My "Best" Medigap options - Approval issues?

[Dash man]

To further advance the discussion, I'd like to ask --

Is it difficult to move from Plan G-HD over to Plan G ??

It depends. Are you within six months of your initial enrollment period? Are you in a state that allows you to change your Medicare supplement at a certain time each year?
If not, will you be able to pass underwriting?
I suggest you consider Plan N instead of Plan G. Likely to increase rates less over time.

 

[Katsmeow]

Web search pulled up this discussion about AARP/United and frankly, I have no idea if these people have no understanding or if they actually had reasonable analysis.

I'll be poking my agent to see if she can provide some valid input.

DH and I both have had an AARP/United plan for years. Most of the people in that discussion really seem at best confused about how the plan actually works.

We picked the AARP UHC plan because the premiums are "community rated" not "age attained"

We recently moved from Texas to Delaware. DH and I's combined premium for the AARP UHC plan went down a little over $30 a month when we moved there. That was a welcome surprise.

As I understand it, without the decreasing discount, the AARP community-rated plan would be non-competitive for those who are just entering Medicare. That initial discount makes the plan more competitive with, for example, an age-attained plan. I think where a community-rated plan looks best is when you are much older and past the point where there is no longer a discount.

I think that is correct.

To further advance the discussion, I'd like to ask --

Is it difficult to move from Plan G-HD over to Plan G ??

Does your state allow you to move without underwriting? If not, then it may be impossible to switch plans.

 

[badatmath]

It was the person paying $610 a month I thought was depressing. Ridiculous for something only covers 20% of the bill but maybe that is for a couple.

 

[Katsmeow]

It was the person paying $610 a month I thought was depressing. Ridiculous for something only covers 20% of the bill but maybe that is for a couple.

For a couple depending on age I would think that was definitely possible. When my mother died in 2018 she had a supplement (Plan G) from Cigna. Her premium was over $300 a month, I think somewhere in the mid-300 range. But -- she was 94 and the amount went up due to age.

 

[fosterscik]

Maybe with Cigna, but UHC/AARP currently is $218/month at age 90 for a non-smoking male plan G and $193/month for a non-smoking female in TN. There will obviously be general health care inflation between now and when we reach 90 but that's true for all plans.

 

[pb4uski]

It was the person paying $610 a month I thought was depressing. Ridiculous for something only covers 20% of the bill but maybe that is for a couple.

Perhaps they are choosing the wrong plans. Over the last 4 years we have had Plan G in two different states and over that time our cost was $125-$211 per person per month... currently $211 and $168.

My 93 yo FM, in yet another state pays $347/mo.

 

[RetMD21]

I've been trying to track down previous rate increases and what sign-up discounts were "provided" since I'm signing up for Medigap for the first time. Specifically for the four providers I originally posted. Yes, I do understand that past performance does not indicate future performance ... but what other information do we have to work from? Bottom line is that I would like to make a selection while at least making some assessment of where the rates "might" go in the future.

Web search pulled up this discussion about AARP/United and frankly, I have no idea if these people have no understanding or if they actually had reasonable analysis.

I'll be poking my agent to see if she can provide some valid input.

One person was complaining about excess part B charges for late sign up. Another was complaining about a 7% increase in a medigap charge. Another one was arguing mad because AARP didn't do the disappearing discount in their state. Not much to learn there.

Telly had a great thread about Mutual of Omaha's closed book scam https://www.early-retirement.org/fo...-provider-selection-for-my-plan-g-100099.html

 

[FiveDriver]

It depends. Are you within six months of your initial enrollment period? Are you in a state that allows you to change your Medicare supplement at a certain time each year?
If not, will you be able to pass underwriting?
I suggest you consider Plan N instead of Plan G. Likely to increase rates less over time.

Thanks for your response Dash Man. I just did an after-hours google search, and Plan N premiums appear to be lower in my state. I'll make a few phone calls during business hours tomorrow to get real quotes.

From your experience, what's the major difference between Plan G and Plan N ?

Why do you think that Plan N rates will increase less over time ??

Thanks, as I will keep researching.

 

[Dash man]

Thanks for your response Dash Man. I just did an after-hours google search, and Plan N premiums appear to be lower in my state. I'll make a few phone calls during business hours tomorrow to get real quotes.



From your experience, what's the major difference between Plan G and Plan N ?



Why do you think that Plan N rates will increase less over time ??



Thanks, as I will keep researching.

The reason Plan G rates may increase faster is because Plan G is the “Guaranteed Issue” plan for folks with these scenarios:

1. You leave a Medicare Supplement plan to join a Medicare Advantage plan for the first time, have been in the plan less than a year, and wish to go back to Medicare Supplement (trial right)
2. You joined a Medicare Advantage Plan at age 65 and want to switch from Medicare Advantage to a Medicare Supplement plan during the first year (trial right)
3. Your Medicare Advantage plan is dropping coverage in your area, or you move out of the plan service area
4. You have Medicare SELECT and decide to move out of the plan’s service area
5. Your employer plan that supplements Medicare ends
6. The Medicare company did not follow the rules or misled you
7. Your Medicare Supplement insurance company goes bankrupt.

Those folks are generally older and sicker, so the Plan G pool gets more expensive.

With Plan N, there is an up to $20 copay for office visits. Doesn’t apply to Imaging or lab work. There is a $50 emergency room copay unless you’re admitted. In January I was in the hospital for four days under “observation” and technically not admitted. I had to pay the $50 and three $20 copays for doctor visits.

Plan N also has this thing called “Excess Charges” that some people are afraid of, but it’s really not a big deal. 98% of doctors accept Medicare payments. The 2% that don’t can charge excess charges where Medicare will only pay them 95% of the Medicare rate, the the doctor can add up to 15% more, so it works out to a maximum of 109.25% for the entire bill, or 9.25% more than you would otherwise have paid. Medicare will not send the balance to your Medigap supplier, so the doctor will likely ask you to pay up front, so there wouldn’t be a surprise billing. Then you’d have to submit the bill for reimbursement. You can check the Medicare website in advance to see if a doctor accepts Medicare, and for an emergency they are not permitted to charge excess charges. I personally don’t know anyone who has actually run up against excess charges and seven states prohibit them. I don’t believe you need to worry about them.

 

[badatmath]

How long was plan F "the thing" before they "invented" plan G? (I didn't find a start date which made me think it must be pretty old).

I am wondering if in a few years they will have a "plan H".

I can already tell I am going to miss my retiree insurance just as I miss my employee insurance. . . Hoping they don't do away with my retiree insurance . . . but won't be shocked if they do.

 

[FiveDriver]

The reason Plan G rates may increase faster is because Plan G is the “Guaranteed Issue” plan for folks with these scenarios:

1. You leave a Medicare Supplement plan to join a Medicare Advantage plan for the first time, have been in the plan less than a year, and wish to go back to Medicare Supplement (trial right)
2. You joined a Medicare Advantage Plan at age 65 and want to switch from Medicare Advantage to a Medicare Supplement plan during the first year (trial right)
3. Your Medicare Advantage plan is dropping coverage in your area, or you move out of the plan service area
4. You have Medicare SELECT and decide to move out of the plan’s service area
5. Your employer plan that supplements Medicare ends
6. The Medicare company did not follow the rules or misled you
7. Your Medicare Supplement insurance company goes bankrupt.

Those folks are generally older and sicker, so the Plan G pool gets more expensive.

With Plan N, there is an up to $20 copay for office visits. Doesn’t apply to Imaging or lab work. There is a $50 emergency room copay unless you’re admitted. In January I was in the hospital for four days under “observation” and technically not admitted. I had to pay the $50 and three $20 copays for doctor visits.

Plan N also has this thing called “Excess Charges” that some people are afraid of, but it’s really not a big deal. 98% of doctors accept Medicare payments. The 2% that don’t can charge excess charges where Medicare will only pay them 95% of the Medicare rate, the the doctor can add up to 15% more, so it works out to a maximum of 109.25% for the entire bill, or 9.25% more than you would otherwise have paid. Medicare will not send the balance to your Medigap supplier, so the doctor will likely ask you to pay up front, so there wouldn’t be a surprise billing. Then you’d have to submit the bill for reimbursement. You can check the Medicare website in advance to see if a doctor accepts Medicare, and for an emergency they are not permitted to charge excess charges. I personally don’t know anyone who has actually run up against excess charges and seven states prohibit them. I don’t believe you need to worry about them.

Thanks for explaining the subtleties of Plan G vs Plan N, that is enlightening.

So, to quantify the potential OOP dollar difference --
with Plan G-HD, you would have to account for Plan G-HD's $2700 deductible.
with Plan N, you would have a lower monthly premium plus the slightly higher ays (about $500 in lower annual premium + say, $100 in additional copay per year).

Any other considerations ??

 

[Dash man]

Thanks for explaining the subtleties of Plan G vs Plan N, that is enlightening.



So, to quantify the potential OOP dollar difference --

with Plan G-HD, you would have to account for Plan G-HD's $2700 deductible.

with Plan N, you would have a lower monthly premium plus the slightly higher ays (about $500 in lower annual premium + say, $100 in additional copay per year).



Any other considerations ??

The Plan G-HD still has Medicare pay their 80% first. You pay the 20% Medicare doesn’t pay up to your deductible. The deductible will increase every year as all things healthcare related do because of inflation. I have not seen the $20 Plan N copay increase.
The Plan G-HD includes having to pay the Part A Hospital deductible of $1,632 for 2024 and possible coinsurance for longer stays over 60 days. Remember that deductible can occur more than once per year. Regular Plan G and Plan N pay the Part A deductible and coinsurance.
The Part B deductible requires both Plan G and Plan beneficiaries to pay the annual deductible of $174.70 for 2024 before benefits kick in.

 

[ncbill]

The Plan G-HD still has Medicare pay their 80% first. You pay the 20% Medicare doesn’t pay up to your deductible. The deductible will increase every year as all things healthcare related do because of inflation. I have not seen the $20 Plan N copay increase.
The Plan G-HD includes having to pay the Part A Hospital deductible of $1,632 for 2024 and possible coinsurance for longer stays over 60 days. Remember that deductible can occur more than once per year. Regular Plan G and Plan N pay the Part A deductible and coinsurance.
The Part B deductible requires both Plan G and Plan beneficiaries to pay the annual deductible of $174.70 for 2024 before benefits kick in.

Plan G-HD is capped at a maximum out-of-pocket (not really a deductible) which includes the Part B deductible, so it is not $2,700 plus $226, but just $2,700 for 2023.

And offers co-insurance coverage for longer hospital stays & coverage of the Part A hospital deductible just the same as Plan G:

Medicare Supplement High Deductible Plan G

 

[teej1985]

Plan G-HD is capped at a maximum out-of-pocket (not really a deductible) which includes the Part B deductible, so it is not $2,700 plus $226, but just $2,700 for 2023.

And offers co-insurance coverage for longer hospital stays & coverage of the Part A hospital deductible just the same as Plan G:

Medicare Supplement High Deductible Plan G

This is the first I've heard of G HD covering the Part A deductible. has something changed? Or is that one website just wrong?

 

[Dash man]

This is the first I've heard of G HD covering the Part A deductible. has something changed? Or is that one website just wrong?

I was wrong. This is from Medicare.gov:

https://www.medicare.gov/medigap-su...HIGH_G?fips=42091&zip=19473&year=2024&lang=en

“What you will pay

Monthly cost (premium)
$37 - $105*
Plan deductible
$2,700
Hospital (Part A) deductible
$0
Medical (Part B) deductible
$226
Part B copays/coinsurance
$0 Generally your cost for approved Part B services after you pay $2,700 deductible
Footnote *
Doesn't include the standard Part B premium for $164.90 each month.

*
Covered services

What you will pay for Part A services

Hospital stays
Days 1-60: $0
Days 61-90: $0
Days 91-150: $0 while using your 60 lifetime reserve days
Additional 365 days: $0 for Medicare-eligible services
After the additional 365 days: All costs
Skilled nursing facility (for Medicare-covered stays)
Day 1-20: $0
Days 21-100: $0
After 100 days: All costs
Blood (during a hospital stay)
First 3 pints: $0
After 3 pints: $0
Hospice care
$0
What you will pay for Part A & B services

Home health care (for Medicare-approved services)
$0
Durable medical equipment (covered by Medicare)
First: $226 (Part B deductible)
Then: $0
What you will pay for Part B services

Covered Part B services
First: $226 (Part B deductible)
Then: $0
Preventive services
$0 Generally for most preventive services Medicare covers
Part B excess charges
$0
Blood (outside a hospital stay)
First 3 pints: $0
After 3 pints: $226 (Part B deductible), then $0
Tests for diagnostic services
$0
Footnote
Note: Although the Part B deductible of $226 appears more than once, you only pay it one time each year.

Extra benefits - not covered by Medicare

Foreign travel emergency
First: $250
Then: 20% and amounts over the $50,000 lifetime maximum”

 

[teej1985]

That doesn't really tell us anything though because it doesn't specify what you pay for before the HD plan starts paying. Everything I've heard if that you are subject to the A deductible. That would be a major change and we would see all the brokers talking about it.

 

[Katsmeow]

How long was plan F "the thing" before they "invented" plan G? (I didn't find a start date which made me think it must be pretty old).

I am wondering if in a few years they will have a "plan H".

I can already tell I am going to miss my retiree insurance just as I miss my employee insurance. . . Hoping they don't do away with my retiree insurance . . . but won't be shocked if they do.

I guess it all depends. When I turned 65 DH had been on Medicare awhile but I had been paying for his employer subsidized retiree insurance. In many ways it was a nice policy since it covered both in network and out of network (higher out of pocket for that). But, there was a network and they never paid enough for out of network (based on what they ridiculously considered reasonable). Still, it had a good network.

I was paying $1118 a month for coverage not including the $1500 deductible and 20 coinsurance until the $3500 OOP max was reached. As soon as I turned 65 all I had to pay was the Part B premium and medigap premium and Part D. All of those were far below the $1118 a month. And, of course, the Medicare deductible was far below the retiree deductible and no coinsurance with my Plan G. My medical costs went down so much!

(And instead of retiree insurance I then received a retiree HRA each year which has been enough to cover the Part B premiums and all or most of the Part D premiums -- depending on plan chosen).

 

[meleana]

I'm just signing up for Medicare and have been working with an agent to help me select/sign-up. My intention is to sign up for Medigap (G), with one of the major providers, and my agent came up with the following as the best candidates; obviously based on which ones she is signed up to represent (sigh). There are other providers available in Colorado. My biggest concern has been with the reputations for denying coverage and/or significant cost increases. I'm not concerned with the noted cost differential.

So, I'm looking for a bit of input or thoughts on any notable issues with coverage denial or is there one of these providers that have worked out well.

1.) (Anthem) Blue Cross Blue Shield Of Colorado - $135.99
2.) Cigna National Health Insurance Company - $137.80
3.) Humana Insurance Company - $145.06
4.) AARP Medicare Supplement Plans, Insured By Unitedhealthcare - $150.80 + AARP membership ($20ish)

Per my agent, the only major difference is that Anthem and United provide coverage for a fitness facility membership

We have Anthem BC/ BS in NH plan G and it’s been great.

 

[MBSC]

That doesn't really tell us anything though because it doesn't specify what you pay for before the HD plan starts paying. Everything I've heard if that you are subject to the A deductible.

You pay all Part A and Part B cost sharing until it totals $2800 (2024). That is why it is referred to as a deductible. The Part A deductible counts toward meeting the $2800. If you have already met the $2800 and then have an inpatient hospital admission, the HD plans pay it. The timing of the Part A deductible determines if you or the plan pays it.

The link posted by ncbill contains one chart with a blue background. It says "Medicare Supplement High Deductible G(*) Benefits" and then lists covered benefits AFTER the * is satisfied (identified as the plan deductible at the bottom).

The second chart has stars marking covered services with a highlighted footnote saying they are covered after the plan deductible is met.

Dash man's post says you will pay the plan's monthly premium and $2700 plan deductible first, then it acts like a regular G.

Effective January 1, 2024, the annual deductible amount for these three plans is $2,800. The deductible amount for the high deductible version of plans G, F and J represents the annual out-of-pocket expenses (excluding premiums) that a beneficiary must pay before these policies begin paying benefits.

Reference: https://www.cms.gov/medicare/health-drug-plans/medigap/f-g-j-deductible-announcements

High Deductible Plan G

Medicare (Part A) Hospitalization: After you pay $2,700 deductible plan pays $1,600 (Part A deductible).

This high deductible plan pays the same benefits as Plan G after you have paid a calendar year $2,700 deductible. Benefits from the High Deductible Plan G will not begin until out-of-pocket expenses are $2,700. Out-of-pocket expenses for this deductible include expenses for the Medicare Part B deductible, and expenses that would ordinarily be paid by the policy. This does not include the plan’s separate foreign travel emergency deductible.

Reference (document page 12): https://www.bluecrossnc.com/content/dam/bcbsnc/pdf/hosted/shopper/outline-of-coverage.pdf

 

[teej1985]

You pay all Part A and Part B cost sharing until it totals $2800 (2024). That is why it is referred to as a deductible. The Part A deductible counts toward meeting the $2800. If you have already met the $2800 and then have an inpatient hospital admission, the HD plans pay it. The timing of the Part A deductible determines if you or the plan pays it.

That was my understanding. Other commenters suggested otherwise.

 

[Sulli]

I just did my medicare sign up after much research, talking to a nonprofit agency and getting recommendations. I went with your #1 option, $133.50.

 

[Deuce]

It's possible that you can't, as Texas might care more about corporations than consumers.

I googled colorado insurance consumers medicare.

Why would you say this?

 

[teej1985]

Why would you say this?

Because I could not find such information for Texas.

 

[Sunnymar]

I have Plan F-HD and am healthy, I view it as the best plan out there. My monthly premium equals my savings for the HD, if I had medical expenses I'd paid my deductible sooner and have the same plan F coverage. Since I'm healthy I save money every year, while having the protection of broad insurance available. Other's may have different reasons for their chosen plan, but this works for me, just as plan G-HD works for many people.

 

[Scuba]

While I like the excel spreadsheet, I can't find one for Florida, but I go to https://www.medicare.gov/medigap-supplemental-insurance-plans/#/m?year=2024&lang=en

and then when I get to plans just scroll down the list... and that should work in every state and zip code.

Thanks for this link. I just took a look at it as DH will be eligible to sign up for Medicare soon. We know we want traditional Medicare with Medigap and I think the plans that work best for us are either Plan G (not the HD option) or Plan N. From the link you provided, it appears that Plan G is slightly more expensive with respect to the monthly premium, but it covers "excess charges" for Part B, while Plan N does not.

As far as insurers, it seems that the AARP/UHC program is something most people are pretty happy with. We want to try our best to choose correctly the first time. DH had quadruple bypass surgery in 2022, and while he's really healthy now, I am guessing he would have trouble with medical underwriting given his heart attack last year.

Have I understood the differences between Plan G and Plan N correctly? Any other factors you all recommend we consider in our decision-making?