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