Washington State Medicare Supplement Question (Medigap)

[AzDreamer]

Hello All, and thanks for the wealth of information that has been accumulated here because of your contributions.

I am looking at getting a HD-G or a HD-F plan for 2022 but am finding it is not easy to get price quotes from all the companies offering these policies, A few will give quotes easily using their website but not all.

Also, there is probably a difference in how easy these companies are to work with. Is there a website that has information about customer satisfaction so I can eliminate companies that hire people to make their customer's lives difficult?

I talked to a couple agents but there are some companies that aren't represented by these people. Premera BlueCross BlueShield of Washington has a plan that is $81.12 cheaper per year that my current HD plan but the agents I talked to did not work with this company.

What I am asking you folks for is advice about the HD plans in Washington state so I can pick the right company without having to do all the work, I'm retired now and prefer to spend my time in leisure.

Thanks,

Henry

 

[REWahoo]

Henry, I recommend you contact Boomer Benefits, an independent agency specializing in Medicare supplement plans nationwide. They should be able to answer all your questions. Many on this forum have used them and most are happy with their service.

 

[travelover]

Have you seen this? LINK

 

[Chuckanut]

I don't think plan F is available any more for new people. Plan G is the replacement. Functionally, it's pretty much the same except for a deducible and the rates.

 

[Telly]

Have you seen this? LINK

Interesting. The State of Washington makes it easy to see prices, nice!

As I scrolled down to page 4 in that document, I saw United of Omaha and United World. Compare the prices between them for F and G. I strongly (hahaha) suspect that in the time period that the State of Washington is using, that MoO is closing the book on "United of Omaha" and opening the book on their "United World". Too bad for the folks in the book that closed... bend over for the coming increased vigor of rate increases.

Some Financial Advisors push particular mutual funds because they can get maintenance fees from the funds. Some independent insurance brokers can get back-channel incentives to write at least X new policies a month from some insurance companies. At least the one ins. co. that makes a big game of it. It's still buyer beware.

 

[Happyras]

I had/have the same issues here in WA. We have been on State Farm G, but rates went up. I decided to go with a HD G plan, and MoO has never called me back. I decided to go with Premera for $47/mo (auto draft discounted rate).

I logged in on line by creating a new application log in. My old log in did not work at all. I was able to sign up effective Dec 1, but then I had trouble getting my wife signed up.

I had a person who was willing to help from Premera, but I was eventually able to get both done on line without any help. I am not sure what MoO cost would be effective Jan 1, or if Premera will change price early in 2022, but then in WA you can always jump plans anytime that occurs.

 

[AzDreamer]

Hi All,

Here is an update on my Medicare supplemental insurance quest.

I talked to a few advisors and finally talked to one that lives in my area and knew the local options better than the out-of-state advisors did.

I ended up choosing a $0 Advantage plan, something I did not expect would happen when starting out. The plan has reasonable and predictable copays so I know what the bill will be in advance.

My primary care physician copay will be $0. Specialists copays will be $35 and I don't need a referral from my PCP. I won't have to change any of my doctors.

Dental coverage is $2000 per year. The only difference between in and out of network dentists is whether I get billed or pay first and get reimbursed later.

Routine eye exams are $0 and there is a $300 reimbursement per year for glasses and contacts.

Instead of paying for Medigap and Part-D plans it looks like I will get both those benefits for $0 per year.

The Seattle area has over 60 Advantage plans and they have become much better and are more competitive than they were a few years ago.

 

[Dash man]

Hi All,

Here is an update on my Medicare supplemental insurance quest.

I talked to a few advisors and finally talked to one that lives in my area and knew the local options better than the out-of-state advisors did.

I ended up choosing a $0 Advantage plan, something I did not expect would happen when starting out. The plan has reasonable and predictable copays so I know what the bill will be in advance.

My primary care physician copay will be $0. Specialists copays will be $35 and I don't need a referral from my PCP. I won't have to change any of my doctors.

Dental coverage is $2000 per year. The only difference between in and out of network dentists is whether I get billed or pay first and get reimbursed later.

Routine eye exams are $0 and there is a $300 reimbursement per year for glasses and contacts.

Instead of paying for Medigap and Part-D plans it looks like I will get both those benefits for $0 per year.

The Seattle area has over 60 Advantage plans and they have become much better and are more competitive than they were a few years ago.

Make sure they fully cover chemotherapy drugs!

 

[ejman]

Make sure they fully cover chemotherapy drugs!

+1. I have Medicare Supplement Plan G here in Oregon. Just curious I checked on advantage plans available to me in this area and I found that the primary drug used for my treatment ($15,000 per infusion) was not covered.

 

[Happyras]

Again, I live in Redmond WA, and mostly use Evergreen Hospital doc's, but some docs are at Swedish or not in HMO/PPO's, which I feel are the best for ortho and skin cancer.

My plan G this year only paid out $700 that Medicare did not, but my premiums were $1950/yr, so I did the math and risk and decided to go with the HD Premera Plan G for $564/yr. The whole issue with those advantage plans is the OOP costs for minor and major procedures. If I had used an Advantage plan this year, I would have paid much more than $1950 in copays for the two Mho's cancer surgeries and cardio doc visits. If I had thrown in a knee surgery, that would really have been a lot more OOP, as I find the Anesthesia docs are typically not in network AND they do not advise you of that before surgery. Those guys alone can rack up high OOP costs for copays and non-covered fees. Last year I had a bi-lateral hernia operation covered by plan G. Had I been on an advantage plan, it would have cost me thousands in OOP until I reached the max OOP.

Its quite a game, I hope the OP considered these costs of minor surgery and docs not covered by the plan......and their copays.

If so, then I am open to learning more!

 

[MBSC]

I have Medicare Supplement Plan G here in Oregon. Just curious I checked on advantage plans available to me in this area and I found that the primary drug used for my treatment ($15,000 per infusion) was not covered.

The post is a little unclear. Infusion is covered by original Medicare's Part B benefit so it's also covered by the MA plan's Part B benefit. Therefore, the drug is listed as not covered if you searched for it under the MA's Part D plan.

However, MA plans have Part B drug step therapy. Are you saying the drug is not covered due to this?

The specific thing to look for that I’ve heard people get into trouble with is what they say you are responsible for 20% of the cost of chemotherapy treatments or drugs. This not restricted by any promised out of pocket maximum and can add up quickly.

CMS regulations require that ALL copays and coinsurance for Part A/B services, including chemo infusion coinsurance, count toward the MA plan's MOOP.

There are a few oral chemo drugs that fall under Part D, so the Tier 5 coinsurance does not count toward the A/B MOOP. Each MA summary of benefits clearly state it does not include the Part D plan's cost sharing. A person on original Medicare with a stand-alone Part D plan also incurs these Part D expenses so it is not unique to Advantage.

Medicare Managed Care Manual
Chapter 4 - Benefits and Beneficiary Protections
Section 50.1 – Guidance on Acceptable Cost-sharing

Maximum Out-of-Pocket (MOOP) and Combined (Catastrophic) Limits on cost-sharing:
To provide for transparent plan benefit designs that permit beneficiaries to better predict their out-of-pocket costs, all MA plans (employer and non-employer) – including HMOs, HMOPOS, local PPO (LPPO), Regional PPO (RPPO) and PFFS plans – are subject to a mandatory maximum out-of-pocket (MOOP) limit on enrollee cost-sharing for all Part A and Part B services.

In addition, both RPPO and LPPO plans are required to have a combined limit on cost-sharing that is inclusive of both in- and out-of-network cost-sharing for all Part A and Part B services. The MOOP dollar limits include all cost-sharing (i.e., deductibles, coinsurance, and co-payments) for Part A and Part B services...

Source: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/mc86c04.pdf

 

[MBSC]

The whole issue with those advantage plans is the OOP costs for minor and major procedures.... I find the Anesthesia docs are typically not in network AND they do not advise you of that before surgery. Those guys alone can rack up high OOP costs for copays and non-covered fees. Last year I had a bi-lateral hernia operation covered by plan G. Had I been on an advantage plan, it would have cost me thousands in OOP until I reached the max OOP.

If so, then I am open to learning more!

This is a common misconception. MA plans follow CMS managed care cost sharing rules, not those of under 65 group and individual plans. When a MA member goes to an in-network hospital, they pay the inpatient/outpatient/ER copay. That's it. There are no separate copays for anesthesia, surgeon, assistant surgeons, or ER physicians. If you compare an under 65 plan's summary of benefits to a MA summary of benefits, the MA does not have rows for 'inpatient hospital physician/surgeon coinsurance', 'outpt hosp physician/surgeon coinsurance' and so on. When there is no cost sharing listed, the plan pays 100% unless it's not covered by original Medicare.

Balance billing has never been allowed in Medicare Advantage. The MA PPO pays out-of-network providers the amount original Medicare would have allowed less the member's copay/coinsurance. This also prevents 'surprise medical bills' by out-of-network providers at in-network facilities. When an MA member goes to an in-network hospital, both HMOs and PPOs pay the OON providers so they appear to be in-network from the member's perspective.

Due to the structure of MA cost sharing, it is difficult to hit the MOOP unless the person is paying the chemotherapy coinsurance, having PT/specialist visits 3x a week for months, or receiving skilled nursing. These can cross the calendar year so MA members may pay the MOOP twice.

If you spend 2 days in the hospital and the MA PPO has a $400/day inpt copay for days 1-5 (in-network), then you owe $800 and the plan pays the ancillary claims. Follow-up visits may incur specialist copays. The outpt hospital copay is typically $250 and sometimes there is an x-ray copay. For PPO out-of-network hospitals, add the amounts Medicare, Medigap and you paid on the hospital facility claim to determine the allowed amount. (The approved amount on the MSN may be higher). If the allowed amount is $3500 and the PPO has 40% OON coinsurance, then you would have owed $1400 with the plan paying the ancillary claims. I wholeheartedly agree that HD-G is a great Medigap plan.

Medicare Managed Care Manual
Chapter 4 - Benefits and Beneficiary Protections
Section 50.5 – Guidance on Other Enrollee Out-of-Pocket Liability

No balance billing: As indicated in section 170 below, an enrollee is responsible for paying non-contracted providers only the plan-allowed cost-sharing for covered services.

Section 110.1.3 – Services for Which MA Plans Must Pay Non-contracted Providers and Suppliers

<snip>When an enrollee visits an in-network provider, even though that in-network provider may work with an out of network provider, then the enrollee is only responsible for in-network cost-sharing.

Section 170 – Balance Billing

When enrollees obtain plan-covered services in an HMO, PPO, or RPPO, they may not be charged or held liable for more than plan-allowed cost-sharing.

Section 170.2 – Balance Billing by Provider Type

• Contracted provider: There is no balance billing paid by either the plan or the enrollee.

• Non-contracting, original Medicare participating provider: There is no balance billing paid by either the plan or the enrollee.

• Non-contracting, non-participating provider: The MAO must pay the non-contracting, non-participating (non-par) provider the difference between the enrollee’s cost-sharing and the original Medicare limiting charge, which is the maximum amount that original Medicare requires an MAO to reimburse a provider. The enrollee only pays plan-allowed cost-sharing.

MA plans must clearly communicate to enrollees through the Evidence of Coverage (EOC) and Summary of Benefits (SB) their cost-sharing obligations as well as the enrollees’ lack of obligation to pay more than the allowed plan cost-sharing as described above.

Source: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/mc86c04.pdf

 

[AzDreamer]

For 2022 I am switching from a HD-G Medigap plan to a Medicare Advantage plan. The MA plan has zero-dollar monthly premiums, my copays are known in advance, and there are benefits like a Silver Sneakers health club membership, vision, and dental.

Can someone list the major pros and cons of a HD-G Medigap plan vs a Medicare Advantage plan? I wonder if there are HD-G features that I overlooked.

 

[Happyras]

Well, for one, quality of care can vary by HMO and specialty. The HD-G allows you to choose who you see for what you need. I see friends stuck in an HMO that does not have access to the best care options. My wife and I like the option to find the best specialist if needed, without some restricted list of network docs.

Also with the HD-G, I believe the OOP costs can be far less once you pay the deductible.

 

[RetiredHappy]

If you have minor illness, Advantage plans are great. If and when you have something serious which needs the best doctors and timely treatment, Supplement plan is the way to go. Someone whom I know who is on Advantage plan, symptoms of bladder cancer back in early August, lots of delays with referrals and rejection of out of network provider, and finally confirmed to be bladder cancer in late October, surgery in December and found that it was extensive and had invaded into the bladder wall.

 

[sengsational]

Interesting. The State of Washington makes it easy to see prices, nice!

As I scrolled down to page 4 in that document, I saw United of Omaha and United World. Compare the prices between them for F and G. I strongly (hahaha) suspect that in the time period that the State of Washington is using, that MoO is closing the book on "United of Omaha" and opening the book on their "United World". Too bad for the folks in the book that closed... bend over for the coming increased vigor of rate increases.

Some Financial Advisors push particular mutual funds because they can get maintenance fees from the funds. Some independent insurance brokers can get back-channel incentives to write at least X new policies a month from some insurance companies. At least the one ins. co. that makes a big game of it. It's still buyer beware.

I did a bit of math on the PDF from above.

|G|A|N|K
A|34
N|48|14
K|102|68|54
GHD|153|119|105|51

So what that's saying is that an "A" would save you $34/mo on average over a "G", and an "N" would save you $48/mo on average over a "G", etc. So the state of Washington has helped the rest of us if we are trading off the letter vs the price. For example, if we're looking at a "G", for instance, if we see an "N" from that company that's just $20/month cheaper, we can probably pass on it (not very aggressively priced). I hope that helps out the OP.

My question for a bit more exploration into selecting a company adds a few more attributes to consider when selecting your medigap insurance company. We've talked price and customer service rating, obviously important.

Isn't it true that if you come down with an expensive medical condition, you're pretty much stuck where you are? That's because you'd need to go through medical underwriting, and nobody would take you, or if they would, you'd be charged a whole lot. So each year, you can pick-up and leave if you're healthy, which is great, but if you aren't healthy, you're stuck.

And picking up on the quoted post, one reason not to use a company, even if they have a great price and have great customer service is if the company is in the habit of "opening a new book" when their claims cause price increases. So buying an inexpensive policy that's going to skyrocket in price when they close the book and all the healthy people leave is really what I'd like to avoid.

A question that just came to me: If a company does close a book, does it do so for all the letters that the company offered, or can they pick and choose, closing the book on just some letters?

I tried to get specifics about these "sick duck pools" out of BoomerBenefits, but got nowhere when I originally asked. When I forced the issue, specifically about Mutual of Omaha, they guy finally admitted this "gotcha", but still wouldn't come forth with which companies had that reputation.

Also, I tried to get some information on if all policies offered in a state offered equal compensation to the seller, and, unsurprisingly, didn't get a straight answer on that either.

So I'm just dipping my toes in the water, as DW will be turning 65 next year, but it seems like avoiding the sick duck pool, is a primary factor for me.

And when selecting a letter plan type, I'm not so concerned about paying something at the time of service in exchange for a lower premium. I know a lot of people find it comforting that they pay the one small deductible and that's it. But I don't mind making it more like house insurance and the like, where it hurts a little bit before the insurance kicks in. Prevents breaking the bank, but you have some skin in the game. My thinking, and I'd like feedback on this, is that maybe a letter plan type that requires a little more payment at time of service might attract healthier people?

 

[REWahoo]

A question that just came to me: If a company does close a book, does it do so for all the letters that the company offered, or can they pick and choose, closing the book on just some letters?

It closes the book (stops writing policies to new insureds) under that particular insurance company name - for all letters. It simultaneously opens a new book (starts writing new policies) under an new name.

When I forced the issue, specifically about Mutual of Omaha, they guy finally admitted this "gotcha", but still wouldn't come forth with which companies had that reputation.

The digging I did into this subject a few years ago indicated MOO was the first to implement this strategy, but now virtually all of them do it to one degree or another. About the only exception I found was the UnitedHealthcare Medigap plans sold through AARP, which are (no surprise) more expensive than most other plans. This is especially true when you factor in their "disappearing discount" which starts at age 65 (39%) and decreases by 3% annually until it phases out completely after 16 years (at age 81). IOW, it is a 3% built in annual price increase in addition to ongoing premium increases due to added medical costs.

My conclusion was (and still is), when it comes to Medigap insurance, you can pay more now or pay more later, but you will still pay.

 

[AzDreamer]

Two of the biggest complaints about Medicare Advantage plans that I have read here are you don't have access to out-of-network doctors, and you need referrals to see specialists.

If there was a MA policy that didn't have these two problems, would that make a difference in your choice of a MA plan vs a Medigap plan?

I live near Seattle where the MA plans are very competitive. The Aetna Medicare Elite Plan (HMO-POS) plan I chose for 2022 doesn't require referrals to see specialists and all the doctors and hospitals I currently use, and have used in the past, are in the network.

I am not trying to be argumentative, but it helps me to understand a problem better when pressing for details. There is still time for me to revise my plans for 2022.

Am I overlooking something that you think is important?

 

[Dash man]

Two of the biggest complaints about Medicare Advantage plans that I have read here are you don't have access to out-of-network doctors, and you need referrals to see specialists.

If there was a MA policy that didn't have these two problems, would that make a difference in your choice of a MA plan vs a Medigap plan?

I live near Seattle where the MA plans are very competitive. The Aetna Medicare Elite Plan (HMO-POS) plan I chose for 2022 doesn't require referrals to see specialists and all the doctors and hospitals I currently use, and have used in the past, are in the network.

I am not trying to be argumentative, but it helps me to understand a problem better when pressing for details. There is still time for me to revise my plans for 2022.

Am I overlooking something that you think is important?

MA plans can change each year, supplements don’t.
Providers can opt out of an MA plan or be dropped when their contracts are up. Your current providers may be with the plan now, but will they be part of the plan in July? This year or next year?
Most doctors accept Medicare and supplements. You can go to any doctor that accepts Medicare (~96%)you want anywhere in the US.
Supplements have to pay if Medicare pays.
MA plans are managed by the insurance companies and make the decisions.
I want the health coverage I’ll want when I’m sick, not the cheap one when I’m healthy.

 

[sengsational]

^Agreed. MA plans have all of the annoying features that I've been putting up with from my PPACA policies, especially limited network "gotchas". Here's another one, CVS Minute Clinic is apparently not playing ball with Blue Cross any more; they surprise billed me for the flu shot, which had always been 100% covered before deductible in the past. The annoyances associated with typical HI policies has me wanting to get as far away from them as possible, and traditional Medicare is just that.

 

[MBSC]

The Aetna Medicare Elite Plan (HMO-POS) plan I chose for 2022...

Am I overlooking something that you think is important?

The out-of-network POS option only applies to dental providers so the PPOs are better than HMO-POS. I would not consider a plan without OON coverage.

With Aetna Medicare Advantage HMO-POS plans, you have a network of providers to use for medical care. Most of our HMO-POS plans require you to use a network provider for medical care. But there are options to go out of network for dental care. That gives you more choice and flexibility.

Source: https://www.aetnamedicare.com/en/compare-plans-enroll/medicare-advantage-hmo-pos-plans.html

Aetna Medicare Elite Plan (HMO-POS) H3748-009

With this plan, you can get dental services from any dental provider with savings for staying in network. You must use network doctors for medical care (unless it’s an emergency).

https://rxtools.aetnamedicare.com/2022/Shopping/PlanDetails?id=1JVWSBBR50

Ch.3, Section 1.2

You must receive your care from a network provider. Here are four exceptions:
<1-3 are standard>
Because our plan has a Point-of-Service (POS) option, care you receive for certain services from an out-of-network provider (a provider who is not part of our plan's network) may be covered. As a member of this plan, you may use either network or out-of-network providers for non-Medicare covered dental services covered by the plan.

Source: https://www.aetnamedicare.com/documents/individual/2022/eoc/Y0001_H3748_009_HQ65_EOC22_C.pdf

 

[sengsational]

One thing to think about, a big thing, I think, is to know the pricing type that you're buying into. This doesn't make much difference if you stay healthy and can bail out of the sick duck pool if the prices go up too much, but if you become a sick duck, you're stuck, so it might be wise to pick a big pool with lots of people that aren't fleeing.

There are 3 pricing models. There are variations, but the pricing generally goes like this:

In community rating, the same monthly premium is charged to everyone who has
the Medigap plan, regardless of age. Premiums may rise due to inflation, but not
due to the beneficiary aging. Issue‐age rated premiums depend on the age of the
beneficiary when purchased, but again, they do not rise due to aging. Attained‐
age rated premiums, conversely, rise as the beneficiary ages.

AARP is a hybrid, where it's community rated, but has a built-in 3% increase every year, plus whatever amount they need to in order to keep the books in balance. Unless mentioned, everybody below is using "attained age pricing".

I called 6 companies today and got a wide variety of responses. My goal was to get a price for a female in my county turning 65 in March 2022, no tobacco. That's all they need to know to give me a price.

AARP UnitedHealthcare: Real person reached, but seemed more interested in getting specifics on the individual (name, address, DOB, etc) than giving me prices. I said I just wanted to understand what they were offering and the prices, but they wouldn't provide the information. I asked basic question about "Standard" and "Level 2" options (listed on the medicare site), and they wouldn't even explain the difference. And they wouldn't explain what "Household" meant. They did give me a web site address and I looked-up the prices myself. I noticed that if you want to continue the nightmare, you can choose a "Select" plan, which puts you into a limited network (shudder). With Non-"Select" with "Household" G$87, N$68, K$45, increasing at least 3% as far as the eye can see.

TransAmerica: Real person that listened to my questions and responded to me. Didn't seem to have an alternate agenda. Described pricing of "issue age pricing" and indicated that this pricing was enforced by the state and that everybody in the state with that letter paid the same thing. G$147, N$111, K$64.

Physicians Life: Recording "emergency situation, call back in an hour". Tried that, same message. This company also has issue age pricing, which is why it made it to my list. Most companies don't offer this pricing model. According to the Medicare web site, this company offers both "issue age" and "attained age" and also has "innovative" priced of both of those. I thought the pricing here might be interesting. They have high deductible G as well. Too bad they didn't pick up the phone.

BlueCross BlueShield NC: Got a guy who seemed annoyed that he couldn't just take my order for a medigap policy. He said the pricing was on the web site, and I obliged him by taking that and ending the call. The web site had a feature of their letter plans called "Blue to Blue", which says that at certain times of the year, you're allowed to switch to a different letter or into a traditional medicare from an advantage plan without underwriting. They didn't say what the pricing would be in such cases, but that seems like it might be a negative; if people can shift around, then they can go cheap until they get sick, then go full service later, and that would have lots of high utilizers clumped together, driving high prices. But I'm not sure how they're doing the pricing with this scheme. Needs more research. G$100, N$90, K$67, Ghd$38.

Mutual of Omaha: I don't remember what happened on the phone, but ended up on the web site, which seemed to be pushing pretty hard for people to go through an agent. So we have agents like BoomerBenefits pushing MoO and we have MoO pushing for agents to be involved. Hmmmm. Call me skeptical. I don't like to have things sold to me...I'd much rather buy them. G$94, N$71, Ghd$31.

Colonial Penn: This company had G, N, K, Ghd on the Medicare site, so decided to give them a shot. The number from the Medicare site led to a really nice guy who admitted he didn't have pricing and could not sell me a policy. Seemed very knowledgeable and in fact led me through the basics (that I already knew, but he talked, I listened). He gave me two phone numbers to call if I wanted to get pricing. The first led to an overseas call center. Demanded personal information before they'd give me pricing. I excused myself from that call and called the next number. Same script, same refusal to give prices.

 

[sengsational]

I'm not sure how I got this far without finding this. Pricing in NC:

https://www.ncdoi.com/medisupp/search_new.asp

 

[MBSC]

I asked basic question about "Standard" and "Level 2" options (listed on the medicare site), and they wouldn't even explain the difference. And they wouldn't explain what "Household" meant.

For UHC/AARP, household discount applies when both spouses are enrolled in AARP Medigap plans under the same AARP membership number. They don't have to be the same plan letter.

For most carriers, household discount means both spouses enrolled in that company's plans, however, for some it just means another person 65+ in the house and for others it means another adult in the house. On the NC DOI website, if you click a company name it shows the discount % but not details.

No need to look at plan K. It has a $6620 (2022) MOOP that excludes excess charges. With HD-G, Medicare still pays 80% so the $2490 'deductible' acts like a MOOP. HD-G has a lower premium. Plans A,B,K and L are high premium/low benefit similar to closed books.

Level 2 rates are those changing plans with underwriting with some medical issues that disqualify them from the preferred rate but not bad enough to be rejected. Each carrier sets their own criteria so this is one of the few situations where an experienced broker can add value.

But I don't mind making it more like house insurance and the like, where it hurts a little bit before the insurance kicks in. Prevents breaking the bank, but you have some skin in the game. My thinking, and I'd like feedback on this, is that maybe a letter plan type that requires a little more payment at time of service might attract healthier people?

Medigap plans 'HD-G' and 'N' fit your requirements. You are correct. They have healthier enrollment pools. May I suggest you pick a plan letter first based on your DW needs. If it ends up being HD-G, people usually choose United American because few other companies sell it and the premiums are competitive. They're too small to have subsidiaries and close books. If you buy directly, the call center agent is paid a flat commission. They do push an annuity type product that automatically pays cost sharing for those who don't want to keep track of medical bills but you can say no to it and other fluff. You only have to dive deeper into the weeds if you decide another plan letter is more appropriate.

 

[sengsational]

I called NC DOI and talked with a helpful person there. They ran the prices for all the "G" providers, sent me a PDF.

In NC, there's apparently a law that says each provider can sell policies with exactly one of the three pricing schemes (1:Attained Age - starts low and goes up every birthday, 2:Community/No Age - highly discounted base rate that everyone pays, but the discount erodes predictably, and 3:Age Issue - everybody pays the same amount, but the initial price is expensive compared to the others).

So looking at the offerings, 94% of the companies offer only Attained Age pricing. The few companies not falling into that category are AARP/UnitedHealthcare (the only one in NC with Community pricing), and two offering Age Issue pricing (Transamerica and Old Surety).

The NC DOI rep offered a clear warning about this very commonly used Age Attained pricing; she said she saw the prices on these polices jump up considerably (20% per year was common, she said) and as a result, a lot of people had to decide between insurance and some other essential living expense, so dropped their medigap insurance.

The footer on the PDF I got lead me to a company that's in the business of making the pricing and features accessible. It looks like it's $20/month, or $30 if you want more information on "Rate Adjustment History, Rate Change Data, and Market Analytics".

This video is kind of an advertisement for this product, but we here on this board are not the target audience. The target audience are people in the business of being an intermediary in the Medicare Supplement sales process. But I thought I'd include it here, just so we can be better shoppers when we're in the sales process. The valuable thing in the video, IMO, is it shows you all of the statistics that the sales rep has access to, so you know how to ask about the features you care about.

https://youtu.be/ucEPZbZklgM