I want to explain that and go over the differences between the Medigap plans and the Medicare Advantage so that you can look and make an educated decision on what plan is best for you. If you call my office at 1-844-552-7426 we can set up a free 30 minute phone consultation.
Let’s jump into the data. So first things first, Total Medicare Advantage enrollment. Take a look at this chart because it’s really mind-blowing. So in 2007, there was 8 million people enrolled in a Medicare Advantage. Now, I remember in 2009 and ’10 right after the economic crash, I was taking a lot of people out of Medicare Advantage plans and putting them on gap plans or Medigap plans, and it’s surprising that I see 11 million people were enrolled in Medicare Advantage because it seemed like so many people were jumping ship back then. Let’s fast forward from 11 million in 2010 to 28 million in 2022. It is like a graph that is shooting straight up to the moon in the last 10 years. But why is this?
Well, let’s take a look at some of the raw data so we can see why are people switching. The first thing that I want to do is go over to medicare.gov. Now, this is the government website, so this is not just some private guy who’s writing about this. This is one of the main reasons that I see people jumping over to Medicare Advantage plans. And once again, I’m giving you data about this, and I’m not being biased about the gap plans or the Medicare Advantage. So if you comment down below, don’t say that I’m trying to pitch the Advantage plans or the gap plans, I would never do that to anyone. I literally show you all the data so that you can at least try to make an educated decision. And if you can’t, contact somebody like me and ask them questions over the phone for your individual needs for your insurance.
So covered services in Medicare Advantage right here. With a Medicare Advantage, you may have coverage for things original Medicare doesn’t cover, like fitness programs and vision, dental, and hearing services like routine checkups or cleanings. Plans can also choose to cover even more benefits. What are they? Transportation to, doctor’s visits, over-the-counter drugs, and services that promote your health and wellness. I’ve seen cigarette cessations, I’ve seen all sorts of things. Plans can tailor their benefit packages to offer these benefits to certain chronical ill enrollees. These packages will provide benefits customized to treat specific conditions. You have to check about that. But this is the reason why people are looking at it.
Another reason, let’s take a look at some of the prices and so forth. So one of the reasons is if you look at the Medigap Plan G, and this is just some numbers that I put up there, if you look at the gap plans, G, N, and High Deductible G, they all cost a premium out-of-pocket. So what does that mean? Well, Medicare Advantage, a lot of them are not charging a premium. It’s zero premium. So that entices a lot of people. Whether it’s right or whether it’s wrong, you can leave your comments in the comments section below, but this is what enticing people, hey, do I want to pay $140 for a G Plan or 237? All depends on where you live. Could depend on your age. But some people look at the zero out-of-pocket. And then they might look at, hey, what’s the maximum out-of-pocket for the Medicare Advantage as opposed to the G Plan?
So on this chart, I showed three different examples. And this 237 I put in there for another video, so this is way off. But basically some people say, I don’t want to pay this money up front, even though the maximum out-of-pocket for their hospital and doctor could be way less than their max out-of-pocket for the Medicare Advantage plan. But take a look, I did three Medicare Advantage Plan charts on this next page, and it shows three different Advantage plans with three different costs for their maximum out-of-pocket. I always tell people, if you’re looking at Medicare Advantage, first things first, ask what the maximum out-of-pocket is because you get hit by a bus and you’re in and out of the hospital for a year, are you going to pay $1,900 for the year or are you going to pay $7,000 for the year?
Then I would look at, do my doctors accept this plan? Does the hospital I want to go to or multiple hospitals accept this plan? You can do this very easily through an agent or through the company. They usually have on their website where you can punch in your doctor’s name and see if they’re in the network. Because when it comes to HMOs, down here, you have to use the network or they simply will not pay for the procedure and the PPOs will charge you more if it’s out-of-network, so you really have to look at that.
Let’s get back to the chart that shows the Advantage compared to the Plan G, N, and High Deductible G. Now, a lot of people, I have said this multiple times before, thanks for staying with me so far in this video, I know I can be long-winded, but I’m going to get to certain things that you do not want to miss. But for this, if you are turning 65 or going on Medicare for the first time, I have mentioned, and people have commented in my other videos below, that, in my opinion, you want to get on a Medicare supplement plan, or if you get on a Medicare Advantage plan, within the first year, you want to look and see about the Medigap plans. You’re going to have to make a decision when you turn 65, do you want to get on a Medigap, do you want to get on a Medicare Advantage?
The good news is either way you go, there is a way to get to the other side. And what I mean by that is, and I have mentioned in a lot of my videos a thing called a trial right, and people have asked me this in the comments, I’m going to be very thorough about this. This is one of the crucial laws to Medicare, and I literally have gotten calls from people that said, “I talked to my agent or I called this company, they have never heard of this trial right.” Well, sorry to say, but a lot of these people do not know what they’re talking about, and I will prove to you that they don’t know what they’re talking about.
Let’s go over to the Medicare & You Handbook. So if you know the handbook right here, this one, Medicare & You, everyone gets this when they’re turning 65. The government will send it. You can request one from calling Medicare or probably your Social Security office. But multiple people have tried to read this book. I would not do that. It’s 128 pages. But if you look at it says Medicare & You 2023. Now, this is on PDF also. So let’s go all the way down to page 78. Now, believe me, if you have this booklet, it’s 2021 or 2024, whatever, it’s probably going to be on the same page or around the same page. If you look here, a trial right, what the heck does this mean? Stay with me. Do not leave this video. I’m telling you this is one of the most important things you will ever read about Medicare. Believe me.
If you join a Medicare Advantage Plan for the first time and you are not happy with the plan, you have a trial right under federal law. If you talk to your agent or talk to somebody and they said, “I’ve never heard of this,” they haven’t read the laws of Medicare. Believe me, I’ve met hundreds of agents that don’t know about this, and I’m telling you, they just don’t realize, which is fine. Maybe they’re agents that are just got into the business or nobody told them, but they should watch this video. Under federal law, to buy a Medigap policy and a separate Medicare drug plan if you return to original Medicare within 12 months of joining the Advantage Plan.
So what does this mean? Let me show you an even easier chart to explain this. I’m going to go over this Medicare Guide and I’ll show you the cover to this. This trial right, you have a guaranteed issue right. What that means is you can go to a Medigap Plan without any underwriting. No health questions will be asked of you if you do this trial right and there’s a few circumstances where you can do this. The one that I just read is, you join a Medicare Advantage Plan when you’re first eligible for Part A at 65, and within one year of joining, you decide you want to switch to original Medicare. So let’s just say you’re 65, you want to look at this Medicare Advantage plan, you get on. Within one year, you’re unhappy or you see four months, this isn’t for me, you can go, look, you have the right to buy any Medigap policy that’s sold in your state by an insurance company. And it has the asterisks, but it says Plan C and Plan F are no longer available. Don’t worry about that. That’s not a big deal. The biggest trial right that I personally have used many, many, many times, and believe me, I’ve talked to customer service agents at companies, Fortune 500 companies that don’t realize this, so don’t listen to people if they’ve never heard of it.
Trial right, you dropped a Medigap policy to join an Advantage Plan. Let’s say you’re 75 years old, you’ve been on a Medigap policy for 5, 10 years, you drop it, you switch to a Medicare Advantage Plan for the first time, you’ve never been on a Medicare Advantage plan, that’s the deal, you can have never been on one. You switched to the plan for the first time, you’ve been in the plan less than a year. They’re talking about you’ve been in a Medicare Advantage less than a year. After you switch, you’re able to go back to the Medigap policy. I’ve done this many, many, many times before. The Medicare Medigap policy you’ve had before, you have the right to buy the Medicare policy you’ve had before if the same insurance company you had still sells it.
Now, some people would say, well, what does that mean? I literally have had a company that stopped selling Medigap policies. So I’ve had people that literally, they were on an F plan or a G plan that the policy kept going up and up and up in price, and they said, “Brian, I got to get out of here.” I said, “This is a perfect situation.” Here’s what you do. You go into a Medicare Advantage. It doesn’t matter if you’re there one month or one year, whatever it is, less than one year, try it out, switch back. Your company no longer sells it, so if this is the case, if your former Medigap policy isn’t available, you can buy a Medigap Plan A, C, D, F, whatever, G that’s sold in your state by any insurance company.
Let me give you an example for this. There was a company, I was one of their number one reps in the country in 2010 or ’11 a couple years maybe in a row, they stopped selling the Medigap policy. A lot of my clients, I found out about this years ago, and I said, “Listen, your plan has gone up significantly. This is what we’re going to do. We’re going to put you in a Medicare Advantage. You’re going to do a trial right. You want to go back to the other plan, no problem. You will have to get a letter from the plan that no longer sells Medigap policies, and then we can get you into an even cheaper plan from any company that sells in your area.” I’ve done this multiple times. It is one of the most important things in Medicare.
But let’s get back to the charts. So if you want to get on a Medicare Advantage Plan, you’re going to have to dig into these plans. There could be an AARP plan, that’s a PPO, an HMO. There might be multiple PPO plans in your area. So you have AARP, you might have Humana, Cigna, Aetna, all these companies, WellCare, what do I choose from? Well, number one, you have to look at the individual plan, the individual state, and the individual zip code that you’re in. You Can’t talk to your brother-in-law who lives in Florida and you live in New York and think that you have the same exact plans. It doesn’t happen like that.
Now, the other plans, let me just switch over real quick, the G, N, and High Deductible G have the same benefits throughout the entire country. If your brother-in-law has a Medigap Plan G, he can tell you about that plan because the only thing that’s going to change is the premium, the price and the company. So he can say, “Oh, I’m on an Aetna Plan G, and it’s fantastic, and I did this and it didn’t cost me anything.” The only difference if you say, “Oh, okay, but I looked at Plan G and my agent told me about Cigna,” and he has Aetna, it doesn’t matter. The only thing that’s going to be different is the company and the price. The benefits are going to stay the same. So you can listen to your brother-in-law for a Plan G, Plan N, or High Deductible G. Don’t focus on the company that your brother-in-law has, just focus on which plan, and if he loves it and he tells you, “Hey, this is what I did. It cost me nothing or it cost me $20,” whatever it may be, you can listen to him.
But the Medicare Advantage plans, I’m telling you, it’s shot up to 28 million people that are on these plans, and half of these people I feel sorry for because they do not even understand what plan they’re on. Some of these plans are horrible, some are great. I’ve heard all different things in the comment section below. I did three examples of Advantage plans where you have Medicare Advantage #1 is a PPO, and look, the max out-of-pocket is 7,550. So here’s what you need to do. I’ll show you this chart real quick. Sorry, I’m talking pretty fast, but I did this video earlier and I had decided to redo it because it was 20 minutes long, and I was talking like that guy who used to have those commercials, like the speed talker. So I try to slow it down and try to make it less than 15 minutes long.
The first thing you’re going to do is you sign up for Medicare A and B, you choose Medicare Advantage or Medigap. If you choose Medicare Advantage, you’re done. If you choose Medigap, you have to get a drug plan and a vision, dental, and hearing. So let’s jump over here to the other chart, it shows the Medicare Advantage. If you go this route, you have to look at number one, maximum out-of-pocket. Is it 75/50 for the company? Is it 1900 for the plan? What is the max that you’re going to pay? If you get hit by a bus and you go in and out of the hospital, what are you going to pay for the year? That’s the first thing you look at. The next thing you want to look at is how much is it per day in the hospital and how much is it for outpatient, meaning a surgery, you go into the hospital and come out that day or an outpatient surgical center. And the third thing is going to be like MRIs and CAT scans and so forth. How much are you going to pay for that?
I give three examples here as you can see on the screen. The Medicare HMO is much cheaper than these, but you have to watch because you have to look at the network. Are your doctors and hospitals in this network? That is the final question that you must ask. But what I would do, and I show prices of different plans and different parts of the country, what I would do if I was turning 65 and getting on a plan, number one, if you get on a Medicare Advantage Plan, remember that trial right. You have up to one year, if you do not like it, you can go over to a gap plan. The reason why gap plans are so essential to understand that you can switch into them is because they do have medical underwriting at certain times. Certain times they do not, certain times they do.
If you get on a Medicare Advantage Plan, you’ll want to look at these gap plans the first year you’re on that and make sure you’re happy. If not, you can jump right into these gap plans, G, N, or possibly High Deductible G. I don’t think that was on there, the high deductible. Actually, I think it was just G and possibly N. I’ll have to look at that. But you can jump right over, let’s say a G Plan and then stay on that for a year, and then during open enrollment, you can always get on a Medicare Advantage Plan.
The next trial right is, let’s say you’ve been on a gap plan and you’re saying, you know what, I’m spending all kinds of money. My neighbor and my brother-in-law is tell me about a Medicare Advantage. I want to check it out. You can go to a Medicare Advantage during that open enrollment, get on the Medicare Advantage for up to one year because you’re going to start January 1st. For up to one year you can stay on that Medicare Advantage, make your decision, call your agent, and say, “I want to go back to my Plan G or back to my Plan N. I don’t like this plan. It’s not what I thought.” You can do a trial right then.
