My "Best" Medigap options - Approval issues?

[Steelart99]

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

 

[ncbill]

If you can afford the higher "deductible" (really an OOP maximum) why not go with G-HD?

And if a treatment is Medicare-approved there is no denial under a Medigap plan.

Denial is an issue with Medicare Advantage plans, most of which are also HMOs which require pre-approval for most treatments anyway.

 

[PaunchyPirate]

Medigap insurance companies do not get to decide what they will pay or not. If a medical procedure is covered by your traditional Medicare, the Medigap company must pay their portion of the payment after Medicare pays their portion. If a medical procedure is not covered by Medicare, then the Medigap policy also doesn't cover anything for that procedure. The "coverage" is decided by your traditional Medicare. Not the Medigap company.

You are correct to be researching price increase history, customer satisfaction scores, etc. Unfortunately, I do not have any experience or knowledge specific to Colorado. These are all major insurance providers. I would probably pick the lowest cost one if nothing else jumps out in your research.

 

[pb4uski]

Those are all solid players and reasonably priced monthly premiums in my opinion, so just go with your gut, but if it were me I would lean towards BCBS.

I would stick with a Plan G over a Plan G-HD at those affordable premium levels. At $136/month for G, how much can the annual savings really be vs the risk of having to pay the high deductible?

 

[ShokWaveRider]

We went with AARP as they have a reputation of selecting the best plan providers. My main concern would be price increases after the initial perceived low payments. AARP have been good for me for the last 5 years with modest low increases over that time. not the cheapest for a reason I guess.

 

[sengsational]

If any of those companies are operating in your state under a slightly different name, then they have a history of "closing the book". That business practice allows them to sell now for less, but over the whole span, as the cohort ages, can cost a lot more.


I suspect all but UHC use an "attained age" pricing model, meaning the pool of people in with you are all the same age. That means utilization will increase and price will follow. Plus increases due to inflation. UHC/AARP is community priced, so the pool has mixed ages, and they discount the early years.

 

[teej1985]

Those are all solid players and reasonably priced monthly premiums in my opinion, so just go with your gut, but if it were me I would lean towards BCBS.

I would stick with a Plan G over a Plan G-HD at those affordable premium levels. At $136/month for G, how much can the annual savings really be vs the risk of having to pay the high deductible?

According the state's compiled listing - https://drive.google.com/file/d/1iMgDgxNHiVWE28jEq63XMTOkdCmrU9mb/view?pli=1 - G HD is as low as $35/mo

 

[MichaelB]

I think OP has good options and it’s really not possible to predict future price increases by insurer.

When choosing our policies I looked at 5 years of data that I tracked. It was generally inconclusive, so I decided to go with the 2 biggest insurers in our state, BCBC and UHC-AARP. Both policies had roughly the same premium, now 6 years later BCBS is about 10% more expensive.

 

[badatmath]

If any of those companies are operating in your state under a slightly different name, then they have a history of "closing the book". That business practice allows them to sell now for less, but over the whole span, as the cohort ages, can cost a lot more.


I suspect all but UHC use an "attained age" pricing model, meaning the pool of people in with you are all the same age. That means utilization will increase and price will follow. Plus increases due to inflation. UHC/AARP is community priced, so the pool has mixed ages, and they discount the early years.

+1. I have read this is one of the most important things to consider. YMMV as I don't really know what I am talking about.

 

[Steelart99]

OP here: I had done some research that had me posting the original question:

OPINONS from valupenguin.com:
Anthem insurance (BCBS) denies claims twice as often as the industry average. Using publicly available data on individual health insurance plans purchased through the marketplace, we found that Anthem denied 36% of medical claims during calendar year 2019. In comparison, the average rate of claim denials across the health insurance marketplace was 17%.

UHC health insurance policies can be more expensive than average, and interacting with the company can be frustrating, according to comments on the Better Business Bureau. UnitedHealthcare gets about 22% more complaints than a typical insurer of its size according to the National Association of Insurance Commissioners (NAIC).

Humana customers consistently report being happy with their plans and gave especially high marks for Humana's care of chronic pain and illness. One of the largest companies within Humana has nearly five times as many complaints about its Medicare Supplement plans versus the average, according to the National Association of Insurance Commissioners (NAIC)

Cigna offers fewer Medigap plan options than some competitors, and its rates are higher than other large companies. Cigna also has below-average customer service ratings and more complaints for its Medigap plans than other companies. If you want plans other than A, F, G or N, lower rates or an overall positive customer experience, Cigna is not a good option for you.

 

[Steelart99]

If any of those companies are operating in your state under a slightly different name, then they have a history of "closing the book". That business practice allows them to sell now for less, but over the whole span, as the cohort ages, can cost a lot more.


I suspect all but UHC use an "attained age" pricing model, meaning the pool of people in with you are all the same age. That means utilization will increase and price will follow. Plus increases due to inflation. UHC/AARP is community priced, so the pool has mixed ages, and they discount the early years.

Yes these are all Attained-Age. I had quite the discussion with my agent about Attained-age versus Issue-Age as there were a few of those available in Colorado. Her final reply after consulting with her agency leader:

"Although several factors can cause your premium to increase, attained-age-rated policies are usually a better option. For someone turning 65, a premium could be $100 monthly on an attained-age policy and $140 per month for an issue-age or community-rated policy. Yet, all three policies will increase over time, eventually evening out.” “Although several factors can cause your premium to increase, attained-age-rated policies are usually a better option. For someone turning 65, a premium could be $100 monthly on an attained-age policy and $140 per month for an issue-age or community-rated policy. Yet, all three policies will increase over time, eventually evening out.”

 

[aja8888]

According the state's compiled listing - https://drive.google.com/file/d/1iMgDgxNHiVWE28jEq63XMTOkdCmrU9mb/view?pli=1 - G HD is as low as $35/mo

Where can I find a comprehensive list like this for Texas?

 

[Sunset]

I'll repeat what someone else already said:

With Medicare supplemental plans (aka medigap) , Medicare decides what is covered and the medicare supplemental plan pays it's share.
They don't get to deny you anything, as it's ONLY Medicare that could deny something.

People often confuse regular insurance denial actions with medigap plans.

For example ALL plan G's will pay out the same amount for Medicare approved procedures without any denials.

In typical insurance selling, some medigap plans like G (as example) will offer G plus some other stuff to justify a higher cost by offering gym memberships, dental discount. But that just confuses the choice.

 

[Sunset]

....

"Although several factors can cause your premium to increase, attained-age-rated policies are usually a better option. For someone turning 65, a premium could be $100 monthly on an attained-age policy and $140 per month for an issue-age or community-rated policy. Yet, all three policies will increase over time, eventually evening out.” “Although several factors can cause your premium to increase, attained-age-rated policies are usually a better option. For someone turning 65, a premium could be $100 monthly on an attained-age policy and $140 per month for an issue-age or community-rated policy. Yet, all three policies will increase over time, eventually evening out.”

Not what some folks here on the site have reported happening, as closing the book re-writes the rules of the game.

 

[Steelart99]

I'll repeat what someone else already said:

With Medicare supplemental plans (aka medigap) , Medicare decides what is covered and the medicare supplemental plan pays it's share.
They don't get to deny you anything, as it's ONLY Medicare that could deny something.

People often confuse regular insurance denial actions with medigap plans.

For example ALL plan G's will pay out the same amount for Medicare approved procedures without any denials.

In typical insurance selling, some medigap plans like G (as example) will offer G plus some other stuff to justify a higher cost by offering gym memberships, dental discount. But that just confuses the choice.

Yes, I did read that, but for some reason that didn't fully register. Could all the Medicare documents/Information be ANY MORE confusing? Thanks for the repeat as that does make a difference.

 

[Steelart99]

Not what some folks here on the site have reported happening, as closing the book re-writes the rules of the game.

Hahaha ... that's why I posted that note. I've had quite the argument and was totally surprised that her understanding of the meaning of those terms was questionable. After a week, her complete reply back to me started with:

"I have had a heck of a time trying to get a straight answer but I did confirmed with my agency leader that my understanding of Attained Age vs Issued Age vs Community Rated pricing models for Medicare Supplements was correct and the way Medicare.gov explains them is a bit confusing"

https://www.medicarefaq.com/faqs/medicare-supplement-plans-medigap-pricing-methods/

Yeah ... not convinced

 

[teej1985]

Where can I find a comprehensive list like this for Texas?

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

I googled colorado insurance consumers medicare.

 

[Teacher Terry]

In 3 years my Bc/Bs went from 150/ month to 200 on a F plan. I used the birthday rule to switch to a G plan and get it back down to 150.

 

[Dash man]

AARP/UHC has a plan without the gym membership that’s a little cheaper if you don’t think you’ll use it. If your agent won’t sell it to you, you can buy direct.

You won’t ever have to contact the insurer you pick except for payment purposes. Medicare sends the bill to them directly and they just pay. Easy peasy.

 

[Jimmie]

AARP/UHC offers more than just a gym membership. https://www.uhc.com/medicare/health-plans/medicare-supplement-plans/wellness-extras.html

Also, it's highly unlikely you will ever need to call a supplement provider customer service dept. As mentioned numerous times here, as long as medicare pays, then the supplement provider has to pay. There's no option for them to deny payment. Once you get approved and setup auto-pay for payments, your experience is on cruise control.

I would say to stay knowledgeable about reading your Electronic Medicare Summary Notices posted on your medicare account. It's not that unusual for a medical provider to make a mistake on a medicare billing code, which in turn will force you to contact your doctor about it.

 

[pb4uski]

According the state's compiled listing - https://drive.google.com/file/d/1iMgDgxNHiVWE28jEq63XMTOkdCmrU9mb/view?pli=1 - G HD is as low as $35/mo

True, but there are many less insurers to chose from for the G-HI plan. Humana offers both and the savings are $84/month ($135/mo for G vs $51 for -HI) so the annual emium savings are $1,008.

Meanwhile, the Plan G-HI deductible is $2,700 higher than Plan G. In both cases you need to pay the $226 Plan B deductible as well.

How lucky does one feel?

For an extra $1,008 annually, I prefer the surety of knowing that my maximum deductible is only $226 vs $2.926 but if someone else prefers to buy the Plan G-HI then that is fine.

It's like the old Fram oil filter commercial... pay me now or pay me later.

 

[Dash man]

Plan N will give you lower premiums than Plan G, if you don’t mind paying up to a $20 copay for office visits. Don’t worry about the scare tactics about Excess Charges, since you will likely never see one. If in the rare chance you did, they typically average $50.

 

[tutan]

Is there any reason to switch between medigap plans in the future? Or it’s too risky to switch for whatever reason, eg. coverage gap, underwriting, etc.?

 

[teej1985]

True, but there are many less insurers to chose from for the G-HI plan. Humana offers both and the savings are $84/month ($135/mo for G vs $51 for -HI) so the annual emium savings are $1,008.

Meanwhile, the Plan G-HI deductible is $2,700 higher than Plan G. In both cases you need to pay the $226 Plan B deductible as well.

How lucky do you feel?

For an extra $1,008 annually, I prefer the surety of knowing that my maximum deductible is only $226 vs $2.926 but if someone else prefers to buy the Plan G-HI then that is fine.

Not sure why you'd compare Humana's products rather than the cheapest G vs cheapest G HD. BTW, the $2700 includes the $226. It's not in addition. Paying $2700 would mean that you have ~$50k of negotiated Medicare approved charges. The bigger gamble is if you get hospitalized and have to pay the $1600 Part A deductible.

 

[Katsmeow]

AARP UHC doesn't play the games other carriers play with closing their book and creating a "sick duck" pool. Also AARP is very clear on pricing. When you first join you get a discounted price. Each year on your birthday for the first 10 years or so you premium goes up a bit as part of the discount goes away. This is a set amount which you can know right from the start. Once a year they do an overall premium increase which is relatively small in my experience.

All Plan Gs cover the same thing. The only time I have spoken with UHC is when we moved and needed to update.

We went with AARP as they have a reputation of selecting the best plan providers.

AARP UHC supplement plans do not select plan providers. That works with traditional Medicare where you can select anyone who takes Medicare. There are AARP UHC Medicare Advantage plans but this thread is not about them.