Horizon BCBS – Bfit program reimburses up to $20 per month for gym memberships, while AmeriHealth offers $150 in fitness fees reimbursement. Aetna provides $200 for policyholders and $100 for their eligible spouse every 6 months, while Oscar offers $400 for policyholders and $200 for their eligible spouses. The Blue365® program offers gym membership and reimbursement details, and members must work out at least 12 times a month. Gym membership is included in several Medicare supplement (Medigap) and Medicare Advantage (Part C) plans in New Jersey.
The New Jersey Health Plan Savings (NJHPS) decreases the cost of premiums for current Marketplace enrollees and new enrollees. Joining Blue365® can help save money on products and services from popular companies that can help you live an active and well-balanced life. The shop and compare tool allows users to compare plans based on eligibility for financial help, monthly premiums, covered doctors, and estimated total healthcare costs for the year.
Fit center insurance in New Jersey is tailored to your needs, including Renew Active, which includes gym membership at no additional cost, a large and extensive fitness network of gyms and fitness locations, and on-demand services. Many health insurance plans offer fitness benefits like gym membership discounts or full or partial wellness reimbursements to their customers.
The Active and Fit Now program includes a fitness membership to your choice of 8,300+ gyms and/or 1,700+ premium exercise studios with 20-70 discounts on most. Ambetter Health insurance offers exclusive savings on perks like gym memberships and mental wellness programs to help you stay well and stay healthy.
📹 Health Insurance 101: How Insurance Works In 90 Seconds | BCBSND
Health insurance can be complex. At Blue Cross Blue Shield of North Dakota, our customer service staff wants to simplify and help …
What is the maximum income to qualify for NJ FamilyCare?
NJ FamilyCare is a healthcare program for adults aged 19-64 living in New Jersey, either as US citizens or qualified immigrants. The total family income must be at or below 138 of the Federal Poverty Level, with a single person receiving $1, 732 a month and a family of four receiving $3, 588 a month. The program also provides medical coverage to individuals aged 65 years or older, as well as those determined blind or disabled by the Social Security Administration or the State of NJ.
Immigrant adults must have Legal Permanent Resident status in the US for at least five years. Some immigrants, such as refugees and asylees, can qualify if they are lawfully present. Immigrants aged 19 and 20 with very low income can also qualify.
What is the income limit for NJ FamilyCare 2024?
Individuals whose income falls between $1, 733 and $2, 573 per month for a single adult and $2, 352 and $3, 492 for a couple (in 2024) are ineligible for NJ FamilyCare due to their income, according to the guidelines provided by the US Citizen or Qualified Immigrant.
Does NJ FamilyCare cover braces?
Orthodontic services are available exclusively to children under the age of 18, and the provision of such services is contingent upon the presentation of sufficient documentation substantiating the presence of handicapping malocclusion or medical necessity.
Is HMO or PPO better?
PPO plans have higher monthly premiums than other types of insurance, but they offer greater flexibility in terms of using healthcare providers, both within and outside of the network, without the need for a referral. Furthermore, out-of-pocket medical costs may be higher. The majority of HMO plans facilitate comprehensive healthcare management through the designation of a primary care physician (PCP). In contrast, PPO plans do not necessitate the involvement of a referral.
What is the best health insurance in NJ?
The best health insurance in New Jersey is AmeriHealth, which offers low premiums for single adults and families. Horizon Blue Cross Blue Shield is the best for nationwide coverage, while Oscar Health is the best for no-cost virtual and preventative care. Humana is the best for PPO plans, and Ameritas is the best for adult and child orthodontia benefits. To find the best health insurance in New Jersey, compare quotes from competing companies using this form. These options help residents find affordable and comprehensive health insurance plans that fit various needs and budgets.
How much is health insurance in NJ per month?
The mean monthly premium for health insurance in New Jersey is $451 for bronze, $628 for silver, and $984 for gold.
Is NJ FamilyCare the same as Horizon NJ Health?
Horizon NJ Health members receive benefits and services through the NJ FamilyCare Program, which are free or low-cost based on income level and family size. Benefits include doctor visits, preventive screenings, dental care, vision care, lab tests, prescription drugs, hospitalization, and mental health. To apply, call the State’s Health Benefits Coordinator or apply online. Representatives can help complete the application. To apply, call 1-800-637-2997 (TTY 711).
What are the 4 most common health insurance plans?
A variety of health insurance plans are available, including PPO, HMO, POS, EPO, HSA-qualified, indemnity, HRAs, and employee stipends. Additionally, alternative health benefits, such as health reimbursement accounts (HRAs) and employee stipends, are available for organizations of all sizes. The optimal health insurance plan is contingent upon the specific needs, financial resources, and desired level of medical coverage of the individual or entity in question. The following sections will provide a brief overview of the aforementioned plan types.
What is Plan D in NJ FamilyCare?
NJ FamilyCare-Plan D is a state-operated program providing managed care coverage to uninsured children under 19 with family incomes above 200 percent and up to and including 350 percent of the FPL. It also covers parents/caretakers with children who do not qualify for AFDC-Related. A care plan is a licensee’s written description of a resident’s needs, preferences, and capabilities, including who, when, and how often care and services are to be provided.
Does NJ FamilyCare have OTC benefits?
Wellpoint, previously known as Amerigroup, provides prescription drug coverage for NJ FamilyCare members at a cost of $15 per quarter for over-the-counter items and prescription drugs for essential medications. With a history of serving NJ FamilyCare members since 1996, Wellpoint strives to optimize the benefits available to its clients.
Is NJ FamilyCare and Medicaid the same thing?
The NJ FamilyCare program, which began as Medicaid in the 1960s, expanded to include various age and eligibility categories. In 1998, a federally-funded movement authorized states to provide health insurance through the Children’s Health Insurance Program (CHIP) for children whose family income made them ineligible for Medicaid. In 2000, New Jersey was granted permission to use CHIP federal funds to cover certain parents, pregnant women, and children, renaming their program NJ FamilyCare.
📹 5 Reasons NOT to Get a Medicare Supplemental Plan? 😱
In today’s video, Marvin from Medicare School is walking you through the 5 REASONS you should NOT get a Supplement plan!
I have a supplemental plan and as long as I can afford it, I will never change it. An example, I was in the hospital some years ago, for six days. I had numbers of tests for possible cardiac issues. At the end of all that, and follow up visits, I never saw a bill. I had no copays either. I didn’t need to call anyone, I didn’t need anyone’s approval. I still travel and I have coverage anyplace in the US that takes Medicare patients. Advantage plans are being pushed is because they are working toward privatizing Medicare. I won’t be here for that. Just the fact that Advantage plans are being pushed as hard as they are, puts me off.
The only reason to go on an Advantage plan is if you need health insurance there is no way you can afford to pay for a supplement plan. If you later want to switch back from an Advantage plan to original Medicare with a supplement, you can go back on original Medicare, but you have to go through underwriting and be accepted into a supplement plan. If you are in good health, fine. But if you have health issues, good luck getting a supplement plan. When you choose at age 65, you could be making a decision that you will be stuck with for the rest of your life. Choose wisely.
I was one of those who lives healthy: diet, exercise etc. Diagnosed in sept with metastatic gastric and liver cancer. The advantage plan would sink me. One thing that’s evil about advantage plans, is that if you go into a hospital that covers you Dr network, there are many separate services that may not be in network, in the same hospital: radiology, specialists, lab. Many of these services work independently of the hospital.
If you’re healthy, Advantage is great. If you get sick, it’s an issue of $7000 max out of pocket / year. It’s a risk and unpredictable. If one can afford the $300 or so monthly premium, traditional Medicare is more predictable. Keep in mind also Advantage will steer you to low-cost providers, nursing facilities, etc.
At 64 I am healthy and I totally get it. But we are all at risk of one day not being healthy. Some more than others. For me it is all about peace of mind since I can afford the premiums. I will gladly pay my $226.00 and then be totally covered. Also I rather pay up front each month and be done with it, not having to worry about a huge bill if something does happen.
It’s now 2024, and am poor. I have a supplemental this yr, not sure for 2025, but I will never take a medicare advantage plan. They are worthless, and costly. A woman in my area, had a medical advantage plan. Her doctor found a lump on her spine. He wanted to see it more clearly and to make check it out “IF” it was cancer. She went to an MRI to have the procedure done. Before she could lay down in the tube, a tech asked her to get dressed and go back to the front office. She was perplexed and didn’t know what was wrong. The front desk tech told her that her medicare advantage plan was not going to cover her MRI. She called her plan and yup, they would not pay for it. Long story, short, she paid for her own MRI, and tumor was not cancerous. Out of her pocket to $2000.00. I’ll stay on original medicare, even if I Can’t afford the supplemental plan. Everyone on YouTube, who speak about Medicare Advantage Plans say they are terrible. I can tell you my own physician will not take any Medicare Advantage Plan.
A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won’t cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. It is not what you pay, it is what you get as in delays, restrictions, inferior care and NO!!!
I will never get another disadvantage plan and I had 2 before. I will never give up the freedom of my original Medicare plan to a third party for a few trinkets. I don’t need to get a permission slips from any doctor if I decide I want to see a specialist. When I signed up for the Disadvantage plan I didn’t know what I was in for. I quickly changed back after the network doctor blocked me from seeing an orthopedic for my leg issues. He seemed offended and asked why I wanted to see a specialist and said ” I’m a doctor “. I have been seeing several specialists since then and my leg condition has been steadily improving.
Keep loving your supplement plan if you have it and if you can afford it, my husband changed one year to an Advantage Plan and he almost die, the waiting for the authorization was not bad was around 3 or 4 days but when you feel bad those days are a nightmare plus the VA benefits if your are feeling bad you do not want to be back and forth in those buildings where everything goes slow. So we learned a lesson and we could afford to pay the supplement, so he went back and if there’s a time that we cannot afford it we would buy less groceries or lower something in our lifestyle to keep paying. Have the peace and the help when you are in pain is priceless.
I don’t believe I ever hear reasons most people go the Medigap or supplemental route. 1. With advantage plans your drug coverage is ok, but not great. even though with mendigap or a supplement more drug coverage is possible that would not be covered under the advantage I’m talking about drugs that run into thousands a day. advantage plans probably wont cover and that means out of pocket which can be over the top. 2.With medigap, if you travel you’ll have better coverage . advantage plans are basically for regional network doctors and hospitals I’m basically spending 4,400.00 a year same with the wife sure its expensive real expensive but if some catastrophic medical condition comes up were hoping things are covered. All those high pressure advantage plan ads on TV should tell people its a basic money grab by the insurance companies.
If you choose a Medicare ADVANTAGE plan and decide you want to go back to original Medicare you have to go thru UNDERWRITTING…if you have any pre existing conditions you may NOT be able to go back to medicare and if accepted premiums will cost alot more… Be very carefull…call Medicare office to get # of a true medicare advisor…not medicare advantage advisor they get paid to sell ins plans They sound alot like medicare agents…alot of people are picking “C” advantage plans not knowing….be very carefull
Honestly, I know not all providers are in a network, in fact, they don’t want to be IN NETWORK… I will NOT consider a Medicare Advantage Plan because the people I deal with are always sucker punched by the PLAN… and these people tend to NOT pay their bills… Max out of pocket costs a LARGE percentage of their annual income, if not ALL of their income… AND a Medicare Advantage Plan is basically COMMERCIAL insurance… and you have to beg to get your health care covered….
The only reason to enroll in Medicare Advantage plan is if one can not afford the higher monthly premium of Medicare supplement. Dental insurance is more like a coupon and vision once a year not any better. As for free gyms fitness, this is a choice not absolute necessity and there are alternatives at practically no cost for better health such as walking and couple dumbbells, we are talking seniors after all not body builders . Lets don’t forget a good diet. How is waiting several days for authorization to receive any type of imaging regarding a serious health issue? Why it is so hard to switch back to Medicare supplement from Advantage plan?
I don’t know if the people complaining on here Don’t realize that this is just another way to look at things. He’s very helpful and I appreciate it he’s not saying you shouldn’t get a supplemental plan he is saying some people should go with an advantage plan under certain circumstances one of the circumstances being you can’t pay the premium for the supplemental plan It’s a no-brainer.
Be extremely careful on your choice! The only real justification for choosing an advantage plan is budgetary. You are too poor to pay for original Medicare plus a supplement! Understand that advantage plans remove you from original Medicare and impose a for profit insurance company in control of your healthcare! These plans entice you with “benefits”, but the cost is your healthcare. Everyone should understand that for profit insurance companies have profit margins (they have to pay their executives) and there is only one payor, you.
One of the big problems for the Advantage plans is that they are trying to pull more profits with their pre-authorizations. My BIL’s cancer surgery was delayed a month for no reason. It’s not like there were alternatives to him having surgery. I’m having to get preauthorizations on meds where there are no alternatives due to my diagnosis.
An interesting article. One thing I understand about Medicare Advantage plans is that a person is essentially limited to a particular geographic area when one is enrolled in one of these plans. I have a Plan G, and I like knowing that anyone who accepts Medicare in any part of the country can provide the covered services. I travel quite a bit, sometimes spending weeks at a time in 5 other states in different parts of the country, using driving between them, so it’s reassuring to be able to do this without needing a referral, etc. I have already used services out of state, and I also like that my Plan G even includes $50K of international benefits. A question I have–if some Medicare Advantage plans are essentially free, who pays for the various “freebies” associated with them? As I’ve heard, and sometimes even say, “there is no such thing as a free lunch.”
I have AARP/United HealthCare Supplemental Plan F. So far, at age 78 and since the get-go, I’ve had annual health and eye checks, prostate cancer and surgical removal, cataract surgery in both eyes, and a bad fall resulting in a badly fractured femur, two operations with titanium nails and clamps plus, plus three-plus in a great constant care facility for daily physical rehab therapy. Also included was a new wheelchair to take home. My Medicare and the Plan F supplemental covered everything 100%. So, O.K., I’ve been paying the supplemental premiums. But, wow, that’s what insurance is for. I still have my life’s savings for retirement and my heirs if there’s anything left.
The bottom line is if you can afford a supplemental plan and a part D drug plan and dental and vision, it is expensive but you will be COVERED. I have a G plan. If you can not afford a supplemental plan, choose the very best advantage you can afford and hope all the bases are covered if you get sick. With an advantage plan, medicare gives the company you choose around $1400 per month to take care of you. This is why you see all the television ads promising ” more benefits”.
Love the tongue in cheek except some may believe you believe what you are saying. Supplemental is the only way to go. If you can afford $7000 out of pocket and don’t want to see the doctor you want to see but be assigned whether you like the person or not, those are the reasons to get an Advantage plan. Oh, your therapist would have to be in plan also and your copay per visit might be $50. (Supplement, no copays ever. Never. Ever. Ever. Ever. Does your dental mater if you have dentures? Does cheaper gym matter once you hit 70 or break a hip? You will pay a copay for PT. Supplement? No physical therapy copay and Humana advantage etc can tell you how many visits a year I think. Check out these things.
You failed to mention the other main problem — trying to find competent doctors. I have a list of over 6 pages of viable lawsuits (each 1 short paragraph) that I could file, but the board of medical examiners want me to sign a release of liability form for every valid claim. When I struck a deal with the hospital, they agreed to give me free medical care for life. Screw that! Not even for free! They couldn’t even properly set a clean break in a broken arm one time! (They used that to scam medicare for all it’s worth.) 40+yrs of misdiagnoses, I’ve learned my lesson. I even had to trick them into giving me CT’s and MRI’s (& then requesting test results on DVDs) so I could find out the true problem for myself. Best just to avoid ANY “doctors” — ever!
First time I have seen one of these agents say some good things about advantage plans. I liked Kaiser in my pre medicare days but as an advantage provider they and others have large out of pocket gotchas that can run into many thousands of dollars. As a one time event I could handle this but if it were to reoccur several years in a row it would be very damaging financially for me and likewise for many other people of modest means. I stick with plan N which has predictable and more modest MOOP costs. I pay $100/mo for the supplement and part D plus $164 for part B. My biggest gripe is actually part D which I consider to be fake insurance. Insurance is not supposed to pay for every bottle of aspirin. It is to prevent drug costs from bankrupting you. Even the lady who sold me my Part D coverage admitted I could be out of pocket $10K+ for drugs and for a permanent condition that could be my MOOP for every year! And their coverage and deductibles are so complex and convoluted one never knows what you will be hit with till you get the bill in the mail. Thats my two cents, anyway
Here’s what some aren’t aware of… Once you go on an Advantage plan, they get your Medicare benefits. You give those up to be on their plan. That’s how they offer those “perks”. That’s why you see so many ads about Advantage plans. These insurance companies aren’t stupid, they’re in it to make a profit, and they do! They pay for all of these ads, and still win… Just like this guy. He doesn’t spend all of this time for free. He’s making a fortune selling insurance. Keep that in mind… It now harvest time for insurance companies during open enrollment, and also when you first become eligible for Medicare… Good healthcare insurance isn’t cheap. It can’t be for the cost of what they’re responsible for… Medicare is here for a reason. Older people have health problems! Do you really want to give that up to at the mercy of an insurance company? ?? To decide what you get, who you can see, and where you can go? The premiums aren’t really that bad. Medicare is going broke doing this. What does that tell you? Before some people with individual insurance are eligible for Medicare, they’re paying $1K a month for health insurance, and the benefits aren’t nearly as good as what Medicare and the gap policies offer. That’s how much the risk is… So $300-$400 a month for pretty much full coverage for those 65 and over, and more as we get older, really isn’t that bad… I think it comes down to part of a strategy of planning for retirement. These facts and figures are out there. Did you do your research beforehand?
We are looking for advice from these articles. You are confusing me, for one, that you usually are in support of supplement plans. Why are you taking the opposite approach now? You should be more consistent with your advice. It’s confusing enough without you flip flopping. I know at the beginning when you say that you will never be sick, etc. you are being a bit sarcastic. You had me in favor of supplements, now I’m confused again. Someone who hasn’t watched your other articles might take this one seriously and sign up for Med Adv, only to be sorry later. You didn’t cover how once you’re on MA you’re stuck there forever in most cases.
A doctor’s office may turn you away if you owe them too much, but it’s the law that emergency rooms have to treat you until you are stable for discharge and they evaluate you and usually you have been seen by the doctor and nurse when the financial advisor comes to get the insurance and ID card and that’s why some people live in the ER and hospital in a way and they are called frequent flyers, because they are admitted and treated no matter what amount of money that they owe and the hospital usually knows that they will never be able to collect the debt and they are constantly closing people’s medical debt and forgiving it using building money or unused employee salaries budgeted for new employees that they have not been able to find. They have unused budgeted money for a lot of stuff. The hospital may find ways to save money during the year and at the end of the year, they use it for employee bonuses, indigent care, they may add it to the building fund, etc
Social security checks can only get garnishment for federal taxes, IRS taxes and federal loans. Hospitals have to provide 500,000 or more to indigent care and they want to give it to legitimate patients. They know that if you are on social security, your checks, IRA, your house and car cannot be touched for the medical debt and it’s a waste of money to collect the debt. The hospital has other funds and accounts for different things and they move that money to pay for uncollectible debts and they ask the city for money for indigent care and you just need to make like $20 per month payment for the medical debt and after so long the hospital will write off the medical debt if you are on social security. Even credit card debt can be forgiven if you ask them and you have to pay federal taxes on the forgiven credit card debt or you can just ignore the credit card debt and the most a credit card company can do is get a lien on your house if you own a house, but they can’t enforce the lien while you and your spouse are alive. There are lawyers for free that can evaluate your debt if you are on social security by googling and searching for them.
Advantage plans are a scam, the total out of pocket mentioned in not the total liability that you may have with these plans. These guys also make a higher commission on the advantage plans. If you can afford to stay on regular Medicare and add the medical and drug plan that is what you should do. IMHO. Advantage plans are managed plans and you will have to fight for many claims that you may have.
All this info is so helpful. I am on medicare, And have a supp. I have plan J because I originally got it because it had prescription pay on it. When they required us to get plan D for prescriptions, I just kept the plan J, but I have to see if I can save money by changing to F orG. Keep putting these informative articles out. You make everything so clear.
when we retired we were asked if we planned on traveling? we said yes. then were told if we get an advantage plan and we need medical care while on the trip (in the states not abroad) that most of those plans available to us would not cover even an emergency room care. we looked into and yep none of them would. had to be at specific hospitals and in network docs. so before you jump on an advantage plan consider everything not just saving money. plus all the supplemental ones would cover anything if that hospital or doc accepted medicare.
Great article, thanx for all the info. I live in Ca and currently on supplement plan N its $227 a month probably one of the most expensive states but I will stick with it, cause I like the freedom to go to any Dr I want that takes medicare, plus I can afford it and I do have medical issues that may require surgeries in the future.
I think it is absolutely disgusting that no one knows all the “rules”. Even my rep at our local Social Security office didn’t think to ask me if my husband was retired. Because he is a Federal retiree, has a Federal Health insurance plan through Blue Cross/Blue Shield I found out after 6 phone calls to Social Security that this is not a qualified plan and I owe the Social Security Admin $10,000 over the next ten years. Who is in charge here? Not once, until the last phone call did anyone think to ask me. So, there you have it. I am so disgusted with my government I could cry.
Only thing I think you missed was at the beginning, and that’s to note the supplemental plans are also called ‘Medigap’ plans. I checked with my dentist, optometrist, and few other Ds & Os about the Advantage plans’ coverage (as I thought it was very limited) and the common answer I got was very few in my area take those as insurance. My dentist even recommended a few insurance brokerages that represent multiple dental insurance plans that I can contact for coverage.
You failed to mention that those selling the advantage plan makes $1000 more than regular medicare. I would NEVER use the advantage plan!!. Especially in a rural area where it’s hard to find any doctor, much less one that takes Medicare advantage. Hearing aides? Covered under G. Glasses, covered as a discount, Dental insurance, much better plans through your own dentist or private company. You are just selling a product here, not telling the whole truth.
This article is very well done and is additional backup to convince me that I still need a supplement rather than an advantage plan. Going through each reason was a simple yes or no checkmark. Sadly some viewers have left comments about how confused this article left them, but I surmised they just tuned you out rather than listened completely.
I agree about the cost. however; you didn’t mention the negatives of plan C to any great extent. First it discriminates against rural, semi-rural and suburban areas when it comes to zero premium plans and plans offered. only large cities and counties qualify which leaves out the majority of potential policy holders. Plus; since many seniors on Medicare travel quite a bit they are at the mercy of having their health care benefits be determined by the Plans Limited Area of coverage in which they will have to pay a lot more out of pocket for those medical costs if they occur outside the plans coverage area. other disadvantage include plans usually changing every year forcing people to review their plan every year at enrollment time to see how your plan compares to other companies. I have a supplement and i don’t have to worry about coverage throughout the US and i can choose any doctor locally that takes medicare patients and I don’t need to get referrals.
Just been screwed! Been on Medicaid while working paying zero. Now on disability, making 1/2 what I did while working. Now on Medicare paying $300 a month. Have about $600 left after deduction. They cancelled my Medicaid. Didn’t know they would kick you off ACA when you become disabled. I will have to cancel part B and go without coverage when I cannot pay my bills or eat.
I see the title. That is enough for me to post this reply. My wife is 85 she has had a supplemental since 65. (not the year, her age) It has gone up every year. this year it is at 469.10, The ONLY thing I have to cover is the $226.00 deductible. If Medicare pays anything the supplemental covers the rest. We think it is very good. Oh that companies name? Great American Life. They do as they say. It is covered. Edit: she has a G plan, I think. it is the second one down for her age.
Are you for real? 😩😩😩 Only reason to take a Medicare advantage plan is if one can truly not afford a supplement in my humble opinion. And definitely not an HMO that gives out free q tips and toothpaste. I bet joe Namath and JJ walker don’t have the plans they advertise. Other than a true financial situation then no go to advantage. Heard advantage plans pay higher commissions to brokers like yourself. 😩😩😩
Hello Marvin, Quick question. When verifying my earnings record should I look at just the last 35 years or all the way back to my first earnings in the 1970’s? My last 35 were my best and make up my highest earnings, so I do I really need to look at those lower early years? Thanks I follow your website and will be retiring early next year. Ed
Which Medicare Advantage plans give a buyback or cash back for Part B of Medicare? I’m on an MA plan because I’m on disability and the supplements are unaffordable to me upwards of five to six hundred dollars per month. I like my ma plan from a local company in Michigan, but they don’t give money back on part B and that would help me quite a bit to have that extra cash in my pocket. My particular plan has a high Hospital deductible that amounts to about six or seven thousand dollars, so I’m not happy with that if I ever do go in the hospital it would be very difficult. But one thing you didn’t mention is that there are Indemnity plans that can help cover those extra costs of deductibles and co-pays. In fact I just reminded myself I need to look for one of those for next year.
Thank you for all this information, I just retired and I’m currently looking for information to make the right decision. The problem I have with Medicare Supplemental plans, is that the drug plan only covers the medicines that I’m already taking, or at least that is what I understood, so what if I develop a kidney decease, or I need some expensive recurring medication in the future, and it’s not covered? thanks.
Be careful when choosing between Original Medicare and Medicare Advantage, you only have a one-time six-month period to choose a Medigap supplement plan for Original Medicare without undergoing medical underwriting, one can’t just flip flop back and forth between the two without undergoing medical underwriting after this one-time 6-month period. “Medigap Open Enrollment Period, which begins once you are aged 65 or older AND have Medicare Part B. Your Medigap OEP is one of the few times your application will not undergo medical underwriting thanks to guaranteed issue rights. Medical underwriting is how the insurance company determines whether to sell you a Medigap policy and what to charge for it. Guaranteed issue rights mean that you cannot be denied a Medicare Supplement policy nor charged a higher premium – even if you have preexisting medical conditions. Some states offer a bit more flexibility when it comes to joining a Medigap plan. And two – New York and Connecticut – don’t allow medical underwriting at all.” “Medigap Open Enrollment Period Six months long. The Medigap Open Enrollment Period begins the first day of the month you are 65 and are enrolled in Medicare Part B. It lasts for six months after the Part B effective date. For example, if you turn 65 in July and your Medicare Part B enrollment starts on July 1, your Medigap Open Enrollment Period would end on December 31.”
The problem – you may be healthy now, but there are no guarantees you will always be healthy. And once you are sick, you can’t switch to a supplemental plan unless you share all your medical information with them and they don’t have to accept you if they suspect that your illness will be costing more money than your monthly payment to them. You could be stuck with that advantage plan and paying everything over the yearly maximum every year for the rest of your life.
Why would anyone put a for-profit corporation in charge of what they’ll get or not get for medical services. A high deductible F or G is not very high in fact, it’s a third the MOOP on 97% of advantage plans, and that’s if you stay in network waiting for approvals. 🙏 No thanks. You don’t need a Cadillac F or G supplement either. They cost as much as the deductible in many states. You need a major health crisis to ever reach your deductible on an FHD or GHD. Only then would I have to pay $2,800 MOOP. THAT’S EQUAL TO A HUNDRED DR’S VISITS WITH BLOODWORK. WOW😂😂😂 After that, not a dime, and I’ll go anywhere I want when I want. If you can’t afford that how are you ever going to afford a serious health crisis on an advantage plan that changes yearly. 🤔
Well, I appreciate your critique why it’s better to have a Medicare advantage plan however, your tone was somewhat negative. Of course we don’t have a crystal ball to say we we will never get cancer or sick etc. etc. it’s a personal Choice for a period of time. In NY you can re-visit your MAP vs Supp Plans.
Prior authorization requirements on many services, plus a very generic formulary on mapds, are still grounds for original medicare and a standalone. I believe that mapds are a “house of cards”, but only time will tell. Having an insurance company’s board of directors managing health care is very unsettling. Health conditions can also make a person of “prisoner” of mapds. Tight finances is the only reason I would ever recommend one. Best regards.
I think you forgot a reason. The opposite of 2, you’re disabled or very low income and qualify for your states medicaid where your Medicare premium could be paid in full, you could have 0 deductible, 0 max out of pocket, 0 to $4 on any prescription, and medicaid pays most if not all your overages. You may also qualify for additional perks such as $200 a quarter for OTC, free gym membership, Medicare365 where you earn points towards gift cards at certain retailers for things like annual tests, blood work, volunteering, taking classes, and steps on your fitbit (that was also free), and monthly funds on a food card to be used at certain retailers. Many of the plans are expanding the food and otc cards to include being able to pay for necessities, pet food, rent, utilities, and more in 2023. BTW, thank you for this. I’ve seen so many articles of people 100% bashing all medicare advantage plans as if they are the spawn of the devil. But for many people they aren’t, they are actually a necessity. I’m disabled and a supplement plan would cost me so much money. I qualify for medicaid and all I pay is $1.80 a month for 1 Rx and $3.80 every 90 days for another, everything else is free. I now get my vitamins, supplements, cold meds, allergy meds, tooth paste, and more through my OTC allowance and pay nothing. In fact, I buy and stock up on some stuff so that I use most, if not all my allowance. I’ve been able to eat better due to my food allowance each month that I use mostly on fresh fruits and vegetables that I couldn’t afford a lot of without it.
For me, a Plan C would be best because of the Perks: I currently have health insurance through my State’s “ACA” plan and the Advantage plans are similar. I’m retired, but not 65 yet (will be later this year). I DO wear glasses, have hearing aids, belong to a gym, and go to the Dentist. All of these benefits is why I would do better with a Part C plan.
One of these points is ridiculous. Yes, you guessed it. People who think they will remain healthy for the rest of their life. Seriously? That’s tantamount to saying I will live to be very old, but will not have health problems when I do. It’s magical thinking. Have you seen a lot of old people? Also, you should realize that you can’t just switch to a supplemental plan when your health does start to decline, because companies can simply refuse to take you (at that point, you’re stuck with “Advantage plans”. In my view, if you have enough retirement savings, supplemental plans (especially G) allow you to forecast exactly how much you’ll pay, by allowing for premium increases. Remember, you’ll also be getting COLA on your SS payments, which will at least partly offset the premium increases. Also, if you plan to do a lot of traveling in your retirement, you will end up paying a lot more for medical care while you are away from the Advantage plan network. If you plan to travel a lot, supplemental is the way to go.
As a service to your viewers, you should do more to emphasize the downside of part C plans. You only make passing comments about having to be in-network, the possibility of not being able to switch back to supplemental plans, medical underwriting to switch back (and possibly higher premiums than if you started out with supplemental). etc.
You are speaking to one of the most vulnerable population including myself which is our seniors, who are prone to illnesses as we get older.You are using one of the most ancient sales rules ever was, which is cost, TELL THEM ALL THE ADVANTAGES not only that it’s costly so that they can make informed decisions – yes cost is always top of mind for us however do you know what I value more than cost is quality of life with the freedom to choose any doctor, any hospital, anywhere in the 50 states which an advantage plan does not give but a supplemental plan offers – the last thing we need as we get older and possibly sicker is to be waiting around for someone to decide/approve if we should get the medical attention we need because they decided it’s too expensive for them. So there may be other things in our lives that we can cut back on so that we can afford the premium in the event we are met a a catastrophic illness, and can get the care we need – Of course if someone cannot afford the premium they do have options as with an Advantage plan – but please give them all the information so they can truly decide if it’s something that they cannot afford .
I’m 55, I plan to keep working until age 60 or 62. I want to retire then and need to come up with health care coverage until age 65. My choices that I see now are to stay part-time or PRN and work a couple days a week or month until age 65 which would allow me to stay on my work health plan, or I need to find coverage in the market for my wife and I for 5 years.
You couldn’t get me to sign up for MA ever! Once you have a major health issue, all the red tape you go through to be treated (like pre auth) is ridiculous. Plus doctors can leave the networks. So you might find yourself looking for someone else when you like the person you were going to. Going out of network will cost you. I can get treated anywhere in the US. I have a supplement and an Rx plan. I pay only $5.20/mo for the Rx Plan and I am on insulin. My supplement is under $120/mo. Go online and read some horror stories about people who had to wait for treatment because it was not approved – you have to go through an appeal process. Regular Medicare is the best insurance. MA is not. Legislation from two House progressive lawmakers wants to change the name of Medicare Advantage (MA) to “alternative private health plan,” because that’s what it is – PRIVATE insurance. It has nothing to do with Medicare and calling it such is deceptive.
Except if after a year or two your Avantage Plan, to stay solvent, doubles or triples its out-of-pocket, and you want to return to a Supplement Plan, you will face underwriting, not a great prospect. Advantage Plans were designed for businesses, not seniors. Stick with your Supp plan, no matter how healthy you are…..now.
I have a Medicare advantage plan. I have Rx coverage with it. One of my prescriptions was a “tier 5” drug which are the most expensive and lower coverage. My most important drug cost $1300 dollars a month. I went almost a year without it. After my second hospital stay they helped me find a program that would help.
I had a supplemental plan when I went on Medicare and spent a couple hundred a month for the plan including part d and didn’t use it so switched the next year to a zero cost advantage plan with lot’s of free perks which includes drugs. I can switch to a supplemental plan anytime in the future if I need it since I live in Massachusetts.
If you can afford it the supolemental plan is the best option. Do the math. Also, freedom to choose and not being dictated to by an insurance company on your health needs. Finally, the perks are pretty cheap if you just look at what is available. Zero premium, perks giveaways is a marketing ploy. Especially when you have paid actors pitching this to you. The sales people selling Advantage plans get higher commisions, too.
Lets be honest, nothing is for free! they can promise extra benefits but they are not free, you are giving up something for something else. It boils down to what is it that you want, like or need. I’m sticking with the old medicare, it is not perfect, and i wish they had better customer service to address grievances, but the communications aspect is broken. I retired from the DOD, got Tricare for life, supposedly 50 years ago I was supposed to get “free medical” for life, well not really, when you turn 65 you are kicked out of the military medical system, you keep pharmacy benefits, if you are close to a base, if not and you mail order you pay a co-pay. VA is the same, cookie cut plan, If you try to get an advantage plan with all the “free” stuff they spit out every time, and really don’t need and will never use, you will regret it. From finding doctors, to getting approvals, to changing plans every year to save a few bucks, it just a nightmare, co-pays will drive you nuts, not to mention dealing with pharmacies and price increases. Remember when generics were affordable? Well now they are not. The medical care system in the US is very unaffordable, most people go without the proper care for the same reason. Don’t want to burst a bubble, but then again, it already burst. Don’t get me started on your politicians, and their lack of motivation on doing what is right for the common folks. They are bought and sold by the same companies that you and I use to “provide” or “not” the medical care we urgently need!
In some of your other articles you use as a reason NOT to get an advantage plan the fact that they are essentially HMOs / PPOs with a network. So what about people who are already in such a plan prior to retirement and like that system? Switching to a supplemental plan could mean having to find new doctors and facilities. For example, I have Kaiser through my employer and really like it. I like the doctors and like the fact that there is no paperwork. If my doctor orders something it’s automatically approved. Kaiser doesn’t offer a supplemental plan option, only advantage. So going with a supplemental plan would actually mean an uncomfortable change for me. I’m probably not the only one in this situation.
The examples of “about $30” for a Part D to enroll, and of “about $125-$150 for MediGap” are way low compared to either my area of maybe just due to my age. My MediGap “G” plan costs $251 a month, and the “better” Part D plans run $20 up to $95 a month or higher. ((Or are those number examples assuming a new person enrolling at age 65?))
I’d like to hear your thoughts on Advantage PPO plans. My husband is healthy right now and we live in Florida so he is on a 5 star rated HMO Advantage plan with no Part B premium. There are also Advantage PPO plans. My thought is that if his health took a turn for the worse and we wanted to see an out of network doctor. We could switch to a PPO plan and still have max out of pocket capped unlike traditional medicare. What do you think?
Have you published a article that goes into detail for the best Medicare choice for Federal Retirees? Question: My present FEHB plan with Kaiser offers a MA plan but I will have to pay my regular $400 monthly premium plus part B $164 monthly premium. They will supplement up to $200 monthly to cover part B.
I am new to Medicare, frustrated and want to NOT be included as married in my income to get what I need and can afford. California is really expensive and I hear from friends that drs are dropping Medicare patients from their practices. How can o make a decision on this when the stories I hear scare me away?
Everybody should be aware that if the HMO doesn’t have a contract with a nursing home you don’t get to go there. Kaiser tells you where you’re going to go you don’t have a choice . They will tell you that all the other beds are full. After being a participant of Kaiser HMO for many many years you’re just sent out to any nursing home that they choose because the other beds are full. this is a bigger problem if the nursing home is many many miles from where you live, your husband or wife, can’t come to see you very often.
Thanks, I’m going to be working in Calf. and on the SEP until I’m 70 and then moving to Florida. Should I do B & N (I’m healthy enough) and switch if I choose after moving to Florida? I’m originally from Florida and a might just need a freezer for protein. I sure hope Florida doesn’t capsize before I get there. Thanks, James.
So as I do the math I come up an average of $125-$150 a month for a supp vs copays and deductibles averaging (which I thought you said) of $4K-$7K. The math on that does add up to me – paying $1.5-$1.8k a year for supps vs not expecting any deductibles or copays for 4-6 years (totals approx $4-$7K) while being 65yrs or older seems like quite the roll of the dice. Doing the math I don’t think I’m missing anything- if I am please let me know.
Marvin, what about State Government employees? I retired from the State of NJ and, I will be enrolling in Medicare within the year. They offer MA and supplement plans. I’ve tried reading their fee charts but, I cannot nail down what it would cost me monthly. I also cannot determine if it’s any cheaper to me to go with one of the States plans or, if I should shop around. Maybe I could call you and you could decipher what the NJ deal is and if it’s comparable. You mention Federal employees and why they should consider a MA, I’m just wondering if that applies to State Government employees. Thanks
He keeps saying “C plan”, but he means “C part”. “C plan” is a supplemental plan which is no longer available similar to an “F plan” or G or N plans. And though he means “C part”, it needs to be said that there is no Part C of Medicare. That’s what the healthcare corporations call it to make you think that you are still in Medicare. However, if you elect to go with “medicare advantage” erroneously called Part C, you are no longer in Medicare. You have joined a healthcare corporation and are no longer covered by Medicare but by the corporation you selected.
I see people being very spiteful on here about the host “being misleading” and directing towards MA, when he had said differently in the past…. what I caught that stood out to me was his comment about “you have a crystal ball and know for a fact you’re never going to get sick, have cancer or any major medical issues, then go ahead and get a MA”….he’s sarcastically telling you right there that if you can afford it, you know what to do and get a Supplemental, because there’s no way any of us will ever be able to predict the future.🤷♀️
Hello Marvin. I am a current client with Medicare School and will be retiring from federal employment at the end of 2024 at the age of 66. I don’t have an HSA and I enrolled in Medicare Part A when I turned 65. I have the opportunity of maintaining my FEHB Medical Plan post retirement BUT I am concerned because it appears that I would need to enroll in a Medicare Advantage (MA) Only plan to cover the gaps that Medicare A and B would not cover. All of the information presented by Medicare School shows that the Advantage Plans would subject me to provider networks and preauthorizations for medical services. While the financial benefits for maintaining my FEHB coverage is substantial, does this outweigh the restrictions of being on an Advantage Plan ? If I want the BEST possible coverage, and paying the premiums for the Supplemental Plan and separate Drug Plan are not an issue, would I be better served by terminating my FEHB coverage and getting a Supplemental Plan to cover the gaps and not be subject to the restrictions under the Advantage Plan ? Or am I missing something or confused about the coverages available under the FEHB MA Only coverage ? Thank you for your time and keep up the great work.
I am not yet of Medicare age. I am both a disabled veteran and retired military. I receive compensation from both. I receive medical care from the VA and through Tri-Care. I use the VA and express scripts for medication depending on what is service connected and what isn’t. What is recommended in my situation in regards to Medicare and the different parts? Please advise. Thank you.
I think there is a 6th reason and I would like your opinion on my particular situation…I am going to retire in 2023 and I will go on Medicare. I won’t have a retiree health plan when I retire. So I have to ‘choose’ between Supplemental Plan and “Plan C”. I am leaning toward the Advantage plan (even though I can afford and have budgeted for Supplemental plans), primarily because we are healthy and we like and are used to the “pay as you go” medical insurance since that’s what we’ve had most of our working careers). However, both my wife and I have underlying medical conditions and I have that “one chance” to get a plan G for example without medical underwriting at the time I retire. Your articles are very clear about that. But lets say that I move from where I’m living now out of State a few years down the road, that is from one State to another. Won’t I be able to switch to a supplemental plan if I choose in the new State without medical underwriting. To me and for us, this is the most important thing. I do not necessarily want to pay for what I consider “premium insurance” of the supplemental plans out of the retirement gate. We are young and healthy except for the underlying conditions. But I thought I had only one chance. Upon moving out of State however, I will have a ‘second chance’ will I not? Without the need for medical underwriting? and that’s because my Advantage plan will no longer cover me in my new State. Please advise. I have been told this by other Medicare Insurance brokers, but I would like to hear it from you.
Love the way you snuck in “Now you might have to be on it permanently because you will have to be medically approved to change, but….” Wow! Oh, yeah, also…. Your Medicare Advantage doctor may not agree with your insurance provider’s decision to approve a less expensive treatment before paying for a more expensive one that your doctor may recommend. Providers in Medicare Advantage networks may also have to take time away from patients to spend it on pre-authorization paperwork. Another wow! Insurance providers making medical decisions! Great idea!!!! 🙄
I’m SO frigging confused. The more I listen to these people, the more my head spins. I’ve been satisfied for years with original Medicare and a secondary drug plan as a retiree. Now the ex-employer has shot me over to a MA plan and discontinued the other arrangement. The plan sounds great IF they stick to what they say. But they also come right out and say they can change whatever they want at any time. My income’s pretty low. First I decide to go with the MA, then somebody on here tells the MA horror stories. But I doubt I can pass the underwriting for a Supplement plan at my age. For a while I had forgotten how much I hated that company.
I love how everyone not on Medicare thinks Medicare is free to the elderly. It’s not, and it’s a terrible plan that had to be made mandatory because nobody would choose it if it was an option, just like Social Security. My wife and I have TriCare plus a dental and vision plan ($100/month total). When I turn 65 I am forced to pay for Medicare Part B in order to maintain TriCare, which is not free. By the time my wife and I are both on Medicare (another 5 years), our costs will be the same as what I was paying each month for my FEHB Aetna plan which covered everything including dental and vision. This is nuts. The Govt does this on purpose so the average person won’t realize how badly he/she is being robbed. I personally can use the VA for 100% of everything and pay $0/month and $0 for Rx. My wife would still require health insurance and therefore the TriCare plan etc is a must have.
If I were you Marvin I would review this article you made very carefully. Look at the article from the perspective of a person trying to live on SS pension and you will see you are enticing a lot of poor people to gamble on an Advantage Plan then die sooner because they will not go to the doctor on time.
What he is saying is that there ARE circumstances where you don’t need the supp. If you are in the military you prob already know about TriCare & the other one. If you are a Fed or State or another union plan you pretty much are covered. My mom is retired State employee and has Medicare coverage thru that. Of course she retired 30 years ago. I have a friend whose mom was a state employee in a diff state with the same situation. He is not telling us G is not good just that in certain instances you don’t need any supp. Most of us do not have these circumstances so please don’t get upset. People put down civil service jobs and unions but they are blessings for retirement.
People need to remember with Advantage plan the max out of pocket can be SEVERAL thousand dollars that must be reached EVERY year. If one has cancer or a complex illness or you choose to use an out of network provider this can be devastating. Also, finding oncologists in some areas of the US that are in some of these networks is near impossible so treatment may be out of network. There are no max out of pocket for out of network services.
I have heard that negotiating for lower prescription with result in people on Medicare not being provided with the latest and new drugs such as those for Alzheimer’s. Whether or not this is 100 accurate or not, it does bring up a concern. Is one better than the other (Supplement or a Advantage program) when it comes to availability of medications? I have to re-watch but I thought something was mentioned about there being a difference between the two options for procedures/surgeries. Thank you.
BUT one thing you dont mention is the downsides of Medicare Adv. This is not a one size fits all like you make it sound. You only state one side of a bias and attempt to create a bias confirmation. An honest approach is a complete matrix of both pros/ cons and thete are many cons in medicareAdvap. Its not just about frills/cash.
My spouse has traditional. I chose a Humana advantage. She has serious medical issues. I (knock on wood) do not. We flat out cannot afford both of us on traditional. It would be in the range of 7 to $800 per month. Yeah no. Of COURSE ideally I would like traditional. Not an option for me. So we pay for her. My plan is zero premium, and gives me $125 toward part B. Best I can do for myself. Better than nothing.
Yes sir are there anyway I can get you to respond to my sister she’s just now downloaded your YouTube articles I have to get her email but she needs some help about her social security disability and SSI and some other questions you wanted to ask you if anyone possible this is the first time I’ve ever done this so I exactly sure how it works I’m going to give her your YouTube website and maybe you can help her thank you sir
Your articles are incredibly informative and have helped to clarify my Medicare options. I turned 65 in August and I just signed up for traditional Medicare A & B, which won’t take effect until February 1st as I’m in the last month of my initial enrollment period. I currently have health coverage through my employer until Medicare kicks in and I’ve just started looking at supplemental plans. One thing I’m still confused about: Are G plans the same as 1A plans? I’ve spoken to one insurer so far and when I asked if the plan we were discussing was a G plan, the rep didn’t know what I was talking about. He did say it was a 1A plan. Can you explain 1A plans vs. G plans or are they the same? Thank you.
My brother center apply to you for me so I’m trying to get in touch with you myself about the social security disability and SSI I’m 62 years old I’ve been getting social security disability for about 5 years now and I went to my bank yesterday and they had cut my check my $400 dollars. Please reply to me so I can talk to you about this and there’s more things I need to tell you
This guy is a crook. What he does not say is that the advantage plans DO NOT COVER as well as your regular medicare will. Insurance companies play games not to cover treatments if you get very sick. Regular medicare covers you. Advantage plans try to get out of covering you or stalling on treatments. The real reason for an advantage plan is to make money for the agent selling it and the insurance companies. Stay away from advantage plans. They are designed to make money for insurance companies. Not to take care of your health. Keep your regular medicare at all costs. Advantage plans are junk!
I don’t want that supplement plan no thanks at this time I just want my original back and the insurance making it hard to leave o sign up on the 27 of March I ask to desenroll and cancel application on March 28 and they still process that application and lied say they did but didn’t they still sent it to medicare office how can get them do right thing and plus my agent told me I didn’t have to change my Doctor’s or miss my upcoming appointment which wasn’t true 😢 😕 I miss my upcoming appointment cause of this plan and they don’t expect it 😢 he said they do help me get back anyone please i can’t see my Doctor’s or get my prescription due to he change my prescription drug plan without my permission even after I told him don’t switch my part d come to find he submitted application for it 😢now i don’t have my part A or B to use or D because of this Medicare advantage plans
About to start Medicare in December, and there’s no way I’d do Advantage. I’m finally escaping from provider network hell, and “Advantage” would put me right back into it. As well, the notion that you’re going to stay healthy all the way till you croak is a fantasy. And if you don’t get a supplement plan at initial enrollment, you may not be able to get one later. I despise the way Medicare is set up, with all these traps for the unwary. It’s outrageous.
Advantage Plans is the privatization of Medicare. I learned when my 90 year old mother had to go to a rehab center. Advantage plans she would have been out in two weeks as told by by the administrator. With regular Medicare and her supplement plan allowed her to stay 100 days. I will never go on an advantage plan. I go to any doctor or specialist without a referral.