*Real Cost Example* Medicare Supplement Plan G vs High Deductible Plan G vs Medicare Advantage Plan

We used a real-world, high-cost claim to show how a Medicare Supplement Plan G, a High Deductible Medigap Plan G, and a $0 Medicare Advantage plan would cover this particular example. The results may surprise you.

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Federal Disclaimer:

[JBoya]

I am sure you covered this in another video, but to me the big difference is the ease in which you can get care. With Original Medicare, if your doctor says you need a procedure, you get the procedure. With Advantage, the insurance company can override the doctor's opinion and force you to try some alternative lower cost techniques first, and perhaps only regardless of what your doctor says you need.

[MrRibby]

With original Medicare, if your doctor says it is medically necessary, both Medicare and the second payer must cover it no questions asked. With Medicare Advantage, the for-profit insurance company can veto the doctor and deny your surgery or tests, etc. Original Medicare may cost more, but at least you have control over your health decisions and not a for=profit insurance company.

[ga]

There have been multiple providers in our area that have stopped accepting certain Medicare Advantage plans, leaving those people left in the lurch. For me, original Medicare + supplement plan is a more stable choice and I've no regrets.

[neninocencio]

Thank you so much of your very detailed video. I learn more and more about original Medicare, Medicare Supplement and Advantage plan. And thank you of using the white board in that way we/I can see the figures you’re comparing of the three kind of health insurance plan which makes me understand more. Very helpful.❤

[jimmylawrence]

Thank you for the video. It is very informative and kind of surprising to me. I enjoy actual examples like this one.

[MsSkymom]

The only fly in the ointment that I can see is you have to get preauthorization for the Advantage plan, so there is a possibility that you cannot even get the surgery if your plan says no and/or requires other treatments before resorting to surgery. I'm happy to pay the extra premiums to ensure that I can see who I want to see, and avail myself of the treatments we agree are necessary without interference.

[jeffsaraiva]

Thank you Erik! I wonder how many times I am going to have to watch this video to finally get it! :-) Cheers

[thman]

I'm 68. I pay $78/mo for Mut of Omaha Plan N and $8/mo for my Part D drug plan (Wellcare). All drugs are tier 1 - I pay $0 for 6 meds. Can't beat it.

[jennyfinnell]

Love the color coding on the white board. I'm slowly absorbing medicare info with video's like yours!

[Paul-GrnHil]

I use a HDG plan for a couple reasons. My wife and I split our time between 2 homes so the flexibility of a Medicare plan without network limitations gives us great peace of mind. I like the cost savings of a high deductible plan vs the standard G plan for the years I have no major claims which is more often than not. There is no doubt that when a major claim is incurred, the Advantage of low deductible plan will be the better option but I’m willing to take the long term risk and flexibility offered by my HDG plan.

[walterbazarewski]

Very informative and somewhat surprising to me. White board examples always help with information. Thank you for this video.

[bookmagicroe]

Plan G premiums will cost a lot more depending on age and medical issues. My husband has Original Medicare and
Plan G. He has heart disease, macular degeneration, diabetes, and is 89 years old, and the cost of his United Healthcare premium is $416 a month.

[miguelberrios]

This is interesting, I signed up for an Advantage plan and so glad I did. I'm presently on BCBS HMO plan, so I am used to getting approvals and referrals to see specialists. And the fact that I can go to any facility on a true life threatening emergency, and be covered as In Network, makes this plan a no brainer for me. Thanks for all that you do for us with your invaluable information. God bless.

[donnasloane]

Thank you...I've done all this research but it is great to have it all verified

[jimbo]

Fantastic explanation, so much better than doom and gloom anti Advantage plans.

[danielrussell]

Now, if your 10 follow-up visits roll into the next calendar year if you are on a supplement plan the $260 deductible would reset, increasing your costs. Thank you for this example. There is so much bashing of Medicare Advantage plans, it's nice to see them put in a good light. In addition, on Medicare Advantage you may also have some coverage for vision, dental and prescription drugs that you do not get on a supplement plan.

[charlesluck]

When it came to deciding on a supplement plan, my choice hung between Plan G and Plan HDG.
The difference in the premium between the two plans is roughly $2, 000 in premium cost.
In my mind, with the Plan G, I would have to pay the $, 2000 increased premium regardless of whether I use medical services or not.
Whereas, with the Plan HDG, I would pay up to the $2, 700 deductible, only if I actually use medical services that year.
If I have a healthy year, without major medical expenses, I set aside the $2, 000 in premium savings, for years when I can apply that money to the deductible in not so healthy years.

[garybalatennis]

I appreciate this video. I too was surprised by the result in this one example scenario.

I look at all this, this way. What is the purpose of health insurance in the first place and in the long view?

It is to cover you for the Worst Case medical care scenario(s) over the length of time of your remaining years.

You will probably have on average more good years than bad, especially from Age 65 to 75, then Age 75 to 85. This argues for “pay as you go”.

But in bad years, you gonna pay dearly if the pay-as-you is MA, especially if they keep upping their Max/out-of-pocket. (I myself am inclined to go HDG, with a much smaller Max.)

But the worst case(s) could and would be a lot worse for anyone than this example here in this video.

There is going to be much more pre-surgery work up, alternative treatments etc before a worse case surgery or even multiple surgeries. In other words, lots more MA co-pays.

Moreover, over 10 years, MAs are gonna “change” their plans every year, increasing their co-pays, deductibles and Max/out-of-pockets, and dropping perks, cancelling gym memberships and dental plans, and even adding premiums.

(If you think MAs are gonna “add” more freebie perks every year, think again. They find hidden ways to “pay” for their perks by upping co-pays, deductibles and Max/out-of-pockets.)

Also, any procedure that you and your doc could want might be denied flat out under MA pre-authorization denials vs. original Medicare.

You ain’t in control of your health decision, but a nameless, faceless bureaucrat in a profit-making company.

And then there are worst case “chronic conditions” that require on-going, repeated multiple doctor and specialist visits, triggering MA co-pay after co-pay (examples such as cancer, diabetes, heart disease, blood and lung diseases, long COVID, etc etc).

Looked at from Birds Eye view over the span of many years and even decades, MA might not look so sweet.

Just my 2 cents.

[DanMiller-rkwo]

This was very informative and actually was surprising to me, since most of the information I have seen indicates that MA plans will cost more than Med Sup plan G when major medical expenses occur. I think it should be pointed out, however, that in many if not most cases surgery for a joint replacement (apparently the case you explained) will follow a series of doctor visits, physical therapy visits, imaging and possibly alternative therapy prior to the surgery event. In my case for a hip replacement, there was an initial visit with the primary care doc to report the symptoms, followed by X-ray and follow up visit with PCP to receive diagnosis and discuss treatment options. Physical therapy was the first alternative we agreed on (24 sessions) with some minor improvement in my pain level. Next step was a corticosteroid injection in the hip, which often provides weeks or months of relief. I got about a week of improvement. THEN the sequence you described began for the surgery. So in my case the total expenses were considerably larger. There is also medical equipment cost for rehab to take into account. I believe this sequence is fairly typical for joint replacements.

[paulaefta]

Your videos have done SO MUCH to help me navigate this often confusing system and I thank you for it! In general terms, and without a change in health status, how difficult is it to switch from G-HD this year to G in subsequent years? Also, is it wise to take advantage of an issue age premium now, at 65 and healthy - even though it is 32-62% higher (G-HD & G, respectively) than the most economical premiums in these plans? Thanks again - you do an incredible job of explaining things!