Medicare Supplement Plans F,G, and N

[Ian S]

I've signed up for Medicare (Parts A and B) starting August 1 and am now in the midst of choosing a Medigap plan. I know F tends to be the most popular with the most coverage but it's also the most expensive and IIRC, won't be taking in new recruits after 2020 so its premiums may climb more rapidly after that. The only difference between F and G is that with G you have to pay the Part B deductible. It's typically cheaper and sometimes a much better deal even if you wind up having to pay the deductible. Plus, I've not heard of any plans for closure like will probably happen to F. So, I've been leaning a bit towards a G plan.

I've been looking at offerings here in Arizona and have met with a couple of agents. One has recommended Physicians Mutual but their prices seem a little higher than for say AARP/UHC offerings. The AARP plans also offer Silver Sneakers membership which would save me $15/month as my gym would become free with Silver Sneakers membership. AAA also offers plans from Aetna but I'm not sure whether they include Silver Sneakers. BCBS of Arizona also offers some competitive pricing but apparently not Silver Sneakers membership. Alas, neither AARP nor BCBS offer a Plan G but they do offer Plan N policies which are like G but where you have doctor visit co-pays of up to $20 and ER co-pays of up to $50. You'd also be responsible for physicians' excess charges of up to 15% for any non-participating doctor. I've checked and all of my doctors are participating. Plan N monthly premiums run $20 to $40 less than Plan G and $50 to $80 less than Plan F so I'm giving them some thought too. I did hear that those $20 co-pays can add up if you're in a hospital and various doc pay you a daily visit although others have said such visits may not be subject to the copay as they are not "office visits" per se.

Now most of these policies come with early enrollment discounts that decline annually for 10 or more years so you know your rates climb due to that. But what about premium increases in general over time? That sort of info is harder to find and could make the difference over a longer time period.

Anyway, I'd like to hear of folks' experiences with the F, G, and N plans and how their costs increased over time. Also any other pros and cons to the plans and the companies I mentioned or others I might consider. Thanks!

 

[REWahoo]

Have you considered Plan F high deductible? Might be worth a look if you don't have any chronic health problems and are OK with a ~$2000 annual deductible.

Regarding cost, in the five years I've had F(hd) it has increased from $44/mo to $53/mo.

 

[Options]

I've signed up for Medicare (Parts A and B) starting August 1 and am now in the midst of choosing a Medigap plan. I know F tends to be the most popular with the most coverage but it's also the most expensive and IIRC, won't be taking in new recruits after 2020 so its premiums may climb more rapidly after that. The only difference between F and G is that with G you have to pay the Part B deductible. It's typically cheaper and sometimes a much better deal even if you wind up having to pay the deductible. Plus, I've not heard of any plans for closure like will probably happen to F. So, I've been leaning a bit towards a G plan.

I've been looking at offerings here in Arizona and have met with a couple of agents. One has recommended Physicians Mutual but their prices seem a little higher than for say AARP/UHC offerings. The AARP plans also offer Silver Sneakers membership which would save me $15/month as my gym would become free with Silver Sneakers membership. AAA also offers plans from Aetna but I'm not sure whether they include Silver Sneakers. BCBS of Arizona also offers some competitive pricing but apparently not Silver Sneakers membership. Alas, neither AARP nor BCBS offer a Plan G but they do offer Plan N policies which are like G but where you have doctor visit co-pays of up to $20 and ER co-pays of up to $50. You'd also be responsible for physicians' excess charges of up to 15% for any non-participating doctor. I've checked and all of my doctors are participating. Plan N monthly premiums run $20 to $40 less than Plan G and $50 to $80 less than Plan F so I'm giving them some thought too. I did hear that those $20 co-pays can add up if you're in a hospital and various doc pay you a daily visit although others have said such visits may not be subject to the copay as they are not "office visits" per se.

Now most of these policies come with early enrollment discounts that decline annually for 10 or more years so you know your rates climb due to that. But what about premium increases in general over time? That sort of info is harder to find and could make the difference over a longer time period.

Anyway, I'd like to hear of folks' experiences with the F, G, and N plans and how their costs increased over time. Also any other pros and cons to the plans and the companies I mentioned or others I might consider. Thanks!

Have you read this book:

https://www.amazon.com/Medicare-Dummies-Patricia-Barry/dp/1118532783

Correct me if I'm wrong, but it sounds like you may be making many of the mistakes outlined in the book, including making your choices based on talking to agents, possibly relying on big name insurance companies, and possibly failing to conduct apples to apples plan comparisons.

I'm not eligible for medicare yet, but to better instruct my lifetime health care projections, I'm reading the above book for the second time (this time highlighting important sections), and intend to use the medicare website to "dummy" my medicare cost projections. This as opposed to relying on averages provided by studies and websites such as Fidelity.

I can't say enough good things about the above book as the medicare enrollment process has so many moving parts (as you are finding out). This book does excellent work of unraveling those parts in plain English, in an easy-to-read format. The author is the "medicare expert" for AARP and has researched and answered many confounding situations with medicare in this role. I haven't found information on medicare this thorough elsewhere. I highly recommend reading it before signing up for anything as you could literally save yourself a thousand dollars a year or more.

For those who are already enrolled in medicare, she advises comparing plans annually, as costs/plans/benefits change. In one example, she shows how she helped a friend save over $1K in part D by comparing costs when enrolling, and how for the next five years until his death, he saved money every year by reviewing part D plans during open enrollment as every year plan details changed.

 

[omni550]

Ian S,

I had good results from speaking with Chris Westfall, an agent licensed to sell in most states. He has several excellent videos on YouTube and his website is Senior Savings Network - Insurance Savings for Seniors

Chris has a software program into which he inputs your data (age, state of residence, etc.) and it spits out a list of the various insurance companies who write Medigap policies in your state and what the monthly premiums are.

He was able to find me a Plan G through Aetna for $113/mo (with the $147 deductible).

A friend's uncle (retired accountant) who had been on Medicare for about 5 years saved ~$300/mo. by giving Chris a call.


omni

 

[MBSC]

I agree with researching HD-F. The "deductible" is misleading. Original Medicare still pays first. You just pay the remaining cost share until the $2180 OOP limit is met.

The agents can provide you the rate history for any carrier they represent. The 2016 Arizona Medigap rates can be found here: https://insurance.az.gov/sites/default/files/documents/files/2016MedSuppPremComp20160503.pdf

The 2015 Arizona Medigap rates can be found here: http://aaaphx.org/wp-content/uploads/Arizona-Medicare-Supplement-Premium-Comparison-Guide.pdf

List of carriers offering plans in AZ: https://insurance.az.gov/sites/default/files/documents/files/MedSuppList.pdf

Some of the smaller carriers with the best rates do not use outside agents. They use call-center agents. You call the carriers directly to request quotes and enroll in a plan. The above guide includes those carriers. Check out a copy of "Medicare for Dummies" from your local library.

Plan N: The Mayo Clinic in Florida does not accept assignment on Medicare Part B claims and bills the additional 15% in excess charges. You may want to research how the one in AZ handles this. The "up to $20 copay" only applies to office visit CPT codes. Hospital visits use different CPT codes so the copay does not apply. I have seen physical therapy incorrectly coded as office visits and subject to the copay. The Plan N member simply tells the provider to resubmit to Original Medicare with PT codes and everything is fine. The fear of excess charges and copays keeps sick people away making the Plan N risk pool healthy and resulting in fairly stable premiums.

Plan N copay explained: https://www.cms.gov/Medicare/Health-Plans/Medigap/downloads/Plan_N_Guidance2.pdf

The "up to $20 copay" is actually a 20% coinsurance capped at $20. Established patient office visit allowables are generally in the $70-90 range so the "copay" is usually in the $14-18 range.

 

[Ian S]

Have you read this book:

https://www.amazon.com/Medicare-Dummies-Patricia-Barry/dp/1118532783

Correct me if I'm wrong, but it sounds like you may be making many of the mistakes outlined in the book, including making your choices based on talking to agents, possibly relying on big name insurance companies, and possibly failing to conduct apples to apples plan comparisons.

Thanks for that suggestion! I'm actually doing a lot of research on my own and this book will help with that.

 

[Ian S]

Have you considered Plan F high deductible? Might be worth a look if you don't have any chronic health problems and are OK with a ~$2000 annual deductible.

Regarding cost, in the five years I've had F(hd) it has increased from $44/mo to $53/mo.

Yes I'm now giving some thought to that plan especially since I'm now aware it's less a "deductible" and more a cap on OOP costs arising from my 20% share of what Medicare allows. My only concern is what happens in 2020. It would seem that F-High Deductible plans might be spared as they require patients to have some skin in the game but my research so far says they may not meet the letter of the law.

 

[MichaelB]

One thing to keep in mind as you compare policies is how they are priced, community vs age related. There are three ways to price, as explained here, a policy may have a lower premium today but if it is attained age based it will increase faster than the others.

 

[Ian S]

I agree with researching HD-F. The "deductible" is misleading. Original Medicare still pays first. You just pay the remaining cost share until the $2180 OOP limit is met.

The agents can provide you the rate history for any carrier they represent. The 2016 Arizona Medigap rates can be found here: https://insurance.az.gov/sites/default/files/documents/files/2016MedSuppPremComp20160503.pdf

The 2015 Arizona Medigap rates can be found here: http://aaaphx.org/wp-content/uploads/Arizona-Medicare-Supplement-Premium-Comparison-Guide.pdf

List of carriers offering plans in AZ: https://insurance.az.gov/sites/default/files/documents/files/MedSuppList.pdf

Some of the smaller carriers with the best rates do not use outside agents. They use call-center agents. You call the carriers directly to request quotes and enroll in a plan. The above guide includes those carriers. Check out a copy of "Medicare for Dummies" from your local library.

Plan N: The Mayo Clinic in Florida does not accept assignment on Medicare Part B claims and bills the additional 15% in excess charges. You may want to research how the one in AZ handles this. The "up to $20 copay" only applies to office visit CPT codes. Hospital visits use different CPT codes so the copay does not apply. I have seen physical therapy incorrectly coded as office visits and subject to the copay. The Plan N member simply tells the provider to resubmit to Original Medicare with PT codes and everything is fine. The fear of excess charges and copays keeps sick people away making the Plan N risk pool healthy and resulting in fairly stable premiums.

Plan N copay explained: https://www.cms.gov/Medicare/Health-Plans/Medigap/downloads/Plan_N_Guidance2.pdf

The "up to $20 copay" is actually a 20% coinsurance capped at $20. Established patient office visit allowables are generally in the $70-90 range so the "copay" is usually in the $14-18 range.

Thanks for this info. I had the 2016 Arizona publication but not last year's. As I understand it, Mayo in AZ also bills the excess charges. Good to know about the different codes for in-hosptal and office doctor visits.

 

[Ian S]

One thing to keep in mind as you compare policies is how they are priced, community vs age related. There are three ways to price, as explained here, a policy may have a lower premium today but if it is attained age based it will increase faster than the others.

Good point. Fortunately, it seems policies with attained age pricing are illegal in Arizona.

 

[reubenray]

I am going through the same process being I will be turning 65 in September. After doing a lot of research and getting info from another forum I have decided on a High-Deductible F Plan from Thrivent Financial for Lutherans. Their plan also has discounts for dental, vision and hearing aids.

I am in reasonably good health and only go to the doctor once a year for check-ups and prescription refills. The cost difference between the regular F and the HD-F is over a $100 a month.

 

[REWahoo]

My only concern is what happens in 2020. It would seem that F-High Deductible plans might be spared as they require patients to have some skin in the game but my research so far says they may not meet the letter of the law.

I find it frustrating the fine folks responsible for the implementation of the law haven't made a determination of whether or not F-HD plans will be impacted in 2020. After all, they are one of those highly-efficient, well-run government agencies aren't they?

 

[MichaelB]

I find it frustrating the fine folks responsible for the implementation of the law haven't made a determination of whether or not F-HD plans will be impacted in 2020. After all, they are one of those highly-efficient, well-run government agencies aren't they?

Disclaimer - the following may be a really naive post, as it assumes these changes in Medicare and MediGap are based on reasoned policy that will continue to be applied in a uniform manner.

That aside, the reason for eliminating MediGap F is because it covers the Medicare B deductible. They are eliminating all plans where Medicare pays "first $ coverage". MedGap F-HD is the ideal policy because of the high deductible, so we should expect it to continue and perhaps even take center stage as the "ideal MediGap policy".

 

[kaneohe]

Yes I'm now giving some thought to that plan especially since I'm now aware it's less a "deductible" and more a cap
on OOP costs arising from my 20% share of what Medicare allows. ................. F-High Deductible plans might be spared .....................................

actually isn't it both and either term by itself misleading? cap on OOP suggests that you might be getting some reimbursement from Medigap before you reach that number but you don't until you pay that deductible.

 

[MBSC]

I find it frustrating the fine folks responsible for the implementation of the law haven't made a determination of whether or not F-HD plans will be impacted in 2020. After all, they are one of those highly-efficient, well-run government agencies aren't they?

CMS and NAIC are working toward a solution. There was recently a comment period to take input on a draft HD-G. The comments are being reviewed and taken into consideration.

www.naic.org/documents/committees_b_senior_issues_exposure_plan_g_high_deduct_chart.pdf

Disclaimer - the following may be a really naive post, as it assumes these changes in Medicare and MediGap are based on reasoned policy that will continue to be applied in a uniform manner.

That aside, the reason for eliminating MediGap F is because it covers the Medicare B deductible. They are eliminating all plans where Medicare pays "first $ coverage". MedGap F-HD is the ideal policy because of the high deductible, so we should expect it to continue and perhaps even take center stage as the "ideal MediGap policy".

CMS and NAIC are leaning toward the creation of HD-G for new enrollees in 2020 and beyond. The reasoning is that consumers in 2020 may find it confusing that they can buy this Plan F but not that Plan F. If created, HD-G would be identical to HD-F.

 

[Ian S]

actually isn't it both and either term by itself misleading? cap on OOP suggests that you might be getting some reimbursement from Medigap before you reach that number but you don't until you pay that deductible.

Yes, it's a combination. I think the confusion arises from the fact that with a Medigap policy, you have in effect three policies: Part A for hospitalization costs, Part B for doctors and other non-hospital costs and the Medigap plan. Although the Medigap F-Hi Ded plan won't pay until you're OOP for that ~2200 deductible, the Parts A and B will pay once you meet their deductibles. So, for example, if you have a few doctor's visits and treatments during the year and the billed costs run to $1,000, you would not pay that $1,000. Instead, you'd pay the Part B deductible of $166 plus 20% of the remaining $834 for a total of $333. At least that's how I understand it to work.

 

[MBSC]

If you use an agent, be aware of cross-selling other plans. This new video is from the agent's perspective. The client received the Medigap Plan G she requested but also ended up with Final Expense (life insurance) as well as Cancer, Heart Attack, and Stroke indemnity plans.

Edit to add: The $ shown in the screenshot is the agent's first year commission, not a monthly premium.

 

[molly312]

My personal experience: Both my husband and I have Plan F. My husband is in perfect health and to date, would have saved some money on High deductible plan F, or one of the others. I, have breast cancer and for us Plan F has been a God sent blessing. My bills have been large and many. No, we did not plan on this. Along with the physical and mental stress of this disease, we have been relieved of weekly billing fights and tons of paperwork. Yup, you can figure out what is the best for less this year. However, few people figure that they are going to get a future serious medical condition when doing the math. We endorse Plan F - had wonderful support from both Anthem (first policy) and then AARP.

I will also add - that for us, the biggest challenge is the Part D, drug plan. When you sign up for one, they give you a formulary. However, there is no guarantee that they won't change their formulary mid-year and leave you with huge increase in drug costs.

 

[athena53]

If you use an agent, be aware of cross-selling other plans. This new video is from the agent's perspective. The client received the Medigap Plan G she requested but also ended up with Final Expense (life insurance) as well as Cancer, Heart Attack, and Stroke indemnity plans.

That's just horrifying. "Dread disease" plans, which cover only specific illnesses, are generally a bad idea.

We had a mad scramble for health insurance when I ER'd; company pretty much dropped us onto COBRA the day I left. I knew COBRA wasn't a good long-term solution and wanted to get "real" coverage ASAP. DH was Medicare-eligible and even though I spent 38 years in the property-casualty side of the insurance business, I still found the process bewildering. Our agent wasn't great, but at least she didn't try and sell us extra coverages and she pointed out the subtle fact that if you select one type of plan (Medicare Advantage?) and then want to switch to the other type, they're allowed to decide whether or not to accept you. Because DH was switching from my employer's plan, he was automatically accepted. So, you're making choices that may have long-term implications.

I have a couple more years till I'm Medicare-eligible but will definitely get the most recent edition of "Medicare for Dummies" when it comes time to make decisions.

 

[kaneohe]

Yes, it's a combination. I think the confusion arises from the fact that with a Medigap policy, you have in effect three policies: Part A for hospitalization costs, Part B for doctors and other non-hospital costs and the Medigap plan. Although the Medigap F-Hi Ded plan won't pay until you're OOP for that ~2200 deductible, the Parts A and B will pay once you meet their deductibles. So, for example, if you have a few doctor's visits and treatments during the year and the billed costs run to $1,000, you would not pay that $1,000. Instead, you'd pay the Part B deductible of $166 plus 20% of the remaining $834 for a total of $333. At least that's how I understand it to work.

Yes, I think I have the same concept of how it works. From an overall system bottom line point of view, the 2200 acts like an max OOP number but you still get reimbursed by Medicare (not Medigap) before then. From the point of view of the F Hi-ded plan, the 2200 acts like a deductible, since you get nothing from Medigap until then.

 

[Ian S]

My personal experience: Both my husband and I have Plan F. My husband is in perfect health and to date, would have saved some money on High deductible plan F, or one of the others. I, have breast cancer and for us Plan F has been a God sent blessing. My bills have been large and many. No, we did not plan on this. Along with the physical and mental stress of this disease, we have been relieved of weekly billing fights and tons of paperwork. Yup, you can figure out what is the best for less this year. However, few people figure that they are going to get a future serious medical condition when doing the math. We endorse Plan F - had wonderful support from both Anthem (first policy) and then AARP.

I will also add - that for us, the biggest challenge is the Part D, drug plan. When you sign up for one, they give you a formulary. However, there is no guarantee that they won't change their formulary mid-year and leave you with huge increase in drug costs.

The problem is that Plan F is going away for new enrollees in 2020. Consequently, there may be substantial increases in premiums for those who are grandfathered into those plans. The other point I'd make is that there are many cases where you can save money with Plan G over Plan F no matter how much your medical coats are! There are many policies where Plan G is cheaper for the year than F even if you have to pay the Part B deductible under Plan G.

As for the drug plans, I agree you have to watch the formulary and if it changes to your detriment then you should change as soon as permitted.

 

[haha]

In my state of Washington, you can always move laterally from one company' s Medigap policy to another of the same or lower level.


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