In the last video I did I went over the top five reasons why you should not get a Medicare
Advantage plan! And in this video I’m going to do the exact opposite and give you the top five reasons
why you should get on a Medicare Advantage plan.
My name is Brian Monahan. I’ve been a licensed insurance agent for 15 years, discussing
Medicare with people just like yourself. So in this video, I’m going to actually compare the two plans so
that you can make a decision on whether you want an advantage plan or whether you don’t.
In this video I said that I’m going to go over the Medicare Advantage vs Medicare supplement plans
and I said that I’m going to be pro Medicare Advantage. Which I’m going to take that but basically just
take a look and see what you think. These are different scenarios. So in the last video I did I did the
scenario of the med sup being what you want to get.
If we go up here we see “premium.” So put that in yellow.
Now a lot of people ask, “How can that be? It doesn’t make any sense!” Well number one: the
government gives subsidies for these plans. Basically they said to the Medicare Advantage plans,
whether it be Aetna or AARP or Blue Cross, they said, “Hey! We don’t want to take care of these Medicare
people! We’re the government! Not a business. So. Here’s the money. You are the professionals. You
take care of it!” So that’s how they do it.
So the Med Advantage is zero a month. Now I took the med sup or the Medigap (those words
are the same thing) Medicare supplement and Medigap are the same thing. If you look at this $600 a
month. Now I have clients and did have clients that were paying $600 a month for their med sup. Some
people ask, “Well how did they get into that, paying that much?” Well the Medicare supplements plans you have to apply for the plans. So if you’re on a G Plan and when you turn 65 you’re automatically allowed in if you’re
in your initial enrollment period. And then if you have something major happen like cancer or heart attack
or a stroke then if your plan keeps raising the rates and you want to go into another plan a lot of times the
other plan will not allow you into the plan so you have to stay where you are. If they keep raising rates on
you and you’re unhealthy you can get to the point where you’re paying $600 a month for that plan.
So that’s what I did. So we’re taking that as an example. The last video I did I put $400 a month.
There’s a lot of people that are paying $200 a month for their med sup and I wouldn’t be so pro-medicare
advantage. So let’s now go into Hospital. Hospitalization, now this is Hospital stay, so for the med
Advantage a lot of the plans that I’ve seen and that keep in mind there’s different Med Advantage plans
but I’m going over the general. What I have seen with these plans, it costs about $250 per day.
Now a lot of you would say, “Well the medicare supplement is zero for hospital and this is $250 a day that’s
a lot of money!” Keep in mind it’s $250 a day for the first seven days. If you were to stay there that’s
only if you stay over at the Hospital. So how you get the $600- you’d have to stay you know basically three
days or over $600 three days in the hospital each month.
Let’s go down to what really matters. Let’s get to the juicy stuff. So what really matters is this
M-o-o-p. That stands for maximum out of pocket expense. Basically let’s put this in yellow. So the max
out of pocket here for the Med Advantage plan, a lot of plans that I’ve Seen for 2023 and it’ll be a little bit more
in 2024 most likely but the max out of pocket is $7,550. This is what you will pay. The max out of pocket
meaning if you go to the hospital- $250 a day it has to add up to $7,550. Once you hit that you’re paying
zero for all your other expenses. So that’s basically almost like a deductible and then you pay zero but it’s
your max out of pocket. Well with the med sup I put here $7,200 because if it’s $600 a month times that
by 12 you’re automatically paying seven thousand two hundred. Now some people would say, “Yeah but
you’re not paying anything out of pocket!”
Well here’s where it gets a little interesting. So let’s take this out of yellow. Let’s put the drug
plan in Yellow. So the drug plans- a lot of the Medicare Advantage ppos and hmos they have a drug plan
that’s attached to it and you pay zero for that plan per month.
Now you’re still going to pay co-pays. Let’s say you’re on simvastatin or Lipitor. Whatever it may
be. The general copay of what you’re paying, you know if you’re taking a generic, it might be five bucks it
might be zero. If you’re taking the brand it could be fifty dollars or even a hundred dollars if it’s an
expensive brand but to get the plan it’s attached and it’s at zero. With the med sup you have to get an
additional plan and the average is about $35 maybe $40 right now but you have to pay this each month.
Separate to this $600 over here which equals $7,200. So now take this by 12. Let’s make it easy we’ll do
it by 10 months that’s $350. So now you add now we’re at the exact amount of the Medicare Advantage
7550. So you’re paying that out of pocket no matter what and you say, “Well, hey you know! So okay so
Well, let’s move on. Let’s move on to vision, dental and hearing. Let’s put that in yellow.
Now vision, dental and hearing- Med Advantage Plans- a lot of them cover it. Zero cost. It’s just attached.
Then once again. You still have a co-payment but they do have free glasses that you get once a year. A
lot of them I’ve seen get $150 towards glasses.
You know hearing aids, instead of five thousand dollars, they’re like $999 per hearing aid. I
mean they have some good deals now. With a med sup you have to get a separate Vision, dental, hearing
and you’re going to pay like $40, maybe more. Maybe $60 a month. So you have to add this to
your max out of pocket because this is what you will be paying. $600 plus $35 Plus $40. So the $600 now
turns into $675 per month. Almost $700. So now you’re paying more than the maximum out of
pocket of $7,550.
Now keep in mind- the co-pays for the dental, vision, hearing and drug plan don’t go towards this
$755 but neither do the ones on the med sup. Your drug co-pays don’t go towards you know it’s extra.
You’re paying $35 a month but you still have co-pays. You’re paying $40 a month for dental, vision,
hearing but you go get a crown done you’re going to pay out of pocket. So really what it is the max out of
pocket is what you really have to look at right here. This row put it in blue. What you really have to
look at and decide how much I am paying in premiums over here for the med sup.
Now when I, from what I’ve seen, most people would say, “Well here’s where it really gets itchy you
know I want to stay in skilled nursing.” Let’s just say you’re paying over here you’re only paying $200 a
month well $200 times 12 is $2,400 not $7,200. So if you’re paying $2,400 for the year this is starting to
seem the med sup is starting to seem way more attractive than the med Advantage at this price but for
some people it’s not.
They say, “You know what? I haven’t been in the hospital in three years. I’m in good health. I don’t
take any drugs and I get a free drug plan! You know I might wear glasses and I get that for free! That’s
great!” So even if they go to a cat scan or MRI once a year it’s $300. You just tack that on to like where
the premium would be and this you’re paying per month and this $300 is only once per year so some
people love the Medicare Advantage because of that reason!
They say, “You know what? The max out of pocket is $7,550 but I’m already paying that with the
med sup. So I want to go over here even though the skilled nursing I only get 20 days at a zero cost and
this one I get a hundred well if I hit this max out of pocket then it’s zero anyway and they kind of mix and
match!” So you really have to make a decision on your own which you think is better.
I say the first thing that you do is you look at the premium. Then you look at the max out of
pocket and you say what am I paying with the med sup? If you’re in that $500 $600 whatever range which
a lot of times people might be in their 80s or they might be in their late 70s. They have to look at that.
Now the one thing with the Medicare Advantage you have to make sure your doctors are in
network. Where the med sup there are no networks. Anyone who accepts Medicare has to accept the
med sup. Not true with the Medicare Advantage.
Another thing that people tend to forget and they say well I didn’t know what the Med sup you
have to get accepted into the plan! Well yes you do. With the Medicare Advantage you’re always
accepted. So the one thing that I’ve shown people is one little loophole that I found and I I kind of
like this. It’s a trial right. So if you were never on a Medicare Advantage and you’re on a med sup you’re
paying these high premiums for 12 months one time. You can take a look. It’s up to 12 months. You can
go on a Medicare Advantage see if you like it. If you don’t- switch back to the exact plan that you had and
you’re going to pay these high premiums but switch back to the exact Med sup that you had and no
health questions will be asked. You’re automatically accepted but that’s only one time.
Medicare Advantage you’re always accepted so you have to be really careful with that. Make sure
that you want the Medicare Advantage. If you are going to be spending a lot of money out of pocket and
so forth but here’s the thing: I’ve had people on both of these and it’s really a flip of a coin! People ask me
what is my opinion? Well I can always give my opinion. When this premium is 150, 200, 300 because I’ll
say listen, this is a way I like these plans way more. You can go wherever you want you don’t have to
worry about it.
Nobody ever complains about the coverage but when this starts to get high this premium or if
they’re not going to the doctor or Hospital people start to look at this med advance and say, “You know
what? I’m saving way more money!”
Just got off the phone with one of my clients yesterday and he’s like you know I’m
a little bit nervous whatever but he’s like you know I spent $90 the whole year. He’s like the only
thing was my drug plan. Now here’s the thing. You have to get the drug plan. So let’s say you’re on an
Aetna a PPO plan it will give you an Aetna Silverscript drug plan and who knows how much those drugs are
going to cost? You have to ask your agent, “Hey look up my drugs. How much are they going to cost for
the year?” because this guy was paying $1,400 out of pocket for the year for his co-pays with drugs. He
said the copay with other drug plans, which you can get whatever drug plan you want on a med sup,
they’re separate. So if there’s 30 different drug plans in your area you get to choose. With this you don’t.
With the med Advantage you do not get to choose. You have to take, if you have an Aetna Med
Advantage, you’re going to get the hospital and doctor coverage from Aetna. You’re going to get the drug
plan coverage from Aetna. You’re going to get the dental, vision and hearing plan from Aetna.
With this med sup you have the med sup for your doctor and hospital outpatient centers
and surgeries and that sort of thing, skilled nursing but then you get a separate drug plan. So you get to
choose whichever you want. You get an Aetna Med sup with a Signet drug plan and then you can get
three different companies.
Some people hate that. Some people like it. They want the choice of getting the best plan
for whatever. Some people take a lot of drugs some people don’t. So if you’re not- you get the least
expensive plan. Some people have need hearing aids soon so they might want to look at you know okay
well the hearing aid you know for this company it’s better whereas opposed to Aetna is the it’s
really not that great. I’m just giving examples. So, that’s the bottom line with the Medicare Advantage
I hope this video helped. My number is in the description box below. Take a look at this other
video that I did on why you do not want a Medicare Advantage. I went over some of the pitfalls that I’ve
heard and make your own decision. If you need any help you can always call my office. Thanks for
watching the video. I’ll see you at the next one.
Disclaimer: This video and blog post are for entertainment purposes only. If you want advice on Medicare or any of its plans, please speak to a licensed agent, whether it is me or another licensed agent. No advice should be taken from this video or blog post. If you don’t speak to me about your individual concerns, we can’t give you my 100% opinion.