In this solo video, Matt Koppin provides a comprehensive overview of the U.S. Medicare system, detailing the four parts (A‑hospital insurance, B‑medical insurance, C‑Medicare Advantage, D‑prescription drugs) and their coverage. He explains how Medicare can be kept as the primary payer, allowing beneficiaries to use any provider and typically pairing it with a Medigap supplement—specifically highlighting Plan G as the most comprehensive option for covering hospital and other costs. Koppin contrasts this with Medicare Advantage (Part C), where a private insurer becomes the primary payer, imposing network restrictions, often offering zero‑premium plans with added vision/dental benefits, but exposing beneficiaries to higher out‑of‑pocket maximums (≈$5k‑$15k) and prior‑authorization hurdles, especially for chronic conditions. He discusses cost factors such as the 2023 Part B premium ($164.90/month), variation in supplement premiums by zip code, and the trade‑offs between paying a regular supplement premium versus potential high out‑of‑pocket expenses under Advantage. Throughout, he advises that individuals with chronic health issues or who anticipate extensive medical use should consider keeping Medicare primary with a Plan G supplement, while healthier beneficiaries might find Advantage suitable. The video ends with a contact number (706‑779‑5038) for personalized assistance.
Chapters
Hey, Matt Koppin here talking Medicare insurance today. Did you know that Medicare has 4 parts to it? Yes, they have a Part A and Part B, Part C and Part D. Of course, on your red, white, and blue Medicare card, they do have the Part A and Part B listed for on your Medicare card. And of course, the Part A has to do with your hospital insurance, and it's an entitlement program normally. Free through the government. If you worked and paid taxes and paid through the Medicare tax system, then, then you're entitled to Medicare Part A. Part B is your medical insurance and it pays your doctor bills and all your outpatient. And of course, Part B is not an entitlement program. The government does charge a premium for that, and this year for 2023, the premium is $164.90 a month. Which either you pay it monthly or quarterly, or you pay it monthly on a Social Security deduction from your Social Security check. And then there's also Part C and Part D. And Part C is what they call Medicare Advantage today. It's been around since 1997, and that was back when it was called Medicare Plus One. And in 2003, 20 years ago, President Bush changed it from Medicare Plus One to Medicare Advantage. And so it's done a lot of changing over the years. 2 years after that, Congress passed and enacted the Medicare Part D for the prescription drugs. And so in 2006, we started enrolling people on Medicare drug plans. And so there are different ways to have your Medicare benefits paid when you become new to Medicare, or if you're current Medicare beneficiary, this is some information for you to know. That the primary way to have your Medicare benefits paid in the traditional way is to keep Medicare primary. So when you keep Medicare primary, that means all the claims from the doctors and hospitals, emergency rooms will go directly to Medicare. So the providers will file with Medicare. And when you have Medicare Primary, there's no network. You can go to any doctor, any hospital in the United States, and you don't have to worry about precertifications or prior authorizations or anything. You just make appointments and go because you have that freedom knowing that you don't have a network and they're going to file with Medicare. So when you do have Medicare Primary, then folks will usually take out a supplement insurance to help pay the Medicare deductibles and coinsurance. Because those amounts and numbers keep increasing every year to where Medicare increases their deductibles and their coinsurance that you have to pay. And so the government has a guideline that they use throughout all 50 states, including Puerto Rico, that people can purchase a Medicare supplement when you're a Medicare beneficiary. And They have, uh, these plans available. It's a guideline. It's available throughout the whole country, and they're, they're different plans. They have A, B, C, D, they got G, and they got K, L, M, and N. Um, and so all these plans are the same with each company because this guideline is the same throughout the whole country. So like one of the plans on here that you can purchase is Plan G. Well, Plan G is actually the same no matter where you live. I have customers in Georgia, South Carolina, North Carolina, and Florida, and Plan G is Plan G, just like Plan N or, or Plan B or, or Plan C. You know, they're all the, the same if it's the same plan letter throughout the whole country. And that is the best benefits you can purchase when you keep Medicare primary and get a regular Medicare supplement. Because Plan G is going to pay 100% of your hospital bills. You're not going to have to worry about anything if you have any type of confinement benefit with your health. And so Plan G is always the best way to go, especially when you have some chronic health conditions and you may be turning 65 and going on Medicare for the first time. I would probably recommend supplement and keeping Medicare primary and getting a Medicare Supplement Plan G. Now all these different companies have these different rates for Plan G, just like the other supplement plans you can purchase, but we always try to look at which company's got the lowest rate. So we look at your zip code and where you live, and that tells us a lot about which company might have the best rates for you. Even though, you know, somebody in South Carolina's got a Plan G and somebody over here in Georgia's got a Plan G, you know, it's going to be the same benefits, same coverage, but it's not the same premium because it goes by your resident address and where you live that determines which company has the lowest rate. Now, there's also other ways to have your Medicare benefits paid. And another way is to privatize your Medicare to an insurance company. So when you do that, the insurance company becomes primary and they have a network of hospitals and doctors. Now when you privatize your Medicare to an insurance company, that's what Medicare Part C is all about. That's Medicare Advantage. And of course there's always a lot of solicitations about Medicare Part C and Medicare Advantage plans. Because each one of those are different. One company could have 5 or 6 different Advantage products, and that's just with one company. But we have 4 companies here that, uh, in this area that have Medicare Advantage and have been active in it for several years. And each company though has several different plans even in the same county in which you reside. But one thing about Medicare Advantage is sometimes We have people that have relatives that live in neighboring counties that can't get the same plan that you can get in the county in which you live in because they all go by counties, where supplements are, are statewide, nationwide. They actually go by zip code. Uh, on Medicare Advantage, they do have networks, so you have to go to certain doctors, certain hospitals, and if you go out of network, you pay more out of pocket. Most Advantage plans are zero premium plans. That means the government pays most of the premium. So these plans are designed, approved, and developed by CMS. CMS is the Center for Medicare and Medicaid Services, and they are the government agency that approves these plans. So anyway, when you have these type of plans, a lot of times you can get some of the perks that come with it, with vision, dental, and the prescription drug on Medicare Part D will also come with them. And it's just a matter of knowing what your copays are going to be, whether your doctor's in network, or if you have a specialist or more than one doctor. Sometimes it's hard to find all of them that's in the same network with the same plan. The thing is about Medicare Advantage products is, you know, I always tell folks they work fine if you don't have a lot going on with your health. 'Cause if you just go to the doctor a few times a year and you're not hardly paying no copays, then everything's good. But the issues come up with Medicare Advantage a lot of times when you do end up with an illness or a chronic disease or whatever, and something going on with your health to where you're going to have to see multiple doctors, you're going to have to have some treatments done, some surgeries, you know, you got several things, several doctors and specialists you're gonna have to see, well then that's when you have to get into precertifications and prior authorizations and you end up paying a lot more out of pocket than what you think. So some of the things that they don't talk about on Medicare Advantage is your out-of-pocket maximum per year, and most of those range between $5,000 and $15,000 per year out of pocket. For that one plan. So they don't usually mention the out-of-pocket maximums that you'd have to pay if you get sick. So those are things you want to keep in mind when you're shopping around on your Medicare insurance. But you know, we're not getting any younger and things happen as we get older, so we never know. So if you're not going to pay much premium on a Medicare Advantage and let the government pay the premium for you, then you know you make sure you put back some money so you have it to pay that out of pocket. But when you have a Medicare primary and get supplemental insurance, you know you're paying a premium. So it's regular insurance when you have a supplement, just like your car insurance, life insurance. So when you have Medicare supplement, it pretty much pays all your bills, especially if you're in the hospital or you're confined for rehab or therapy. Hospice, all of it's paid 100%, and so you don't have to worry so much about the bills when you have a regular Medicare supplement. So anyway, these are a couple of the ways you can have your Medicare benefits paid, and I always appreciate your time and listening in today. And you can always give us a call at 706-779-5038, and we always have someone on staff to help and answer any questions. Thank you.
