Well, if you are just turning 65, or perhaps you've been on Medicare for a
couple of years, and you put your TV on anytime during the day through the month
of, say, September to the end of the year,
chances are you saw a Medicare commercial.
In fact, you probably saw about 10,000 of them.
This is because these insurance carriers want to sign you up, tell you they're
giving you all of these benefits, but they're leaving out the fine print.
Now, my name is Russell Noga with Medisupps.com.
Today I'm going to compare Medicare Advantage versus Medigap, cover the pros
and cons of each and help you decide which one of those is best for you.
So what is Medisupps.com?
Well, we're an online insurance agency, helping seniors for the last 11 years
with their Medicare insurance, and licensed in 47 states.
So, whether you're sitting in Oklahoma, or Florida or California, wherever you
are, chances are we can help you out as well.
Now, I'm the guy who's going to give you the fine print.
I'm going to cover the differences of Advantage plans and Medigap insurance.
And make sure you understand both, as well as give you my personal
recommendation, having done this for so long.
If you ask any agents who sells either of these products, what plan they have
their parents on, most of them will tell you the same thing.
I'll leave that for later, though.
For people on Medicare, there are a couple of different options they can go
with when it comes to what type of coverage they want.
First option is they can enroll in a Medicare Advantage Plan.
What happens there is they opt out of Medicare and enroll in a private,
though Medicare approved company, their Advantage Plan, and they are now under
the managed care in their network.
Or they can go on a Medigap Plan, where Medicare Supplement Plan and Medigap are
the same thing, simply follows Medicare wherever you go.
It's nationwide coverage.
Or they could just have Medicare Part A and B, and nothing else.
Now, most people don't do that.
They'll either go with one of the first two choices, which is a Medicare
Advantage Plan or a Medigap Plan.
Now, I should point out that you cannot have both of these at the same time.
You can either have a Medicare Advantage Plan, or Original Medicare and a Medigap
Plan.
Now, Original Medicare is Medicare Part A and Part B.
Remember, Part A covers hospitalization, and Part B covers doctor services.
Then you would add a Medigap Plan to that.
Medicare Advantage Plans, you opt out of Part A and B, and you enroll in a
private company's managed care plan.
And that's why you can't have both at the same time. They won't allow it.
So I'll start with Medicare Advantage Plans.
That's what you see all the commercials about, they've got ex-NFL football
players telling you how great they are.
Let me talk about the benefits of those.
Again, you opt out of Medicare Part A and B to enroll with one of these.
Now, this will be with a private insurance carrier.
Names you've probably heard of, such as Aetna, Kaiser, Cigna, Blue Cross, they
all offer various Advantage Plans.
But you have to see which ones are available in your area.
And that's because these are network plans.
They're either HMOs or PPOs. And not every plan in the country is going to be
in your area.
Okay, so let's get to what do Medicare Advantage Plans cover?
Well, by law, they have to cover at least what Medicare Part A and Part B
cover.
They need to equal that coverage, no matter which company provides that.
However, beyond that coverage, each plan can pick and choose how much they want
to cover.
Now, remember I mentioned that you opt out of Medicare Part A and B to enroll
in this plan.
Many, many companies offer zero premium Advantage Plans.
However, that doesn't mean they're free.
And it all starts with the fact that even though you opted out of Medicare to
enroll in one, you still must pay the Part B premium.
So you're still paying for Medicare, and even though it's a zero premium
Advantage Plan, while there are other costs.
And I'll get to more of those in a moment.
However, you don't get out of paying that Medicare Part B premium.
In fact, just the other day I had a woman call me and say, "Russell, I don't
pay anything for my Advantage Plan. It's great. Why should I go with a Medigap
Plan?"
And I said, "Well, you're paying the Part B premium."
Now, she was very sweet and insisted that she didn't, however, I had to
remind her, "Check your Medicare Social Security check and see if it's coming
out of that," because it was.
So you still pay the Part B premium if you have a Medicare Advantage Plan.
So Advantage plans are offered usually HMOs or PPOs.
HMOs are definitely the most popular, but these are plans that will have a
network, they both have networks.
And with an HMO, you typically will have to have a primary doctor.
And then if you want to see a specialist, you would need to get a
referral.
You would usually only get coverage if you stay within the network of the plan
if you're on an HMO.
If you enroll in a PPO, you might have some flexibility of going outside your
network and then having a little higher cost for your coverage.
But the coverage in network would be a reduced cost.
Now, when it comes to Advantage Plans, and I get asked about them daily.
The first thing I always tell everybody is you'll have a network, you'll have to
call your doctor and see if they even accept the plans in your area that are
offered by these different companies.
I would say a lot of people stop right there and say, "Nope, I don't want to
network. I want to be able to choose which doctor or specialist I can go
with."
Now, I'll get to Medigap plans in a moment, but they give you that
flexibility.
With Advantage Plans, a lot of the coverage, you need to stay within your
network.
Now, the exception is if you're traveling and you're outside of your
network, and you have an emergency,
then you will get coverage by most of these plans.
There are many Medicare Advantage Plans out there that also include prescription
drug coverage, they have that bundled into the plan.
And if you saw those commercials, they certainly told you that, and they
pitched it to you that that was a great thing.
Well, let me explain. There's probably 20 to 30 or more different drug plans
available in every state.
They all have what's called different formularies.
This means what they cover, which drugs they will give certain prices for.
If you have an Advantage Plan that includes drug coverage, you're stuck
with that drug plan.
Now, let me tell you why that matters so much.
You take a specific amount of prescription; some people take none,
other people, I've seen lists of a number of prescriptions.
Well, everybody's different.
And because every insurance carrier offers, for drug plans, at least, offers
different formularies, you're stuck with this one drug plan.
It doesn't mean that's the best option to get your prescriptions.
Now, perhaps it's going to work out great for you. I'm not saying it's not.
However, it's one more variable to consider where is if you enrolled in a
Medigap Plan, you can choose your own Part D drug plan.
Well, one question I do get asked a lot about Medicare Advantage plans is,
"Russell, I see these zero premium commercials. I can get for free, I can
get dental, sometimes hearing and vision benefits, all for free."
Well, as you know, the old saying, "Sometimes you get what you pay for."
Now, in this case, they have to cover as good a benefits as Part A and B
Medicare.
But how can they offer these plans for free?
Well, I'll tell you, the government comes in and says, "Listen, Humana,
Aetna, whoever's offering these Medicare Advantage Plans,
we will pay you per month to provide coverage for those folks who want to
enroll in your private plan."
So these companies get subsidies from the government and then ensure you, and
then opt out a Part A and B.
So they're off the government's hands and into the private insurance carriers
hands.
That's how they can offer these zero premium plans.
But one big consideration with Medicare Advantage plans is, a lot of their
coverage changes every year.
And that's based on what the government's going to give them.
They say, "Well, maybe we're getting a little less. Let's shave off a little
here."
Well, what that means is you have to watch this every year.
So we know it might be a zero premium, we know you've got a network, and you've
got to stay in the network to get coverage.
But you also need to watch it every year, because the plans change.
So that means yearly maintenance to see, or at least have somebody who can help
you a yearly to make sure that you're always with the best plan.
Now, let's say your plan changes dramatically, you want to switch to a
different company.
Off to the phone you go to see if your doctors accept that company.
And they might not.
So you have to be very careful with a Medicare Advantage Plan, or at least
take all those factors into consideration.
Now, I mentioned you get coverage for emergencies outside your network.
Well, I have a lot of clients who are RV-ers.
I've been doing this for 11 years.
I've got so many different clients that are out on the road, and I'm very, very
jealous.
By the way, I'm up here in Bend, Oregon right now.
Anybody who's watching, stop on by, we'll get coffee back there.
On me, of course.
But if you are an RV-er or you travel a lot, you'd be out of your network the
entire time.
Now, in case of an emergency, you will get coverage, however, they're going to
make sure that's an emergency.
But if you do travel quite a bit and you are on the road like many of those
RV-ers, a Medicare Advantage Plan is probably not going to be the best option
for you.
Now, at this point in the video, you might be saying, "I think this guy likes
Medigap Insurance better than Medicare Advantage Plans."
Well, you'd be right.
However, I do know that different people have different budgets and different
health conditions, and some plans work out better than others.
We could still help you if you're wanting a Medicare Advantage Plan.
However, being an independent insurance agent and agency, I can pick and choose
which companies and products that I feel are the best that I want to promote.
And yes, in my opinion, if you can afford it and it works out, a Medicare
Supplement Plan by far is superior coverage to a Medicare Advantage Plan.
They have their uses, the Advantage Plans.
However, with Medigap Insurance, you're talking about some of the very best
coverage you ever seen in your life.
And quite honestly, relatively speaking, they're not that expensive.
Now, I do understand everybody has different budgets; a Medigap plan might
be out of somebody's range.
And, again, I completely understand. In that case, we can help you to get set up
with an Advantage Plan, I can steer you in the right direction.
However, I encourage you to at least let me show you the Medicare Supplement
Plans that are available in your area. And there's a number of reasons why.
Now, we could start with the fact that like I mentioned, there is no network
with Medigap Plans.
Medicare is a Federal program. That means it's across the country.
Of course, wherever Medicare is, your Medicare Supplement Plan can go and of
course, provide you coverage.
So you literally could call up a doctor in say, Houston or wherever you want or
a specialist.
As long as they take Medicare, they will take your Medicare Supplement Plan from
any company, because those plans are standardized.
And I'll get to that in a minute.
But I do want to stress, there isn't a network.
That alone has a lot of people loving a Medicare Supplement Plan over a Medicare
Advantage Plan.
Now, what I get asked a lot is, "Why do they call them two different names? Why
couldn't they just settle on one name?"
Well, they kind of did. The government calls them Medigap.
That's because Medicare Part A and B, again, A being hospitalization and B
being doctor services, they don't pay all of your bills.
There are gaps or expenses in the coverage that you're required to pay, or
you get a Medigap Plan and that will help pay those for you.
Now there are a variety of different Medigap plans available. And they are
all in letters.
Remember I just mentioned Part A and Part B.
Those are parts of Medicare, then you have a Part D drug plan.
There's a part C in there, and that's Medicare Advantage Plans.
Just think of those as parts, and let's just put those over here for now.
Because talking about Medigap Plans specifically, well, they're also
lettered, just to confuse you a little more.
Now. I think they should have numbered them, by the way.
It would have been a heck of a lot easier.
There are just a few different plan letters that most people go with out of
the 10 available.
And again, these plans help pay those gaps or expenses in Part A and Part B
Medicare.
Now, the most popular Medicare Supplement Plans or Medigap Plans are
Medicare Plan G, Medicare Plan N, and Medicare Plan F.
Now, I'll start with Plan F, simply because that has the most coverage.
However, there are some guidelines now that come with that.
And that is the fact that if you're new to Medicare, you're not allowed to
enroll in a Plan F anymore.
On January 1 of 2020, Medicare removed that from the lineup for anybody new.
If you had a Plan F prior to that, you could keep it and of course, if you're
out thereand you've got a Plan F, I do want you to listen carefully because
there are better options for you.
You could keep the Plan F, however, nobody new can enroll in one on January
1 or later if that's when you enrolled in Medicare.
Now, for the folks who have Plan F, yes, you got to keep it, but in reality, it's
very expensive for very little benefit over another plan, which I'm about to
talk about.
What is that? And what does it do?
Well, Plan F covers 100% of those gaps in Part A and Part B, like I mentioned.
Yes, that means you get no medical bills and of course, you've got Plan F, you
realize that, and that's probably why you kept it.
However, you're paying only one...You're paying a higher premium for just one
benefit over what Medicare Plan G has.
That benefit is who pays what's called the Annual Medicare Part B Deductible.
Plan F pays that deductible for you.
The only difference in Plan F verse Plan G is you pay the deductible out of
pocket yourself on Plan G.
Now, we're in 2020, rapidly approaching 2021.
This year, the Part B deductible is $198.
Again, on Plan F, it pays that for you, and Ion Plan G, you pay it out of pocket
yourself.
So, let's talk about the premiums of both.
Because with Plan F, you are paying substantially more than $198 a year for
them to write a check of $198 to pay the deductible for you.
That is a very expensive service fee.
In fact, I just ran some quotes for a couple earlier before I made this video.
And they were paying about 500 extra dollars a year combined over Plan G,
just to get $198 deductible paid for them.
That's a lot of money for just writing a check; somebody's writing a check with
your money.
That's why I always recommend we look at Part G or Plan G.
Because Plan G, you simply write the check yourself but you save on those
premiums, then it pretty much turns into a Plan F, and you get 100% coverage.
Now, Medicare Plan G is definitely the most popular plan for those reasons.
It's got great coverage, relatively low premiums.
One thing I do need to mention, with any Medigap Plan out there, every company
has the exact same benefits within each plan letter.
This means if it's a Mutual of Omaha Plan G, it's the same as an Aetna Plan
G.
However, each company offers different premiums.
Sometimes substantially different.
So now, we are independent agents, which means we shop all of the top companies
for our clients, and people like yourself, now and for years to come when
you get a rate increase.
That allows us to shop everybody and then bring you to some of the lower
premiums.
If you just go direct to an insurance carrier for any of these plans, they're
going to tell you one rate.
Their's!
And how do you know it's the lowest?
How do you know if they even have a household discount?
Maybe they don't.
A lot of different factors.
Now, our service is free. There's never a cost for anything we do.
But having been in business for over a decade, helping 10,000 people or more
now with their Medicare insurance.
Believe me, they love it, because every year we do this for them. We shop the
companies.
And you always know you're in the best spot possible for your Medicare
Insurance.
Now, let's about one other popular plan that I mentioned, which is Medicare Plan
N.
With Plan N, you still pay the Part B deductible like you do on Plan G,
however, it's lower premiums than Plan G.
So you might say, "Well, great, Russell, I want that one. That sounds good. I'll
take lower."
Well, you might have some additional out of pocket expenses on Plan N.
What those are is, after you pay the deductible on Plan N, if you go back to
the doctor, you might have a co-pay, but it will never be more than $20 for the
visit.
Now, it could be less than 20 or it could be no co-pay. It just depends on
what you go for.
And that's each doctor's visit.
Also, with Plan N, if you visit the emergency room, there is a $50 co-pay if
you're not admitted and you go home.
And with Plan N, there are things called Part B Excess Charges that are not
covered.
Now, this is very rare. Most doctors take the assigned rates for Medicare and
don't even charge these; probably never see one. However, it could come up.
In that event, you would have to pay a small percentage of a percentage of a
Part B Excess Charge.
But again, these are extremely uncommon.
So with Plan N, you get the benefit of the lower premiums, than say, Plan G.
You might have some additional out-of- pocket expenses.
But if you're healthy, you're probably thinking, "Wow, that sounds good because
I don't go to the doctor very often anyway."
And a lot of people are like that.
I have many clients, some who never go to the doctor. I know them, though.
They're very healthy.
But they have a Plan N, because they know "Geez, what if I break my ankle,"
or God forbid something does happen, you still have great coverage, but you had
those lower premiums all year long with Medicare Plan N.
Now, as I mentioned, the Medigap Plans, you would need to enroll in a separate
Part D drug plan if you wanted prescription coverage.
But remember I mentioned, the plan not built in is a good thing.
You get the flexibility of choosing any plan that matches your needs and your
prescriptions.
This is a big deal, because if you choose the wrong plan, you can end up
paying thousands extra for brand name drugs, especially if you take them.
And with those Medicare Advantage Plans, the plan is built in, you're stuck on
their drug plan.
So you could see the difference of these two plans, Medicare Advantage Plan verse
Medigap.
And you can see the flexibility that you really get with a Medigap Plan verses
the Advantage Plan.
However, on the Advantage Plan side, I understand budget comes into play.
Zero premium sounds really, really great.
A lot of people during October, call us, begging them to take us off their
Advantage Plan.
I'm not gonna lie here. This happens. It's our busiest time of year.
And most people say, "I want to get back to Original Medicare and on a Medigap
Plan."
Not everybody, of course. A lot of people don't call us.
They stay on their Advantage Plan, and that's fine for them.
But we deal in Medigap Insurance, which in my opinion, is the best of the best.
And if that's something that you want, and it can help you, by all means, give
us a call.
Now, if you do want an Advantage Plan, you can call us as well, I'll certainly
help you out with that.
However, to get enrolled, or to learn more about any of these,
just give us a call.
Our phone number is 1-888-891-0229.
We're here all the time.
We're a small group, but we have big service.
And like I mentioned, we've been doing this a long time, helping people get the
lowest premiums on their Medigap Insurance now and for years to come,
because you will get rate increases.
So again, I'm Russell Noga with Medisupps.com.
I can't wait to talk to you. Ask all the questions you have when you call us.
We're here to help you and answer those questions, and get you in the best spot.