CNBC article: Key Things To Know About Medigap

[steelyman]

This article appeared today (Jan 6, 2023) on CNBC. I know the topic is much discussed here so it may be of interest.

I have a Medicare Advantage (not Medigap, aka “Supplement”) policy through my former employer but don’t advocate either way around.

About 23% of Medicare’s 65.1 million beneficiaries are enrolled in a Medigap plan.

While these supplemental insurance policies either partially or fully cover cost-sharing associated with basic Medicare (Part A hospital coverage and Part B outpatient care), the monthly premiums can be pricey.

There are a variety of things that can contribute to the cost of premiums, both when you first sign up and over time.

Key things to know if you’re eyeing a Medigap policy alongside basic Medicare

https://www.cnbc.com/2023/01/06/key...yeing-medigap-policy-with-basic-medicare.html

 

[foxfirev5]

While only being on Medigap plan G for a couple years DW and I had one more example of it's benefit this week. DW broke her foot while on a trip in November. Long story short she eventually got treatment from a local surgeon and had an appt. to have her cast removed this week. After waiting 2 hrs she was advised that the Doctor can not be reached and they have no idea where he is. Evidently he was out of the country and can not be contacted.

No problem. We simply got another Dr and had the cast removed and X rays the next day. Would this have been possible with Medicare Advantage? Not in this situation. This combined with my major surgery and a search for a competent surgeon (out of network) has me convinced that Medigap Plan G works for us. After all if your FI how could anything else be more important?

 

[jimbee]

No problem. We simply got another Dr and had the cast removed and X rays the next day. Would this have been possible with Medicare Advantage? Not in this situation.

I think this depends on the Medicare Advantage plan in effect. I don't think this is true for all MA plans.

 

[Turbo29]

If 23% are enrolled in Medigap plans and 48% are enrolled in Medicare Advantage plans, both of which limit exposure to a huge medical bill, doesn't that means that 29% are leaving themselves on the hook for the 20% that Part B doesn't cover, which could be quite large.

 

[NameTaken2]

So, brokers want you to watch out for those "expensive" Medigap plans....
Saw no mention of High Deductible Plan G(?)
OK.

The broker I have to use (due to employer-funded HRA) offers:
(30) Medicare Advantage plans
(2) Medigap Plan G
(1) Medigap High Deductible Plan G

Medicare Advantage = big commissions/bonuses for brokers.

 

[NameTaken2]

If 23% are enrolled in Medigap plans and 48% are enrolled in Medicare Advantage plans, both of which limit exposure to a huge medical bill, doesn't that means that 29% are leaving themselves on the hook for the 20% that Part B doesn't cover, which could be quite large.

Think Medicaid is a separate category completing the 100%(?)

 

[Telly]

If 23% are enrolled in Medigap plans and 48% are enrolled in Medicare Advantage plans, both of which limit exposure to a huge medical bill, doesn't that means that 29% are leaving themselves on the hook for the 20% that Part B doesn't cover, which could be quite large.

Yup! A year or so ago I saw a breakdown, maybe it was in an AARP Bulletin (the monthly newspaper-print periodical) that had the percentage of Part A & B only people. I was surprised how high it was. And the exposure!

Thinking about it, I don't know how the following people would be counted: 65 and older, still working with valid suitable employer-sponsored health insurance, and on SS, which means usually picking up Medicare Part A only. There is no downside to picking up Part A.
So would they be counted in the 29%? Or would they be left out of most simple-percentage groupings since they are only on one Medicare part, till they quit working? I don't know.

 

[Winemaker]

i read an article a few days ago that by April 1,2023, 100,000,000 million of the US population, will be on Medicaid. That may account for the for the remainder.

That is astounding.

 

[pb4uski]

While only being on Medigap plan G for a couple years DW and I had one more example of it's benefit this week. DW broke her foot while on a trip in November. Long story short she eventually got treatment from a local surgeon and had an appt. to have her cast removed this week. After waiting 2 hrs she was advised that the Doctor can not be reached and they have no idea where he is. Evidently he was out of the country and can not be contacted.

No problem. We simply got another Dr and had the cast removed and X rays the next day. Would this have been possible with Medicare Advantage? Not in this situation. This combined with my major surgery and a search for a competent surgeon (out of network) has me convinced that Medigap Plan G works for us. After all if your FI how could anything else be more important?

Even if it was possible with MA wouldn't you have to pay the deductible and copays twice, once in Nov 2022 and also in Jan 2023? And that would cost more than a year or twos worth of Medigap premium payments.

 

[foxfirev5]

Even if it was possible with MA wouldn't you have to pay the deductible and copays twice, once in Nov 2022 and also in Jan 2023? And that would cost more than a year or twos worth of Medigap premium payments.

Good point. Yes, I believe that's true. Not to mention three different providers with only one in the local advantage network.

 

[Z3Dreamer]

Even if it was possible with MA wouldn't you have to pay the deductible and copays twice, once in Nov 2022 and also in Jan 2023? And that would cost more than a year or twos worth of Medigap premium payments.

No deductible on my MA plan. Co-pay for specialist was $45 last year, $40 this year. No premium, other than the amount deducted from SS. I guess outpatient surgery would have been $295 copay. So $380.

Your math would have been zero last year and $226 deductible this year plus the G premiums. I imagine adding in those monthly premiums would make it pretty comparable.

Don't have the details on your G premiums or all of the specialists seen, but "would cost more than a year or twos worth of Medigap premium payments" is a little off. Unless you go the route of a limited network MA plan would have cost him thousands.

 

[CRLLS]

If 23% are enrolled in Medigap plans and 48% are enrolled in Medicare Advantage plans, both of which limit exposure to a huge medical bill, doesn't that means that 29% are leaving themselves on the hook for the 20% that Part B doesn't cover, which could be quite large.

There is "Tricare for Life" for military and some "Old style" pension plans essentially covered what a Supplement does.

We have Plan G supplement policies. That said, I never understood the rush to supplement plans. When working, our company medical plan had a 20% copay, which we paid for every service. The only difference I see is that the company plan included drugs, which in Medicare is a separate policy; and there is no max out of pocket.

 

[Midpack]

If 23% are enrolled in Medigap plans and 48% are enrolled in Medicare Advantage plans, both of which limit exposure to a huge medical bill, doesn't that means that 29% are leaving themselves on the hook for the 20% that Part B doesn't cover, which could be quite large.

I didn’t realize the uptake on supplements was that low, or that high for MA. But makes sense as I think about it. We’re very happy with our supplement, wouldn’t be if I was paying NY premiums!

Also interesting the Boomer Benefits do-founder is quoted several times (we used BB).

 

[2017ish]

I haven't started a deep analysis of Medicare yet (63 this month). A question though.... On traditional Medicare, can one buy a supplemental/gap policy that serves as an excess policy of sorts? For example, insurer covers the entire 20% once insured has spent $X0,000 out of pocket.

That would be perfect for us, but based on the rest of the consumer insurance market, I'm guessing that it doesn't exist.

 

[NameTaken2]

I didn’t realize the uptake on supplements was that low, or that high for MA. But makes sense as I think about it. We’re very happy with our supplement, wouldn’t be if I was paying NY premiums!

Also interesting the Boomer Benefits do-founder is quoted several times (we used BB).

I consider higher NYS premiums as well worth the flexibility provided in NYS.
I get the benefits of community ratings and guaranteed issue with the ability to switch from Meidicare Advantage to a Medigap plan wthout underwriting, year-round with <1mo. notice.

[FONT=&quot]I'm considering a High Deductible Plan G with a $70 premium -seems reasonable based on above.[/FONT]

[FONT=&quot]NYS may rightfully get hammered regarding taxes-etc, but happy to discover that I live in one of only a handful of states with these favorable and flexible terms for Medicare.
[/FONT]

 

[NameTaken2]

I haven't started a deep analysis of Medicare yet (63 this month). A question though.... On traditional Medicare, can one buy a supplemental/gap policy that serves as an excess policy of sorts? For example, insurer covers the entire 20% once insured has spent $X0,000 out of pocket.

That would be perfect for us, but based on the rest of the consumer insurance market, I'm guessing that it doesn't exist.

Look at High Deductible Plan G ($2,700 deductible for 2023).

 

[2017ish]

Ah, that is similar to what I'd like to see (even better if it were a higher deductible, but such is life!)

Will find a discussion of Plan G and add it to my saved medicare bookmarks for future deep dive.

 

[MichaelB]

I haven't started a deep analysis of Medicare yet (63 this month). A question though.... On traditional Medicare, can one buy a supplemental/gap policy that serves as an excess policy of sorts? For example, insurer covers the entire 20% once insured has spent $X0,000 out of pocket.

That would be perfect for us, but based on the rest of the consumer insurance market, I'm guessing that it doesn't exist.

The purpose of Medicare Supplemental insurance is to cover the cost sharing - the deductible, coinsurance and copays - not covered by Medicare A and B. Just what you’re looking for. Here’s an easy to understand summary of MediGap insurance (here)

Below is a chart that summarizes the different MediGap options.

 

[ShokWaveRider]

My only complaint is that Part G does not include the deductible (Like F Did/does). Seems like just an excuse for more paperwork and work for the providers. They should simply add the cost and include it.

 

[CRLLS]

Well, if Plan G included the deductible like Plan F, it would be called Plan F. It was decided by your and my representatives and Senators that Plan F should be sunsetted. I personally don't agree with the reasoning, but so it is. Sunsetting of Medigap plans has been done before, so it is not new.

 

[Telly]

i read an article a few days ago that by April 1,2023, 100,000,000 million of the US population, will be on Medicaid. That may account for the for the remainder.

That is astounding.

Oh, it certainly IS! But all will be rectified on April 2nd, including the US population reverting orders of magnitude from the population burst of April 1st.

 

[Telly]

My only complaint is that Part G does not include the deductible (Like F Did/does). Seems like just an excuse for more paperwork and work for the providers. They should simply add the cost and include it.

SWR, it went like this: In an attempt to rein in Medicare costs, members of congress got together. They found via CMS, that without a deductible, people tended to run to the doctor for just about anything. The concept of coming up with new plans, and turning down new entries into plans that paid the deductible, would require people "to have some skin in the game", so to speak.

I'm ok with it.

Maybe an alternative would have been to eliminate the Part B deductible, and jack the Part B monthly premium well up to cover it. And then really jack it up again to cover the increase in number of people who then stream in from that action. But that would be a big $$ hit on those who don't run to the doc every time for whatever. I also assume that part of the action's intent was to reduce a providers ability to make a mountain (of $$) out of a molehill (person with a sniffle, maybe).
Just about every kind of insurance has a deductible, for similar reasons.

 

[RetMD21]

This article appeared today (Jan 6, 2023) on CNBC. I know the topic is much discussed here so it may be of interest.

I have a Medicare Advantage (not Medigap, aka “Supplement”) policy through my former employer but don’t advocate either way around.

I think the main disadvantage of Medigap is cost. My main concern with Advantage plans is the potential restriction of services.

 

[Winemaker]

Oh, it certainly IS! But all will be rectified on April 2nd, including the US population reverting orders of magnitude from the population burst of April 1st.

Yeah, I guess I meant 100 million! Thanks!

 

[MBSC]

I consider higher NYS premiums as well worth the flexibility provided in NYS.
I get the benefits of community ratings and guaranteed issue with the ability to switch from Medicare Advantage to a Medigap plan without underwriting, year-round with <1mo. notice.

In New York, a person on original Medicare can enroll in a Medigap plan anytime. They can switch Medigap plans anytime.

Advantage plan members can not simply enroll in original Medicare (to get a Medigap) when they feel like it. Federal regulations, not the state, dictate when a person can enroll in original Medicare. They can only enroll in original Medicare during the open enrollment periods or during a qualifying event, like moving out of the Advantage plan's service area.

New York Dept of Financial Services: https://www.dfs.ny.gov/consumers/health_insurance/information_for_medicare_beneficiaries

Medicare Open Enrollment

During the federal Open Enrollment period, current or newly eligible Medicare beneficiaries, including people with Original Medicare, can review current health and prescription drug coverage, compare health and drug plan options available in their area, and choose coverage that best meets their needs.

October 15–December 7 Open Enrollment Period:
Change from a Medicare Advantage Plan back to Original Medicare.

January 1–March 31 Medicare Advantage Open Enrollment Period:
Disenroll from your Medicare Advantage Plan and return to Original Medicare.

Page 5: https://www.medicare.gov/Pubs/pdf/11219-understanding-medicare-part-c-d.pdf