There are countless people who have chosen to go with a Medicare Advantage plan over a Medicare Supplement. Folks enrolled into Medicare Advantage products are enamored by the low monthly premiums (sometimes $0/Month), and the modest co-pays for doctors, specialists, lab and testing, and many other services.

What could go wrong with such a plan?

Let me highlight a few medical events that I perpetually bring to people’s attention when considering an enrollment into a Medicare Advantage plan. As a consumer you’ll easily understand the good to great news, but the bad news needs to be understood as well! Three areas in particular should be noted:

1. Hospital stays
2. Skilled nursing facility stays
3. Chemotherapy drugs and other Part B drugs.

First understand that not all Advantage plans are created equal as co-pays will vary from plan to plan. Take the hospital stay, for example. A common out of pocket will be $250-350 per night co-pay for days 5 thru 7. Keeping the math easy, let’s say the hospital stay co-pays tally up to $1700 for a week in the hospital. Let’s also assume you have a hospital stay in February for your back, and another stay in October for you heart. That’s two stays, totaling $3400 in this example. Here’s my question to my clients: Do you want to pay these co-pays, or would you like an insurance carrier to pay this for you? If you want the insurance to cover the $3400 you should consider a hospital indemnity plan.

The same can be said for number “2” above, a skilled nursing facility stay, particularly with an event that keeps you there longer than 20 days. I say 20 days because at this point you will have per day co-pays under many plans. For example, one plan in Maine will have you pay $160 per day for days 21-57. Do the math on that stay. You would have a co-pay bill over $5000. Now, the same question as the hospital stay is before you: Do you want to pay these co-pays yourself, or would you like an insurance carrier to pay this for you? If you want the insurance to cover the $5000 of skilled nursing care you should consider a hospital indemnity plan.

Lastly, there is number “3”. Under Medicare Advantage plans you will pay 20% for outpatient care (which includes Chemo drugs and other Part B drugs) until you hit the “maximum out of pocket,” which for many plans is between $5-7000 per year . If you’re diagnosed with cancer, are you comfortable paying the maximum out of pocket of the plan you chose, or would you like an insurance carrier to pay this for you? Many people are not comfortable with this type of expense, especially if the treatment goes from one year into the next – You could hit the max out of pocket twice!

So, Blue Goose is a huge advocate for Medicare Advantage plans. We enroll people into them each and every week, but you need to understand all aspects of the plan, not just the great news.
If you’re concerned about these larger types of co-pays, please ask how we can potentially eliminate them and give you peace of mind through a hospital indemnity plan. Premiums are considerably lower than traditional Medicare Supplement plans, and for most part premiums will have not change year to year for consumers.

Just ask, we’ll be happy to quote you right over the phone.