Medicare expert, Toni King explains the difference between Medicare Supplements and Medicare Advantage PPO plans.
With a Medicare Supplement, there is no network of any kind. You have the freedom to use any healthcare provider or facility that will bill Medicare. The Medicare Supplement will pay what your Medicare Parts A and B will not.
With a Medicare Advantage PPO Plan, there are lower-cost in-network providers or facilities as well as out-of-network benefits that will cost you more. In 2022, a popular Medicare Advantage PPO Plan has a maximum ranging from $5,400 to $7,550 in-network, while out-of-network costs range from $7,550 to $11,300.
Most never consider they could have an out-of-network provider or facility for their medical claim, but in these current times, many healthcare providers and facilities are out of network with a Medicare Advantage PPO Plan.
Let’s take a look at the key differences between the two plans!
View Episode Transcript
*The following is the output of transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors.
Life can be confusing, making good decisions even harder. Now there’s one place you can visit for the resources that you need to make the best decisions based on your life circumstances. It’s senior resource dot com. It’s a well-organized website that offers information that seniors really need. Toni’s book, the Medicare Survival Guide Advanced, is available there, and so are all of Toni’s podcast so mark it down senior resource dot com and book market because you’re gonna want to visit regularly. It’s senior resource dot com where you can order Toni’s book, listen to Toni’s podcast, and learn so much more about things like independent living, long-term care planning, financial planning, the best cities for retirement living, social security, and of course Medicare. The terms and conditions of Medicare change annually, so stay on top with the information that you need to have so that you can have the very best Medicare coverage and the very best that Medicare can provide. Toni’s Medicare moments podcasts are there to inform and guide you along the way. Don’t miss an episode. Visit Senior Resource Dot com today and be sure to tell your friends about this great website. Toni, welcome to our podcast. Well, thank you, Jim, and I need to let everybody know my name is not just Toni King. I am now called Miss Medicare. Did you like that? Because I am on Medicare, I am in the middle of it, and I just want to thank everybody for listening to today’s Medicare moments podcast. I took the Medicare and new handbook and put it in people terms. Medicare survival guide advanced edition helps people to personalize their Medicare. Today, we’re going to talk about something that just really confuses a lot of people. You know, there’s over sixty million people on Medicare right now and ten thousand turning sixty five every day. Can you believe that? Jam Ten a thousand. So today we’re gonna talk about the difference in a Medicare supplement versus a Medicare Advantage PPO plan. You know, are they the same? A lot of people think they are, so we’re going to discuss it. It’s important to know because, with Medicare, it’s what you don’t know that will hurt you. So let’s get started. Well, Tony, today we have a question from Stephen, who happens to be in the Sugarland, Texas area, which is near and dear to your heart, I know, and he writes, Dear Toni, what is the difference between a Medicare supplement and a Medicare advantage PPO plan. I’m turning sixty and I’m bombarded with marketing material and we can all relate to that because the mailbox just stuffs itself around this time. At this age, friends have told me that a Medicare Advantage PPO plan is the same as a medicare supplement because both have a network of doctors. To us from my retiree employer, medical plan now has a Medicare Advantage PPO plan, and I’m concerned if a medical catastrophic incident happens, will the medical providers I am now seeing accept this Medicare Advantage PPO plan. Thanks for taking time to answer this, Stephen from Sugarland, Texas, Toni, and that amazing because Steve and I just need to let you know what’s going on. Everyone talks to their friends. Everybody wants to give people opinions on Medicare, and this can lead you to choosing the wrong type of Medicare plan. For your medical situation. You know, Medicare supplements and Medicare Advantage plans are totally different types of Medicare policies. Did you know that, Jim well, I do so, Toni. We’re talking about a PPO plan. So that’s why, a preferred provider organization, that’s it. That’s it. It’s your preferred providers, providers that are the top of the line for you. And that’s what it is. It is a PPO plan, a preferred provider organization. With the Medicare supplement, there is not a network of any kind. That’s what people don’t understand. It’s the hardest thing to understand. There is not a provider network to have to deal with. So I underline the words supplement here because that sounds like a lot of freedom in my book. If it doesn’t have a network, that’s right. With the Medicare supplement, you’re gonna pay your out-of-pocket whatever medicare part a and part be will not pay with a Medicare Advantage PPO plan. And it’s not an HMO. We’re talking about the PPO plan. People think it’s the same because you can go to as many doctors as you want to well, there’s lower costs with it when you are in network, your providers and facilities, they’re in network, but then there’s also out of network benefits and out of network costs that can cost you more. In two, a popular Medicare Advantage plan has a maximum range. Look at this. This is all over the place. It goes from fifty hundred dollars for one plan to seventy-five hundred and fifty dollars for another plan for in-network PPO plans, while out-of-network costs range from seventy-five hundred to eleven thousand, three hundred dollars. So if you’re here in the Houston area, which is where I’m at, and that’s where Stephen is in, and you’re going to MD Anderson, they are always out of network, so your costs will be eleven thousand, three hundred dollars. So most people think that in network is less, and it is, but it’s still a lot of money. Even in that range that you quoted from dollars to almost seventy-six hundred dollars in network, then out-of-network kick is up over eleven thousand dollars. So you really have to be careful about what you’re choosing or what you think you have that you may not have. That’s correct. And you’re out of pocket with a Medicare supplement when you’re going with like a plan G. that’s one of the top of the line for the Medicare supplement. It’s your part be deductible. And for this year, your out-of-pocket is two hundred thirty-three dollars. That’s it. That’s my out-of-pocket two D thirty-three dollars, and I think that’s yours. I do not have a network. I can go to any hospital or doctor. Anyone auto medicare supplement can visit a hospital or doctor, and there does not have to be a network. They’re just accepting Medicare. So let’s just discuss some of the differences in the two plans. What do you think, Jim, let’s take a break and we’ll be right back and we’ll discuss that right after this. Okay, welcome back, Toni. We are getting ready to take a look at the different plans and Medicare supplement and Medicare Advantage. Let’s go there. Okay, well, let’s talk about a Medicare supplement. A Medicare supplement works directly with the original Medicare. Medicare pays its share of the Medicare-approved amount. You always want to make sure that you’re going with a doctor that will build Medicare that’s Medicare-approved amount for medically necessary services that are covered by the healthcare cost, your Medicare supplement will pay its share. With a Medicare supplement you choose, you don’t have to worry about it. You just pick up the phone and go to a doctor, a hospital, a home health agency, skilled nursing facility, whatever you need to use for your medical healthcare that accepts out a care assignment for your healthcare. You and your healthcare providers are in control of your healthcare. You’re in control of your healthcare. If you don’t like what that doctor is doing, you can change and go to another one, but you have to make sure they accept Medicare. Correct. That’s the baseline. And when you’re in a nursing home, you get to pick which nursing home you want to go to. If you don’t like the one you’re in, you can go to another one that is accepting Medicare. Here’s a downside to a medicare supplement. The monthly premium goes up each year, you’ll have a write increase. You generally have a write increase every year, but the rate increase is really not that great when you consider what the out-of-pocket could be on the other side. Correct, but some people get surprised when they get a little you know, three, five percent, ten percent, right increase. You need to get a prescription drug plan. It does not have prescription drugs, so it’s not included. So you’ll want to enroll in a set break what they call stand-alone Medicare part D prescription drug plan, okay, which is really important because you need that and most folks take prescription drugs right and good. Our X is not considered a medicare part D plan, so people need to realize that you can get a penalty for part d a later enrollment time. And right now we are fixing to start. The Medicare annual enrollment starts in October through December seven, and that is for changing your Medicare part d plan and for changing your Medicare advantage plan. You can change your Medicare supplement any day of the week. So I just want to let people know if they have a Medicare part d plan and they want to look for something that might be a little less expensive. That would be the time, all right, during that annual enrollment period. Correct. So now let’s talk about a Medicare Advantage PPO plan and to qualify, you must live in the area. You have to have medicare part a and B. Like I said, you have to live in your area, that area, your Zip Code area for at least six months out of the year. So if you move somewhere else for another six months, and you’ve got to change your advantage plan. So it’s ZIP code righted. And that comes into play a lot of times when people in the north like to go to Florida for six months out of the year and then back up to Minnesota for another six months out of the year. So is that where that would be an issue. Correct, so they have to adjust and plan accordingly. Correct. And you want to make sure that you talk to your doctor and make sure that your doctors are accepting that Medicare PPO plan the one that you’re choosing and choosing a Medicare Advantage plan. Medicare pays the insurance company, so whatever plan you pick, Medicare is paying that insurance company a certain amount of money each month for your care. You don’t use your Medicare card. You use that Insurance Company’s Card, whichever company you choose. And you need to keep your medicare part a and part B it must always remain in effect. You’re not using your Medicare card, this is important. Correct, you’re using the insurance company card. Correct. So when you go to a hospital or wherever, that’s what you evidence as your coverage. Correct, that’s what you have to use. And if you do take your Medicare card and you try to get Medicare to the claim, they’re going to deny the claim because you chose a medicare part c plan, which is the Medicare Advantage PPO plan, and Medicare want’s that company to pay for the claim. You still have a Medicare card and you have the Medicare advantage card. Correct. The onus is on you to evidence the right form of insurance. Well, you just need to show your insurance car insurance card. Right. They always ask you to put your Medicare card away so you don’t use it. That’s important. That very important, and that’s generally what the insurance companies are are an agent that comes out and talks with you will tell you put your card away because you will not be using your Medicare red white and Blue Card when you go to the doctor or the hospital or you visit your pharmacy. Like we said, you must always use your Medicare advantage card insurance card, not your red, white and Blue Card. You know, you’ve got to stick specifically to the medical providers that are still accepting that advantage plan, that M A P D plan. You want to make sure that they’re accepting it. If they’re out of network, then you’re gonna pay a higher amount. And then with the Medicare advantage plan, they must provide all of your medicare part a and B benefits, so they have to give you what’s in Medicare part a medicare part B. It can’t give you an extra health benefits. And some of the Medicare advantage plans will have prescription drugs. Some of them want you to go ahead and get stand alone prescription drug plan. They do give extra perks such as Jim membership, dental vision, et Cetera. So we hope that helps, and we hope that that kind of explains the big difference and that the right decision can be made so that you’re enrolled in the proper plan that fits your lifestyle, fits your needs, and that helps you along the way to get the best medical care that you that’s right. The best thing you should do is go and talk to your doctor. And when you and I sat down and we did a consultation together, that’s what I told you. Correct. That’s correct, and it works kind of both ways. Sometimes the doctor will take time to talk to you about that, or sometimes they have a department or of a specialist in their practice. Let’s say go over here and just sit down and talk with that person and ask away, ask all the questions that you need to find out the right answers for because what you want is what is very best for you, and they can give you that information. And we always want everyone if you have questions, you know, we have all the articles at senior resource dot com and where are the podcast the podcast to are at senior resource dot com. And that’s the place where we would like our folks to visit and in fact tell your friends because as Tony said earlier in the podcast, ten thousand people a day are turning sixty five years old. You are listening to this podcast. You probably know someone who may be having a birthday within the next year, turning sixty five years old. Senior Resource Dot com is where you would like them to go because they can hear Tony’s podcast Medicare moments. There they can order Toni’s book, the Medicare Survival Guide advanced edition. It’s right there. All you have to do is click on it and you can order the book and it can come in a couple of ways. It can be the e book or it can be the printed book, and we’d like you to do that and you can find out so much more from the articles that Toni writes. Toni has written hundreds of articles over the years and they’re really really filled with a lot of useful information. You can print it. It can be right there for you to have a reference and don’t get second-hand information, get the information that you really need to know direct from Toni because she’s the expert in this and she’s there to help you through it. So thank you for listening to our podcast today, Toni. Well, thank you for being here. Jim, and we just want to say thank you all for listening to the Medicare moments podcast. If you still have questions and you want to personalize your Medicare. Don’t hesitate to call us, don’t hesitate to contact us. visit us by email. My email is [email protected], or like Jim said, you can visit senior resource dot com and that is where all the articles, the books, everything on Medicare, everything on long term care, all the senior and boomer issues. We’ve got a lot of boomers and we just want to say, have a great day. God bless you, and God bless America.
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What You Don’t Know Will Hurt You!
Turning 65 in America is a milestone and one of the markers is enrolling in Medicare. But the system is so complicated, and there is a lot of false information out there.
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