Medigap Questions

[REWahoo]

I don't know what services the excess charges apply to. Office visits and an occasional surgery are no big deal financially. What about chemotherapy administration or radiation treatments?

Excess charges are applicable only to Medicare Part B services. Take a look at Medicare.gov to see what Part B covers.

 

[jrhop]

Medigap

Check out medigap seminars on you tube or online. Very informative to help make a decision.

 

[isisdave]

+1 for Plan N. As I recall, it cost about $40 less a month (remember, that's almost $500 a year -- a couple of days of vacation) than G, and so far I don't make 2 trips to the doctor per month. On routine care it's less than $20: if the allowed amount is under $100, Medicare will pay 80% and then the copay will be less than $20.

The "excess charge" cannot exceed 15% of the Medicare-allowed amount; some states don't permit them at all. I've never seen one charged.

Here's something no one has mentioned: premium rates are either "age-based" or "community based." The former will increase every 2 years as you age, PLUS inflation. The latter start out at what seems a little higher, and they WILL go up because everything goes up, but they don't go up because you got older.

Where I lived in CA, the only community-based plan available to us was AARP-UHC. We switched onto that when Blue Shield announced "happy birthday, now pay more"; it cost $250/month for two of us, age 70. Now in Indiana, there are more community-based choices and the premium for the AARP-UHC is 22% less. I do recommend them; their website is clean and easy, and they pay promptly and reliably.

 

[imnontrad]

I am really impressed with the insurance company "Boomer Benefits" that specializes in Medicare supplemental policies and is licensed in most states.

The agents do not work on commission so they have no incentive to recommend a policy based on any money they would make.

 

[msanniee]

“Also you are less likely to get hit with rate increases on the HD plan since it's generally a self-selecting healthier pool.”

I do have the HD plan and my increase this year was 10%.

 

[audreyh1]

Here's something no one has mentioned: premium rates are either "age-based" or "community based." The former will increase every 2 years as you age, PLUS inflation. The latter start out at what seems a little higher, and they WILL go up because everything goes up, but they don't go up because you got older.

Where I lived in CA, the only community-based plan available to us was AARP-UHC. We switched onto that when Blue Shield announced "happy birthday, now pay more"; it cost $250/month for two of us, age 70. Now in Indiana, there are more community-based choices and the premium for the AARP-UHC is 22% less. I do recommend them; their website is clean and easy, and they pay promptly and reliably.

AARP/UHC created kind of a hybrid rating product because they give you a diminishing discount until age 77? after which there is no discount or age related increase. This makes the initial age 65 pricing a bit more palatable.

They also give a 5% discount for a couple signed up with the same AARP number.

I can’t find the UHC age discount schedule online right now, but I have found it in the past and probably have ia copy of it somewhere. I forget exactly what they call it.

 

[MRG]

I'm 6 months away from 65. What a timely thread.
Thanks to everyone for sharing.

 

[FargoI]

Applying for Medicare A and B on line via the secure social security site was the easiest process I've ever experienced with a governmental agency. Fifteen minutes. Plus they send regular updates on the status. This is assuming one already has a secure social security web account which anyone in this group *should*.

 

[FargoI]

Center for Medicare Services aka Medicare offers some excellent on line and free resources. Medicare and You 2021 is super. Download it today and read asap.

 

[carty1]

Plan F

Isn't Plan F (& F HD) closed to new enrollees?

Not exactly. If you turned 65 before Jan 1,2020, you can enroll in Plan F.

 

[ncbill]

So are those people picking plan N mostly the ones living in states that prohibit excess charges?

 

[REWahoo]

So are those people picking plan N mostly the ones living in states that prohibit excess charges?

Not in my case as they are allowed in TX.

I went with N rather than G for the following reasons:

- N ~$30/mo less than G
- G may be subject to larger future increases than N due to reasons previously discussed
- Easy to avoid excess charges by using only providers that accept assignment
- Excess charges are relatively rare - fewer than 5% of claims
- Should I encounter an excess charge it is limited to 15% of the Medicare approved charge

 

[sengsational]

Right now, excess charges are rare, but could there be a growing middle tier of doctors that have all the patients they need, that flip that switch (adding 15% to the bill), just to slow the flow of new patients? There are plenty of highly qualified doctors in the "concierge" space that don't mess with Medicare or any insurance, so that's a tier. There's the "Accepts Medicare" tier (split into accepts amount or adds 15%). There's the bottom: "Accepts Medicaid" tier. I would guess that the higher the tier, the more likely you're going to get "health" care (as opposed to what's much easier to get: "sick" care). I guess my point is that if the quality of care is better in the excess charges tier, it might be worth it, not only in quality of care, but also for the possible reduction in risk of higher than average increase in premiums.

 

[REWahoo]

Right now, excess charges are rare, but could there be a growing middle tier of doctors that have all the patients they need, that flip that switch (adding 15% to the bill), just to slow the flow of new patients?

Anything is possible but there has been no indication of movement in that direction. From what I can see the frequency of excess charges hasn't changed much over the past few years.

 

[ncbill]

Not in my case as they are allowed in TX.

I went with N rather than G for the following reasons:

- N ~$30/mo less than G
- G may be subject to larger future increases than N due to reasons previously discussed
- Easy to avoid excess charges by using only providers that accept assignment
- Excess charges are relatively rare - fewer than 5% of claims
- Should I encounter an excess charge it is limited to 15% of the Medicare approved charge

So the practical downside (N versus G) is just co-pays?

 

[REWahoo]

So the practical downside (N versus G) is just co-pays?

That's how I see it. And as I mentioned earlier, some of the providers I have used haven't bothered billing me for the small copay as it may not be cost effective to do so.

 

[teej1985]

+1 for Plan N. As I recall, it cost about $40 less a month (remember, that's almost $500 a year -- a couple of days of vacation) than G, and so far I don't make 2 trips to the doctor per month. On routine care it's less than $20: if the allowed amount is under $100, Medicare will pay 80% and then the copay will be less than $20.

The "excess charge" cannot exceed 15% of the Medicare-allowed amount; some states don't permit them at all. I've never seen one charged.

Here's something no one has mentioned: premium rates are either "age-based" or "community based." The former will increase every 2 years as you age, PLUS inflation. The latter start out at what seems a little higher, and they WILL go up because everything goes up, but they don't go up because you got older.

Where I lived in CA, the only community-based plan available to us was AARP-UHC. We switched onto that when Blue Shield announced "happy birthday, now pay more"; it cost $250/month for two of us, age 70. Now in Indiana, there are more community-based choices and the premium for the AARP-UHC is 22% less. I do recommend them; their website is clean and easy, and they pay promptly and reliably.

CA lets you change plans every year, so it's not really a concern and you can take 2 minutes to check the rates and see who you might want get a quote from:

Medicare Supplement Insurance

For Age 65, the cheapest G plan is $1465 annually at State Farm, the cheapest N is also State Farm at $1121.

But as the ages increase, other insurers become cheaper than State Farm.

 

[finnski1]

+1 for Plan N. As I recall, it cost about $40 less a month (remember, that's almost $500 a year -- a couple of days of vacation) than G, and so far I don't make 2 trips to the doctor per month. On routine care it's less than $20: if the allowed amount is under $100, Medicare will pay 80% and then the copay will be less than $20.

.

In NH the plan N and G costs were almost identical. In fact plan N runs about $1/ month more. Anthem Health plans.

 

[REWahoo]

In NH the plan N and G costs were almost identical. In fact plan N runs about $1/ month more. Anthem Health plans.

Interesting.

I just got quotes from seven carriers for NH zip 03301, male age 65. Plan N was less expensive than G for all seven carriers, varying from only $2/mo less for Transamerica Life up to $44/mo less for United American.

 

[RetMD21]

+1 for Plan N. As I recall, it cost about $40 less a month (remember, that's almost $500 a year -- a couple of days of vacation) than G, and so far I don't make 2 trips to the doctor per month. On routine care it's less than $20: if the allowed amount is under $100, Medicare will pay 80% and then the copay will be less than $20.

The "excess charge" cannot exceed 15% of the Medicare-allowed amount; some states don't permit them at all. I've never seen one charged.

Here's something no one has mentioned: premium rates are either "age-based" or "community based." The former will increase every 2 years as you age, PLUS inflation. The latter start out at what seems a little higher, and they WILL go up because everything goes up, but they don't go up because you got older.

Where I lived in CA, the only community-based plan available to us was AARP-UHC. We switched onto that when Blue Shield announced "happy birthday, now pay more"; it cost $250/month for two of us, age 70. Now in Indiana, there are more community-based choices and the premium for the AARP-UHC is 22% less. I do recommend them; their website is clean and easy, and they pay promptly and reliably.

Excess charges are rare but complicated. Here is a >10,000 line list of charges with participating amount, non participating and maximum charge. https://www.wpsgha.com/wps/wcm/conn...pfs-Michigan-99.xlsx?MOD=AJPERES&CVID=nrZpbx8

Last I knew the Mayo clinic charged them.

Ca is exceptional since medigap changes are free from underwriting. Are medigap plans more expensive there.

Healthy 65 year olds should be better off with N but it is hard to know about the future

 

[finnski1]

Interesting.

I just got quotes from seven carriers for NH zip 03301, male age 65. Plan N was less expensive than G for all seven carriers, varying from only $2/mo less for Transamerica Life up to $44/mo less for United American.

This is what we have for Anthem NH.

 

[REWahoo]

This is what we have for Anthem NH.

Makes no sense for N to be more than G. No idea why, but all those rates appear very high to me. Example: I’m paying roughly half what Anthem quotes for N for my age.

 

[teej1985]

Excess charges are rare but complicated. Here is a >10,000 line list of charges with participating amount, non participating and maximum charge. https://www.wpsgha.com/wps/wcm/conn...pfs-Michigan-99.xlsx?MOD=AJPERES&CVID=nrZpbx8

Last I knew the Mayo clinic charged them.

Ca is exceptional since medigap changes are free from underwriting. Are medigap plans more expensive there.

Healthy 65 year olds should be better off with N but it is hard to know about the future

You can change to an equal or lesser plan annually. You can't switch from N to G without underwriting. I think some sates have even less restrictions though.

 

[audreyh1]

You can change to an equal or lesser plan annually. You can't switch from N to G without underwriting. I think some sates have even less restrictions though.

Some Medigap insurance companies may facilitate this but it’s not guaranteed. Very much depends on the state.

 

[CRLLS]

I wonder if the Anthem Plan N has some added benefits that their G doesn't. The various Medicare plans are standardized minimums. Insurers can offer more, such as AARP/UHC offers some form of gym memberships not required by Medicare. Most table comparisons found, do not list much more than the Medicare required benefits. You have to dig deeper to find the "extras".