Home » Medicare Made Simple – Interview with the Medicare expert MARTY SILBERNIK – Part 2

Medicare Made Simple – Interview with the Medicare expert MARTY SILBERNIK – Part 2


Mary: So you just mentioned how you can change your Medicare plan if you have a Medicare Advantage plan. So what’s the difference between the Medicare Advantage plans and the Medicare supplement plans? And why do you need them? 

Marty: Well, that’s a good question. You can have either a Medicare supplement or a Medicare Advantage plan. You can’t have them both. Okay. Medicare supplement is what’s called Original Medicare. You have Part A Medicare Part A which covers hospitalization, Medicare Part B which covers doctors, outpatient, quite a few other things. Durable Medical Equipment anything other than hospitalization with the exception of prescription drugs. Now Original Medicare and Medicare supplements do not cover dental vision, or hearing.

Mary: Okey

Marty: A Medicare supplement is designed to cover the 20% of Part B costs. And the Part A deductibles that would normally come out of pocket a monthly premium, the 20% or all the costs that Part A and Part B would normally transition to you are covered under a supplement. 

Mary: Okay

Marty: With that, once you’re done with your annual Medicare Part B deductible, which in 2022 is going to be $233. All you do is pay your premium, you never see a bill from your doctor, you never see a bill from a hospital, you never see a bill from an outpatient clinic, you got you have 100% coverage. Okay? Together with that, you need to have a prescription drug plan. Those can run anywhere from I’ve seen them run anywhere from $7 a month to $101 a month. And it all depends on the prescriptions that you have the drugs that you need to take. And the area that you live in. Everything on Medicare is geography based. So we we’re gonna qualify that as well. So that’s Original Medicare with a supplement. Medicare Advantage is a plan that combined all of that into a single plan, hospital doctor, prescription drug, it has very limited dental, vision and hearing benefits. It oftentimes he has some over the counter benefits, all the things you see in the television commercials that are going on right now.

Okay, I see Joe Nemeth all the time, I see Joe Montana has a one year plan throwing letters into the bin. And it was his plan.

Medicare Advantage plans are true managed care, they more often than not are HMO health maintenance organisations, you’re limited to the network that the particular company has available to you, you will need to deal with primary care physician, any referrals to a specialist will have to go through that primary care physician. Any procedures, or most procedures that the specialist or the PCP would like to do, will have to get prior authorization from the insurance company. And it really does limit your ability to Original Medicare let you go anywhere in the US. Most Medicare Advantage plans are geographically based, they oftentimes most of the major players have availability for you in other areas of the country. If you’re travelling and you get sick, you can go see one of their network doctors, let’s say you live in Louisville, like I do. And you’re up in Chicago, there’s a network doctor that you can go see. But you you’re locked into their network, networks change every year, doctors go in and out of networks every year. And as I mentioned earlier, you find out that all of a sudden your doctor isn’t accepting the plan. That’s what happens. So you have a lot more limited coverage with Medicare Advantage plan. Dental vision hearing, everybody loves that it’s a big thing on television.

It’s there, it’s very limited. Most plans have a maximum of $1,000 that can be spent on on dental, even less on hearing and vision. So there’s extensive coverage. And the last thing that you hear a lot about with Medicare Advantage is we’re going to put money back into your Social Security account. Well, that’s called a Part B give back. And most of the companies I shouldn’t say most, a few of the companies have plans that will give you anywhere from 50 to the full $143 A month back into your social security. But when they give it they take it away. 

Mary: Right, of course

Marty: That they don’t give you something for nothing. My father used to say, if you’re dealing with a plan that he has to give back, there’s going to be more restrictions somewhere else in the plan. This is why it becomes critical to get a plan that’s custom tailored for you. It’s that’s why it’s critical to deal with somebody who understands the Medicare arena and can take you through all the pros and cons of everything. 

Mary: Well, most definitely. 

Marty: Really flying up here right now. So 

Mary: Yes.

Marty: So just, so we understand. 

Mary: No, it’s that’s why it’s so challenging to know, to listen to like these TV ads and to really make an informed decision about what your care should be. I mean, I was carrying an insurance policy, and they no longer carry it. So they were giving me a new primary care physician and I said no I’m not going to someone new, like you were saying, you know, you build up that rapport with that physician, you don’t want to change. Right. So what other things should Medicare recipients be looking out for in terms of like these drug insurance plans, I know that Medicare supplements can be very expensive they can go, I mean, isn’t there like up to F through n or something? 

Marty: Yeah, the plans are all lettered. Let’s talk about the three most popular plans real quick, there’s a change, which is a comprehensive plan that covers everything. Now, for people who were eligible for Medicare prior to January 1 2020. There’s also a Plan F, which also includes that the only difference between an F and A G is the F plan includes your annual Part B deductible, not a big deal. Okay. But G is the is the comprehensive plan, and is the next most comprehensive plan. The N covers everything that the G does. But for a lower premium, you may have to do a copay, a $20, copay to a doctor a $50 copay to a hospital.

Under the G there’s no co pays under the M there is, but oftentimes that premium can be 50, $60 A month less on the N plan that is on the G. And the third plan that I recommend more often than not in the supplement world is what’s called a High Deductible G. Now only a few companies write a High Deductible G. But you have a very, very low premium. In most of the cases, I’m dealing with that premium is anywhere from depending on the company $39 to $55 a month,

all the benefits of that comprehensive CI plan, but you’re responsible for the first for 2022, it’s going to be first $2,490 that Medicare won’t cover. So for example, you go to the doctor, Medicare approves $100 They pay they’re at 80%. That’s $80. There’s $20 left over that normally the plan would be if you were on a G plan. Under the high deductible G you pay that $20 out of your pocket, it gets deducted from that $2,490 And you have $2,470 left for the year. It’s a good viable alternative for people who don’t go to doctors quite very often, who don’t have a lot of health care needs, but want to ensure their protection is on the line should they get sick, because now all you know is your maximum exposure is going to be my premium plus $2,490. After that the plan covers everything.

In the Medicare Advantage world, your maximum out of pocket even though there’s no zero premium that could go anywhere from $6,700 up to $11,000.

So it’s a matter it starts to become a matter of health coverage matters.

 

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