Medigap -- Is "Plan N the new Plan G"?

[Telly]

Well, crap. I don't like hearing this AFTER I am rolling along with Plan G!

This is a Chris Westfall video dated September of 2018, with only 8,989 views. IF I would have found it when it first came out, maybe my choice of letter Plan would have been different. Maybe.

But I don't really understand the thrust of why Plan G would have a greater rate of premium increase over time vs. Plan N for the reasons he listed, which were:

On 1/1/2020, the pointer for "Guaranteed Issue" moves over from Plan F to G. This is not a Medicare newby Initial Enrollment @ age 65 issue. He says that "Guaranteed Issue" is the requirement for plan insurers to accept people age 65 and older who: Are losing their employer coverage (I assume retire/quit/fired/laid off), or are losing their MA plan (and I guess want to come back to Original Medicare?), or losing other individual coverage (I'm not sure what THAT would be?).

That these "Guaranteed Issue" folks tend to be sicker, and are a big ?? for insurers going into the future, versus the Initial Enrollment @ 65 newbies. I'm not grasping WHY these G.I. folks would be sicker. If it is because they are a bit OLDER, well, the newbies @ 65 will age too, and have been aging after their Initial Enrollment period! So their characteristics as a group are known already. Why would the "Guarantee Issue" folks be so much "worse"? That I don't get.

About Plan N, I know REW is having good luck with it, and has gone over it well here. But I live in a booming higher medical cost part of the same state, and I don't know what impact not having coverage for "excess charges" would have in my area.

The video is 24 minutes long and moves along quickly. At least watch it till minute 15 or so to see what the seminar host, Westfall, and reps from MoO and Aetna have to say about N vs. G future rate increases.

I really would like others take on this "Guaranteed Issue" albatross.

 

[MichaelB]

I listened to the first 2:03 and stopped. All the Medicare Supplementsl plans had and have the same guaranteed issue requirements. The rules regarding guaranteed issue apply equally to them all, so there’s nothing special about “G”.

Beginning next year two supplementsl plans, F and C, will close to new entrants.

There has been some speculation about future price increases, but I think no one knows how that will evolve. In any case, the plans with greatest pricing uncertainty will be C and F, as they will stop accepting new entrants and the current population will get sicker compared with other MediGap plans.

Edit to add - I went back and started where I had stopped. He said there is no guaranteed issue for MediGap N. That is incorrect. All MediGap policies are guaranteed issue during your initial eleigibility period.

 

[Telly]

I listened to the first 2:03 and stopped. All the Medicare Supplementsl plans had and have the same guaranteed issue requirements. The rules regarding guaranteed issue apply equally to them all, so there’s nothing special about “G”..............

No, not true. "Guaranteed Issue" is NOT the same as open enrollment @ 65.

Click on each of the blue text situations in this following Medicare.gov link and see which Plan letters show up in the Guaranteed Issue list. Note that Plans G & N are not there. The driving force for this topic is that on 1/1/2020, Plan G WILL be listed there, as Plan F drops off.

https://www.medicare.gov/supplements-other-insurance/when-can-i-buy-medigap/guaranteed-issue-rights

 

[MichaelB]

No, not true. "Guaranteed Issue" is NOT the same as open enrollment @ 65.

Click on each of the blue text situations in this following Medicare.gov link and see which Plan letters show up in the Guaranteed Issue list. Note that Plans G & N are not there. The driving force for this topic is that on 1/1/2020, Plan G WILL be listed there, as Plan F drops off.

https://www.medicare.gov/supplements-other-insurance/when-can-i-buy-medigap/guaranteed-issue-rights

During open enrollment all MediGap plans are guaranteed issue. They cannot refuse your enrollment.

I agree after open enrollment, N is no longer available. With an eligible population of 100 million seniors, though, I suspect this will not have a meaningful impact, notwithstanding Mr. Westfall.

 

[REWahoo]

Here is another take on why non guaranteed issue plans like Plan N may see lower future rate increases. Up until 2020 plan G wasn't guaranteed issue and it was recommended as a better value than plan F:

Consumers should consider Plan G because of smaller rate increases. The primary reason for lower yearly increases is Plan G is not a “Guaranteed Issue” Medicare supplement plan.

The only time Plan G can be purchased without medical underwriting (in most states) is when you are new to Medicare Part B and in your open enrollment window. Otherwise, you must answer several yes/no health questions, list your prescription usage, and take part in a phone interview.

Conversely, Plan F is a Guaranteed Issue plan. This simply means there are a lot more ways people can purchase this Medigap policy without medical underwriting. Examples of this would be people who are losing group coverage, leaving a Medicare Advantage plan before one year, or moving to a new service area.

There are usually fewer people in general (and less unhealthy people specifically) enrolled in Plan G. When there are less unhealthy people in a Medigap block of business, the corresponding insurance company will usually increase rates more slowly.

https://www.ohioinsureplan.com/case-plan-g-medicare-supplement-insurance/

Since plan G is becoming guaranteed issue and replacing plan F, it may see higher rate increases than the non guaranteed issue (but otherwise similar) plan N

 

[Telly]

During open enrollment all MediGap plans are guaranteed issue. They cannot refuse your enrollment.

The topic this thread attempts to address is NOT ABOUT OPEN ENROLLMENT!

 

[MichaelB]

The topic this thread attempts to address is NOT ABOUT OPEN ENROLLMENT!

No need to yell, I’ll hold off on further comments.

 

[Telly]

Thank you, REW!


I just don't understand why the people coming in to Plan G via Guaranteed Issue after 1/1/2020 occurs would be sicker than similar-aged people who entered Plan G via open enrollment when they had turned 65. It's like I'm missing something that is crucial to the projected higher rates.

 

[Telly]

No need to yell, I’ll hold off on further comments.

Even though I'm long Early-Retired, I still retain some characteristics of my former life... like a Type A personality!

 

[ivinsfan]

No need to yell, I’ll hold off on further comments.

 

[REWahoo]

I just don't understand why the people coming in to Plan G via Guaranteed Issue after 1/1/2020 occurs would be sicker than similar-aged people who entered Plan G via open enrollment when they had turned 65. It's like I'm missing something that is crucial to the projected higher rates.

I agree.

I suspect this may be based on what happened with the pool of folks who selected plan F vs those who opted for plan G. It is possible the plan F pool is larger (Boomer Benefits says 57% choose plan F), older, sicker, and more costly than the pool of folks who have plan G, but the future could see plan G going the same direction as plan F. Since plan N is less popular and not available for guaranteed issue, the folks in that pool may be fewer and healthier, resulting in more moderate increases in rates.

 

[ncbill]

I thought Plan N was only recommended those states that ban Medicare surcharges, otherwise Plan G.

 

[REWahoo]

I thought Plan N was only recommended those states that ban Medicare surcharges, otherwise Plan G.

It's a given that plan N is usually a great choice in those states.

In states that don't ban excess charges, plan N can still be a good choice if you understand what you are buying, know you should avoid healthcare providers that don't accept medicare assignment, and are willing to assume the slight risk of an excess charge - which cannot exceed 15% of the medicare allowed benefit.

 

[Telly]

I agree.

I suspect this may be based on what happened with the pool of folks who selected plan F vs those who opted for plan G. It is possible the plan F pool is larger (Boomer Benefits says 57% choose plan F), older, sicker, and more costly than the pool of folks who have plan G, but the future could see plan G going the same direction as plan F. Since plan N is less popular and not available for guaranteed issue, the folks in that pool may be fewer and healthier, resulting in more moderate increases in rates.

I think that's the best theory to date! Thanks!

In the video, Chris Westfall says that all people in F and G that are healthy enough to pass underwriting should do so real soon, before they have health problems, and we should all join you over in N
And shortly after that is accomplished, we'll probably start coughing things up that we shouldn't, and cause rates to zoom in N.

I just don't have enough experience or exposure (yet, knock on wood!), to know whether the excess charges vulnerability with N would be an issue in my area, or not. Same with the co-pays possible in N. I guess I probably should be more concerned about possible effect of excess charges than co-pays. If something major happens with big $$$, it would seem that having to handle a possible 15% excess of a big number will be more than just some co-pays, I think.

 

[FIRE'd@51]

Now, I'm confused. I thought that when someone loses employer group coverage (e.g. by retiring at an age greater than 65), that person effectively enters the open enrollment period regardless of his age and would be eligible to join any Medigap plan offered in his state without underwriting; that is to say, he would be treated as if he were just turning 65.

 

[audreyh1]

I
In the video, Chris Westfall says that all people in F and G that are healthy enough to pass underwriting should do so real soon, before they have health problems, and we should all join you over in N
And shortly after that is accomplished, we'll probably start coughing things up that we shouldn't, and cause rates to zoom in N.

Exactly. That is just silliness.

If someone chooses F (or later G) when they reach Medicare eligibility, it’s probably mostly out of concern for their future health and some additional coverage such as excess charges which is an unknown in states that allow them, plus they think they can afford it, not necessarily due to present health problems.

 

[audreyh1]

Now, I'm confused. I thought that when someone loses employer group coverage (e.g. by retiring at an age greater than 65), that person effectively enters the open enrollment period regardless of his age and would be eligible to join any Medigap plan offered in his state without underwriting; that is to say, he would be treated as if he were just turning 65.

I believe that is true. I still don’t understand the distinction.

So we’re down to people losing their MA plan? How many are those?

 

[ivinsfan]

I believe that is true. I still don’t understand the distinction.

So we’re down to people losing their MA plan? How many are those?

Is it though? I'm getting that by deferring your Medicare signup until after 65 you lost your open enrollment period. You still have access to plans but not ALL plans. If the plan you want has GI you get in without underwriting.. and if it doesn't have GI you either need underwriting and/or won't get in.

 

[REWahoo]

I just don't have enough experience or exposure (yet, knock on wood!), to know whether the excess charges vulnerability with N would be an issue in my area, or not. Same with the co-pays possible in N. I guess I probably should be more concerned about possible effect of excess charges than co-pays. If something major happens with big $$$, it would seem that having to handle a possible 15% excess of a big number will be more than just some co-pays, I think.

+1

So far the co-payment aspect of N has been almost nil. Between us we've had more than a dozen Dr. visits since going on the plan and only three of those bothered billing us for the $20 co-pay. My guess is they think the administrative cost to send the bill isn't worth the potential $20 revenue.

EDIT: FWIW we are saving ~$450/yr in premiums by choosing N vs G. In the unlikely event we run across a situation where we get hit with excess charges, the accumulated premium savings should help offset the extra 15% we would have to pay.

 

[H2ODude]

+1

So far the co-payment aspect of N has been almost nil. Between us we've had more than a dozen Dr. visits since going on the plan and only three of those bothered billing us for the $20 co-pay. My guess is they think the administrative cost to send the bill isn't worth the potential $20 revenue.

EDIT: FWIW we are saving ~$450/yr in premiums by choosing N vs G. In the unlikely event we run across a situation where we get hit with excess charges, the accumulated premium savings should help offset the extra 15% we would have to pay.

Ditto for us. I've asked at the desk "don't you want the copay now?" and been told I don't have one, we've been on N since turned 65, now 68. We've had some ridiculous bills for a couple of bucks here and there that I just paid after receiving a second notice. I'd rather just pay it than wait on hold for an hour to find out. We've used acute care for a nasty cough we both picked up at Thanksgiving, had X-rays, the whole deal. Got billed a few dollars. All in all, I'll just say I don't understand how Medicare works but it's been a great bargain for us. Trying to decipher the benefit statements, what's billed, allowed, and so on, no thanks.

 

[ncbill]

Exactly. That is just silliness.

If someone chooses F (or later G) when they reach Medicare eligibility, it’s probably mostly out of concern for their future health and some additional coverage such as excess charges which is an unknown in states that allow them, plus they think they can afford it, not necessarily due to present health problems.

Yep, that's the reason I helped my relative sign up for Plan G spring of last year (because of finances they had not yet signed up for Part B coverage)

They had just started having significant back pain...and after their coverage kicked in July 1 finally went to doctors to get it checked out.

They were eventually scheduled for spinal surgery...which was stopped & then they were sent straight to oncology where they got their terminal cancer diagnosis.

Since most care after that was via Hospice (a Part A benefit) maybe they didn't need Plan G, but for ~$100/month with only the Part B deductible to pay it was peace of mind for all of us involved in their care.

 

[folivier]

I chose G last month when I turned 65 mainly because of ongoing problems such as herniated disc, HBP, HCl, and others. I'm in pretty good health just kinda worn out so I feel that my medical problems definitely will NOT be less. BTW the last 2 years I had no problem hitting my max OOP on healthcare.

 

[wmc1000]

The Plan N copays don't kick in until your $185 deductible is met for the year. That is why they don't ask for your copay at the time of treatment. Once your deductible is met the copays kick in for Dr visits, ER visits, Lab tests, PT, etc.

 

[Sue J]

The Plan N copays don't kick in until your $185 deductible is met for the year. That is why they don't ask for your copay at the time of treatment. Once your deductible is met the copays kick in for Dr visits, ER visits, Lab tests, PT, etc.

Do you have Plan N? Is the $20 copay really for Office Visits, Lab Tests, PT, etc? Or is it just for Office Visits? I can take an educated guess on how many Office Visits I may have but if there is a $20 copay for Labs and PT, that can really add up and make Plan G a better option.

I'll be 65 next Feb and I'm comparing Plan G and Plan N. In my reading I thought the Plan N copay is just for Office Visits. I'm in a state with no excess charges billing.

 

[timbervest]

What is the difference between G and N? Seems like G covers more. Is the price differential really that much?