The Myths of Medicare Advantage

In short, No. You pay the Part B premium whether you get an Advantage plan, a supplement Plan or just want to go to the Doctor on original Medicare. Now when you sign up for an Advantage Plan, that Amount that Medicare pays in claims for your Part A and B together on a per year Average, is given to Private Insurance company you signed up with. They are now responsible for All of your claims. That is why they can have plans with $0 premiums. It isn't a gimmick. Just Math.

Most common excuse we hear for being on a supplement plan is "I don't pay at the doctor". Okay, I don't put $100 of gas in my car and dump it out for new gas at the end of the month because I didn't use it. That is what Supplement plans are for healthy people that only go for annual visits. They are Ferrari plans that you pay Ferrari prices for. They also come with no other coverage. This is where Advantage plans save you money. Even if you hit the few "big" copays with Advantage, you are probably still spending less in a year versus a healthy year with 2 doctor visits on a supplement. Most Advantage plans have $0 copays at your primary care provider specifically because people that visit their doctor regularly help keep everyone's costs down. 

 Lying through omission is still lying. First, if you are on a supplement plan already, you have a one year guarantee to return to your previous supplement plan if you switch to an Advantage plan. It is good once, the first time you are on an Advantage plan. Let’s get more into the fibs. If you are not healthy and you get an Advantage plan, then you are "Stuck". When they say stuck, they mean in an Advantage plan. What they leave out is that it didn't matter if you were in an Advantage plan or a Supplement plan. Once you are on a supplement. plan you use the Guarantee Issue for Supplement plans, not Advantage plans. This means for a single year you could likely have lower costs on a cheap Supplement plan. But what about the following year. They won't talk about that. This is where omissions happen. If you aren't healthy enough to Qualify for a new Supplement Plan then it doesn't matter what plan you were on before, you will still not be able to go to supplement plans. You got it because you are not in good health, and it pays for everything (mostly). At the end of year one, they are staring at you and your bills you brought them. Guess what? Rate adjustment, guarantee issue at a good rate, now gone. You are no longer considered preferred, your rate just skyrocketed. Time to shop for a new plan...but you don't pass the health screeners, or the rates are way too high, and you would go premium broke. This is the function of what the fibs are trying to scare you into. Advantage plans let you go to a supplement plan if you want, just like your employer's insurance, there is a time of year to elect something different. The other factor, this whole scenario is based on somebody being "uninsurable" to a supplement plan. Advantage plans don't have uninsurable. The only real qualifier is having Medicare.

Everyone wants to know what the Max out of Pocket is because that is the assumed amount they will pay during the year. Truth be told the number of people reaching their max out of pocket are going up for one reason, The max out of pocket keeps coming down. What is that number? We dont' get a solid number as every company has a different one and Medicare didn't really say. But it's pretty low. To err on the conservative side, maybe 25%. That conservative and rounded up. Until we get a real study on it, we won't have an accurate guess. But we have plenty enough customers that would agree that the Max out of pocket isn't as important as other plan features. It is important to know that you won't pay more than the max out of pocket, but it is more important to have a plan that helps you avoid unnecessary costs by having access to health care, good customer service, and a healthy network of doctors so you won't have to worry about where you go. "Moop" shopping just isn't very effective with most of these plans.