Medigap plan G vs plan N

[VanWinkle]

S.O. is going to be going to medicare in August this year. She has enough health concerns that we are likely going to traditional medicare and a medigap policy. Plan N seems to have the same coverage as G, but does not cover charges that are above what Medicare pays. How often is this a problem? Could someone with plan N let me know their experience with plan N and any problems with charges above what Medicare pays?

Thanks in advance,

VW

 

[REWahoo]

6+ years on plan N for DW and I, and after multiple surgeries and dozens of Dr. visits from many different providers, not a whiff of excess charges from any of them.

There have been several threads on this subject, here is one from a couple of years ago: What is your experience with Plan N

In reality, Part B "excess charges" are relatively rare, said to be charged less than 5% of the time. Excess charges can almost always be avoided by confirming in advance that the provider accepts medicare assignment. And even if you do end up with a provider who charges more than Medicare allows, they are limited in how much they can charge.

As explained in post #10 of the linked thread, the most you could be on the hook for after payment from Medicare and the plan N provider is 9.25% of the Medicare allowable amount.

 

[Texas Proud]

Not long on the plan but I do get the charge of $20 from most Drs.... sometimes it comes in at just over $18 though... never an excess charge...



Considering the difference in premium costs I would have to go to a lot of Dr visits to make it worthwhile...

 

[single2019]

S.O. is going to be going to medicare in August this year. She has enough health concerns that we are likely going to traditional medicare and a medigap policy. Plan N seems to have the same coverage as G, but does not cover charges that are above what Medicare pays. How often is this a problem? Could someone with plan N let me know their experience with plan N and any problems with charges above what Medicare pays?

Thanks in advance,

VW

I just signed up for Plan N. Before doing that, I put my zip code on “find care” on Medicare.gov with many specialities. I didn’t find a single doctor within 50 miles that accepted Medicare but charged the excess charge

 

[MBSC]

Excess charges are not really a factor since the Mayo Clinic became a participating provider. 0.3% of Part B claims are non-assigned and roughly 40% of them are mental health.

IMHO, your only concern should be if the "up to $20" office visit copays offset the ~$25 premium savings at 65 and ~$60 savings at 80 (varies by carrier and location).

We [CMS] are pleased that the favorable trend of participation continued into 2023 with a participation rate of 98 percent.

Reference: https://www.cms.gov/files/document/medicare-participation-announcement.pdf

In 2022, 98 percent of clinicians billing the physician fee schedule were participating providers, meaning that they agreed to accept Medicare’s fee schedule amount as payment in full. Clinicians who wish to collect somewhat higher payments (of up to 109.25 percent of Medicare’s payment rates) can “balance bill” patients for additional cost sharing if they sign up as a nonparticipating provider and choose not to “take assignment" on a claim, but very few clinicians choose this option: In 2022, 99.7 percent of fee schedule claims were paid at Medicare’s standard payment rate."

Reference (page 99): https://www.medpac.gov/wp-content/uploads/2024/03/Mar24_Ch4_MedPAC_Report_To_Congress_SEC.pdf

 

[DrRoy]

I have to decide the same thing.

 

[VanWinkle]

I appreciate the replies and feel much better about considering Plan N instead of G. S.O. will have the final choice, but I will be able to inform her better thanks to your replies.

VW

 

[FiveDriver]

I used the AARP/UHC website, with zip code specific pricing on their available plans. AARP/UHC seems to offer the best rates and is still Community based in my area. They also offer a G+ and N+ which is a Wellness adder, featuring some Vison, Hearing and Dental discounts and includes a Gym membership.

It appears the difference between Plan G and Plan N is enough to make N much less expensive on a annual basis -- IF the only difference is the $20 co-pays. I visit my Primary Care Doc twice a year, and my Dermatologist checks for any Sun Damage every September. Knock Wood.

https://www.uhc.com/medicare/health-plans/plan-summary

 

[sengsational]

Here's another N over G... Apparently in 2018 they changed a the law that made Plan G the dominant recipient of all guarantee issue business. So all the people with special election periods (those that lose a plan through no fault of their own) are dumped into Plan G. These people can be coming from Medicare Advantage plans and they don't need to go through underwriting. So that means the G pool might be taking on a bunch of former MA people that would not have passed underwriting (ie expensive people), and that would drive the rates up.

What I don't know is if the N and G rates are required to be insulated from each other. Logically, it seems they should be, but AARP/UHC Medigap just raised both N and G, and I think it was about the same percentage. It would take some research to figure that out. And it's complicated by the fact that the justification for the rate increases is separate for each state.

 

[ncbill]

Can't remember if it was here or another forum but I have seen at least one person note the co-pays once they developed health issues that required frequent office visits to several different doctors.

The above would easily overwhelm a $60/month savings for Plan N versus Plan G.

Why not Plan G-HD?

IIRC, the consensus expectation for that plan is relatively stable monthly premiums year over year (at least compared to Plan G) but max OOP increasing annually.

 

[Qs Laptop]

From what I've heard the "excess payment" charges rarely occur, but when they do it's usually related to anesthesiologists during some specialized surgery procedure. I didn't figure it to be a likely thing to happen to me.

I went N over G. In Minnesota I do have a $25 office copay, but curiously it always comes out to be $17.87.

Plan G has no copays. Both plans have a deductible of $240. But plan G is a lot more expensive than plan N. It works out that I'm better off paying less money for Plan N and paying the copays, then paying more for Plan G and not having copays. I don't go to the doctor more than 10X a year.

 

[VanWinkle]

I used the AARP/UHC website, with zip code specific pricing on their available plans. AARP/UHC seems to offer the best rates and is still Community based in my area. They also offer a G+ and N+ which is a Wellness adder, featuring some Vison, Hearing and Dental discounts and includes a Gym membership.

It appears the difference between Plan G and Plan N is enough to make N much less expensive on a annual basis -- IF the only difference is the $20 co-pays. I visit my Primary Care Doc twice a year, and my Dermatologist checks for any Sun Damage every September. Knock Wood.

https://www.uhc.com/medicare/health-plans/plan-summary

Thank you for that website link, it is very helpful as we were thinking UHC for her supplement.

 

[Ian S]

I'm nearly 9 years on Medicare. I started on Plan F because AARP/UHC didn't have a Plan G. When their Plan G became available I switched to that because the annual deductible was less than the difference in annual Plan costs. While Plan N would have saved some money over the years, I like the fact that once my annual deductible is paid - usually early in the year for me - there's no more fussing with copays and such on Plan G. But, if your primary concern is lower overall costs, then Plan N is most likely to be cheaper than Plan G.

 

[anethum]

I chose Plan G for the same reason as Ian S. I don't want to mess with co-payments. I do have a bit of a concern about "excess payment" because I was handling my mom's healthcare bills for many years and she did have a significant excess payment charge from an orthopedic surgeon.

Here's another N over G... Apparently in 2018 they changed a the law that made Plan G the dominant recipient of all guarantee issue business. So all the people with special election periods (those that lose a plan through no fault of their own) are dumped into Plan G. These people can be coming from Medicare Advantage plans and they don't need to go through underwriting. So that means the G pool might be taking on a bunch of former MA people that would not have passed underwriting (ie expensive people), and that would drive the rates up.

I question that. When someone's insurer ceases to exist, I don't think there's anything automatic about entering Plan G, and even if that's the case, there's no reason to think that people's whose plans are ending should be any sicker than others already in the Plan G pool. Furthermore, folks who were in an Advantage plan which is ending can and probably will choose a different Advantage plan.

 

[qwerty3656]

I chose Plan G for the same reason as Ian S. I don't want to mess with co-payments. I do have a bit of a concern about "excess payment" because I was handling my mom's healthcare bills for many years and she did have a significant excess payment charge from an orthopedic surgeon.


I question that. When someone's insurer ceases to exist, I don't think there's anything automatic about entering Plan G, and even if that's the case, there's no reason to think that people's whose plans are ending should be any sicker than others already in the Plan G pool. Furthermore, folks who were in an Advantage plan which is ending can and probably will choose a different Advantage plan.

Here is something from the state of NY

"Existing insureds covered under plans C, F, or high-deductible plan F prior to January 1, 2020 may continue to renew their coverage due to guaranteed renewability. All three of these Medigap plans cover the Medicare Part B (medical insurance) deductible. On or after January 1, 2020, insurers are required to offer either Plan D or G in addition to A and B."

https://www.dfs.ny.gov/consumers/health_insurance/information_for_medicare_beneficiaries

 

[CRLLS]

I just checked the UHC (AARP) website and within their family of supplements there seems to be no rhyme or reason for their pricing. They offer 3 different Plan Gs. Their basic "Plan G", a "Plan G+ Wellness" , and a "Select G +Wellness" which prefers you use their network of drs and hospitals.

One would think that the savings between each variation of the same plan letter would be a fixed number. But it isn't so. The following is for their lowest risk client. Female, age 65, non-tobacco user, and can answer "no" to all of their health questions.

From Plan G to Plan N is $29.92 savings per month
From Plan G+ to Plan N+ is $7.95 savings per month
From Select Plan G+ to Select Plan N+ is $6.33 savings per month

I was surprised to see that the savings are not the same. This is just one data point with one hypothetical person. Who knows how this changes as one ages. Certainly, other supplement providers have their own pricing methods and differences. Be that as it may, the "savings" between Plan G and Plan N appears difficult to paint with a wide brush. The devil is in the details. And the details are well hidden.

 

[Texas Proud]

I'm nearly 9 years on Medicare. I started on Plan F because AARP/UHC didn't have a Plan G. When their Plan G became available I switched to that because the annual deductible was less than the difference in annual Plan costs. While Plan N would have saved some money over the years, I like the fact that once my annual deductible is paid - usually early in the year for me - there's no more fussing with copays and such on Plan G. But, if your primary concern is lower overall costs, then Plan N is most likely to be cheaper than Plan G.

This was proposed to me by one of my friends parents who have been on F or G for a long time... they really like that they get no bills at all...


As he said to me 'you have enough money to not worry about the premiums'.... so it is really a decision on if you want to get rid of any bills.. but, I did go with N as I like the cheaper options if possible..

 

[sengsational]

I question that. When someone's insurer ceases to exist, I don't think there's anything automatic about entering Plan G, and even if that's the case, there's no reason to think that people's whose plans are ending should be any sicker than others already in the Plan G pool. Furthermore, folks who were in an Advantage plan which is ending can and probably will choose a different Advantage plan.

It's usually not about an insurer walking away from their patrons, typically. More common is when people can lose coverage "through no fault of their own" by simply moving out of the area covered by their current carrier. At that point, they fall into the "guaranteed issue" category. Those are basic facts that most people here probably would agree upon, I think. I searched for "default medigap plan guaranteed issue" and got

Plan G is the most popular Medigap Plan and the default guarantee issue plan.

That's from "omahainsurancesolultions", so take it with whatever quantity of salt you wish. I didn't take the time to actually find the law. I'm probably not nearly smart enough to interpret the actual law if it were laid out in front of me, hehe!

 

[Running_Man]

The biggest advantage of having Plan G over Plan N is the doctor knows they can bill more and be paid and I have found that when you need top care it is easier to get with plan G. My Father in Law had heart surgery at age 91 and he got top care from Mayo doctors in Scotsdale.

 

[REWahoo]

The biggest advantage of having Plan G over Plan N is the doctor knows they can bill more and be paid and I have found that when you need top care it is easier to get with plan G. My Father in Law had heart surgery at age 91 and he got top care from Mayo doctors in Scotsdale.

This doesn't seem logical to me.

Other than the virtually nonexistent excess charge issue (see post #5 above), the only difference in G and N is the "up to $20" office visit copay for N. I can't see any dr not providing someone with N "top care" over a concern they might have to come after you to collect that twenty bucks.

 

[MBSC]

The biggest advantage of having Plan G over Plan N is the doctor knows they can bill more and be paid and I have found that when you need top care it is easier to get with plan G. My Father in Law had heart surgery at age 91 and he got top care from Mayo doctors in Scotsdale.

This doesn't seem logical to me.

Other than the virtually nonexistent excess charge issue (see post #5 above), the only difference in G and N is the "up to $20" office visit copay for N. I can't see any dr not providing someone with N "top care" over a concern they might have to come after you to collect that twenty bucks.

I believe Running_Man is confusing Part B participating/non-par with Medicare Advantage. Once a provider decides to be non-par and not accept assignment, original Medicare limits billing to 109.25% (115% of 95%) for everyone, whether they have secondary coverage or not.

"Easier to get top care" is a theme used by some to differentiate original Medicare from Advantage plans with HMO/PPO networks and prior authorization requirements.

Mayo Clinic warned Medicare-eligible patients in Florida and Arizona in October [2022] that it does not accept most Medicare Advantage plans.

Reference: https://www.beckershospitalreview.com/finance/hospitals-take-aim-at-medicare-advantage.html

 

[Dash man]

From Medicare.org

It's usually not about an insurer walking away from their patrons, typically. More common is when people can lose coverage "through no fault of their own" by simply moving out of the area covered by their current carrier. At that point, they fall into the "guaranteed issue" category. Those are basic facts that most people here probably would agree upon, I think. I searched for "default medigap plan guaranteed issue" and got That's from "omahainsurancesolultions", so take it with whatever quantity of salt you wish. I didn't take the time to actually find the law. I'm probably not nearly smart enough to interpret the actual law if it were laid out in front of me, hehe!

Understanding Guaranteed Issue Rights
Private insurance companies are lawfully obligated to sell you a Medicare Supplement policy if you enroll during your initial enrollment period you qualify for guaranteed issue rights

Guaranteed issue rights are also known as Medigap protections. If you qualify, a private insurance company must abide by government regulations to give you access to certain Medicare Supplement plans, it must offer coverage for all pre-existing health conditions, and it cannot charge you a higher premium for the insurance plan due to health problems, either in the past or present.

Here is a list of some situations that may provide you with guaranteed issue rights to purchase a Medigap plan if you meet specific criteria:

• You have another form of health coverage that is changing or that you are going to lose within a short period of time.

• You have a Medicare Advantage (Part C) plan that is leaving Medicare or is ending its coverage in your area. This is also true if you are moving out of your plan’s service area.

• You are covered by Original Medicare Parts A and B as well as a group health plan provided by your employer or union that is ending. This is true if the group plan has been offering extended coverage after Original Medicare coverage ends.

• You are covered by Original Medicare Parts A and B and Medicare SELECT but you are leaving your coverage area for Medicare SELECT.

• You have a Medicare Advantage (Part C) plan but are switching back to Original Medicare.

• You initially had a supplement plan but now have a Medicare Advantage plan (and have had it for less than one year), and you wish to change back to a Medicare Supplement plan.

• Your private insurance provider goes bankrupt or your policy ends in a way that is not your fault.

• Your private insurance provider has been misleading or fraudulent and you decide to cancel your plan because of this.

In some cases, if you are in your “trial right” period for a Medicare Advantage (Part C) plan, which is up to 12 months after initial enrollment, you also have guaranteed issue rights to purchase a private supplemental health insurance plan during this special enrollment period. Federal law allows 63 days of guaranteed issue rights after you disenroll from your Medicare Advantage plan, giving you time to enroll in a Medicare supplement plan.

 

[anethum]

Nobody has explained why those people who qualify to enroll under Guarantee Issue would be more expensive to insure than those who are already in a Plan G pool. The circumstances which result in someone having Guarantee Issue eligibility have nothing to do with their individual health. In the absence of any explanation or data, I think that Guarantee Issue is a red herring as far as Plan G rate increases are concerned.

BTW, I believe there's one other additional cost for Plan N holders vs. Plan G holders: Under Plan N rules, there's up to a $50 co-payment for visits to the ER which don't result in hospital admission.

 

[audreyh1]

Nobody has explained why those people who qualify to enroll under Guarantee Issue would be more expensive to insure than those who are already in a Plan G pool. The circumstances which result in someone having Guarantee Issue eligibility have nothing to do with their individual health. In the absence of any explanation or data, I think that Guarantee Issue is a red herring as far as Plan G rate increases are concerned.

BTW, I believe there's one other additional cost for Plan N holders vs. Plan G holders: Under Plan N rules, there's up to a $50 co-payment for visits to the ER which don't result in hospital admission.

I agree with the red herring assessment.

 

[Dash man]

The reason guaranteed issue folks drive up the price is simple. They’re older and older people tend to be sicker. Additionally, some people on Advantage plans will move back to original Medicare because of a medical problem they have as they age.