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over 50% of all people today that are on Medicare have selected Medicare Advantage plans or are switching to an advantage plan sadly many who have made that decision are doing so for the wrong reasons so in this video I'm going to share with you my honest advice about Advantage plan so you're aware of the seven wrong reasons and the two right reasons to choose an advantage [Music] plan now wrong reason number one would be this this is someone that says I'm healthy I'm turning 65 or maybe now going on Medicare 67 and I am planning on staying that way and just so you know I hope that statement does describe you and I do hope that you will stay healthy uh the rest of your life but the truth is uh as we age uh our uh immune system begins to break down we tend to have more health problems and so really the truth is it's not a matter of um uh if it's going to happen but when it's going to happen let me just share with you some very common chronic conditions today uh that happen to people that are 65 and above diabetes osteoporosis heart disease kidney disease Alzheimer's dementia arthritis stroke incon and COPD and on and on we could go with uh chronic conditions now the reality is this they say that people 65 and above that 95% of all people today 65 and above are going to have at least one of these conditions and almost 80% are going to have two of those conditions so you may be healthy now and I hope you stay that way but the likelihood is something is going to happen with with your health all right so we're making a decision at 65 or thereabouts uh that could impact us for the rest of our life because we're making a decision based upon how we feel right now instead of wondering what could happen in the future now I just want to close out this particular reason with the reality of cancer okay cancer of course a terrible disease but notice this 60% of all people today that have cancer in words they're undergoing cancer treatment and have had a cancer diagnosis right now uh 60% of those are going to be 65 and above in fact for everyone that's diagnosed with cancer this year 25% of those people will be between the ages of 65 and 74 high probability I found this stat to be interesting the median age for uh breast cancer right now is 61 and for prostate cancer it's 65 so you can see cancer is impacting people that are Medicare eligible so that is reason number one the wrong reason number one why you should not conclude that an advantage plan is going to be good for you just because your health and planning on staying that way reason number two would be this agents oversell Medicare Advantage plans what do I mean by that I'm just saying to you that insurance agents often times are going to promote Advantage Plans they oversell them by overexaggerating some of the uh uh items about Advantage Plans and they typically do not talk about some of the disadvantages or the problems that occur with Advantage Plans and frankly folks the reason that agents oversell them is because they pay higher commissions and in fact when someone enrolls into an advantage plan versus a supplemental plan that Advantage plan is going to pay the agent almost twice the commission two times as much so they really pay the agent a higher commission but also what's interesting about this is when we write an advantage plan we literally get lifetime residual income okay they pay for life as long as someone keeps that plan it's going to keep paying now we compare that to a supplemental plan supplemental plans again are going to pay about half of what an advantage plan pays in commission and we get about 6 years worth of residual I'll be frank with you uh we don't make a lot of money off anyone insurance doesn't work that way it's very much a volume type of a business and so when an agent focuses on and really overs sales Advantage plan what are they're trying to do they're thinking only about their commission instead of is this the right move for the client okay and so we try to be motivated by first coverage yeah we all make commissions uh uh that's just the way the system works but we have to start with coverage what is really the most important thing not how much is that plan going to put in my bank account but is that going to give you the coverage that you need so again uh wrong reason number two is because an O an agent oversells them in fact we find some agents that's all they want to talk about why because they're concerned about their commission all right that brings us into wrong raason number three and that's this because the advantage plans have low or no monthly premiums watch this stat folks right now there's about 3800 Advantage Plans throughout the country now by the way nine companies uh pretty much dominate the market Market there's some Regional cares for sure but of these 3800 they say right now that for every two out of every three Advantage plan there is a zero premium paid to the insurance company for that plan now we have to pay Medicare this year we have to pay $174.79 a month but the point is uh they're relatively low as someone just looks at the monthly premium and so sometimes that can be attractive but again just because it has a lower no monthly premium doesn't mean there's not going to be some additional out-of-pocket expense and so again when we compare that to a supplemental plan we have to pay a premium because we've gotten rid of the risk or most of the risk that would be associated with any out-of-pocket expenses when I have an advantage plan I didn't pay a premium but the risk I take on will be the risk of my other health care services uh that I'm going to need on that particular plan all right so again these are very attractive and again promoted uh by agents because there are some people all they're looking at is that monthly premium uh that's going to come uh uh because of the plan they're not thinking about other expenses that could come if they have any kind of a health issue that brings us then to the wrong reason number four and this has to do with the perks that are offered by uh the advantage company now again these are heavily pushed by agents uh a lot of ads talk about these additional benefits called perks that are provided by the advantage company uh that original Medicare does not cover uh perks would include gym membership and so what happens is the advantage plan will say uh they will cover uh a certain um uh membership at a gym or maybe YMCA or a community center and if you go to that facility uh and you work out there then they will actually cover that membership fee there's a couple networks one's called Silver Sneakers one's called Silver and fit another is called new active so again it's a benefit or perk offered by the advantage company now the reality is there's only about less than 5% of all people who have that benefit available actually use that but again it is a perk another perk that we have would be some type of a dental allowance now I'm careful and I don't call this a dental plan because most dental plans are pretty thorough a dental allowance means that the advantage company will set aside maybe $1,000 or $1,500 a year and as long as you go to one of their Network dentists then you actually can use an allowance and sometimes uh there's dentist you can find that take it other times it can be difficult but again it's a perk often advertised but highly underutilized also uh the plans will uh do some type of a vision uh allowance and they'll give you one ey exam a year um uh at no cost and then they also will give you some kind of a credit it could be maybe $200 to $250 a year uh towards contacts lens lenses or glasses something again that original Medicare didn't cover but they're going to do also will have hearing aid benefit and again this is a very much a legitimate uh benefit hearing aids uh so what they will do is they will set aside a a type of hearing aids that uh they will cover a network that you have to use and then you'll have some kind of a very reasonable copay and they usually allow you to get a hearing aid at a co-pay somewhere between maybe $400 to $700 uh a year uh per year so again that's a legitimate one as well a lot of the companies this year have what they call an over-the-counter uh perk and uh they will give you some type of a credit towards maybe a card uh maybe $50 to $75 a quarter and you can go online or in their catalog and actually order things that you would just normally get over the counter U it could be supplements could be you know aspirin whatever those kinds of things and so you have an over the counter allowance but my whole point is these kind of things aren offered by original Medicare so the advantage companies often times will talk about these and really uh um uh promote these things because these are things that you wouldn't have if you stayed in original Medicare now my advice is there's no problem with these perks but we should never make a decision uh to uh enroll into an advantage plan because the perks and so what happens many times is that people that are healthy 65 uh you know hardly ever go to the doctor they're very attracted to not only uh a zero premium but also the perks they're going to be offered because they think well at least I can get something out of my plan and and again I like the perks but you should never make a decision uh about uh uh healthc care coverage just because they're going to offer these additional perks there's a lot more to a HealthCare coverage decision than that all right so that's wrong reason number four that brings us to wrong reason number five and that would be this peer pressure oddly enough uh we see this all the time uh meaning what happens is when you're on Medicare uh that's a pretty common discussion with other people that are also on Medicare and you'll have a lot of people today remember over 50% of all people today that are on Advantage Plans uh they've selected them what happens is uh you feel this pressure because what do they talk about they talk about hey I don't have to pay anything you mean to tell me that you have a subm plan and you're having to paying $125 $135 a month for that on my plan I don't have to pay anything well they still are paying something because they have theay pay their Medicare Part B premium but there's no cost of course for the plan or very low cost they also talk about hey I get to go to the gym for free now you're paying for a membership so the point is peers will put pressure on you like you made a silly decision uh to decide to get a supplemental plan uh instead of taking this zero cost free plant uh and because again the person who is promoting them has probably really never had to use the plant uh that's what we typically find they love them until they have to use them but again we have a lot of peer pressure that goes around uh you know at at the golf course or maybe at you know dinner or some you know some kind of a social event with people on Vantage plans and they make you feel like you're crazy because you're actually paying for a plan to get high quality insurance instead of a zero premium uh plan that has a bunch of perks hey if you found this video helpful and you want to see more Medicare information just like it then go below right below the video and you can give us a thumbs up as well as subscribe to your channel and every time I put a new video which is about two every week you'll be notified of that video and others just like you who need this Vital Information will get it as well all right that brings us then to wrong reason number six and that is this misconceptions misunderstanding about switching plans and the reason there is so much misunderstanding misconception is number one agents don't really educate people about the rules for switching plans but also because every year Medicare has this uh uh enrollment period called the annual enrollment period And this is every year October 15th through December the 7th okay now what this is for this would be for someone that is on an Advantage plan and they want to switch Advantage Plans so advantage to Advantage you can do this uh during the annual enrollment period October 15th to December 7th and we make that switch then our new plan goes into effect January 1 of the next year you can do that there's no underwriting involved that the plans in your ZIP code you can enroll uh during the S weeks and it starts January 1 now we have a second enrollment period that's actually called the oep and this is again for Advantage to Advantage and this is January 1 through March 31 okay same thing I'm moving advantage to Advantage if I make that decision in January they'll start my plan in February if I make the switch in February they'll start me in March if I make the switch in March they'll start me April the 1st okay so again uh we have these three months the first year advantage to Advantage all right and so that's uh the way it it works when we're moving Advantage plans but here is the tricky part if someone is on an Advantage plan and let's say they would like to move over to a supplemental plan right now it is true that these are the two times of the year uh we can do this but what is not true is just because you want to do this doesn't mean you necessarily can do this because if I have been on my Advantage plan let's say for a year or 2 3 four 5 years I've been on it for some length of time and now I'd like to get out of the Advantage system and move over to a supplemental plan now uh uh that will not be automatic uh just because I have these dates Avail available to me to do it the timing but the issue will now be now we have to go through medical underwriting which means what we have to submit a health uh application we have to look at your medication so this is process so we're going to ask you a minimum of 30 different health questions we're going to check all your prescriptions you're taking now we having the last 2 years and we're probably going to need some kind of a a statement from your doctor called an attending physician statement and this uh information is submitted then to the uh insurance company and now what happens is they do not have to approve you um and so that summonable plan will look over things if they find out that you have arthritis uh they're going to deny your application if you're an insulin dependent diabetic and you're taking too much insulin or you've had a a complication such as retinopathy or neuropathy or diabetic coma or an amputation they're not going to approve your application if you have spinal cenosis you're going to be denied uh if you're taking depression medication some companies will deny you uh if you've had cancer in the last 36 months they're going to deny you if you have apib in your medical records one incident apib uh you're going to be denied you'll never get a supplemental plant and so what happens is 45 of the 50 states 45 of the states Plus DC in order to switch from a su to an advantage now we got to go through this process the exception of that would be New York Connecticut Vermont Maine and Massachusetts those five states uh give a little bit more leniency from switching uh uh from advantage to a but all the other states follow the federal guidelines and says this you do not have to go through underwriting the first six months of when you start your Medicare Part B so quick example I'm shooting this video today it's July the 3rd 2024 now watch if I started my Medicare this month 71 2024 I have an A and I have a b date of 71 2024 okay what happens is when I first go on Medicare uh there is this thing called a metag Gap open enrollment period That's tied to my B date and this B date uh switching lasts for 6 months so what I can do is I can get any medic app supplemental policy anyone that's sold in my state any policy that I would like to have uh uh during this six-month WI window of my B date with no underwriting at all during this six-month window initially and by the way if you start at 65 or let's say you start at 67 whenever that b date begins I have the six-month window I actually can apply 6 months in advance and then once I hit my B date uh I have six more months where I can get any subal plan uh that I want I select the company and and the plan uh and there's no medical underwriting the company has to cover my pre-existing conditions they have to approve that policy but after that 6 months is over in uh all 45 of the 50 states uh uh and District of Columbia now I'm going to have to go through that underwriting again New York Connecticut Vermont main Massachusetts not so uh a little different rules there but everywhere else um now I have to go through this medical underwriting process so again that six months is is very key so the six months in my example if I had a b date of July 1 again I can apply for a submental plan 6 months in advance now it's not going to start until my B starts but I can do it in advance most people do but I still have 6 months after my B dat so on my example that would be what July August September October November December which means what January 1 in my example 2025 in 45 of the 50 states plus the District of Columbia if I want to get a subal plan in the future now I'm going to have to medically qualify to do that all right so there's a lot of confusion about switching plans and so sure it's easy to move advantage to Advantage no problem there we got two times a year we can do that but to move from an advantage to a supplemental plan that you've been on uh for a year plus now you got to go through medical underwriting so a lot of people have the idea I'm healthy at 65 I like all the perks I have a zero premium and when my health changes in 2 3 4 five years then I'll switch to a subal plan and begin to pay a premium well if that's going to happen if you have that's your plan and you have a health change during that period of time you're not going to get to switch that plan had a lady who is planning to do that one of my clients this last year and what happened was uh she stayed on the advantage plan 5 years she was going to switch at age 70 and literally 2 weeks before her appointment to come and see me uh she was diagnosed with melanoma and they removed it she had to go through some treatments and all that and she really is doing fine but now to switch from advantage to sub metal plan she has to be cancer-free and treatment free for 36 months so again she going have to wait three more years before she can attempt to do the switch so someone's Health could change and then they can never get off that Advantage plan they'd be on that plan really for the rest of their life so we want to make sure you understand the rules for switching because sometimes people make this decision not understanding how that works all right that's going to bring us then to the seventh final wrong reason and then I'm going to give you two Right Reasons by the way but let's talk about this one first and this one has to do with unaware of the problems that come with Advantage plan so what I'm going to say to this is I am saying that there are some disadvantages to Advantage plan and these are things that agents don't talk about they don't want to disclose these but these are critical for you to understand okay and so there are some problems with them number one is this and that would be that now we have a private health insurance company that is replacing original Med Medicare for you so that's why a lot of people even call Advantage Plans replacement plans because now you've come underneath the umbrella of a private health insurance company and all their rules okay uh when you're in original Medicare andb you're coming underneath the government's rules and and the program that they have put together since 1965 and now we have a private health insurance company and you'll see that some of those rules really are a disadvantage if you ever encounter the rule all right number two what happens with a private health insurance company when they put this Advantage plan together they're going to have networks those networks are going to be either an HMO Network or a PO Network now keep in mind when you stay in A and B and get a supplemental plan you don't have a network at all we call it open access you can go to any provider any Hospital any doctor any surgeon as long as they Medicare uh you don't have a network with subal plans but here they always will have a network just frankly it's the only way that they can work and so what they have is they have contracted hospitals contracted doctors people who have agreed to see patients on that particular plan and what happens with these networks is they change here just recently we're seeing several Hospital groups just pulling out of the network uh if you're on that Advantage plan uh and you want to go to a certain Hospital they're no longer in the network so it's no longer an option so these uh chain on a regular basis frankly now one of the issues with the HMO network is you can't go out of your network if that provider is not in the network uh unless you're in an emergency situation you have to go to providers that are only in the network po will let you go out of the network but the problem is it cost you about twice as much to do that co-pays go up co- insurance goes up max out of pocket goes up so yes ppl's give you the privilege but again it's very costly to go out of network on a PO plan okay and so we have issu limited doctors limited Hospital choices especially on the hmos and so again a lot of Agents don't talk about this uh why because they don't want you to realize there could be some restrictions you may get diagnosed with cancer want to go to a certain oncologist hey these oncologists they're not required to take an advantage plan it's totally voluntary uh they can enroll in the original Medicare system so if you have a submental plan if they take original Medicare they have to take your supplemental plan but they do not have to take the advantage number three would be this out of expenses what do agents push what do ads push well they always talk about the zero premium as though everything on the ad Vantage plan is going to be uh no cost to you and that's not true now number one you didn't pay a premium to the insurance company but you still paid Medicare the Medicare Part be premium this year is $174.79 on an Advantage plan that's going to cost you about $300 or $350 a day up to maybe five or 6 or S days you're not going to have an MRI or a CAT scan or a pet scan for free it's going to probably cost you $250 or $300 you don't allow to have cataract surgery or knee replacement uh for free those things are going to have again a co-pay with them and so what happens with the advantage plan even though there's zero premium to be on the plan you have a series of co-pays they're very reasonable they're not they're not crazy high but it's going to cost you uh for all the healthcare service that you're going to need up to a certain limit called the max out of pocket max out of pockets this year on hmos are in the neighborhood of about three to maybe $5,000 for the year ppos are going to be somewhere between about four to maybe 7,000 a year and that max out of pocket means you pay co-pay co-pay co-pay co-pay until you hit the Max and then you're done paying and then those max out of pockets reset every January and then we're back to copay copay copay until we hit the max all right and so even though it looks like on the surface they're all free they're not going to be free for sure because again we have copays up to the max out of pocket all right and then lastly a very big deal and I'll close with this about the wrong reasons and that's a lot of people aren't aware of this problem called the pre-authorization and what a pre-authorization means this this means that on the plan your doctor only recommends that's all they do a doctor uh recommends you have a knee replacement a hip replacement doctor recommends you need an MRI or a CAT scan so a doctor make makes a recommendation but when you're on the advantage plan that doctor submits the request uh to the advantage plan and what happens in order for you to get that scan or that knee or hip replacement or whatever service recommended that Advantage plan must agree with the doctor must approve it uh otherwise they're not going to cover it all right and so there's a whole issue with pre-authorizations they say right now that about 70% of the services that people need on the advantage plan will have to be pre-approved by the insurance company before that service is going to be covered and sometimes they approve them immediately other times they they delay coverage they'll say no we want you to try medications or we want you to try therapy uh and then maybe we'll cover the hip replacement or something other times they just flat deny it they don't agree with what the doctor's saying had a lady who needed a full hip replacement plant said no we'll pay for a rod only and that's all she got okay and so that's the pre-authorization process so we're going to have this with the advantage and again agent will talk about this because this definitely is a negative uh because of the delays and coverage and denials that happen if you have a something Al plan it never happens because the submental plan has no say so uh the doctor and Medicare make all the decisions if doctor says you need it Medicare says we'll cover it in a story you're going to get that KN or hip replacement or scam whatever it is that you're going to need all right so the point is people are usually unaware of these problems because agents don't talk about them because these truly are disadvantages of Advantage Plans hey if you're finding this video to be helpful and you would like to learn more about Medicare you'll notice up here in the right hand corner there's an eye and if you'll click on that eye it's going to take you to uh a 20-minute Workshop uh I see people make mistakes all the time and we don't want that to happen to you and that's why we're giving you free access to this Workshop so go ahead click the link and learn more about Medicare all right that brings us now to the right reasons and there are some right reasons okay I think there's plenty of wrong reasons and again I don't want you to get uh you know trapped by making a decision because of those wrong reasons but there are two right reasons uh for Advantage plan so certainly is a place for them okay number one would be this the first right reason reason and the main one would you be just simply because of your budget uh you may be in a situation where your budget is very tight uh and again you say hey I've got to have something that's low cost and I know I've got to take on the expense and pay as I go but that's all I can do I just cannot barely afford even the Medicare Part B premium and so when someone finds themselves in that position I think they ought to get an advantage plan why because they can't afford let's say they're going to get a g plan and that g plan had a premium of $125 a month right maybe they had an in plan and that in plan's about $100 a month uh and then they have to have a drug plan and sometimes those are low costs and sometimes they could be you know $25 to $50 but my point is if someone cannot afford that extra amount of money in their budget Beyond paying for their Medicare B then that's when they should get an advantage plan they can and so I think there's a place for that or someone says hey I can afford that but I'm not going to afford that well if you're comfortable taking on the risk and to live within Advantage system with you know for the rest of your life then go ahead and do that so again that's the right reason just because it's too tight because what we find when people truly cannot afford this monthly additional expense then they don't keep those plans so it' be better to go ahead and start off with that Advantage plan find the best one you can in your particular Market hopefully a PO so you at least have out of network options and um you have a very good plan uh and so but if it's not the budget please don't try to do it so that's the right reason the second reason that I think it's wise is if someone can get their uh medications to the VA and even some of their other health care services to the VA then I think getting a subal plan uh is uh really a little bit too much insurance now if a person doesn't like the VA system then I I I wouldn't say that but if someone says I like the VA system I've got good care there I've got you know good coverage didn't cost me anything all that then what I would do if I had that if I can get my prescriptions to the VA then what I would enroll in it is what is called a Medicare Advantage only plan in other words it does not include prescription drug coverage because again I get my scripts at the va8 prior to Better Price and so what happens here is now at least I have a civilian option if I don't want to go to the VA if I want to get a second opinion outside the VA system now I have this Advantage plan uh that that can provide that for me or if I'm on vacation I had emergency situation or whatever happens and now you have something for inpatient and outpatient and again we have some kind of a of a limit called the max out of pocket so even if I had to go out it's not going to break the bank it gives me another option Beyond V a so I like that also if you're Tri care Tri care which means uh this is people that are retired military not just that you served in the military that would be VA benefits but this means you're retired military you have Tri care and what happens when you turn 65 it becomes Tri care for life and what Tri care has agreed to do is they will coordinate Tri care with a and b or they'll coordinate uh with your advantage plan and one of the nice things about this here and this here when you take that Advantage plan you have Tri care it's not a permanent decision if you don't like it you just go back and have Tri care only but Tri care will coordinate with the advantage plan and many times that Advantage plan will give you a Part B reduction uh this year we're seeing some of them $50 to $100 a month they give a credit back on your part B so it reduces that and that which increases of course your social security check and so you have a wonderful plan uh again we're going to recommend a PPO Network in that kind of scenario as well so those are two reasons I think it' be very wise at least to consider a Medicare Advantage only plan why because we have some other insurance options available to us either VA or Tri care okay then last I do want to mention there are some of you today that are covered by FB your Civil Service FB federal employee health benefits and again A lot of times people that have this will also look an advantage plan option uh because they can get their meds through the FB plan and then they can sign it for a PO plan uh and get all the perks that come along with that and also uh reduction in their part B uh so again those are the scenarios these three types of people who have other insurance options and those that just simply cannot afford extra for a subal plan and a drug plan [Music]