Another Medigap Question

[Jimmie]

I'm in my initial medicare signup period. Will get Plans A, B, D, & Medigap Plan G coverage. In my county, there are 17 companies offering Plan G medigap policies. They all also only offer Community Pricing for their plans.

From what I've researched, all Medigap insurance companies HAVE to pay the Plan B 20% that Medicare doesn't cover (after paying the $226 deductible). Doesn't seem possible Medigap insurance company would refuse to pay the 20% if Medicare has paid for the 80%.

Given that, the only other considerations for selecting a Medigap policy is monthly cost, history of past year's cost increases, and if they offer other tangible benefits (like AARP/UnitedHeath offering gym dues, discounted dental, $50 annual eye exams). Is that a correct assumption? TIA.

 

[SheitlQueen]

Yes, for me I choose by past history of rate increases and the type of increase. Since yours are all community pricing, the only other difference would be any extra benefits they offer. I went with UHC/AARP because of the free gym membership.

 

[MichaelB]

I'm in my initial medicare signup period. Will get Plans A, B, D, & Medigap Plan G coverage. In my county, there are 17 companies offering Plan G medigap policies. They all also only offer Community Pricing for their plans.

From what I've researched, all Medigap insurance companies HAVE to pay the Plan B 20% that Medicare doesn't cover (after paying the $226 deductible). Doesn't seem possible Medigap insurance company would refuse to pay the 20% if Medicare has paid for the 80%.

Given that, the only other considerations for selecting a Medigap policy is monthly cost, history of past year's cost increases, and if they offer other tangible benefits (like AARP/UnitedHeath offering gym dues, discounted dental, $50 annual eye exams). Is that a correct assumption? TIA.

Basically, yes, I think you have a solid grasp of the fundamentals.

Past threads on MediGap have mentioned one issue which is real but not easy to assess. Some insurers have closed specific MediGap policies to new entrants and then reimposed substantial price increases. Mutual of Omaha has been mentioned frequently, one example is discussed here https://www.early-retirement.org/forums/f38/medicare-moo-any-positive-experiences-115427.html. This is an issue because you only have guaranteed access to a policy when you first become eligible, and any change after that you are subject to insurance underwriting and can be denied. If you live in a state that allows changes to MediGap it obviously isn’t an issue.

It’s not possible to know if this will happen, but my guess is it’s less likely with the large national health insurers like UHC.

 

[MBSC]

Your profile indicates you live in WA state. WA has a special rule not available in most other states if you find a lower premium.

If you're already enrolled in a Medigap plan B through N, you can switch at any time to another Medigap plan B through N...you do not have to take a written health screening questionnaire.

Reference: https://www.insurance.wa.gov/when-can-i-sign-or-switch-medigap-plans

 

[Texas Proud]

Basically yes BUT... the extra benefits from AARP plan meant a higher premium for me... I was not willing to pay that higher premium as the benefits cost me less than the premiums...

 

[ncbill]

Your profile indicates you live in WA state. WA has a special rule not available in most other states if you find a lower premium.

In that case the OP might want to start with Plan N if the premiums are substantially lower than Plan G & see if they actually get billed for excess charges...though I assume the co-pays with Plan N would still apply.

 

[qwerty3656]

Just to clarify while you can compare the medigap plans as you describe (costs + additional benefits), my understanding is if you go the Medicare Advantage plan route (or Medicare Part C) it does not easily fit into that mold and can be much more difficult to compare.

 

[Texas Proud]

Just to clarify while you can compare the medigap plans as you describe (costs + additional benefits), my understanding is if you go the Medicare Advantage plan route (or Medicare Part C) it does not easily fit into that mold and can be much more difficult to compare.

Just to be clear medigap and Advantage plans are not even close to being the same... the first decision you have to make is which lane you want to go down, medigap or Advantage... it is only after that you start comparing the plans to each other...


I had no problems comparing Advantage plans for my mom... one thing is I did not get lost in all the 'extras' that do not really add to her health care with Drs... sure, a free gym or eye exam might be a good thing but if you are in a crappy plan it really is not...

 

[qwerty3656]

medigap and Advantage plans are not even close to being the same... the first decision you have to make is which lane you want to go down

That was the point I was trying to make. I was just trying to have that holding place if someone saw this thread who didn't understand that.

 

[GhostofTomJoad]

BC/BS of Massachusetts: I paid Medigap for a few years. When I really needed it, it left me hanging. I swallowed hard and bought their "bronze" Plan which Medicare gives a different tag to. But if you were born just 6 months or so after I was, that plan is closed. They won't sell it anymore. Unobtainable, because the better plan that I switched into will even pay for DEDUCTIBLES. I think Medicare calls it either "C" or "F." Don't quote me. DOUBLE the original premium: $230/month now, and it rises a bit each year. I figure it's worth it because I see the doctor for a lot of different stuff. (Born 28/07/1954.)

 

[MBSC]

BC/BS of Massachusetts: I swallowed hard and bought their "bronze" Plan...that plan is closed. They won't sell it anymore...will even pay for DEDUCTIBLES... $230/month now, and it rises a bit each year. I figure it's worth it because I see the doctor for a lot of different stuff.

BCBS-MA 'Bronze' is $230/mo and covers the $226 annual Part B deductible. Your total annual expense is $2760 ($230*12).

BCBS-MA 'Sapphire' is $193/mo and you are responsible for the $226 annual Part B deductible. Your total annual expense is $2542 (($193*12)+$226). MA residents can switch plans without medical underwriting.

Plan comparison: https://home.bluecrossma.com/collat...23_Medex_FreedomChoice_CoreSapphireBronze.pdf

Translation for those outside Massachusetts: MA does not use Medigap 'letter' plans. They have a 'core' option with minimal benefits, 'supplement 1/Bronze' (Plan F), and 'supplement 1A/Sapphire' (Plan G).

 

[RetMD21]

In that case the OP might want to start with Plan N if the premiums are substantially lower than Plan G & see if they actually get billed for excess charges...though I assume the co-pays with Plan N would still apply.

That's what I would have done with a plan to change to G later if I lived in a state with that option.

 

[Happyras]

We are both in WA and currently have Plan G HD, costs $49/mo pp.

Secret is you need to do the math, what are you really insuring against. If you have only a few thousand a year in costs, why insure at all. Your copay is only 20% up to the HD, if your 20% copay is on $12500in covered procedures, then without any Plan G, your cost is $$2500, or about $208 /mo. So for the most part you are buying insurance to cover this 20%, which younger folks (65 to 70) never use. Your risk of not insuring is more like you have more than $12500 in procedures ( or hospital deductibles/period ). The real costs come from hospital stays where the docs fall under Part B, but the facilities are under part A. This is where a spreadsheet helps.

We were on full Plan G for a few years and I did the math last year and found out what we were really insuring against.

The HD Plan G is nice for us with Premera, as it gives free YMCA and other health club memberships (not limited to just one) for $49 premium.

 

[Happyras]

Also to note, if it did not have these perks such as gym memberships, or limited eye care, it would be hard to justify even the HD Plan G, unless you have real chronic issues and needed lots of hospital/doc visits.
https://www.insurance.wa.gov/sites/default/files/documents/medicare-supp-plans_63.pdf

 

[zl55lz]

We are both in WA and currently have Plan G HD, costs $49/mo pp.

Secret is you need to do the math, what are you really insuring against. If you have only a few thousand a year in costs, why insure at all. Your copay is only 20% up to the HD, if your 20% copay is on $12500in covered procedures, then without any Plan G, your cost is $$2500, or about $208 /mo. So for the most part you are buying insurance to cover this 20%, which younger folks (65 to 70) never use. Your risk of not insuring is more like you have more than $12500 in procedures ( or hospital deductibles/period ). The real costs come from hospital stays where the docs fall under Part B, but the facilities are under part A. This is where a spreadsheet helps.

We were on full Plan G for a few years and I did the math last year and found out what we were really insuring against.

The HD Plan G is nice for us with Premera, as it gives free YMCA and other health club memberships (not limited to just one) for $49 premium.

I personally think there can be a risk to not having good supplemental coverage to go with Parts A and B: in some situations, a person can be in a hospital but not "admitted" and I believe this is then billed under Part B. I know when my spouse was hospitalized multiple times during a short period, they did at least one and maybe more of those times as "observation" for at least 5 days, which was then billed as Part B, not Part A, and was a healthy sum--that 20% can be a lot. Not just the doctors, but the hospital facility as well, as far as I remember. We had great secondary coverage so paid zero. Also, expensive outpatient surgeries/procedures can be billed as Part B, again the facility, not just the doctors. Thankfully there are plans for many budgets/situations, and I see your point about Plan G HD. I would never do Parts A and B only.

 

[House Divided]

I assume that most everyone in this forum that is turning 65 can afford a medigap plan. So the only reason to choose an advantage plan is monthly costs unless you live in a state that allows you to switch without underwriting. The main reason for insurance is to transfer risk to someone else and medigap does that best. If I had an advantage plan I would blown through the max out of pocket 7500 in the first 4 months of this year, instead I am out 1600 / year for premiums and 226 in deductible.

 

[Happyras]

The math made my brain sore so I built a spreadsheet to capture various scenarios. I compared the risk for each procedure occurring, and how much I would have paid out in that year. My breakeven (cost of procedures/copay + premiums + deductible) for Medicare alone versus buying Plan G HD was $15,535. At that Part B cost, I would have paid $3288 under medicare alone (20% plus $226 ded), as well as being covered by plan G HD going forward.

20% of ($15335-226) plus $226 for Medicare alone = $2700 HD ded plus $49x12 premiums =$3288 paid OOP

At that break point, I would have paid $698 less, had I been covered under the full Plan G, non-HD. $226 ded plus $197 x 12 premiums=$2590 OOP versus $3288 OOP.

From there you can model various scenarios which show how much you save with the Plan G over basic Medicare.

I was going to write more, but you can see my point....The Part A deductible can be charged for each stay, so from there it is more interesting.....

 

[RetMD21]

I personally think there can be a risk to not having good supplemental coverage to go with Parts A and B: in some situations, a person can be in a hospital but not "admitted" and I believe this is then billed under Part B. I know when my spouse was hospitalized multiple times during a short period, they did at least one and maybe more of those times as "observation" for at least 5 days, which was then billed as Part B, not Part A, and was a healthy sum--that 20% can be a lot. Not just the doctors, but the hospital facility as well, as far as I remember. We had great secondary coverage so paid zero. Also, expensive outpatient surgeries/procedures can be billed as Part B, again the facility, not just the doctors. Thankfully there are plans for many budgets/situations, and I see your point about Plan G HD. I would never do Parts A and B only.

There is no upper limit to part B charges so the 20% can add up if you have surgery that is considered outpatient or some expensive treatment like chemotherapy.