs Medigap plans have very
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limited and predictable back end costs
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Medicare Advantage plans on the other
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hand will be different every year you'll
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likely spend more in years where you
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have higher medical usage check the
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plans out-of-pocket maximum limit and
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make sure you have enough set aside to
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cover those costs if a year comes along
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where you have a lot of medical spending
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you should also carefully check in
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advantage plans drug formulary before
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you enroll if you miss the fact that
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your plan doesn't cover one of your
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important brand-name drugs this can
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create back end spending out of pocket
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that you didn't anticipate travel
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Medigap plans can be used anywhere in
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the United States this means they work
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great for snowbirds or people who like
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to visit their grandchildren some
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Medigap plans also offer up to fifty
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thousand dollars in foreign travel
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emergency coverage Advantage plans have
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worldwide emergency coverage final
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thoughts one last thing I'd like you to
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think about is that most people only get
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one six-month window to get a Medigap
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plan with no health questions asked if
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you enroll in a Medicare Advantage plan
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and then later on you wish to return to
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Original Medicare and buy a Medigap plan
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instead you will likely have to answer
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health questions at that point and you
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could be turned down for coverage so
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just be aware that enrolling in a
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Medicare Advantage plan may
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mean that you could lose your
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opportunity to ever get back to Medigap
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coverage again the Medicare open
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enrollment period that occurs in the
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fall is a time when you can change your
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drug plan or your Medicare Advantage
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plan but it does not give you a free
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pass into a Medigap plan with no health
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questions asked many people get this
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wrong we tell all of our clients here at
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boomer benefits about this because we
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want them to understand that if they
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enroll in a Medicare Advantage plan for
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a few years it's not always that easy to
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get back into a Medigap plan later so
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there you have it if you'd like help
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deciding which type of plan makes the
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most sense for you give us a call and
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we'll walk you through the options in
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your state or maybe you have a question
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about one of these types of coverage
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that we can answer for you right here on
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youtube just drop it in the comments
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below and we'll respond with some
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answers to help you out you can also
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grab your copy of our free guide about
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Medicare Advantage plans vs. Medicare
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supplements for some takeaway reading
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I'll drop the link in the notes below
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this video lastly if you haven't yet
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subscribed to our channel hit the red
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button below so that you'll always be
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notified when we upload a new video to
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our channel thanks for watching and
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we'll see you in the next video
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you
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