Subscribe
Share
Share
Embed
For this episode of Seniors Living Healthy, Zach and Nick break down medicare supplements and coverage. They distinguish some of the differences between the plans, and what you can expect with the type of care they provide.
Zach and Nick kick things off by discussing medicare supplements. As the name indicates, they supplement your medicare as a secondary policy to your primary. Zach and Nick shine some much-needed light on the subject. They also cover the gap from the last episode and discuss Medicare Advantage i.e. “Part C.” They break down how it works, and what you need to know. They close with the Pros and Cons of each topic so that you can make the best decision to fit your needs.
Join your hosts Nick Keene and Zach Haire fireside as they discuss the things you need to know as you or your parents begin to live out your golden years. With over 50 combined years in the senior market across the country, Nick and Zach are experts in the senior market and are here to help you live a healthy, full life.
This show's focus is on providing information on Medicare and products that most people won’t take time to explain. They dive into the hard questions and explain things in an easy to understand way. They also have guests on that work in different areas of health and wellness that will be able to give insight and address ways for you to stay healthy.
Nick: Hello, and welcome to season two of Seniors Living Healthy, episode two. As always, I’m Nick. And I have Zach here with me.
Zach: How’s it going, folks?
Nick: In episode two, we are going to talk about the two different types of Medicare plans and how they work with Medicare. So Zach, fire away.
Zach: Good to be back for another episode here.
Nick: Absolutely.
Zach: So, rolling in, you know, last episode we talked about the parts of Medicare. And as you remember, we discussed there are some gaps in those Medicare plans.
Nick: Absolutely.
Zach: So, looking there at the first one, it covers what is called a Medicare Supplement. In the name itself it Supplements Medicare.
Nick: Absolutely.
Zach: So, someone that’s wanting to look into one of these Nick, when can they go about getting one? What’s the steps to purchase one?
Nick: Yeah. So, for an individual looking to purchase a Medicare Supplemental plan, it’s important to remember, Zach, that Medicare Supplements do exactly what they say, right? They Supplement Medicare, right? So, Medicare is the primary, right, and the Supplement policy as the secondary. So, the easiest way to answer that question, Zach, is an individual has to have Medicare Parts A and B before they can buy a policy that Supplements Medicare.
Zach: Got you. So, you know, after they’ve sat down, talked with us, talk through and they decided a Medicare Supplement is the route I want to go, when can you purchase that coverage? When are they eligible?
Nick: Sure. So, there’s several different crowds here we want to talk about right, Zach? So, the first one would be those individuals new to Medicare, right, they’re in their initial enrollment period. So, for those individuals that are looking to go on Original Medicare A and B when they turn 65, the month of their 65th birthday, they can actually apply for a Medicare Supplement policy up to six-months in advance of the month of their 65th birthday, right? Now, this is what’s called the open enrollment period, right?
And it’s worth mentioning, for these individuals, they get that monopoly card, right, they get that get-out-of-jail-free card. So, a lot of times when people are purchasing Supplemental coverage, they have to go through underwriting, right, they have to answer health questions, they have to answer tobacco usage questions. Some companies use height-weight charts to rate them or decline them, et cetera. So, in that open enrollment, regardless of your health, you’re not going to be asked health questions; anybody qualifies. Regardless if you’re a tobacco user, you’re going to get a non-tobacco rate. Regardless of your height and/or weight, you’re going to get a standard rate.
Those individuals can choose any plan with an effective date concurrent or after their eligibility, meaning the month of their 65th birthday, right? Now, they also have up to six months after their 65th birthday to be able to purchase those plans under the same scenarios, right? Then, of course, you have those individuals that have been on Medicare for, you know, any given time. They’re out of that initial enrollment period; they can actually switch plans year-round on Supplemental coverage, right? But the kicker there is once you get out of that enroll open enrollment period, you do have to go through underwriting, you do have to answer those health questions, you do have to answer those tobacco usage questions, et cetera.
And it’s worth mentioning also, you know, don’t let that be a turn-off. You know, if you’re listening and you do have pre-existing medical issues, you’ve been declined before, that doesn’t necessarily mean you can’t get coverage now. That’s a phenomenal opportunity. Reach out to us. We’d love to ask you those questions and we’d love to see if we couldn’t help you out, right?
Zach: Yeah, definitely debunking a big theory there: you can’t get a Supplement except in annual enrollment period when you can actually get it—
Nick: Absolutely. That is—
Zach: —any time of the year—
Nick: —a hundred percent incorrect. Yep.
Zach: Yep. So, also kind of covering our bases, you know, we’ve been new to Medicare, someone currently on Supplement and wanting switch. We’ll touch on Advantage plans here a little bit, but what if someone is on a Medicare Advantage plan? Are they able to switch to a Supplement?
Nick: So, we’ve got two different paths here, right? Let’s go back to those new to Medicare people, right? So, when you are in your initial enrollment period, right, with those Medicare Advantage plans, you got a three-month window prior to your 65th birthday and you’ve got a three-month window post your 65th birthday. Beyond that, you know, you can kind of go back to our previous episode, we talk a little bit about the times those people can make changes, but just to reiterate, once you’re out of that initial enrollment period, you can only make changes October 15th through December 7th, right, coming back onto Original Medicare January 1st and put a Supplement plan in place, or for those individuals that are now beyond the Annual Election Period, they purchased a Medicare Advantage Plan, they can actually use the Medicare Advantage open enrollment period running January 1st to March 31St. To disenroll Medicare Advantage and go back on Medicare and get a Supplement, Zach.
Zach: Got you. So, now we know when you can get one, and we’ve mentioned before, you know, it is a Supplement, so it does Supplement Medicare. What exactly is it covering?
Nick: Yeah. So, you know, there are a number of different plans out there, Zach, right? You’ve got plan A, B, C, D, F, G, K, L, M, N. But the predominant amount of those plans that we see on a day-to-day basis, right, are going to be the F plan, the G plan and the N plan, right? So, what I want to do is focus a little bit more on those, you know, and realizing there are other plans. If you’re interested in a different plan, have questions, certainly, you know, feel free to reach out.
But for that F, G, and N plan, Zach, those Supplement plans are going to come in behind Medicare. And if you recall in last episode, or maybe the listeners do as well, you know, we talked about the cost associated with Part A right? We talked about that $1556 deductible that they’re paying when they go into the hospital. All three plans are covering that deductible. We talked about the $389 a day, day 61 through 90 in skilled facility care. All three plans are paying that.
We talked about $778 day 91 and beyond using those lifetime reserve days. It pays that, right? We talked about the $194.50 in skilled facility care that the insured is responsible day 21 through 100. Those plans pay that. So, very simply, between Medicare and those common plans, it offers one hundred percent hospitalization, right, regardless of how long you’re in there, what happens while you’re in there, how frequent you go in there, still going to give you one hundred percent coverage, right?
And then of course, on the outpatient side, the Part B side, you know, we recall that Medicare is an 80/20 coinsurance, right, so Medicare is always going to pay their 80% and then, of course, the Supplement pays the remaining 20%, right? The only difference being is you know, obviously plan G and plan N don’t cover that Part B deductible, which is $233 in the year 2022. And then, of course, plan N also has those $20 copays at the doctor and $50 at the ER if the individual is not admitted.
Zach: Yep. And something else to point out about Supplements that are a big question we get asked a lot are, you know, networks.
Nick: Yeah.
Zach: You know, do I have to call my doctor when I’m signing up for Supplement? Do I have to make sure oh, they take company X?
Nick: Yeah. So, you know, we—and we get that, Zach, because, you know, if you think about our market coming out of the workplace, they’ve been on group insurance, right? They’ve had plans, they’ve had networks, et cetera, so they’ve kind of been psychologically indoctrine to ask, do you accept my insurance company, right? But you know, what we try to explain to people is it’s a fundamental shift, right? Medicare is the primary when you have Supplemental insurance.
The Supplement is the secondary, so whatever Medicare pays first on and its leftover, that’s the Supplement’s job, and it’s going to pay. So, you know, the question isn’t, “Does my doctor accept company X? Does my hospital accept company X?” The question is, do they accept Medicare? Because as long as they accept Medicare, regardless of what provider, regardless of what plan they choose to go with, that’s going to be accepted as well.
Zach: Got you there. So, you know, you kind of touched on it briefly, you know, plans are standardized, so everybody’s plan N, plan G, plan F is going to be the same across the board.
Nick: Sure.
Zach: Another big question we get asked a lot is, can it be canceled, you know? If I sign up in open enrollment, they don’t ask me health questions, I get out of that open enrollment period and I do have a pre-existing condition. Can that affect me?
Nick: Yes. So, let’s use some insurance-speak here, right? Guaranteed renewability is what the insurance companies and the brochures say. But you know, basically, all that means is when you have a policy that’s guaranteed renewable, it means it cannot be canceled for any reason other than non-payment, right? So, if you’re that individual that gets in under open enrollment, maybe you’re currently being treated for cancer, right?
Just because you have a higher level of claims this year, next year, whenever, than the rest on aggregate in your pool, they cannot cancel you, but more importantly, Zach, they cannot charge you any more than everybody else in your zip code, your gender, and your age, right? So, not only can you not be canceled for higher-level claims, you can’t be singled out for higher prices as well. So, that’s good to know for those people that say, “Hey, I’m coming on to this and I’ve got some challenges. I’ve got some issues. I’ve got some pre-existing conditions, what’s going to happen when I have to use this? Can they cancel me?” And the question is no, they cannot.
Zach: Yeah. So, looking there at it, you know, we do have a lot of couples that go on Medicare at the same time, so looking there at it, you know, we do have companies that offer household discounts, whether you’re both on the same company, or you can live with somebody. Most companies are age 60 or older, but we do have some companies out there, they are at age if you live with anybody. So, that does another way to kind of save some on a premium there—
Nick: Yeah those—
Zach: —with a Supplement.
Nick: And you know, Zach, those discounts go anywhere from 5 to 14%. So, you know, if you live with anybody, regardless of their age and whether they’re Medicare eligible or not—you know, we’re going to ask you that question, if you call, but keep us honest. Let us know because that could save you 14% a month simply living. It could be a grandchild, it could be a sister or brother, it could be a spouse, whatever. You know, as long as you live with them, you can get that discount.
Zach: So, you know, we also talked about plans being standardized. Plan N and G nowadays are your most common.
Nick: Sure.
Zach: Plan F used to be very common. There’s a lot of myths—the best way to put it—out there about them. Do you want to debunk all those here real quick?
Nick: Here we are, [Mister Debunk 00:11:29], right?
Zach: [laugh].
Nick: No, you know, he a couple years ago, when they made the [unintelligible 00:11:33], you know, changes to Medicare. You know, basically what they were doing is they were trying to eliminate the opportunity to purchase a plan that covered the Part B deductible, that outpatient $233 deductible, and they succeeded. But the caveat that isn’t broadcast, the caveat that isn’t out there because those plans are guaranteed renewable, all of those people that had those plans—plan F, plan C, the two that cover that Part B deductible—can still keep those plans. And because they can still keep those plans, they can still purchase those plans. So, very simple: for individuals, regardless of age, that were first eligible for Medicare, prior to January 1st, 2020 can purchase, keep, or switch F and C.
It’s only those individuals that were first Medicare eligible after January 1st, 2020, they can no longer purchase those plans. And I want to give a quick thing here, Zach. The number one people that we are saving the most money on are those individuals that have been on plan Fs for five years plus. If you’re out there listening and you’ve been on a plan F for a number of years, you’ve watched your premium go up, no doubt.
I’ll challenge you. Give us a call and you’ll be shocked at the amount of money you can save switching. And remember, Zach, since those plans are standardized, you know, the only two things that are going to change for these individuals switching is the name on their insurance card and the premium they’re paying each month. The benefits they’re receiving don’t change. You know, we have times that we cut people’s premiums in half, sometimes more for those individuals that are on those F plans. Call, let’s see what their savings can be today.
Zach: Yep. So, wrapping up, Medicare Supplement there, you know, as a whole name themself, they do Supplement Medicare. So, they’re going to take care, in most cases, that $1,500 deductible on your Part A. They’re also going to take care of that 20% of your Part B. Again, no networks; as long as the doctor, hospital, whoever takes Medicare, they’re going to take the Supplement, no matter who it is. And again, you can change at any time of the year. You don’t have to wait till that October 15th deadline—
Nick: Absolutely.
Zach: —to make those changes.
Nick: And one thing to mention here, too, guys is… you know, we get a lot of phone calls, we get a lot of requests for information, and people will say, “Hey, my neighbor, my cousin, my spouse—whoever—has this plan. I want this plan.” One thing we want people to focus on is Supplemental coverage is different from plan to plan. And just because what’s best for you doesn’t mean it’s what’s best for me, right? So, if you have questions, if you’re wondering what plan is best for you, you know, our job is to ask those difficult questions. We’re going to ask those questions to determine and we’ll help you, right? Ultimately it’s their choice, but we certainly want to be the best help we can be, right?
Zach: All right, so just kind of moving on along down the line here. The next one is Medicare Advantage plans.
Nick: Sure.
Zach: See a lot of those on TV, radio, especially in October, those times a year. So, how does a Medicare Advantage plan work with Medicare?
Nick: Yeah. So, you know, we get asked this question quite frequently, and you know, the easiest way to answer that is it doesn’t, right? I mean, so a Medicare Advantage plan—and if you listened to our last episode, you noticed that we skipped Part C, right? We did A, B, and D. And the reason for that is Part C of Medicare is Medicare Advantage, right?
And with Medicare Advantage, it actually replaces your Part A and B of Medicare. So, it’s worth mentioning, you have to have Part A and B, to purchase a Medicare Advantage plan. But ultimately, it is going to replace your Medicare, therefore you no longer have access to Medicare’s nationwide network. It just kind of ceases to exist, right?
Zach: Yep. Yep. So no, since it does take away A and B, are there, you know—are you tied down to where you have to go with it?
Nick: Absolutely, yeah. So, you know, when you’re purchasing a Medicare Advantage plan, what you’re really doing is you’re replacing that A and B of Medicare, and you know, every Medicare Advantage plan has to offer benefits, at least equivalent to Original Medicare. But what you’re doing is you’re taking your benefits out of Medicare and you’re putting them with a private carrier, right? I mean, everybody gets the solicitations, emails, phone calls, you know, commercials, the whole nine, direct mail pieces, et cetera, you know? So, we know that providers, right?
But when you go with UnitedHealthcare, when you go with Humana, when you go with Blue Cross Blue Shield, when you go with Cigna, when you go with all of these company’s Medicare Advantage plans, they have networks associated with them. Now, some plans have more restrictive networks than others, right? But ultimately, yes, you’re always going to have a network when you’re on a Medicare Advantage plan, at least their traditional ones, the HMOs and the PPO, right?
Zach: Yep. So, then also kind of talking generically because we can’t go into plan specifics on things, and there are a lot of Advantage plans out there in the area, so just kind of generally speaking, when you’re comparing Medicare Advantage plans, what are the differences in them? What are the different ones out there?
Nick: Yeah. So, I mean, the obvious answers here, Zach, are the costs, right? Whether it’s a zero premium or a higher premium, the network accessibility, right? Is it an HMO? Do you have to have a primary care doctor to gatekeep all of your care, right, where you know, you can only go to your primary care physician, and to see a specialist or go out of network, they have to give you a referral, right?
Or maybe you’re on a PPO where you don’t have to have that primary care physician requirement, but to get the lowest and best costs, you still have to stay in-network, right? So, it really doesn’t matter, you know, what you’re talking about when it comes to network accessibility. They’re always going to be there, right?
Zach: So, you’re looking there at it, are they guaranteed renewable like a Supplement? So, if you’re on an Advantage plan, does it roll over every year, or do I have to make a change?
Nick: Yeah, so let’s kind of go two different ways here. First, the plans aren’t guaranteed renewable in the sense that a provider—be it a doctor or a facility—has the choice on an annual basis to withdraw from that network. And quite frankly, we get that phone call quite frequently, the first of every year. “Hey, what options do I have? You know, I was on X company and my doctor no longer participates,” right?
But more importantly, as well, on an annual basis, these companies can actually choose to completely discontinue a plan and/or pull out of the service area altogether, right? So, there is no guarantee that the plan you’re on is going to exist next year, and there is no guarantee that the doctors or facilities you’re using this year are going to be with the plan next year. However, assuming those two things don’t happen, if you are on a plan and it is still available, it will roll over into the next year. There is no need to re-enroll.
Zach: So, what are some costs associated with an Advantage plan: co-pays deductibles, things like that.
Nick: Yeah. So immediately, you know, some plans have premiums. Some don’t. Some plans have drug premiums, some don’t, right? All plans—for the most Part—are going to have Part A cost in the hospital. All plans for the most Part are going to have what we call a MOOP, right—more insurance-speak—which stands for maximum out-of-pocket expense, people coming off group insurance may know that as a major medical deductible, right? You’re going to have all of those type things. You’re also going to have a coinsurance on your outpatient care until you reach that maximum out-of-pocket till you reach that major medical deductible. So, common things are going to be premiums, co-pays, deductibles, or maximum out-of-pockets.
Zach: So, you know, another thing you see a lot with some Advantage plans is having to have referrals. And so, can that cause you to have restricted access to doctors and/or facilities?
Nick: So, Zach, we use this example all the time, and you probably already know where I’m going with this before I do it. But the example we give on network restrictions is MD Anderson, right? MD Anderson, Houston, Texas. Anybody’s ever been to that facility—I have—it’s nicer than most hotels you go to, okay? So, you can imagine it’s not cheap, right?
And facilities like that don’t want to take discounted payments, right? Now, that doesn’t mean that your plan doesn’t participate there. Some do, but the example that we give clients if you live in wherever, do you want to go to your cancer doctor that has an X cure rate, or do you want to go and have access to go to the best and the brightest, right? Whether we’re talking Emory Hospital in Atlanta, Mayo Clinic in Boston, MD Anderson in Houston, if you’re on Medicare and have a Supplement, walk right in. The challenge is, when you’re on those Medicare Advantage plans, those facilities may not participate in your network, regardless of the type of Medicare Advantage plan you’re on. So yes, we always tell people that Medicare Advantage plans are restrictive and their access to the best and the brightest.
Zach: Also, so you’ve touched on it briefly; so with a Medicare Advantage plan, what are some of the additional benefits added to it, you know, including prescription coverage, if possible?
Nick: Yeah. So, just to recap here and build, Zach, you know, Medicare Advantage plans when you’re replacing Medicare, they have to offer benefits, at least equivalent to Medicare, but what we’ve seen over the last few years is a lot of these companies and a lot of these plans are, like, piling on additional benefits, right? And they’re becoming quite common, you know, they’re becoming quite liked in the Medicare community. So, some of those additional benefits that you see are the holy grail, right: Dental and Vision. Medicare and Medicare Supplements don’t cover dental and vision.
Some of them are covering over-the-counter benefits, right? They’re getting a monthly or a quarterly benefit to spend at the drugstore on things like Band-Aids, alcohol, Tylenol, things like that. You see some that are offering transportation, right? Some plans, one that we looked at the other day, offered 21 round trips, for transportation per year, right? We’re seeing all kinds of additional benefits and feel free to throw any in here, Zach, if you’re thinking of some I’m not. But basically, these are benefits that Medicare doesn’t offer that the provider has the option to offer, though they don’t have to.
Zach: So, before we, kind of, move to the next step there, million-dollar question. If you’re on an Advantage plan, you still paying that Part B premium?
Nick: Absolutely, Zach. So remember, you have to have Part B to replace it. And to replace it, you still have that cost, right? And the standard premium is $170.10 for 2020. Remember those Medicare Savings Programs—some people pay less with ARMA, some people pay more, but absolutely, there is no way to get away from that costs, just because you have a Medicare Advantage plan.
Zach: Yep. So, staying with Advantage plans, I’m going to kind of switch gears a little bit. We’ve been discussing what Advantage plans are in a nutshell. So, just kind of who can purchase a Medicare Advantage plan?
Nick: Yes. So, this is very simple, Zach. So, individuals that have A and B of Medicare that reside in the plan service area that have a valid election period, be at an initial enrollment period, annual enrollment period, Medicare Advantage open enrollment, or a special enrollment period can purchase MA coverage.
Zach: So, if you are getting ready to turn 65, getting ready to go on Medicare, what’s your timeframe to look for Advantage?
Nick: Yeah, so your initial enrollment period for Medicare Advantage plan, Zach, is going to be three months before your effective date, the month of, and three months after your Medicare effective date, right? So, just to give an example, if you’re an individual that’s turning 65 next month, right, you have the month of May, three months prior and three months after May to put in a Medicare Advantage plan under your initial enrollment period.
Zach: So, you know, if you’re not new to Medicare, you’ve been on Medicare for a few years, that is where you see all the commercials October 15th through December 7th, annual enrollment period. That’s the most common time, say, to make changes to your Advantage plan. But there are some other opportunities out there throughout the year.
Nick: Absolutely. Yep. So, you know, just kind of recap in here, that Medicare Advantage open enrollment period, right, those individuals can only make changes if they’re currently on a Medicare Advantage plan, right? So, you have to have one to use that election period. But if you’re currently a Medicare election—or excuse me a Medicare Advantage plan during the MAOAP—or Medicare Advantage Open Enrollment Period—you can make one change to another Medicare Advantage plan or you can disenroll that Medicare Advantage coming back to Original Medicare.
Zach: And so, before we kind of wrap up Medicare Advantage plan, something else want to touch on is something we focus on a lot for veterans. There are plans out there, Medicare Advantage plans that don’t have drug coverage because they can go to the VA for those plans.
Nick: Sure. Sure. So, you know, basically what we’re looking at, you know—and we see this quite frequently—you know, Humana has the Honor Plan. Wellcare has the Patriot Plan, et cetera—these plans are designed specifically for individuals that have credible drug coverage, right?
Almost all of them are MA only, meaning they’re Medicare Advantage with no PD prescription drug portion. And if you recall, if you have Medicare and don’t have credible drug coverage, you’re going to be penalized. So typically, these types of plans are for individuals that are veterans, I.e. Honor, Patriot, things like that.
They actually don’t offer drug coverage because they allow them to use the VA to fill their prescriptions, but by not offering that benefit, a lot of times they’re bulking up or adding additional benefits elsewhere, so what we see a lot of times is we see individuals that are using the VA as their health care, that are using the VA to fill their scripts, but they’re purchasing the MA, which almost always has a zero premium to get those added benefits, right? So, if you’re a veteran, you’re using VA, you’re using it for your health care, for your drug coverage, maybe you’re needing dental coverage, maybe you’re needing some additional coverage, these plans are great options because you can lean on them for those additional benefits, right?
Zach: Yep. So, to kind of wrap up Medicare Advantage plan, they replace A and B of Medicare. So, they’re going to have some similar gaps in Medicare, but they’re going to have added benefit—albeit dental, vision, hearing, you know, drug coverage, things such as that—and they vary by network; that’s something definitely you need reach out to us, you know, local agent, whoever, to get an idea of what plan works best for you in your area because they do vary by the area.
Nick: Yeah, yeah. And it’s worth mentioning here, Zach, you know, as we wrap up here, there’s advantages to getting drug coverage with your Medicare Advantage plan and there’s disadvantages, right? And one thing that we like to point out is, when you buy an HMO, when you buy a PPO, they either come with drug coverage or they don’t, right? You can get an MA-only, HMO, PPO or an MAPD HMO or PPO. If you’re buying an MA only that doesn’t come with drug coverage, you cannot purchase standalone drug coverage in conjunction with those plans, right?
And consequently, if you’re buying an MAPD, right, that comes with drug coverage, you have to take the drug plan that comes with it, whether it covers all of your drugs or not, right? So, we certainly want to encourage people, if you’re considering Medicare Advantage coverage, check those prescriptions and make sure they’re covered. If you’re considering Medicare Advantage, make sure the pharmacy you use is a preferred pharmacy, make sure you’re getting the best costs associated, right? And then of course, if you’re thinking about choosing a Medicare Advantage plan, you want to make sure that everything you’re needing is covered on that plan, right? And you know, that’s what we’re for. If you’re out there looking at these plans, have questions. Maybe you’re on a current plan, don’t know if there’s something better out there, right, reach out to us: 844-437-4253. We would love to help.
Zach: All right, so we’ve gone through the basics of Supplement and Advantage plans. Now, to kind of put a nice little bow on it before we wrap up this episode are we’re going to look at the pros and cons of the two, kind of do a cost-benefit analysis, essentially, to see, maybe help some people answer some questions if they’re leaning one way or the other. So, I mean, you know, basically, Nick, what are the pros and cons of these, of a Supplement?
Nick: Well, let’s start with Medicare Supplements, and then we’ll go to Medicare Advantage plans. You know, comprehensive-wise what coverage is best? Medicare Supplements, right? It’s paying what Medicare doesn’t. The only con to Supplemental coverage would be cost, right?
It’s cost-prohibitive for some people. You know, as far as the benefits to Supplemental coverage: a, open access, you still have Medicare’s in-network nationwide, regardless of where you’re at; it pays in addition to, Medicare pays, Medicare Supplement pays the rest, right? So, you know, you’re getting better access, open access, and more paid, right, that would be the pros to Supplements.
And then of course, conversely, the cons to Medicare Advantage are really inverted, right? So, the cons to Medicare Advantage plans are restrictions or access to the best and the brightest. The cons would be out-of-pocket costs in the form of those co-pays, in the forms of those deductibles, right? The cons would be, you’re stuck. You can only make changes at certain times of the year, right?
So, one of the things that we like to tell people—and look, we get it—everybody wants to Supplement coverage for the Medicare Advantage cost. And unfortunately, that does not exist or it would put both products out of the market, right? So, it’s very simple. You can buy a plan that pays your bills, the price is the same every month, it’s budgetable. Not only are you buying those claims being paid, you’re buying peace of mind, you’re buying a product, knowing regardless of what happens to you, what level of care you need, you’re covered. That’s Medicare Supplements.
Or do you say, “I’m the individual, I don’t want to pay anything, I don’t want a monthly premium, and if I get a bill, I’ll deal with it.” Right? So, what we like to tell people you can pay upfront, or you can pay on the back-end, but it’s a heck of a lot cheaper to pay upfront than it is to pay those 20% and those maximum out-of-pockets these types of plans have.
Zach: Yep. So, just kind of wrapping up episode here. You know, broke down Supplements and Advantage plans; obviously pros and cons to both. We would be more than happy to talk to you about those, whether it be you know, give us a call at 844-437-4253 or reach out to our email, zach@getsbi.com or nick@getsbi.com. We’d be more than happy to go more in-depth in those plans for you, explain a little more.
You know, no matter where you’re listening to this at, you know, we’re licensed in 37-plus states, so odds are, we can help you and be more than happy to. So again, you know, thanks for tuning in and listening to us. Hope we answered some questions for you cleared some things up. But as always, thanks for listening and we’ll catch you guys next time.