Here's How Much You Would Need to Pay With Medicare | Medicare Supplement vs Advantage

I've got my whiteboard here and I'm going to go over how your total knee replacement costs would be covered by a Medicare Supplement Plan versus a Medicare Advantage plan so that you can make a more informed decision around these two options I'll be looking at a Supplement Plan G the most popular at the moment Supplement Plan n the next most popular and a typical Medicare Advantage plan with a national maximum out of pocket at around $4,800 all of this is assuming that you've had zero medical cost for the year up until the point when your knee starts to hurt if you're new here we do these comparison videos often and we use numbers from specific cases I would appreciate it greatly if you subscribe to see more of these but your real life numbers could be higher or lower depending on where you live and where you go for the surgery but the principles of how all of this is covered by the different Medicare plans are applicable regardless of your specific costs okay so your knee hurts and you've likely done one or two doctor visits before to determine that you need a knee replacement we're going to assume that you went straight to an orthopedic specialist who orders an x-ray I know that I'll have haters here that will say that with certain plans you can't go straight to a specialist and that's fine many do but there are those that don't and it really won't make an impact on this analysis okay that first consultation with the orthopedic surgeon has a bill of $450 Medicare will likely tell the provider no we'll only pay $200 and if the provider participates with Medicare they will say okay the X-ray Bill comes in at around $200 and Medicare agrees to pay $100 in this example all of these are Part B expenses so your pre-operation part B bill is is $650 with Medicare negotiating costs to$ 300 with a Supplement Plan G you have the part B deductible first which is $240 here in 2024 so you would pay the first $240 out of your own pocket and then Medicare Part B starts in on the remaining $60 left over Medicare covers 80% so $48 and your plan G covers the remaining $12 with plan n the exact same thing happens here and you're paying the $240 Part B deductible out of your own pocket while the remaining $60 are picked up by Medicare and the plan n now plan n does have those additional co-pays of up to $20 for every doctor visit under certain billing codes usually for Diagnostic and evaluation purposes but those co-pays don't start until after you have met Your Part B deductible a couple more notes on those co-pays they are up to $20 they can be less again the co-pays are based on specific billing codes so some visits will have the co-pays and other visits won't these $20 co-pays do not count towards your part B deductible with Advantage plan remember the advantage plan is replacing original Medicare so original Medicare doesn't pay anything for this whole conversation around the KNE surgery for those on an Advantage plan other than the dollars that the government pays the insurance companies to take on this risk the advantage plan insurance company itself negotiates its rates with the facility and they are generally pretty close to medicare's negotiated rates for certain procedures they may be a little bit higher or for other procedures they may be a little bit lower okay there's a specialist copay on Advantage Plans I looked at a bunch of plans here locally in the Inner Mountain West and the average was about $25 per visit and this is where people can jump in the comments and get mad about me not mentioning a primary care visit there are Advantage Plans where you need a referral from your primary care provider in order to see a specialist many plans don't have this as well though so most Advantage Plans do not have a primary care co-pay anyway so it doesn't really affect the cost picture here but it does affect the convenience aspect of choosing an advantage plan next there is a co-pay for the X-ray the average for the plans that I look looked at was $10 okay we've made it through the pre-operation services and the advantage plan is winning with a total cost so far of $35 compared to the $240 of both Plan G and plan n but let's keep going this changes now that it is surgery time the build amount for this surgery is $76,000 and sticking to the strange way that the US healthcare system works the hospital or the facility throw out this astronomical Bill and then the insurance company or Medicare says yeah we're not paying that we'll pay $119,000 and then a surgeon's office again if they participate with Medicare they say okay so now that we have the Medicare agreed amount we can figure out how much you get to pay most knee Replacements are outpatient surgeries which means that the surgery itself will run through Medicare Part B original Medicare pays 80% so $15,200 and then normally the remaining $3,800 would go to you to pay but the beautiful thing about your Supplement Plan G is that it covers all of that pretty awesome coverage Supplement Plan n will work the same way so far you've met the part B deductible already so met Medicare pays the 80% and then your Supplement Plan and covers the rest also pretty awesome coverage with the advantage plan there is an outpatient surgery copay and this will vary depending on the plan that you pick we see them range all over the place and many plans are kind of between $200 and $400 so we're going to go right in the middle at $300 and that comes off of the maximum outof pocket left right now supplement plans are coming in with the same total of $240 while the advantage plan is now up to $335 but we aren't down yet after the operation there are post up follow-ups with your doctor and there is a 90-day window that is called a 90-day Global period where there are no costs to you for the physician follow-ups and any other services that the hospital or the facility provide related to that operation so you aren't being build for follow-up visits however physical therapy is not included in that and after a knee surgery physical therapy is very important now most people after knee surgery go home and then they start going to physical therapy some go into a skilled nursing facility for a short amount of time I'm going to cover the going home and the Physical Therapy route but I do want to talk about skilled nursing and Medicare for a minute I would argue that one of the biggest issues that we see in the industry surrounding Medicare Advantage plans is skilled nursing coverage generally they approve 2 days at a time and then they have to recertify every 48 Hours Advantage Plans can be notorious for limiting the number of days in a Skilled Nursing Facility the Advantage Plans look for significant Improvement meaning you are getting better and they are trying to get you to go home now some people make the mistake of watching these videos and they come to the conclusion that I am recommending one plan over another in reality I make these videos as much for people who have already made the decision as those who have yet to make their decision so for those who are considering an advantage plan or you already are on one if you have any doubts or concerns about Skilled Nursing Facility coverage I highly recommend that you contact some skilled nursing facilities in your area prior to getting an advantage plan or prior to the surgery and asking how they would interact with your plan remember on an Advantage plan you are dealing with networks and finding a skilled nursing facility that is in network can prove difficult because many skilled nursing facilities are not the biggest fans of Advantage Plans okay let's move on after speaking with an orthopedic surgeon friend he said a typical Physical Therapy regimen is 3 days a week for 1 month then you go down to 2 days a week for a month and then you go down to 1 day a week for a month that comes out to 24 physical therapy sessions total we're playing the whole build versus agreed upon amount game here Physical Therapy offices will build let's say $100 per session Medicare will agree to something like $40 per session and that puts us at $2,400 build and $96 $ for the Medicare allowed amount physical therapy visits are build as outpatient service so Part B that means that Medicare pays 80% or $768 and your supplements Plan G and plan n pay the remaining $192 and you don't have any cost to deal with since Physical Therapy isn't diagnostic nor an evaluation visit you shouldn't see that $20 co-pay through plan n either the advantage plan has co-pays for physical therapy in this example we'll use the average of several plans at around $25 per visit after 24 visits we to a total of $600 in co-pays on the advantage plan that brings the maximum out of pocket left to $3,865 now the Gap has widened between the supplement plans and the advantage plan Supplement Plan totals are still at the $240 while the advantage plan total is now at $935 in out-of-pocket costs to you and let's take a minute to appreciate the cost of a $76,000 plus Bill only being $240 and $935 respectively this is much better coverage than I get on my existing plan but we still aren't done yet we are done with the procedure itself but there are other costs that we have to factor into this coverage for you to get the complete picture of what something like this would cost you on Medicare to even have Medicare coverage in the first place you need to pay for Medicare Part B which for most people is $17.70 per person per month this number is income based so those with higher incomes will pay more but for most it is $174 70 everyone with Medicare Part B pays these premiums regardless of whether or not you have a supplement plan or an advantage plan the exception is those with low incomes meaning Medicaid you can get partial or full relief from paying Part B or there are some Advantage Plans that do have a Part B give back but again these are exceptions and we're dealing with what most people experience so the annual cost with Part B with some rounding is $2,100 for all three options these dollars do not count towards your advantage plan max out of pocket on top of the Part B premium you will have to pay a premium just to have the supplement and Advantage plans for a plan G the national average is around $150 per person per month for a 65-year-old those numbers will increase as you get older so that turns into $1,800 per year Supplement Plan G does not cover dental vision or prescription drug coverage if you want those you would need to pay more in premiums using averages it's about another $90 per month for drugs dental and vision premiums or another $1,080 for the year for plan and the national average is lower at around $120 per person per month for a total of $1,400 per year Supplement Plan in does not cover dental vision prescription drug coverage either if you want those you would need to pay more in premiums again and we'll add that same $1,080 for the year in here you don't have to get these we highly recommend that most people get Standalone drug coverage in this scenario but not everyone gets Dental Envision it's just an attempt to keep this comparison as close to Apples to Apples as we can because not only do most Advantage Plans not have a monthly premium they also typically include prescription drug coverage some form of dental and vision coverage at no additional charge there are Advantage Plans that do have a monthly premium but for every four Americans on an Advantage plan right now three of them pay $0 in premiums so that's what we are going to go with now we can see the full cost picture for someone on Medicare in this one year with one procedure under our stated assumptions the total amount build $79,200 of that Medicare paid Supplement Plan G the plan paid $44 and you paid $240 plus the Part B premium plus the Plan G premium plus the drug coverage dental and vision premiums for a total of $522 Supplement Plan in is second most expensive at $ 4,820 it saves you about $400 over the Plan G with the advantage plan let's assume that their negotiated rate is the same as Medicare so the advantage plan pays $9,350 they get what we'll say is $1,000 a month from the government to take on this risk so they receive $122,000 for the year netting a loss of $732 and your responsibility comes in at $3,035 so in this example with these assumptions and costs in one single year where nothing else happens the advantage plan would cost this person less if you've made it this far I will occasionally throw in a secret word towards the end of my videos I do this because a lot of people like to let me know how evil I am to not cover every possible scen scario make assumptions and leave things out only to have me point out later in the video where I acknowledge those things they just didn't make it that far in the video to see the disclaimer so there is a code word after this disclaimer this video is not a recommendation to get any of these plans all of these numbers can shift dramatically based on where you live the plans that are available in your area any other health issues that may or may not be going on with you there are other factors that come into the decision like networks of the advantage plans or a lack of network on the Supplement Plan side and many other things that we cover extensively in other videos on our Channel if you haven't subscribed already I kindly ask you to do so here to stay on top of Medicare and retirement topics okay I love wearing cozy shoes and if given the opportunity I'm usually wearing my heed shoes that slip on and off easily but they don't fall off my foot like those pesky sandals so if you leave a comment that happens to mention anything about shoes they could be your favorite shoe style it could be your favorite shoe brand anything about shoes I'll know that you made it this far and people in the comments will be super confused with all the comments about shoes now this video was a look at strictly costs in one year with one major medical situation this video right here goes into more detail about the major differences between supplement and Advantage Plans outside of just costs but what most people forget to take into consideration when making the advantage versus supplement cost decision is covered in this video that looks at 20 years of costs and projections rather than just one I will see you in one of those ah [Music]

Channel: The Retirement Nerds

Views: 45,079

Keywords: retirement nerds, the retirement nerds, 90 days from retirement, 90 days until retirement, 90 days, 90 days to retirement, medicare, social security, finance, medicare supplement, medicare supplement costs, medicare advantage costs, are medicare advantage plans good, are medicare advantage plans bad, medicare supplement vs medicare advantage, advantage vs supplement, supplement plan g vs advantage, Medicare supplemental plan

Id: 9Lx3BntZWkU

Length: 13min 5sec (785 seconds)

Published: Sun Jun 16 2024