REAL COST EXAMPLE | Heart Attack | Medicare Supplement vs Advantage 

Two important notes not mentioned in the video: *ER Visits - Supplement* There are instances where an ER visit, once moved to inpatient, will waive the part B deductible. It would still apply to the surgery and your total costs wouldn’t be affected in this example, but the exact placement of the Part B deductible could shift. *Other Advantage Copays* There are Advantage plans that don’t have all-inclusive copays and a handful of other charges could arise while inpatient. Think Durable Medical Equipment and other various charges that would marginally increase the total cost for the Advantage plan. This is a point you'd want to discuss with your agent if you are considering one of these in your area.

my mother in her later years was DENIED "some" treatments by her advantage plan , financial cost means very little if you can't get the treatment you need. One nursing home turned people away if they had certain advantage plans, advantage plans should never get to play doctor because it could cost you your life.

Plan G for anyone with medical issues. I had my aortic valve replaced last year under my employer insurance, the total for the year, surgery, rehab, etc was around 123k, my part was 5k. The doctors office received approval from Anthem (ppo) the day before the surgery, so that added a lot of stress, I was lucky that I had a great surgeon in my network who was recommended by my cardiologist. I recently signed up for part G, and don't want to be stuck with networks and preapprovals.

My wife and I chose a supplement plan over Medicare advantage for 3 reasons... 1) Advantage plans lock you into a network and the network can change from year-to-year. 2) Advantage plans vary from company to company and coverages can change from year to year. All supplement plans, no matter the company, cover the same maladies as Medicare (though the price may vary). 3) Advantage plans have a "pre-approval" provision for medical treatment. If your Doctor thinks a procedure is necessary, advantage plans have the "right" to deny coverage for said procedure.

Opted out of part B++,,Instead I opted to stay/lead a healthy life style....I'm now 69,,143lbs,,on no meds...

I had a heart attack in 2018. It involved all the accoutrements: Medivac helicopter flight; emergcncy surgery; etc. The helicopter flight alone was over $20,000. My total out of pocket expense: $0. Medicare and Medicare Plan N and my gap insurance covered it all. Later I developed kidney problems and am now on dialysis. It's all covered. Medicare is the best government program in existence. I'm an eyewitness.

I have Kaiser Senior Advantage. Monthly cost - Part B only. Likely costs for a heart attack: ambulance $200, ER visit $190. That's it.

How about the Mayo clinic dropping Advantage Plans for lack of payment etc. as they are slow to pay and have to much paperwork. I have AARP United Healthcare and it took them 8 months to pay a approved dental procedure. Every time I got a denial I would call customer service in India and the last time I called they told me I paid to much for the procedure and I asked him why did you approve it then. Its so much fun getting the run around when your in your 70s and dealing with all of this B.S. Look at the news many other hospitals are dropping Medicare Advantage and then if you try to go back to original Medicare and a supplement plan you have to pay a penalty. So if your on Advantage good luck finding a hospital that will take you, I would suppose the Advantage SCAM companies will send you to a hospital in India or some other country in the future. United Healthcare is buying up all the clinics they can and also with the premiums we pay they are donating millions to politicians ! On the plus side accepting DEATH gets easier every day !

In 2018 I got in a bike accident and crushed my index metacarpal bone in my right hand. The best hand & wrist surgeon in my area would not take my Healthnet insurance because they would not pay him what he was worth. Yet he would take Medicare Supplemental which would pay him about 40% more than a network would pay him. Regrettably, I went to an in-network orthopedic surgeon who botched my care. I ended up going to the hand & wrist specialist to pay out of pocket for surgery...to partially fix what the in-network doctor did to me. Conclusion: The best and highest paid doctors do not work for networks and agree to work for 40% less. Also, Medicare Supplement Plans will pay for the best doctors you can find. My right hand is paying the price for thinking all doctors are the same.

What if you are healthy and eat properly. I have had an advantage plan for about 5 years now. In my first two years, I had no plan. During those years, I did pay for a couple of Dr visits. Also, I had an ER visit. All together, that cost a few hundred dollars. So, with my current advantage plan, I have not been charged for anything. I figured by now that I have saved over $11,000 in G plan payments. That is enough to pay for a bad health situation that may occur. Eventually, I may have to pay the $5000 deductible. 72 year old.

I'm on Plan G and something I like is the quality of service. I don't trust an Advantage Plan to give me the same. I get to pick my providers and specialists

Thank you so much.

What you did not cover in your example are the test performed that every Dr. would want performed before any surgery. These test may be performed at a hospital or at the Dr. office and billed separately from the hospital bill. Also, there would definitely be follow up Doctor visits and possibly physical therapy as well. These things may well be outside of the example you were asked to respond to.

I'm a Medicare agent in SoOrange County CA. I started in JAN 2016. You folks do a great job. THX for all your hard work... and your consistent... spot on accuracy.

@ 90 DFR .. We are at different ages so my spouse was covered under my regular employer insurance while I was still employed. When I retired we could keep the regular employee insurance on myself as I am under age 65, but they pushed my spouse onto a MA PPO plan that matches my pre and post retirement PPO. It’s quite expensive with the combined premiums. The deductibles are $400 out of pocket for us both with a top expense of $2,000 for us both. When I reach age 65 the premiums will decrease as I will be pushed on to the same MA PPO plan as my wife. I feel fairly comfortable being it is a state employee plan that was excellent. Hopefully the plan is what it appears to be moving forward. I am not sure if we can move back to a traditional medicare with supplement insurance? Due to the fact that we are on a retiree plan offered by my state employment with no break in service as required in order to retain it. Thank you 90 Days From Retirement for all your effort into these post!

Thank you for this and other videos. I think you do a great job explaining the details. Maybe a little fast, but then we have pause and replay buttons don't we:) I hope your RU-vid video business is paying off because it's a valuable service for us. My college degree was in insurance, and I spent several years in insurance before moved into another life direction, but Medicare is a whole different animal. A deductible is still a deductible and same with a co-pay, but the administrative issues are quite complicated and interesting. Thanks again.

I had a heart attack Thanksgiving 2022. I was in the hospital for 5 days. The put one stint in one of my arteries. The bill was $167,000 but they discounted it to $116,000. I must be going to a high line priced facility comparing to other costs that I’ve viewed on here for a similar procedure? My private insurance paid all except some small misc charges. I’m now on Medicare with a supplement N. I feel good about my insurance going forward.

Very interesting comparison, thanks.

maybe you should add in the co pay for all the office visits after the surgery on MA plan

Excellent info.!

Two comments: First is that the Medicare approved amount will be much less than 39,000, secondly, how many hospital events are likely ... maybe 1 in every 5 years. During that time one would pay about 10,000 in supplement premiums.

I have KP Advantage care. I had a partial right nephrectomy and I did not have to pay anything.

This doesn't take into account that Medicare Advantage has case managers that may limit the hospital stay, rehab, etc. So Medicare original does not have this and generally will pay for hospital, rehab, etc.

Eric...as another gentleman mentioned in a post about ten months ago, I have the option of enrolling in a group MA plan because my wife is a retired teacher in the state of Georgia. It's a UHC PPO, 3,500.00 MOO, no premium, subsidized by the state. I think you mentioned that you were going to post a video on EGWP plans but I haven't seen it posted yet. I'm having difficulty deciding which way to go - MA versus supplement. If I choose a supplement, I can never go back and enroll in the state MA plan. Are group plans generally better than individual plans as far as denial rates? I saw you video on denial rates for MA plans. I would think that group plans that are subsidized by the state would be more careful about denying service to retirees on their plan due to the fear of loosing the state contract. Anyway, I enjoy you videos...thank you for all your great information!

I was unaware that part B charged a monthly premium? I thought it was a one time payment per year of about $174?

Very good information video

Thank you! I'm meeting with someone who had a heart attack and they have a supplemental plan; I can use your spread sheet as an example....PS most people have no clue what they are being billed...

How about do one on drug costs? When my mom got cancer (plan G) it was the drug copays that bankrupted her. How do the new Part D rules apply? This is way more confusing than Supplements or Advantage plans

Doesn't the 'Surgery' category have Part A and Part B components ?

i just can't be subjected to the in or out of network restrictions of advantage plans. I would rather cut costs by enrolling in a high deductible G plan and have all my options available.

The problem is that this video does not include what happens after the heart attack. The Medicare Advantage plan will most likely require co-pays for every visit to any medical provider needed following the heart attack (Cardiologists, re-hab, etc.). Medicare+Supplement will not. This can get very expensive and easily bring the cost above the Medicare+supplement amount. As to the part D, yes you need to pay for this in addition to your Medicare+supplement plan. However, there is an advantage. You can choose the formulary to cover the drugs your doctor recommends. This is not true of Medicare Advantage. And finally, with Medicare+ supplement, you can go to the Cardiologist you prefer as long as they take Medicare and get all the re-hab or other treatments you need. No networks. Also no pre-approval delays(you do not want these when dealing with cancer or other deadly illnesses), and very little likelyhood of treatment denials. Medicare Advantage may be cheaper(probably in the short term only), but the available care is not even close to Medicare + Supplement. The basic fact that Medicare Advantage plans have limited networks is evidence of that.

Thanks! Although, still a crap shoot. My friend has Advantage for first year & now will switch over to Govt Medicare, she had $3,000 worth of dental work done plus cash in her account. She says she can switch one time without underwriters asking lots of questions. Is this correct?

you forgot to mention if you have a medical event and you are in a out of network area like if you travel out of state is it possible that Advantage will not pay the claim?

If you have government Medicare, you can go to any specific doctor you want, most Medicare Advantage plan demand that you first see your general practitioner, who will then have to refer you to a specialist. Also, you don’t need approval from Medicare for almost all procedures, whereas, Medicare Advantage plans will require an evaluation before approval. Also, if you travel from state to state, or abroad, you advantage plan might not be excepted where you are at. I’m sticking with government Medicare.

Question: where are all the tests that I assume were done while in the hospital? Are they covered by A or B? Thanks!

Other bits to this is follow up care and visits for a MI that required stents. Frequent cardiologist visits, cardiac rehab, possible home health, did this happen in December or January so new year deductions required.

Cost compare high deduct G plan to N plan

Interesting breakdown. My brother came to live here after becoming homeless and had an Adv plan once he turned 65. Recently his heart gave out. Paramedics couldn't start his heart, they took him to hospital after trying 30 mins (if they revived him he would be a vegetable but maybe that's protocol). Hospital sent a bill taking off 900.00 for insurance and billing him almost 7500 grand! Not sure how they got the 900.00 for insurance but his Adv paperwork said In network MOOP is 3,750 and combined in/out network is 8,250 which the hospital is in network. There was no breakdown (just said emerg room) and I'm not calling because he was pretty much destitute (no pension, only SS) and I'm not responsible for his bills so I really don't want to get too involved but I sent a death certificate and copies of Medicare/Adv cards I found. They can do whatever their next step is. Waiting to see what happens next.

Great video, thank you! Knowledge empowers.❤

Medicare Premium $171 a month. Plan G $271 a month. This is NYS

My husband is on advantage plan and we have to pay the first 5 days of hospitalization. I'm not sure why you wrote only $1050 as opposed to the 1750 we would really pay. Can you clarify?

New York does many have excess charges

According to your cited source, “Part A pays: Your inpatient hospital stay and all related outpatient services provided during the 3 days before your admission date.” So I still don’t think Part B is applicable to the surgery in your hypothetical case.

when you talked about inclusive copays on his hospital stay how common are these in the advantage plans and where would it say in the plan details

well you interested in posting your commission on MA VS Medicare Supplement.I doubt it.

I assume high deductible G would have come out about the same as G as the high G deductible would have been reached?

Examples don’t mean anything if you don’t know your “region” or plan provider.

My understanding you are still paying the 165.00 on medicare that is deduct from SSI for the Advantage Plan part you would add the 1978 to the 820.00. Im.l right?

Its people that retire with very good work health plans, that make the rest of us feel lousy, as we have to pay our premiums

Can you compare plan N and plan G with this example or another example I curious to see if dr charged excess charge

Great example and explanation! Thanks Erik!

Your videos have been outstanding & helpful. I will be turning 65 in May. My wife is a retired school teacher and I have the option of enrolling in an employer sponsored Medicare Advantage PPO Group plan subidized by the State Health Benefit Plan. I would love to see a video from you on what to be mindful of when considering an employer sponsored Medicare Advantage Plan. I am on her retiree Healthcare HRA plan and I need to enroll in Part A & B. Thanks for all you do!

Are you able to sell insurance for residents of Florida and/or South Carolina?

Thanks for this!

My concern with MA plans is being limited to in-network providers. I live in a rural area with very few choices.

What happens when the doctors and hospital do not accept the BS advantage plan.

My mom has a supplemental plan through her city of NY retirement plan and she pays close to nothing and the city pays for her premiums too. She also gets reimbursed for her Medicare part b premium. They send her a check every year to cover her premiums.

Most comprehensive & informative yet concise & practical illustration. Great presentation! Thanks..

Good video. Insurance companes do have reputations. As an example, prior to Obama's health care reform, some insurance companies were trying to find was to exclude breast cancer from their coverage. Others would try to go back in time to find ways to deny coverage. In one case the insurance company tried to use a case of acne to deny cancer coverage. Insurance companies(of any kind, not just health insurance companes), have reputations and some are better than others.

Why are people negative about Medicare Advantage Plans?

I'm a few months away from qualifying for Medicare and watch your video with great interest trying to educate myself about these issues - and for all this I thank you! However, (always must be a however) you might want to drop the constant sarcastic comments about the “greedy evil” insurance companies - it makes you sound less impartial and more biased towards the Advantage plans but using some kind of clever reverse psychology. I know you want to sound entertaining and distinguish yourself from the rest of RU-vidrs, but remember your audience, elderly, dementia prone absent-minded soon-to-be retirees unable to grasp nuances- and trust I know all about this! Good luck with your channel!

Well if You get a hearty stay home and take 2 aspirins you will save a boat load

One comment you can die waiting for procedure approval from an advantage plan assuming the AI the insurance uses actually approves the surgery.

Cost should obviously be a consideration. The bigger issue as one ages is quality of care. Talk to any health care administrator to get the true picture of Medicare Advantage plans shortcomings. Your limited when you need the optimal care the most. Sister in law had multiple health issues. Almost every specialist has told her that they would prefer to follow the latest protocols as far as tests, treatments, and meds but their limited to what MA will pay for unless she pays cash which she can't afford to. Off the record of course.. She recently passed which was inevitable, but it was apparent that she wasn't receiving the best care possible from every doctor. I've heard similar stories from multiple people who loved MA until they got sick.

Thank you for another great, informative video!

Its just a Dollar Comparison ! Try talking about the Quality and Choice of Physician / Facility etc. That's where the Real Difference is.

Canada here…my mother suffered a heart attack went to the hospital in an ambulance got a pace maker and left after one month care. Total cost $42 for the ambulance. The medical system in the USA is criminal!

Love this. I’m new at offering Medicare so this helps me understand so much better thanks 🎉

Another outstanding, informative and (as clear as you can make it) explanation of a complicated issue. If it was easy, agents wouldn't be necessary!

Cost comparison between HMO and N plan, knee replacement cost 😭😭

Love your video just wish you would speak a little slower.

Seems like you left out the after discharge care. There will be several close followups with tests before the 6 month or yearly followups begin. The differences between plans with copays for one of them will be substantial I think especially if the cardiac event causes major damage to the organ.

Hello Erik: Maybe it's just me, but it would be nice to just focus the camera on the worksheet while you're explaining it than to go back & forth to your handsome face and to the worksheet. Sorry, but it's just so distracting. Do you want us to see more of you or what you're talking about?

Liked the video. Understand this is for the total cost analysis on the year with heart attack, BUT no one will have heart attach every year, nor anyone will know if the heart attack will come next year before signing up the plans. It will be nice if you can also mention the ongoing cost (every year) vs one time cost for the incident on that year. If I understand it right, one could assume having heart attack or similar event once every 5 years, in that case, I am not sure if that added up premium expenses on plan G could be worth for something else.

Dang - I went to subscribe, but discovered I already was. 😉 I'm four months out from retiring and am trying to wade through all the options and implications of Medicare. In particular, I am seriously considering moving to Mexico, so am trying to figure out how to balance Medicare enrollment with the public health care system (and/or private health insurance) in Mexico. Your videos have been exceptionally useful in filtering out noise from those decisions.

What happens if you are on a Medicare advantage plan and the heart attack happens when you are outside of your network or the ambulance takes you to a hospital that is not in your network?

Missed one cost to taxpayer on the Advantage plans - the taxpayer pays your insurance company around $700 to $900 per month to cover your health costs under their advantage plan. That is $8,400 to $10,800 per month per year. Really messes up the numbers in this article.

Advantage plans deny care to make profits. Read the Office of Inspector General Reports - Advantage plans deny care.

This guy is way off base on the surgery calculation. Inpatient surgeries are covered by Part A not Part B.

I'm not sure why most of this video was focused on what Medicare is paying. I'm more concerned about what I'm paying

Medicare does not pay the costs he is saying , ??? Why is he allowed to lie to us ... Oh he is a beaurocrat ...

Insurance shill