REAL COST EXAMPLE | Heart Attack | Medicare Supplement vs Advantage

How would a heart attack be covered while on a Medicare Supplement Plan G vs a Medicare Advantage plan? Our friend and channel subscriber EightyDeuce submitted this question as well as his bill from when he experienced this on his company plan.

We compare how a Medicare Supplement Plan and a Medicare Advantage Plan would cover a heart attack and surgery. Then, we'll look at the costs for both and compare them to the Employer plan.

Did the results surprise you?

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Federal Disclaimer:

Chapters:
0:00 Introduction
1:01 Assumptions
2:53 Supplement Plan G Costs
5:38 Supplement vs Employer
6:01 Advantage Plan Costs
8:41 Advantage vs Supplement vs Employer costs
9:09 Advantage vs Employer MOOP
10:00 Drug Coverage
10:54 Cost to Medicare
11:29 How is this Possible?
12:10 Wrapping Up

[Theretirementnerds]

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.

[fifenut]

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.

[jackfrost-fuhz]

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.

[wcottee]

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.

[danieldesimonedanny]

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

[oldcougar]

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.

[daltonknox]

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

[jameshuddle]

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.

[cars]

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 !

[woodwaker]

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

[brianmueller]

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.

[mdenson]

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 YouTube 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.

[larryl]

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.

[helenpomerleau]

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

[July..]

@ 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!

[davidhopper]

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.

[randymcintosh]

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

[richardgriffard]

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.

[eckankar]

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.

[orchidme]

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.