Welcome to Medicare School Daily, where we help you understand Medicare, save money,
avoid mistakes, and above all, get the most out of your Medicare benefits. When it's time
for you to go on Medicare A and B, you're also going to need some other insurance. If
you have A & B only, you're putting yourself in a very risky position.
Now, when it comes to other insurance products, there's really only two choices, and those
are called supplemental plans and advantage plans.
These are your two choices.
So today, what I'm going to address is the 6 key differences between these two choices.
Now, before I tell you the differences, let me tell you what they have in common.
It's only one thing, and that is this.
In order to have a supplemental plan, you must be enrolled in Medicare A & B.
If you have an advantage plan, you also have to be enrolled in A & B. A for most people
is no cost.
B carries a premium.
So either way, we're paying a premium for our B coverage, whether we have a supplemental
plan or advantage plan.
Now, beyond that
there are differences.
#1 would be out-of-pocket costs. If you take a supplemental plan,
what you're doing is you're paying premiums.
Now, that premium is going to vary depending upon your age and your gender and where you
live in the country.
But it's in the ballpark of probably $100 to maybe $125 dollars
a month, depending on the plan that you're with.
But you're paying a premium and after that, you're pretty well done.
You may have a small deductible, but beyond that, all your expenses for inpatient/outpatient
coverage is going to be covered by that supplemental plan because you pay them a premium.
You transferred the risk away from yourself. On your advantage plans,
totally different out of pocket,
is going to be co-pays. Copay. Copay. Copay. Copay. For everything you do,
you're going to pay a copay.
You see a specialist, go to the hospital, have a test, you have a copay.
And so instead of paying a premium, you're out of pocket costs
will be co-pays, and you pay those co-pays until you hit a certain max out of pocket
for the year.
All right?
So one is pay as I go;
One is premium based.
Now, the second difference would be network.
If you decide to take a supplemental plan, that supplemental plan is supplementing original Medicare.
So any provider that takes Medicare, they will also take your supplemental plan.
In other words, you would never show up to a provider that says they take Medicare but
would not take your supplemental plan. Because if supplemental plans are nothing more than a secondary
payer, so you
can choose any supplemental plan you want.
So if that provider takes Medicare, you can also go to that provider. It's the
only criteria.
So we have no networks whatsoever.
We call that an open access system.
Anyone takes Medicare,
We'll take your supplemental plan.
Now, when it comes to advantage plans, we always have networks. We have two to choose from.
Those are HMO's and PPO's. Some providers
take both,
some take one or the other, some take none.
But with an advantage plan, you'll always have a network.
And this would be a network of doctors and specialists and hospitals that have agreed
under contract to treat the patients that are enrolled in these particular plans.
So here we have no networks.
Here we're always going to have a network.
Now, pre-certifications.
Now, what this simply means is that if you go to a doctor and the doctor wants you to
have an MRI or maybe a CAT scan or something, if you're on original Medicare, your doctor
has the final say so.
The doctor, of course, has to live within the Medicare guidelines,
But if doc says Medicare is going to cover this,
there's no one else that has any say-so whatsoever.
It is your doctor and Medicare.
So we absolutely have no pre-certs whatsoever.
That's little different when it comes to the advantage plans.
There will be some pre-certs. Now to see your primary care doctor or to go to a specialist,
there's going to be no pre-certification. But if that doctor wants to order an MRI or
CAT scan, it would have to be approved by that plan first.
In the words, the nurse, they're going to have to call in and get it pre-certified. And sometimes
they say yes,
sometimes they say, well, we'd rather you go to therapy for a certain bit of time.
And sometimes they say, check back with us after therapy.
In fact, I had a client once that needed a hip replacement.
The doctor said we need a hip replacement.
She was actually on an advantage plan, and they call the advantage plan for a pre-certification,
And they said go to therapy for 9 months. After that,
call us back and we'll see if you still need that hip replacement.
OK?
If that lady would have been over here, the hip replacement would have been done. Over here, they
had the right to have some say so, and they delayed that hip replacement for 9 months
as she got therapy.
OK, so those are pre-certifications.
Next would be perks.
And the kind of perks I'm talking about would be some dental plans and vision plans; maybe
gym membership.
Supplemental plans rarely include those in their coverage.
Now, few companies do, but that's by and large, very rare.
So if a person wants to have a dental plan or vision plan; if you felt like you needed
that or a gym membership, that would be separate. You'd have to pay a separate costs for that
type of coverage.
If you have an advantage plan, they always include those.
Now, it may be limited dental, limited vision and some gym membership, but they typically
include those. Of course,
they advertise a lot because that is one of the distinctive differences between these
two.
So if you want perks, it's included here to pay for that, if that's something that you
want. Now when it comes
to prescription drug plans. Over here, they are separate.
So if I get a supplemental plan, that drug plan is not going to be part of my supplemental
plan.
It's going to have to be a separate plan.
Now, this is a
favorable thing, because if we have a separate drug plan, that means we get to choose from
typically 20 to 30 drug plans in any given zip code.
So that means we have lots of choices. So depending upon the meds you take, will determine
what prescription drug plan is best for you.
And so we have separate policy, separate plans, and a separate premium.
And these are going to range anywhere from typically $30, $13.
They say the national average right now is about $30 a month for a drug plan,
some really higher than that.
But the point is, it's a separate plan; many to choose from.
If I have an advantage plan,
notice it's included.
So they will embed prescription drug plan.
And honestly, sometimes those are very good plans.
Sometimes they're mediocre.
But you can't pick and choose. Whenever you take an advantage plan, whatever they're betting
within that coverage is the plan that you're going to have to take.
All right?
So that's going to be difference as well.
So it's part of the package here. It's separate
here; we have to pay a separate premium.
Here, we take what they offer us.
All right?
So here they're going to cover inpatient, outpatient, and prescription drugs all in
the same plan.
And then lastly, there are some times when people want to switch plans.
Medicare has an open enrollment period every year, October 15th to December 7th.
So let's suppose that someone was on a supplemental plan, and they wanted to move to an advantage
plan.
There's only one health question that we have to ask you to make that switch.
We'll say and ask you, do you have end-stage renal disease. End-stage renal disease, which
is permanent kidney failure.
You're either on dialysis or you're waiting for a transplant.
And if that's your medical condition and you're on a supplemental plan and you want to move
here, you cannot make that switch.
And honestly, you wouldn't want to make the switch because if you have end-stage renal disease,
it's very costly to get care.
And so you'd want to stand your submental plan, but that is the one question that's
asked to make that switch.
Now, if someone's on an advantage plan, and they would like to move over here to a supplemental plan,
notice underwriting is required.
So if I'm on an advantage plan any more than one year,
so that be two years, three years, four or five years,
And I would like to move from here over to here.
I'm going to have to go through underwriting, which means we have to ask you probably 25
health questions.
We're gonna have to check your prescriptions to see what you're being treated for.
And we're also we have got a statement from your doctor.
And so an underwriter within insurance companies have to approve you medically to make that
switch.
Now you don't have to be ready to run a marathon.
You don't have to be perfectly healthy.
But if there's anything seriously going on with your health, you may not be to make that
switch from the advantage plan over to the supplemental plan because an underwriter has
to approve you to make that switch.
So these are your 6 key differences.
And again, both are good insurance.
They are just different, and we want you to be clear on these 6 key differences. Thanks so much for watching.