Chris Prang, Medicare Insurance Broker

Answer: First, one has to define “better”. What is “better”?

• No networks.

• Less prior authorizations.

• More financial protection if something serious happens.

• Standardized...A Plan G is a Plan G no matter where you live. They don’t change from year-to-year.

After that, the main reasons why more people don’t choose them are as follows:

1. The 800# TV ads from the corrupt, publicly traded e-brokers. The ads and agents that represent these companies do not give full disclosure about ALL the options and pros and cons of each option that a Medicare beneficiary has. Unfortunately many people that have enrolled into Medicare Advantage over the last 5 years or so have little to no clue what they have and the pros and cons that go along with it.

2. Almost 20% of Medicare beneficiaries also receive Medicaid, therefore they have no need for a Medicare Supplement.

3. Many people can’t afford the escalating premiums. For those that can’t, they need to seriously consider a High-Deductible Plan G. It is “The Best Alternative To Medicare Advantage.”

4. Then you have a large percentage of Medicare beneficiaries that have group retiree coverage in place of or in addition to their regular Medicare. These would include those who have retired from federal, state, and local government, as well as those in the military that have Tricare for Life.

5. Lastly, there are people that have truly weighed their options and prefer Medicare Advantage over a Medicare Supplement because of the $0 to low premiums and the extra benefits (dental, vision, etc.). And they are willing to deal with copays, networks, and annual changes. From my experience and research, the vast majority of people that have a Medicare Advantage plan are satisfied to very satisfied with their plans.

So, “better" depends on each Medicare beneficiary's specific needs, philosophy, and budget.

I hope that helps.

Regards,

Chris

Answer: There are numerous things that I would change. But if I had to start with one, it would be replacing the existing Medicare Supplement options with Medicare Supplements that are based on unchanging annual deductible amounts that apply/go towards both Part A and Part B.

Presently, depending on age, there are 10-12 Medicare Supplements to choose from. But there are really only two that people pick from...the Plan G and the Plan N. And a very small percentage pick the High-Deductible G. So it's clear, Medicare doesn't need 10-12 options.

The deductible options would be something like $500, $1,000, $1,500, $2,000. These deductible amounts would never change each year like the Part A and Part B deductibles do and like the High-Deductible G does as well.

This would be much simpler and easier to understand.

Answer: Here are some demographic challenges that Medicare will face in the coming years.

1. Large influx of Baby Boomers still entering Medicare. Baby Boomers will live on average 4.2 years longer than previous generations after turning 65. This demographic shift will put pressure on not only Medicare to fund and cover their care, it will also put pressure on providers being able to meet the demand to care for a large, aging population.

2. Retirees moving from one state to another could also pose a demographic challenge for Medicare. An estimated 10-20% of retirees eventually move to another state…and most of them move to the Southeast (Florida, Georgia, South Carolina, North Carolina, and Tennessee). These states will have to deal with an influx of an aging population that will need healthcare and long-term care services. Therefore, Medicare may have to up the ante for these states and provide more funding to cover the care of Medicare beneficiaries.

3. More and more people have chronic conditions. The number of people with chronic conditions continues to increase with no stopping in sight. Get this…85% of those 65+ have at least one chronic condition, and around 60% have two or more. If the government and the citizens of the US were more proactive in taking care of their health, then this country could save not just billions of dollars, but trillions of dollars. Realize, almost all chronic conditions are avoidable and most of them are curable. And despite the flack some people give about RFK Jr. and Dr. Oz…at least they might try to do something about the epidemic of poor health in this country. There really is no excuse for it. Certainly no other administration, regardless of political party has done much to truly improve the overall healthcare of the citizens and the overall healthcare system.

Those I would say might be the top three demographic challenges Medicare will face in the coming years.

Answer: What kind of plan did you pick? A Medicare Supplement or Medicare Advantage?

I'm guessing a Medicare Advantage plan. But you've provided too little information about the plan type and your needs for anyone to truly advise you well.

Regards,

Chris

Answer: If the company you works for has 20 or more employees, you generally do not need to sign up for Medicare Part B. Odds are, your Medicare Part A will start by default the month you turn 65 (unless your birthdate is the first of the month, then it starts the previous month).

If the company you work for has less than 20 employees, and they require you take Medicare Part B, then generally you should drop the employer coverage and go with full Medicare plus either a Medicare Supplement and Part D drug plan or a Medicare Advantage plan.

What you should do is compare the costs and benefits from your employer coverage to what you can get with full Medicare plus a Medicare Supplement and Part D drug plan, or a Medicare Advantage Plan. Many times full Medicare coverage is less expensive than employer coverage and offers better coverage. But sometimes it's not.

I hope that helps.

Answer: I've never known a bankruptcy to affect the possibility of getting coverage. Certainly it doesn't affect Original Medicare. And I've never seen on an application for a Medicare Supplement, Medicare Advantage, or Part D drug plan, any question related to bankruptcy, owing money, collections, and/or party to a lawsuit.

The only possible way I see is if you defrauded Medicare or an insurance company.

I hope that helps.

Answer: Not likely.

You would need your HMO to be a true POS (Point Of Service) HMO that allows you to see out-of-network providers and still have some coverage.

Or, if your HMO doesn't happen to have a cardiologist in the network, then you might be able to get an exception to see an out-of-network one and be covered. This would take a prior approval/authorization from the HMO company.

Or, if your PCP recommends/refers a cardiologist that is out-of-network, and they are willing to go to bat for you and get the insurance company to get that cardiologist approved.

I hope that helps.

Regards,

Chris (The Medicare Analyst)

Answer: I don't know if I would call it a trick, but it is something that occurs both probably intentionally and unintentionally. And that is "Ghost Networks." A Ghost Network will either have doctors listed as being In-Network, but aren't (this could just be a simple error on the insurance companies provider search, due to it not being updated), or they just aren't accepting new patients.

From my experience, the more common thing that happens is, you search to see if a provider is in the plans network and they don't show up, so you presume they aren't in the network. You may even call Customer Service and ask them, and they search and don't see the provider. But lo and behold, they actually are. But the only way you find out is through the insurance companies provider relations department...which may be hard for a consumer to reach. But I do this all to often to find out, and in most cases a doctor that is not listed or "printing" as they say, is actually in the network.

If you have any doubt, the providers billing department should or better be able to answer the question correctly whether they are in the network with the particular plan you are interested in. Which brings up another point...a provider may not be in all of the insurance companies plans networks, so be sure to check your specific plan.

I hope that helps.

Have a GREAT day!

Chris Prang | The Medicare Analyst

Answer: It really depends on the rural area you are moving to and/or how rural it is. Some rural areas have a good selection of plans, but others do not.

This link from the Kaiser Family Foundation shows a map how the number of plans that are available for each county: https://www.kff.org/medicare/issue-brief/medicare-advantage-2025-spotlight-a-first-look-at-plan-offerings/

I hope that helps.

Chris

Answer: A: They don't know better.

B: They think it will cover them better.

That's why you need to check your Part D plan each year during the Annual Election Period and go with the one or one of the ones with the "lowest overall cost."

I hope that helps.

Chris

Answer: 1. If you are in a birthday rule state, then shop your rate every few years and make a change if the savings is sufficient enough.

2. If you can medically qualify, and you have a Plan F or Plan G, consider switching to a Plan N. The premium increases are typically less on a Plan N, so over time you will save more and more.

3. If you are really healthy and/or live in New York, then seriously consider a High-Deductible Plan G. "Medicare's Best Kept Secret" as I like to say.

4. If you live in an area/state that has high premiums, consider moving to a state that doesn't. You wouldn't even need to change your plan or company. When you move, they should adjust your rate to your new location.

I hope that helps.

Chris

Answer: The 3-day hospital stay to have skilled nursing covered by Medicare and your Medicare Supplement. If you have Medicare Advantage, there's no 3-day rule thankfully.

The silly marketing rules for agents...like the Scope of Appointment and call recorded line. Both are childish and don't stop the bad agents. They only make it harder and less efficient for the good agents and Medicare beneficiaries.

I hope that helps.

Chris

Answer: My initial response is to tell them their extremely misinformed and naïve, but that won’t get you anywhere with them.

First, what is right or works well for one person does not mean it’s going to work well for another person. Medicare Advantage does truly work well for many people, but certainly not all.

There’s no such thing as truly “free” Medicare Advantage plan. You can get pretty close if you have a good Part B giveback, and a low MOOP (max out-of-pocket), but that’s a small percentage of MA plans. You can also be close to “free” if you have Medicaid and Medicaid is paying the deductibles, copays, and coinsurance.

So, ask them what their MOOP is? The MOOP is their Financial Risk Exposure...the most that they will have to pay out of their own pocket in a calendar year. The average MA plan has a MOOP of around $5,400 per year.

Let’s suppose you have a Medicare Supplement Plan G, and you are paying $200 per month for it or $2,400 per year. Add in your Part B deductible of $257 and say a Part D drug plan for $25 per month or $300 per year, and now you have a grand total of $2,957 out-of-pocket for the year. So your Financial Risk Exposure is $2,957 for the year and theirs is $5,400...$2,443 less than theirs.

Now ask him which of you is closer to being “free.”

Next, ask them if they are “free” to see any provider of their choosing. Odds are, they can’t...unless they have a Passive PPO...and there’s not that many of those around. Then let them know with your Medicare Supplement you are “free” to choose any provider that takes Medicare Assignment...which is 95-98% of them.

And lastly, ask them if they are “free” to have any Medicare approved procedure. If they don’t know, then inform them, that they are not “free” to have any Medicare approved procedure and could be subject to Prior Approvals and benefit denials at a far greater rate than Original Medicare and your Medicare Supplement.

That’s what I would tell them or ask them.

Regards,

Chris Prang

Answer: Option 1: Original Medicare + Medicare Supplement (just don't get a "Select" supplement) + Part D drug plan.

Option 2: Medicare Advantage PPO with a Passive Network. That means you can use it in or out-of-network for the same copays.

Option 3: Medicare Advantage PPO from one of the large, nationwide MA companies...like Humana, UHC, Aetna. Humana works very well in Florida.

Option 4: Medicare Advantage HMO or PPO that allows you to travel and use the companies network providers in other areas. You can do this with most Medicare Advantage plans. And ideally from one of the large, nationwide MA companies.

I hope that helps.