Medicare Advantage vs Medicare Supplement Plans 

Medicare Advantage vs Medicare Supplement Plans
Which has more insurance?
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Medicare Supplement Max Out-of-Pocket • Medicare Supplement Ou...
Medicare Advantage Plans Explained • Medicare Advantage Pla...
Medicare Part D Explained • Medicare Part D Explai...
00:00 MAPD vs Medigap
04:20 Summary of Benefits
06:25 PPO Misconceptions
08:40 Maximum Out-of-Pocket for Medicare Supplement Plans
09:20 Medicare Supplement Plan G
09:40 Medicare Supplement Plan N
10:39 High Deductible Medicare Supplement
15:30 Medicare Advantage Plans Cons
16:30 IG Report
22:55 AHA Letter to CMS
By the way, Medicare does cover some acupuncture now: www.medicare.gov/coverage/acu...
How To Choose Between Medicare Supplement Plan N vs Plan G • Best Medicare Suppleme...
Medicare Insurance Companies • Medicare Insurance Com...
Medicare Part D Explained • Medicare Part D Explai...
Medicare Advocate Services • Video
Every year CMS sets maximum out-of-pocket limits for in-network and out-of-network expenses paid by the consumer. For 2022 the maximum out-of-pocket an insurance company can set for their Medicare Advantage Plan is $7,550 annually for in-network services and $11,300 for out-of-network services.
Insurance companies can choose to have a lower limit. But they cannot have higher out-of-pocket limits.
The maximum out-of-pocket only refers to inpatient and outpatient services. Medical Bills. Not premiums or anything to do with Part D.
Two other details we need to point out before we move on.
1. Note that these out-of-pocket limits only refer to “covered” services. If the service is not covered by the plan, the costs of that service is in addition to any maximum out-of-pocket limits. More on that later.
2. Also, I mentioned at the start I would reveal the most common misunderstanding about Medicare PPO’s. Here it is. You will hear agents tell you that with a Medicare Advantage PPO you “Can” see any doctor or go to any medical facility. If the provider is out-of-network it will simply cost you more and have a higher maximum out-of-pocket. In reality, if you want to see a medical provider that is out-of-network you can ask them if they will accept your insurance. They can and usually do say no.
To put it simply, you can see any out-of-network medical provider and be covered by your Medicare Advantage PPO, but only with the medical provider's approval. An out-of-network provider does not have to accept your insurance.
You cannot simply go into a medical facility and demand to be covered as out-of-network.
I will give you the cliff notes version here using the three most popular plans; a Medicare supplement Plan G, Medicare supplement Plan N and the Medicare supplement Plan G-HD high deductible plan.
With the Medicare supplement Plan G your only expense for inpatient and outpatient services is the annual Medicare Part B deductible. That annual deductible is just over $200. That’s it. That is the maximum annual out-of-pocket limit you are at risk for with a Medicare supplement Plan G, just over $200.
With a Medicare supplement Plan N you will also have the annual Medicare Part B deductible. Plus, you will pay up to a $20 copay whenever you see a doctor for diagnosis or evaluation. There is no copay for chemotherapy or physical therapy or preventive care. Just diagnosis or evaluations. There is a $50 copay for emergency room visits. None of us typically know how often we will see a doctor during a calendar year, but it would be unlikely that we would see a doctor once every month. Thus, it is very reasonable to expect a maximum out-of-pocket exposure with the Plan N to be no more than $500. That would be the Part B deductible plus a monthly office visit to the doctor. A $500 annual limit is more than reasonable.
The high deductible plan is also simple to evaluate. Your maximum annual out-of-pocket limit is equal to the deducible. That deductible increases each year with inflation and is currently approximately $2,490.
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