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My hospital billed $174K for a total knee replacement, my Medicare Advantage knocked that down to just under $16K. My cost was under $300.00. How the hell does this happen? Why the outrageous $174K billing??? American Healthcare is Effed up!
@@beoz658 - Are you sure it cost him nothing? according to everything I hear, including this video, if you have an advantage plan, you would be paying co-pays and percentages until you reach your out of pocket. Even with plan G, you at least have to pay the deductible.
Medicare pays the hospital and physicians a fraction of the billed charge. They are also capped at what they can charge a patient. Hospitals and physicians could not survive financially if they only treated Medicare patients. Private insurance patients subsidize the care of Medicare patients. No one, private insurance or Medicare pays the 'billed' charge. The billed charge is set high because Medicare only pays a small percentage of that charge. Yes, American Healthcare is messed up, but everyone is so afraid of 'socialized medicine'. Socialized Medicine works in just about every other developed nation and every ciitizen is covered and no one goes into debt over medical care.
I took Plan G Plus when I started Medicare and thought, "I'll never use it, I'm never sick." That didn't last long and I was so glad I had that G plan. I had a huge hospital bill for 5 days and only out of pocket was my Plan B deductible.
I have Plan F. I'll turn 70 in a few months and so far I haven't came close to taking much advantage of it. On the other hand, I'm very comfortable knowing that if I need it, I have it. When my younger brother turned 65, I tried to get him to get a Supplemental Plan, but he went with an Advantage Plan instead. Considering our rural location, he would need a 200 mile round trip for just about anything other than a simple doctor's visit and could easily need to go much further to find doctors in the network.
I got plan G at age 65 after using my work associated health insurance exactly twice in my life. At age 66, I was diagnosed with cancer. 4 surgical procedures, 20 weeks of chemo, 33 sessions of radiation, not to mention all the evaluations prior to treatment (MRIs, PET scan, etc)....my OOP cost was a little over $200 each calendar year. As all my procedures were outpatient, I did not incur the hospital deductible. I'm hoping to be moved to yearly check ups after my May visit....but even those visits with the associated tests are not cheap. The best thing is that I didn't have anyone telling me where I could or could not get treatment. Of course I had my Medicare B, D, and supplement premiums
wow - that's why we pay the G premiums - a great reminder of what can happen to a perfectly healthy person - sorry you went through that nightmare and hope you have smooth sailing for the rest of your Journey on this planet
@@cgilleybsw Real question. I don’t know what you mean. What part is BS? Also, not sure what you mean by grow up. Am I being naive about something? Thanks.
With Advantage people get sucked in with the $0 premium. They may be good from 65 -75 years old but then things happen and they need to pay big bills. With Plan G you are paying more upfront but it will pay off in the long run when you need it.
@@juliebutler8241Everybody gets sick eventually. No one dies healthy, unless they get hit by a truck! I've known people who have done everything right, grown their own food, ran marathons, you name it. No one is immune. Sure, you can improve your odds that you stay healthy longer, but there are no guarantees, and sooner or later something will get you!
@@juliebutler8241 I've known people to eat like crap and smoke cigarettes and live into their 80s and seen people eat right, exercise and do every single thing right and end up with cancer. Shit happens a lot is your genes too
Exactly! Ask an advantage plan if you can go to a rehab facility after a broken hip. They’ll either deny or give you very few days. Vs Medicare where you have 100 days.
I just retired as an Insurance Agent. You are explaining how insurance works for retirees truthfully and accurately. Unfortunately not everyone listens until it is too late and then they place the blame for their situation not on their bad decisions but on other factors. I have a lot of respect for the work you are doing. Thank you.
this guy makes me want to have tooth extractions with no sedative. Pick the worse possible case, protect yourself from the 0.00000001% issue and piss your retirement savings away on the plan G premiums.
Keep the videos coming!!! They never get old. I am an Ambassador for UHC here in NEO and I love helping people get through difficult situations finding resources to get them help with whatever is going on in there lives medically. These videos keep me sharp and loaded with tons of information to share back to the community!
My wife and I are on a Aetna Medicare Advantage plan. She was 71 years old at the time two years ago.We live in a rural area in Georgia. Wife had a an AFIB episode. Ambulance ride to the hospital, overnight stay and ambulance transportation to a larger regional hospital 80 miles away. She spent two days at the regional hosp. undergoing tests and observation. Underwent a heart ablation procedure to treat AFIB issue. Total bill was over $400,000 Our out of pocket was $500 for the ambulance rides and $350 for the hospital stay and ablation procedure. There was no delay in getting approval fro these procedures. The monthly premium for the Advantage Plan is $0 per month. The Advantage plan has saved us thousands over the years.
You should add on a counselor to your program. I recently had a patient with numerous back surgeries resulting in infections. The wife told me he is in ICU and needed to go to hospice, but she was not ready for him to go to hospice, so he is occupying a bed that is costing her hundreds a day. Her denial will cost her thousands of dollars in end. Families need to be aware of the lack of communication will put them in debt very quickly.😢
@MedicareSchool Thank you for the easy to understand video. We are not Medicare age yet but are following friends'advice to read up on this stuff now while our minds are still 'young'. That said, I don't think we'd want to deal with the Advantage Hoops when we are old, gray and time deprived. We will just pay for the Supplement and be done with it.
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Did someone just mention Mr Ricky!? Damn! You just made my day; what a coincidence.. I've worked with him for over 2years and I can tell how good he is
Marvin, you are a natural at teaching folks about medicare, thank-you for what you do. But, please know that saying (at 12:09) that a Plan G policy will cost about $125 can be misleading. Many about to go on Medicare live in Florida, as I do, and i just had a call with one of your representatives, and a G plan was quoted at between $190 and $227 - that's a far cry from $125. At $125, i'd take a G plan all day long, but at $200 or so, i have to consider the N plans as well.
Thank you for this, while the numbers we use in our videos are based on averages asides from the few states that have much higher premiums such as CA, NY and FL. We do appreciate this feedback and will take into consideration.
I have a plan C PPO way more inexpensive than your presentation. Only $35 per visit my oncologist, $150 per MRI, way less per year than the plan G premium + deductible.
I had plan N my 1st year on Medicare. $200.00 a month plus $50.00 for dental, plus $25.00 for eye examines and $8.00 for prescription. Almost $3,600.00 a year for health insurance. I switched to advantage plan. Save a lot of money that's for sure, and never been denied any medical procedure.
Excellent presentation and 100% accuracy! What is not mentioned is if the initial hospitalization is Observation (out patient designation) and the costs associated with that type of hospital related service(s). That’s part B.
I have a UH MA PPO. My hospital bills were over $105,000 and my out of pocket was $1,5000. So it was almost break even compared to the G plan yet I get vision, dental, hearing, gym membership, and $700 in healthcare products like toothpaste. You can’t beat that.
Notice how he does not add in the price of part B premium you pay monthly to the amount you pay for plan G . So 174 for part B then 125 or more especially if you are a man , that's 299 times 12 months 3,588 and then your deductible of 240. If you are going to show numbers show all the numbers.
That's because the $174 is basically a "fixed cost", meaning that everyone pays that amount monthly. regardless of their choice of A,B only, Medicare Advantage or Plan G Supplement.
@@bobhaare4576 I know that but he added it to the advantage plan and not the plan G in order to make the supplement plan look better. He needs to show the full monthly cost of both plans. He did not. That is like me adding the tax on to one item and comparing its price to another item without the tax and that is what he did in order to make the supplement plan look better.
As another commenter noted, you postulated 10 specialist visits @ $50, which would be $500 total, but you wrote $50 (ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-BClz3V39jm4.html). That would make the total cost $4,050 instead of $3,600 for this MA hypothetical. Throw in a couple "surprise" bills from out-of-network providers, and you'd be even more in-the-hole.
Been there done that in January. Almost two weeks in ICU before stable enough to be transferred for surgery to a heart center for surgery. I don’t remember any of this. De stabilized on transfer and back to the ICU in new hospital. Was there 10 days and had surgery. 1 week in ICU, 3 days in step down. Surgery alone $100,000. Moved to rebab for another 2 weeks. Home healthcare for three months. I have Supplemental Plan ❤ Cost to me……..drumroll----ZERO, YUP ZERO!!!! $000,000,000 OPP’s……..Plan “G”. $174.00 a month
Good presentation but you are missing a couple of things about Medicare A and B allowing procedures. They will pay for surgeries that are "approved" by Medicare. But not all are approved. So, in my case, I am a board-certified plastic surgeon that does a lot of breast reduction surgeries for patients with huge breasts. It's a life-changing procedure. Medicare will NOT do pre-authorizations for this procedure, and if you do the procedure, they may or may not pay for it. So, I can't tell the patient whether or not it will be covered for sure. We won't know until we submit the bill. And they don't post the requirements for coverage so we are guessing. When I do a reduction case Medicare (only the really big breasts) will always deny the payment at first and then my office has to appeal it. and it takes me 8 to 10 months to get aid for the case. However, Blue Cross of Alabama has published criteria for paying for a reduction and will pre-authorize it, so using a Part C plan overseen by Blue Cross is easy to work with and the patient knows it will be covered. I have a similar issue with the procedure to remove excess upper lid skin to improve blocked vision. Very difficult to work with Medicare. They are tough with the procedure that are in the "gray area" of being absolutely medically necessary. Thanks for your hard work.
Good Job, Very well explained. Just two corrections, One is a Typo "Carotid Artery STENT" not STINT. Second, The specialist fees per visit is $50 but only $50 was entered but you said it was about $500. With $50 it accounts for only one visit by one specialist only !!!
I have G high deductible. 366 for the year.. it would be More if i paid it monthly. Like car ot house insurance paying monthly payments they charge 5 dollar service fees . Service fees add up. Does take discipline to save up and avoid those fees . I just pay in full . Well worth the trouble.
125 part G 20-30 part D 174 part B That’s 329 a month at the bare minimum of prices and not including dental, vision, hearing , over the counter benefits, transportation. That’s all separate insurances you will have to add to that 329 a month which can be up to 500 dollars a month for complete insurance. Almost 6000 dollars a year. Part c is no premium and comes with dental vision hearing. Yes it has co pays when you see a doctor but most plans are capped at 3000 dollars a year and the rest is free. So even if you had a bad health year your paying half what you would pay for supplement. And what if you healthy? You pay nothing but the part b which is 4000 less than a supplement you may or may not use. For people on low income like most people on Medicare, a supplement plan is not affordable for them, which is why there is a part c option. Supplements increase every year with no cap, most clients will go to part c after a couple years of supplement because it’s not affordable anymore.
@@wayneguy6043 I am 82 and my wife is 81 and we pay approx $292 and $276 a month each, respectively. The reason for moving from Plan F to Plan G is that the pool of Plan F people is diminishing each year which will cause the costs per individual to increase. If I am wrong on that issue please correct me.
If you have plan F, keep it. It’s so generous that new to Medicare people cannot even get it. My 95 year old mother in law has Plan F. What a godsend when she fell and had to have surgery. Tiny copays. Because of when I was born Plans G and N are best I can do.
Great Video. Your videos plus the experience people I know on MA plans make me glad that my wife and I are on original Medicare and a G supplement. I just had a minor skin cancer treated. No pre-approvals, denials, networks or any crap like that. Just went and had it done. A while back I read a story of a man on MA who had deadly malignant Melanoma. With all the pre-approval delays, it was 7 months before he was treated. This is not what you want when facing cancer.
Brilliant comment. Advantage is a trade-off. You may save a couple of thousand $$ per year. The cost may be your life, due to your reduced freedom of choice. You decide.
@@MerryTrader Pretty much the truth. One commentor said that with original Medicare, you and your doctor make the decisions about your health. With Medicare Advantage, the insurance company makes the decisions about your health.
Are the services they're providing, while requiring advance skills and knowledge and sometimes expensive equipment, really worth $3000 a day? Does that sound like a fair price for what they're providing?
Also worth noting, I am pretty sure you need a part D (drugs) to go along with your Medigap plan G.many are inexpensive I already have plans to switch from my advantage plan to the G plan and a D, drug plan
Interesting that you are planning to switch from Advantage to original medicare. It’s my understanding that you are going to go an underwriting to see if you qualify. After a year in Advantage is almost impossibly to switch back
@@mypphh97 I was told that since I am leaving an employer sponsored group plan there would be no underwriting if I switched to a Medigap plan. I will find out next month when I apply for plan G to start in January.🤞🤞
Hmm I am on an Advantage HMO, low income and my maximum out of pocket cost in 2024 is $2,500 dollars. I like my insurance agent. I get $7,500 in Dental with no copay!
Have an F plan since I eventually will need a 2nd heart valve replacement. My insurance would not let me change to the G plan due to the cost of this surgery. Don’t want to change to advantage plan since I want to choose my doctor & hospital.
Yes, the Medigap plan N premiums vary widely depending on the state you're in...I'm in WA state and pay $143/month, but it sure does give me peace of mind. I had to have emergency eye surgery last year, which completely came out of left field and was so thankful I had the gap insurance.
I’ve had a supplement insurance with my Medicare for 21 years. I would not give it up for anything. I’ve had hospital stays and never had to pay a dime any time ago to Specialist doctor anything I don’t pay anything I just walk out the door. Local State Farm agency is who I use
Thanks. Pre-authorizations + network requirements make Advantage plans useless unless you absolutely can't afford the monthly premiums. Of course, you end up paying more for an Advantage plan and you're at the mercy of insurance companies who exist to under-serve you and maximize their profits. Also, Plan G prices rise a LOT faster than the rates for Plan N - also something to consider
The hdG bill would be the same as the G other than this years $2800 deductible. A lot of that would be made up with the monthly premium difference. Here in Florida G is $186 and hdG is about $60 a month, at this time if you had to pay the deductible every other year it would be about a break-even proposition. As long as you are reasonably healthy the hdG could save you a lot of money. Who knows what the future holds? Once you sign onto a plan it's difficult to switch plans in most states.
My husband had a knee replacement with plan N. We pay before surgery $20 consultation, $20 cardiologist release, $20 primary physician clearance, $20 visit before surgery with nurse practician. I am not sure how much we need to pay for staying him in a hospital for 2 days ( they billed part B for anesthesiologist job, for surgeon visiting him next day and some other pt visits in a hospital. Right now we paying 3 times per week $20 for his pt ( 3 month). If you put all this copay together it is a lot more than difference between plan G and plan N premium.
I was watching the part about A and B only and I don’t think it’s accurate. The co-insurance is 20% but for doctor’s visits Medicare limits the amount they can charge. It’s usually $20. Also, when you talked about the amount that you have to pay the 20% copay on, that amount should be reduced by Medicares approved amounts. For a normal hospital stay with surgery , original Medicare would be sufficient. The only reason to get a supplement is for the unforeseen risks that could happen. I’m probably going to go with a plan N just because I get most of my medical care from the Indian health service.
I live in the northeast. Please do a similar video using numbers from New York City numbers. An MRI around here starts at $1000. Outpatient surgeries probably in the multi 10s of thousands. That $300 outpatient figure must be for a pet with a vet.
i have Tri-Care for life and recently changed to an advantage plan after consulting with your councelors. I like the additional benefits that the advantage plan has over conventional medicare. Will my tri-care for life cover those copays you refer to? Thank you!
My expenses on a $200K hospital bill would be a little above $9.16/day. Depends upon drugs used. January 2023, I had. Right carotid artery stent emplaced. My cost was ZERO.
Absolutely you can either call our office at 1-800-864-8890 and someone on our team can get that scheduled. Or you can schedule an appointment here: medicareschool.com/talk-to-a-guide/?
Please don't use inflated hospital/medical charges as anything close to what Medicare pays. My experience with Medicare Advantage has been that medicare negotiates with the hospital or medical provider and pays (in conjunction with) the insurance carrier. For example, I was helicoptered from the N.Calif coast 120 miles to a hospital in Sonoma County. The bill was $42,000 . Medicare/Ins.Carrier paid $12,500. I paid $0. That was in 2012. I find a real advantage having qualified negotiators deal with extraordinary charges. Please don't blur your salesman wording.
We are all healthy until we are not. We all do not use insurance until we do. I've watched numerous videos, so many you would think I get tired of watching them. But no, I so look forward to them and watch from beginning to end. Just so grateful for all the awesome easy to understand explanations on how it all works. I will never get tired of them and even after I go on Medicare I will continue to watch. 65 and 4 months, still working, not collecting yet but the time will come. I absolutely love the "G" Plan and I would tell anyone if they can afford it to get it, or even look at the "N" Plan. But I will never ever recommend the Advantage Plan. I have a friend on an Advantage Plan. He had an appointment 60 miles away from home with a specialist and when he got their the lady at the desk told him they do not take his Humana Insurance anymore. Too many stories like this one. maybe it will change one day but I am not taking any chances with my health in the insurance companies hands. Awesome Video!
@@BJ-kv4zg…..Yeah, that worked for my mother-in-law….until it didn’t. She thought she was so smart having Cigna Medicare Advantage, because she was one of those very active, healthy seniors. But shortly after she turned 92, she had the typical ‘fallen and hurt my hip’, situations. That was last year….she is still haggling with her insurance to get an MRI approved so that she can get help from a pain management center……still waiting! My husband had neck surgery on four vertebra, bill was over $216,000.00. But he only had to pay the deductible of $226.00, plus his monthly premiums, and his Plan G supplement took care of the rest, along with Original Medicare. Oh, and we both had MRI’s last year….never needed prior approval, just went and had them done! If we had been on an ‘Advantage’ plan, we would both STILL be waiting.
He went there before and they took his insurance. They decided not to anymore. He shouldn't have to call every time and ask if they still take it. Plan "G" for me.@@BJ-kv4zg
So strange here in Sacramento County some Hospitals are not accepting Original Medicare g supplement. But Sutter Health Care will accept UHC Advantage HMO
BJ, read what u posted. "Nothing wrong with the Advantage plan if your healthy".. You've already developed a serious case of denial and need treatment before it's terminal and drains your savings. Advantage Plans cost more out of pocket every year. Your setting yourself up for huge bills and subpar care when your going to need it the most.
The bottom line (talking about cost) is you always pay. Choose to pay when the big medical issue is performed with Advantage.. or up front in manageable budgeted monthly premiums under A,B & Supplement G. Now… the topic of freedom of where and which doctor & hospital, or having to get pre approved, having to have your primary doctor refer to specialists.. is also an issue between the plan options.
I have been enrolled in original medicare + supply for 2 years but still check all information regarding medicare as often as I have time. Original medicare still beats advantage plans most of the time. Good information. Thanks
Friend of mine had a stroke. # different hospitals, 2 week stay with 5 days in intensive care, his estates portion of the bill? $0, because he had an F Plan. Too bad they discontinued them.
I will turn 65 next year. Which plan is best. I require prescription drug care. I heard an Advantage plan is difficult to leave for a Supplemental plan. Thanks for your help.
That's correct. Medicare Part A and Part B have no maximum out-of-pocket costs. Once the 20% coinsurance and any applicable deductibles are paid, the beneficiary is responsible for any remaining costs, regardless of the amount.
It depends on multiple factors like your state, initial part B date. If you are thinking on getting a supplement plan G. Give us a call at 800-864-8890, 6 months before you turn 65. One of our license agents your state would be happy to educate you on Medicare and help you choose the best plan for you.
Unsubscribed. Video length is much too long. Good information, but can certainly be edited to be half the length and still get the same information across
Here is a link for a video on Tricare. ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-JJYauUj8MWU.html Give us a call at 800-864-8890 or schedule an appointment at www.medicareschool.com
I am so confusing here. My husband has Kaiser Advantage, and he had 5 surgeries so far, and he paid $10 for co-pay, and medicine like $100 each surgery which I believe that is cheaper if he had the Medicare A+B.
Always get a approval letter for anything you have done medical before you have your medical issue handled. It became very handy for me when they tried to bill me for something.
Readjust her budget or possibly look at Medicare advantage plan and if she has any chronic conditions consider a chronic med advantage in your area. Their plans structure to allow seniors to have more affordable plans for their chronic conditions
My hospital cost for getting a pacemaker added up close to $200k. They negotiate final bill down dramatically. I think to around $15k. I ended up paying maybe a $20 doctor co-pay only under plan N. I was wondering how much this would have cost under advantage and would they have negotiated the bills down as much?
One thing that bugs me about this type of analysis is it's based on a point in time cost comparison. Do a 5 or 10 year comparison. Also the ever increasing cost of the supplement plan is ignored. As someone who had a spouse who had cancer, the year of the cancer, you are correct, we paid a few hundred dollars, but for the years prior and the years since, the supplement plan has cost us somewhere around $15,000 dollars. So an advantage plan would have saved us many thousands of dollars.
From watching these types of videos, this is why you should get an advisor to help choose your supplement insurance company. Some are much worse than others at increasing your supplement insurance cost as you age. I have had part G since I was 65 and am now 70. It has gone up, but not near as much as I have seen mentioned on the internet.
Just to review the c plan often you are in a region ppo. If your income is stretched then this is a correct choice. I use g plan as I travel a lot and don't want to be restricted to a single plan
@@Jody-kt9ev This is one topic I wish was discussed a bit more. He talked about how a G Plan could cost around $125/mo, AT AGE 65. That's great, but how about at 75? 85? If someone is going to do a comparative analysis, or even just plan a budget for the future, they need to know how quickly the rates increase.
Not necessarily true. Chemo and other cancer treatments can go on for years. Diabetes, which many seniors get, is a chronic illness that also can be expensive over many years. Supplement plan costs are based on age, insurance company and zip code. Do you not think that MA plans do things to cope with increasing costs due to your aging and medical inflation? I personally think the recent complaints about pre-approval time, care denials, and delayed and low pay to providers, is part of this adjusting. Depending of circumstances, MA may or may not be cheaper over time. However, with original Medicare, and a supplement, your care will probably be much better as your network is nationwide, and you. very little chance of pre-approval delays, or denials. In fact, I have seen an article stating that, with some rare cancers, you are more likely to die on MA than original Medicare.
Thank you, unfortunately too many people buy into tha Advantage BS, there is NO SUCH THING AS A FREE LUNCH and Medicare Advantage Programs prey on the uneducated people who do not understand that "you only get what you pay for" SAD!!! Thank you for trying to educate the uneducated!
G and N plans decrease the incentive to stay healthy. HDG is better than Advantage and increases the incentive to stay healthy to avoid the high deductible. Most people have healthcare insurance to pay the medical industry but most don't have a Strong Health Plan to stay away from the medical industry.
High deductible plans are a waste of money. Less than 4% of people who have them EVER make use of them. In other words, they pay the premiums and also pay for all of their medical expenses that Medicare doesn’t.
