My "Best" Medigap options - Approval issues?

[Dash man]

This is from post #59:

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.

 

[REWahoo]

^ What Dash Man said. This also reflects the experience DW and I have had since signing up for plan N seven years ago.

 

[Ian S]

To me, the nickel-and-dime copays of Plan N would be a nuisance I don't want now and even less if and when I become less mentally alert. Happy with my Plan G with its single annual deductible which, for me, is usually satisfied early in the year. A case of BTD perhaps? YMMV.

 

[Dash man]

To me, the nickel-and-dime copays of Plan N would be a nuisance I don't want now and even less if and when I become less mentally alert. Happy with my Plan G with its single annual deductible which, for me, is usually satisfied early in the year. A case of BTD perhaps? YMMV.

My concern is Plan G premiums tend to increase faster than Plan N premiums. Plan G is a “Guaranteed Issue” plan where older and potentially sicker folks will be allowed into the plan. This tends to drive costs up a bit faster. The occasional up to $20 copayments aren’t much of a problem.

 

[CRLLS]

The part about Plan G that I like is that I don't have to reconcile every last little transaction once I satisfy the Medicare annual deductible. I had more than my share of that under ACA and M/C Plan FHD. Let Medicare, the Dr's office and the supplement insurer fight out any discrepancies. That is easily worth the extra cost to me. Admittedly, that hasn't happened yet that I know of. I have seen some resubmittals from the Dr's office once Medicare has approved some charges. It all worked out without my intervening.

Another happy customer of AARP/UHC Plan G.

 

[teej1985]

My concern is Plan G premiums tend to increase faster than Plan N premiums. Plan G is a “Guaranteed Issue” plan where older and potentially sicker folks will be allowed into the plan. This tends to drive costs up a bit faster. The occasional up to $20 copayments aren’t much of a problem.

This seems like a non-issue in states that have the birthday or anniversary rule, or the ones that let people switch at whim.

It also seems like you're better off finding an insurer that doesn't participate in the Close-The-Book shenanigans as younger and healthier will be able to keep signing up for it and keep the costs down for the pool.

See this:

https://www.bogleheads.org/forum/viewtopic.php?p=7553492#p7553492

 

[Calico]

The part about Plan G that I like is that I don't have to reconcile every last little transaction once I satisfy the Medicare annual deductible. I had more than my share of that under ACA and M/C Plan FHD. Let Medicare, the Dr's office and the supplement insurer fight out any discrepancies. That is easily worth the extra cost to me. Admittedly, that hasn't happened yet that I know of. I have seen some resubmittals from the Dr's office once Medicare has approved some charges. It all worked out without my intervening.

Another happy customer of AARP/UHC Plan G.

Ditto

 

[Ian S]

My concern is Plan G premiums tend to increase faster than Plan N premiums. Plan G is a “Guaranteed Issue” plan where older and potentially sicker folks will be allowed into the plan. This tends to drive costs up a bit faster. The occasional up to $20 copayments aren’t much of a problem.

I wonder if anyone has tried to quantify this. In most states, after the initial six month enrollment period, there are few instances where you can switch to any medigap plan. Usually, it would be if someone in Medicare Advantage moves out of their coverage area. Other times it might be if the insurer eliminates their MA plan. But I just wonder how many people we are talking about and whether it's a drop in the bucket compared to numbers who get a medigap plan when they turn 65.

 

[sengsational]

My concern is Plan G premiums tend to increase faster than Plan N premiums. Plan G is a “Guaranteed Issue” plan where older and potentially sicker folks will be allowed into the plan. This tends to drive costs up a bit faster. The occasional up to $20 copayments aren’t much of a problem.

Seems to me N and G are the same with respect to issuance, but there's a difference, theoretical, that might suggest a difference in the magnitude of future price increases.

The two attract slightly different cohorts. If I'm already going to the doctor regularly the extra out of pocket of the N plan is something I'm certainly going to pay. The simple math has me in a G. If I never go to the doctor, the extra expense on the N are something that may or may not happen, so the smallish reduction in premium of the N over the G might have me in an N. Now look at the cohorts. N people might be a bit healthier. As a healthier cohort, they would utilize fewer services. That means smaller premium increases. In theory.

I completely "get" not wanting to keep the books, as I've had to painfully do with 10 years of ACA plans. But with N, the values are small and known in advance. I don't plan on getting detailed. Instead, I plan on just keeping a total, and as long as it's in tolerance, ignore it. If it gets beyond the error bar, I suppose there will need to be an audit, but I don't expect I'll need to do that.

 

[ncbill]

This seems like a non-issue in states that have the birthday or anniversary rule, or the ones that let people switch at whim.

IIRC, for most states the birthday/anniversary rule only permits switching to equal or lesser plans w/o underwriting.

So someone on Plan N would need to pass underwriting to go "up" to Plan G.

 

[teej1985]

IIRC, for most states the birthday/anniversary rule only permits switching to equal or lesser plans w/o underwriting.

So someone on Plan N would need to pass underwriting to go "up" to Plan G.

Sure, my point was someone could switch from G to another G due to the competition of several companies being available for those who are able to use the birthday rule.

 

[athena53]

I was paying $1118 a month for [for subsidized retiree insurance] 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!

I was on ACA before I turned 65. Premiums went down on Medicare, out-of-pocket costs went WAY down.

I wanted to add a note on complaint ratios filed with state insurance commissioners: I doubt they break them out for Medigap vs. others so now you're counting complaints from people who had ACA plans and employer plans (some of which have narrow networks and unrealistically low "reasonable and customary charges) with that insurer.

While I'm not fond of AARP as an organization I'm VERY happy with their UHC supplement, which DH got in 2014 when I retired and I got 5 years ago.

There was, BTW, one time I did have to work directly with UHC. DH was getting weekly treatments for a leg ulcer and although I'm sure he provided the card for his supplement it never got into the record and despite the hospital's boilerplate "Claims have been filed against all applicable insurance and this is what you owe", UHC had never seen the claims. I called, they were very nice, and I sent 30 pages of hard-copy Medicare claim notices to UHC. They paid their share.

 

[Rianne]

My Mutual of Omaha premiums went from $92.22 to $97.50 for 2024. The online account is up to date with every Dr, and hospital event including EOBs. Saw a specialist at Mayo Clinic in Rochester in 2023, 3 day stay with tests, bloodwork, etc. Happy with them so far.

 

[teej1985]

My Mutual of Omaha premiums went from $92.22 to $97.50 for 2024. The online account is up to date with every Dr, and hospital event including EOBs. Saw a specialist at Mayo Clinic in Rochester in 2023, 3 day stay with tests, bloodwork, etc. Happy with them so far.

I would switch away from them while you are healthy enough to.

https://www.bogleheads.org/forum/viewtopic.php?p=7553492#p7553492

 

[Dash man]

This seems like a non-issue in states that have the birthday or anniversary rule, or the ones that let people switch at whim.

It also seems like you're better off finding an insurer that doesn't participate in the Close-The-Book shenanigans as younger and healthier will be able to keep signing up for it and keep the costs down for the pool.

See this:

https://www.bogleheads.org/forum/viewtopic.php?p=7553492#p7553492

States that allow switching with no underwriting typically have higher premiums, simply because a person can switch when they become ill.

 

[teej1985]

States that allow switching with no underwriting typically have higher premiums, simply because a person can switch when they become ill.

I don't know if that's typical or not, but California has cheaper premiums than Arizona and California is the state that has the birthday rule while Arizona is a state that has no such rule.

 

[Dash man]

I maybe wrong generally, but New York has high premiums because of this.

 

[teej1985]

I maybe wrong generally, but New York has high premiums because of this.

I believe New York allows anyone to sign up for anything at any time. That's more generous than the birthday rule which can only be changed a specific time of year and can only change to a similar or less comprehensive plan not a more comprehensive plan

 

[RetMD21]

This link attributes the higher cost of some states to these switching rules. Interestingly I see CA on the higher cost lists on several websites although that hasn't necessarily been the experience of posters here.

https://www.medicarefaq.com/faqs/most-expensive-states-for-medigap/

 

[jim584672]

I maybe wrong generally, but New York has high premiums because of this.

True premiums are higher, that is why you have to do a High G when healthy and "young", and switch to a regular G (or N) when older. Or wait until you actually get sick and do the switch.

 

[REWahoo]

True premiums are higher, that is why you have to do a High G when healthy and "young", and switch to a regular G (or N) when older. Or wait until you actually get sick and do the switch.

I did something similar even though my state has no birthday rule. Both DW and I went with a High F supplement initially and changed to an N after six years. It was a bit of a gamble as we both had to go through underwriting, but it worked for us.

 

[MichaelB]

This link attributes the higher cost of some states to these switching rules. Interestingly I see CA on the higher cost lists on several websites although that hasn't necessarily been the experience of posters here.

https://www.medicarefaq.com/faqs/most-expensive-states-for-medigap/

Florida, home to the 5th most expensive MediGap policy, does not allow changing plans. MediGap is expensive in Florida because healthcare is expensive there, and I suspect that is one of the top drivers everywhere.

 

[Scuba]

Thank you to everyone who has provided insights on Plan G vs Plan N. We have an appointment with a consultant to discuss options in a couple of weeks since DH needs to sign up before 3/1. Apart from his quadruple bypass surgery last year, which was a bit of a shocker, we have always been healthy. The only year he has met his deductible under our current HD plan is last year, and I’ve never met mine. Fortunately we’ve been pretty healthy, but last year was a grim reminder of how quickly that can change. We are both somewhat fiscally conservative and prefer to pay a little more to limit our risk.

With all of that in mind, we are leaning towards Plan G but also open to Plan N. If Plan G is considered an “upgrade” from Plan N, we’ll probably start with that. If we start on Plan G and later want to switch to N, is that possible without going through medical underwriting? Or are we making a long-term commitment by choosing Plan G to begin with?

We are in FL now.

 

[MichaelB]

Thank you to everyone who has provided insights on Plan G vs Plan N. We have an appointment with a consultant to discuss options in a couple of weeks since DH needs to sign up before 3/1. Apart from his quadruple bypass surgery last year, which was a bit of a shocker, we have always been healthy. The only year he has met his deductible under our current HD plan is last year, and I’ve never met mine. Fortunately we’ve been pretty healthy, but last year was a grim reminder of how quickly that can change. We are both somewhat fiscally conservative and prefer to pay a little more to limit our risk.

With all of that in mind, we are leaning towards Plan G but also open to Plan N. If Plan G is considered an “upgrade” from Plan N, we’ll probably start with that. If we start on Plan G and later want to switch to N, is that possible without going through medical underwriting? Or are we making a long-term commitment by choosing Plan G to begin with?

We are in FL now.

In Florida you are subject to underwriting when applying for a new MediGap supplement outside of the first eligibility window. One should assume it is a long term commitment.

 

[MichaelB]

I did something similar even though my state has no birthday rule. Both DW and I went with a High F supplement initially and changed to an N after six years. It was a bit of a gamble as we both had to go through underwriting, but it worked for us.

When we signed up for MediGap there was no way to tell what insurers would do with pricing and such, so I signed up DW with BCBS and I took UHC - a way to reduce the risk of pricing or plan closing. Now, 5 years later for me, DW’s plan is 10% more expensive than mine. Recently I got a quote from UHC for DW. She satisfied the underwriting but the price was 10% more than her current policy, because they are using age attained pricing. So, we’re still locked in.