Medicare Advantage

Now let’s talk about option two: Medicare Advantage, also known as part C or plan C. These are the plans that you see all the commercials about.

And they’re trying to give you everything. And they’ll give you dental and vision, and they’ll cut your grass and give you a brand-new car. I’m kidding. They promised a lot of benefits. And some of that is true. They do give you a lot of that. But let me kind of explain what a Medicare Advantage plan is. Remember option one, that Medicare supplement, it was more like true secondary insurance.

It came in and picked up what what Medicare did not pay. Medicare Advantage plans essentially replace your Medicare. They become your Medicare. Medicare says, “Hey, Medicare Advantage plan. We will give you X number of dollars every month as long as you take care of this Medicare beneficiary. But the deal is you have to give at least as good a coverage as original Medicare.”

Okay. And so let me kind of go over some of these things. Many of the plans have $0 premiums of the Medicare Advantage plans. Remember, you must have part A and part B to get this plan. So you’re typically not paying anything for part A, you’re paying $174 for part B, and now you have this $0 premium Medicare Advantage plan.

One of the cool things about these advantage plans is they have predictable co-payments. Remember when we were talking about part B where you could pay 20%? Well, as you know, 20% of a lot is a lot. And, you know, it’s all relative. But these advantage plans typically have predictable co-payments. Most of these do include part D prescription drug coverage.

You don’t have to go buy that separate plan. And prescription drug coverage included. Many of them have dental vision, hearing benefits, over-the-counter benefits, and gym memberships. And one of the things I like the most about them is they have max out of pockets. And typically, we’re seeing these plans have max out of pockets between $6,000 and $8,000 a year annually.

That’s very important when we go back to what Brett was referencing earlier with chemotherapy. If you really need chemotherapy, you know, this part B drugs could cost 20%, and having a max on this can be extremely helpful and save you lots of money. I’m going to give you an example of a Medicare Advantage plan here. And I just kind of averaged a few plans together.

This is no specific company—a lot of them have $0 premiums. Typically, you’ll see something like $5 at the primary doctor. So instead of paying that $240 deductible with original part B, and instead of paying 20%, you would go straight into just paying a copay. Many of these Medicare Advantage plans eliminate the deductible. You do not have a medical deductible.

So you go to that doctor, pay five bucks, go to a specialist is typically around $30. The hospital they have per day copays on most of these plans. So instead of paying that $1,600 deductible per visit with original Medicare Part A, they build it out where you pay a per day copay. And this example, I put a $300 per day copay, but it maxes out on day seven.

If you go for one day, you’d pay $300. If you go for two days, you pay $600. And, you know, typically that’s a lot better than paying $1,600 per visit. And then services like MRIs are a la carte. You got to have a menu and you’re like, “what am I going to buy today? I’m going to buy an MRI and a CT scan.”

Typically, we see around $275 for an MRI, CT scan, outpatient surgery, which I think is an incredible deal really is $375, if you think about it, if you went and had a total knee operation, you know, more back surgery or whatever, that could cost you a ton of money if you’re paying 20% of the cost with just original part B, but if you have a Medicare advantage plan, you would have that predictable copayment.

So $375 is a pretty good deal. And again, I already referenced max out of pocket. That can really protect you when you get into some of these big-ticket items like infusions or chemotherapy or if you just have a really rough year and you’re in and out of the hospital a lot.