Is Medigap insurance really needed?

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nbseer
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Is Medigap insurance really needed?

Post by nbseer »

Wife is 66, has Medicare A and B. Healthy, active, hates doctors! No prescription medications.

She's currently also covered by my union insurance which ends at end of this year (I just retired).

Until I can get retiree health insurance resumed from my union (in 2 years when I turn 65), we're debating whether to get her Medigap insurance until then, or just stick with Medicare A and B.

This doctor seems to think supplemental insurance is a waste of money...

http://www.huffingtonpost.com/david-bel ... 01861.html

Opinions??
ddunca1944
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Re: Is Medigap insurance really needed?

Post by ddunca1944 »

It's a waste unless one becomes really ill or injured.

My husband was treated for cancer last year. It was a simple cancer. First there were diagnostic tests, then surgery, then a series of radiation treatments, then follow up tests.

His Medigap policy paid $41,624. Our out of pocket cost was $3000.

Like your wife, I am healthy, take no prescriptions and hate going to the doctor. I carry a supplemental policy on myself because I may not always be insurable and I may not always enjoy the health I do now. I'm not a gambler.
Last edited by ddunca1944 on Sat Aug 02, 2014 10:33 am, edited 1 time in total.
Ron
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Re: Is Medigap insurance really needed?

Post by Ron »

You don't need it - until you do.

You feeling lucky? :twisted:

- Ron
chaz
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Re: Is Medigap insurance really needed?

Post by chaz »

Some want to self-insure.
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Sconie
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Re: Is Medigap insurance really needed?

Post by Sconie »

I buy a Medigap Plan F, which is designed to pay just about everything I'll encounter. It may well be "overkill" and not the most economical approach---however---on the other hand, the peace of mind is worth it to me.
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nisiprius
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Re: Is Medigap insurance really needed?

Post by nisiprius »

According to the statement we receive, our insurer's Medigap policies pay out, in claims, 87% all that is received in premiums. To me, that says that despite Belk's seat-of-the-balance analysis ("you're unlikely to ever owe more than your $1,184 deductible") it must happen often enough to matter. Or else that 20% of all the other things Medicare B cover must add up. So, the first question is: is the premium grotesquely out of proportion to the average benefit? I don't think so.

Let's say he's right and it's a waste of money. How much money are we talking about wasting? 13% of $200/month = $312/year.

Now, when he says "The average length of a hospitalization, even for Medicare patients, is about 5 days," my reaction is, why is this even relevant? Does anyone honestly think you can be hospitalized for 5 days anywhere and not end up with one of those $1,184 deductibles? AND, the rules about multiple hospitalizations are complicated but come on, people do get hospitalized twice in a year, and if it's for two unrelated things and they're not within 60 days of each other, I think you get two of those deductibles. In short, in real life, every time you go into a hospital you're going to be get one of those $1,184 deductibles, and a flood of merry every-time-you-turn-around it's $200 here, $300 there, $700 there part-B co-pays.

So, just to think about it.

--On the average, you pay $312/year more if you buy the insurance.

--On a year when you don't go into the hospital, you probably get back less than you put in. But probably not zero. $60 here, $80 there, $30 there, it adds up.

--On a year when (heaven forbid) you get hospitalized twice for two different things, you probably get back more than you put in.

A key number, which Belk never presents and didn't come up right away when I Googled it, is "what's the worst it could be?" For everything that Medicare approves but doesn't pay--i.e. the deductibles and copayments--is there any maximum on the total it could be? Without this number you can't make any sensible decisions. I think mur44 analyzed it and concluded that the maximum was "only" in the ballpark $5,000. Anyone know?
ddunca1944 wrote:His Medigap policy paid $41,624....
Well, I guess it CAN be more than $5,000, then.

The NUMBER of claims my insurance pays every year is surprisingly large, even if some of them are only for $60 and $40 and $80. I don't know how this works in real life if you don't have supplemental insurance I assume that without insurance each of those is an envelope you get in the mail and a payment you need to make manually. Whether you need to find a stamp and write out a check, I don't know.

I think a sane person could judge that it is worth $2400 x 13% = $312 per year to be paying a steady $200 a month, with no paperwork other than reading the statements from the insurance company saying "we paid," rather than having surprise clusters of bills arriving--always when you're just a little short--and needing to be paid. Especially if we are talking about numbers like $41,624, not just 1 or 2 or 3 times $1,184.
Last edited by nisiprius on Sat Aug 02, 2014 10:51 am, edited 1 time in total.
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cheese_breath
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Re: Is Medigap insurance really needed?

Post by cheese_breath »

It's a waste of money until you need it. Just like auto and home owners insurance.
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nisiprius
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Re: Is Medigap insurance really needed?

Post by nisiprius »

P.S. I SERIOUSLY object to Belk's dismissive "I guess that really depends on how much medical care you intend on getting each year."

As if this is some kind of voluntary choice.

(Sarcasm ahead) Oh, I think this would be a good year to have a hernia rupture. I always think springtime is a nice time of year for a rupture, don't you?
Last edited by nisiprius on Sat Aug 02, 2014 11:02 am, edited 1 time in total.
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Ron
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Re: Is Medigap insurance really needed?

Post by Ron »

Sconie wrote:I buy a Medigap Plan F, which is designed to pay just about everything I'll encounter. It may well be "overkill" and not the most economical approach---however---on the other hand, the peace of mind is worth it to me.
I agree. The cost of Plan F (at our joint age of 66) is $126.72 for each of us ($253.44/month total) through United Health Care (AARP) which covers all co-pays and even the Medicare deductible.

You can be in perfect health one day (or so you think) but not the next. Additionally, if I step off a curb and get hit by a car, the person who hits me may have minimum auto insurance to cover my medical co-pay along with the Medicare deductible.

Insurance is for the "what if's" in life. Hopefully, you will never have to use it.

Additionally, you're only talking about a limited amount of time...

- Ron
Last edited by Ron on Sat Aug 02, 2014 10:54 am, edited 1 time in total.
anonenigma
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Re: Is Medigap insurance really needed?

Post by anonenigma »

Very provocative. I'd had that thought about my mother but decided to play it safe and keep a Medicare F supplement in place. In addition to what the doctor discusses, it covers additional days in skilled nursing (if needed - pretty unlikely) as well as the fees of doctors who do not accept Medicare assignment. This latter benefit is not mentioned by the doctor in his article. If a physician who does not accept assignment charged $4,000 for a procedure and Medicare allowed $580 (to follow the example in the article), Medicare would pay 80% of what it allows (the $580), but the patient would be on the hook for both the 20% difference AND the difference between what Medicare allowed ($580) and what the physician charged ($4,000). The Medicare F supplement means the patient does not have to worry about this, which might be really convenient in case the anesthesiologist the patient never met doesn't accept assignment.

I'd like to see more about this from those who've gone without the MC supplements, which increase in price after age 75. My mother's policy currently costs $335 per month. She's almost 98, and with her particular history, the insurance companies have collected far more money than they've paid out.
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Re: Is Medigap insurance really needed?

Post by anonenigma »

One more thing. As I understand it, Medicare covers 100% of all hospitalizations plus lab tests and medications during a hospitalization - after the deductible is paid. What I've seen from my parents' hospitalizations is small charges from doctors, including those who read x-rays and EKGs.
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dodecahedron
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Re: Is Medigap insurance really needed?

Post by dodecahedron »

Another reason to buy MediGap: at the time when you or your loved one runs up the big hospital bills that most make the policy wothwhile, you or the relative dealing with your bills are very vulnerable (because either you or your loved one is very ill or possibly dead). You or the person dealing with your affairs are not in a good position to be challenging the billing errors that frequently seem to crop up with any kind of extended hospitalization.
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dodecahedron
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Re: Is Medigap insurance really needed?

Post by dodecahedron »

nbseer wrote:Wife is 66, has Medicare A and B. Healthy, active, hates doctors! No prescription medications.

She's currently also covered by my union insurance which ends at end of this year (I just retired).

Until I can get retiree health insurance resumed from my union (in 2 years when I turn 65), we're debating whether to get her Medigap insurance until then, or just stick with Medicare A and B.

This doctor seems to think supplemental insurance is a waste of money...

http://www.huffingtonpost.com/david-bel ... 01861.html

Opinions??
My mom was very much like your wife when she started MediCare. For almost a decade, she was in apparently vibrant good health and seemed almost superhuman in her ability to care for her severely disabled husband, but she maintained her MediGap policy. Then, after mowing her lawn with a balky power mower on a hilly lot on a hot summer day, she had an unexpected heart attack and subsequent triple bypass with complications and a lengthy hospital stay. The peace of mind she and her family got during her recovery from knowing she was protected from dealing with shocking bills was priceless. We were able to focus on helping her through the recovery and rehab process without losing any energy thinking about bills.

She did mention that she had gotten a great deal on an excellent MediGap policy at 65, one that apparently is no longer available except to grandfathered policyholders. I have forgotten how much it cost but much less than $200/month, I am sure.

I will definitely have a MediGap in place when I reach 65. Greatly simplifies life at a time when simplification is most valuable!
jeff1949
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Re: Is Medigap insurance really needed?

Post by jeff1949 »

nbseer wrote:Wife is 66, has Medicare A and B. Healthy, active, hates doctors! No prescription medications.

She's currently also covered by my union insurance which ends at end of this year (I just retired).

Until I can get retiree health insurance resumed from my union (in 2 years when I turn 65), we're debating whether to get her Medigap insurance until then, or just stick with Medicare A and B.

This doctor seems to think supplemental insurance is a waste of money...

http://www.huffingtonpost.com/david-bel ... 01861.html

Opinions??
The important thing for me is what my maximum out-of-pocket expenses could possibly be and not the deductible. From my research on this subject all Medicare Advantage plans are required to include a limit on out-of-pocket spending but not the Medigap plans.

My opinion is that Dr. Belk is right on. Thanks for asking. :beer
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Sbashore
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Re: Is Medigap insurance really needed?

Post by Sbashore »

I had the not so pleasant experience of incurring approx. $750,000 in the space of 2.5 years of medical expenses because of late wife's cancer. Being fully insured rather than just having Medicare A&B saved the vision I had for my retirement.
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S&L1940
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Re: Is Medigap insurance really needed?

Post by S&L1940 »

Ron wrote:You don't need it - until you do.
You feeling lucky? :twisted: - Ron
Agree; firstly like our investments, we do not know where our health will be tomorrow. Suddenly needing tests and specialists will push costs to unbelievable levels. The wife and I found out how fortunate we, two healthy people, were to have the coverage
Secondly, when and if you decide to go for gap insurance you will pay a higher premium than what is offered when you are initially eligible.
Even Part D, with all its shortcomings, is a worthwhile purchase.
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gerrym51
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Re: Is Medigap insurance really needed?

Post by gerrym51 »

I would get it
linuxizer
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Re: Is Medigap insurance really needed?

Post by linuxizer »

nisiprius wrote:Let's say he's right and it's a waste of money. How much money are we talking about wasting? 13% of $200/month = $312/year.
nisi, I think this is perhaps the first time I've ever disagreed with you, but the true waste includes not just the 13%/year paid out but the moral hazard-induced welfare losses. In other words, people consume care when they are insured that they wouldn't have otherwise, that care is not care they value at what it costs, and therefore not all of the 87% of premiums you pay out for a Medigap plan represents care you would have purchased had you not bought the Medigap plan.

So the true loss is:
- 13% load
- X% care consumed you wouldn't have were you not insured
+ Y% * X% valuation of care consumed you wouldn't have were you not insured
Last edited by linuxizer on Sat Aug 02, 2014 2:22 pm, edited 1 time in total.
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Re: Is Medigap insurance really needed?

Post by S&L1940 »

linuxizer wrote:
nisiprius wrote:Let's say he's right and it's a waste of money. How much money are we talking about wasting? 13% of $200/month = $312/year.
nisi, I think this is perhaps the first time I've ever disagreed with you, but the true waste includes not just the 13%/year paid out but the moral hazard-induced welfare losses. In other words, people consume care when they are insured that they wouldn't have otherwise, that care is not care they value at what it costs, and therefore not all of the 87% of premiums you pay out for a Medigap plan represents care you would have purchased had you not bought the Medigap plan.
So the true loss is:
- 13% load
- X% care consumed you wouldn't have were you not insured
+ Y% * X% valuation of care consumed you wouldn't have were you not insured
Not seeing the logic here, Insured or not, the dear wife would not have chosen her auto-immune disease with the surgeries and invasive treatments she continues to need and I would have gladly passed up the cancer surgery and the implant of a pacemaker that I "decided" to pursue. All of the preceding happening after we signed up for Medigap coverage.
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Re: Is Medigap insurance really needed?

Post by four7s »

Why does one work to accumulate assets? So that life can be more comfortable, I'd say. If illness strikes you or your loved ones money must not be an issue, but rather getting the best care available so that one can survive. Pay the extra money and have peace of mind 'just in case.' I did, I survived, and I'm glad.
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Re: Is Medigap insurance really needed?

Post by linuxizer »

1530jesup wrote:Not seeing the logic here, Insured or not, the dear wife would not have chosen her auto-immune disease with the surgeries and invasive treatments she continues to need and I would have gladly passed up the cancer surgery and the implant of a pacemaker that I "decided" to pursue. All of the preceding happening after we signed up for Medigap coverage.
Not implying anything remotely close to that.

On average, People consume more care when they are insured--there is ridiculously good evidence (large randomized trials) that demonstrate this. That doesn't mean when you're really sick and an intervention is clearly helpful that being insured would make you consume more care, but it does mean that if you're right on the edge of deciding one way or another it could push you over. Consider back surgery. The evidence shows that on balance it neither helps nor harms patients with low back pain--some patients do worse, some do better. If I were considering surgery, don't you think being on the hook for $30k would make me consider the evidence more carefully?
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Re: Is Medigap insurance really needed?

Post by Sheepdog »

In 2008, due to an auto accident, my wife had big expenses. For that year, her Medigap policy paid $23,000. At that time her annual Medigap premium was $1880; however, in most years the premium is more than the payout. She still has Medigap. I had it also, but switched over to an Advantage plan this year in which a Medigap policy is not required.
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Re: Is Medigap insurance really needed?

Post by nisiprius »

linuxizer wrote:
1530jesup wrote:Not seeing the logic here, Insured or not, the dear wife would not have chosen her auto-immune disease with the surgeries and invasive treatments she continues to need and I would have gladly passed up the cancer surgery and the implant of a pacemaker that I "decided" to pursue. All of the preceding happening after we signed up for Medigap coverage.
Not implying anything remotely close to that.

On average, People consume more care when they are insured--there is ridiculously good evidence (large randomized trials) that demonstrate this. That doesn't mean when you're really sick and an intervention is clearly helpful that being insured would make you consume more care, but it does mean that if you're right on the edge of deciding one way or another it could push you over. Consider back surgery. The evidence shows that on balance it neither helps nor harms patients with low back pain--some patients do worse, some do better. If I were considering surgery, don't you think being on the hook for $30k would make me consider the evidence more carefully?
I don't know. I know what I would do. If I were experiencing debilitating pain that was interfering with my quality of life, I would trust any properly credentialed doctor who said he could help, and if I had $30,000 I'd pay it, and if I didn't, I'd borrow it. The treatment might not be any more effective than Dr. Maturin (in the Patrick O'Brian novels), bleeding every sailor on the ship to balance their humours, but that's what I think I would really do in a situation like that, and it's what I think most people would do.
Last edited by nisiprius on Sat Aug 02, 2014 2:42 pm, edited 5 times in total.
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Re: Is Medigap insurance really needed?

Post by Christine_NM »

linux -

In OP's case, wife hates doctors. Given that, she is not likely to incur extra costs by having Medigap.

The more likely scenario is that she waits too long to see a doctor, incurs higher costs because she waited, and so should have Medigap.

Maybe some people are healthcare shoppers, but I don't know any.
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linuxizer
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Re: Is Medigap insurance really needed?

Post by linuxizer »

nisiprius wrote:No, actually, I don't. If you were experiencing debilitating pain that was interfering with your quality of life, I think you would trust any properly credentialed doctor who said he could help, and if you had $30,000 to your name you'd pay the $30,000, and if you didn't, you'd borrow it.
And if you were experiencing non-debilitating pain? There's always someone on the margin.

Suggest you read the RAND Health Insurance Experiment (Newhouse and Manning) and the Oregon Health Insurance Experiment (Taubman et al) with an open mind. People really do consume more care when they're insured, and the additional care they consume is not necessarily the most health-improving stuff.
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Re: Is Medigap insurance really needed?

Post by spectec »

linuxizer wrote:
1530jesup wrote:Not seeing the logic here, Insured or not, the dear wife would not have chosen her auto-immune disease with the surgeries and invasive treatments she continues to need and I would have gladly passed up the cancer surgery and the implant of a pacemaker that I "decided" to pursue. All of the preceding happening after we signed up for Medigap coverage.
Not implying anything remotely close to that.

On average, People consume more care when they are insured--there is ridiculously good evidence (large randomized trials) that demonstrate this. That doesn't mean when you're really sick and an intervention is clearly helpful that being insured would make you consume more care, but it does mean that if you're right on the edge of deciding one way or another it could push you over. Consider back surgery. The evidence shows that on balance it neither helps nor harms patients with low back pain--some patients do worse, some do better. If I were considering surgery, don't you think being on the hook for $30k would make me consider the evidence more carefully?
If I hold one hand in the over and the other in the freezer, then "on average" I should be feeling pretty comfortable. Insurance companies and government bureaucrats live by averages, but individuals are not statistics and each personal situation is unique. I'll opt to buy the insurance and hope it's a waste of money, in the same way that my auto liability insurance, uninsured motorists coverage, and life insurance premiums are money down the drain. For me, wasting that money constitutes a successful outcome.
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linuxizer
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Re: Is Medigap insurance really needed?

Post by linuxizer »

spectec wrote:If I hold one hand in the over and the other in the freezer, then "on average" I should be feeling pretty comfortable. Insurance companies and government bureaucrats live by averages, but individuals are not statistics and each personal situation is unique. I'll opt to buy the insurance and hope it's a waste of money, in the same way that my auto liability insurance, uninsured motorists coverage, and life insurance premiums are money down the drain. For me, wasting that money constitutes a successful outcome.
Personally I would buy the insurance as well. Not the same as saying the price of peace of mind is only $300/mo.

Clearly I've upset people, although I still believe you're reading something in my words that is very different from what I'm saying. I'm going to bow out now.
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Re: Is Medigap insurance really needed?

Post by betterdays »

nbseer wrote:Wife is 66, has Medicare A and B. Healthy, active, hates doctors! No prescription medications.

She's currently also covered by my union insurance which ends at end of this year (I just retired).

Until I can get retiree health insurance resumed from my union (in 2 years when I turn 65), we're debating whether to get her Medigap insurance until then, or just stick with Medicare A and B.

This doctor seems to think supplemental insurance is a waste of money...

http://www.huffingtonpost.com/david-bel ... 01861.html

Opinions??
Why not get a Medigap Plan F High Deductible? Cost is much less than standard Plan F, but with a deductible.
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Re: Is Medigap insurance really needed?

Post by dolphinsaremammals »

linuxizer wrote: nisi, I think this is perhaps the first time I've ever disagreed with you, but the true waste includes not just the 13%/year paid out but the moral hazard-induced welfare losses. In other words, people consume care when they are insured that they wouldn't have otherwise, that care is not care they value at what it costs, and therefore not all of the 87% of premiums you pay out for a Medigap plan represents care you would have purchased had you not bought the Medigap plan.

So the true loss is:
- 13% load
- X% care consumed you wouldn't have were you not insured
+ Y% * X% valuation of care consumed you wouldn't have were you not insured
I have never understood this theory that people run off and get unnecessary medical care just because they have insurance. Who likes going to the doctor?

At most, there might be some people who have stuff checked on who would otherwise gamble that it didn't need medical attention. The question is, how many of those people saw the doctor unnecessarily vs. how many of them nipped something in the bud before it was much more expensive and harmful.

I have the AARP Medigap Plan F someone mentioned above. I have a lot of medical stuff going on, fortunately none life threatening, but as we get older, many of us become high maintenance medically. I never have to worry about copays or deductibles or the 20% Medicare doesn't cover of various things. $178 a month. Priceless.
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Dale_G
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Re: Is Medigap insurance really needed?

Post by Dale_G »

I am insurance averse. I buy as little as practical. But the wife and I have had Medigap for the past 13 years. I am not positive that the claims paid have exceeded the premiums, but that is likely to be the case.

In addition to being insurance averse, I am also averse to manually paying bills and figuring out EOBs. I do have AARP automatically deduct our Medigap premiums, but I would never allow a healthcare provider to do the same.

My wife has a deductible - about $140, but I have no deductible. The Doc has this figured out. Her first visit of the year is for an "extended visit", typically 40 minutes according to Medicare. In practice the visit is 6 minutes with the Doc and 34 minutes in the waiting room. Anyway, I only get one bill a year.

Note, my no deductible policy costs more than the wife's by exactly the amount of her deductible.

Not having to fool with medical bills makes the insurance worthwhile for me.

Dale
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fandango
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Re: Is Medigap insurance really needed?

Post by fandango »

Here's how I look at Medigap:

With 80% of your medical expenses likely to be in the last 10 years of your life, it would seem prudent to pay the $2000 a year for Medigap coverage. Why would you underinsure at the point when you have the highest medical risk?

Even though you wife may be very healthy now, that can all change after one appointment with your doctor or a specialist. A cardiovascular problem or cancer (the two most likely scenarios) can change your medical future dramatically
and expensively. Also my understanding is that if you miss the initial enrollment period for Medigap coverage, it be will more costly and difficult to get later.
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Re: Is Medigap insurance really needed?

Post by dolphinsaremammals »

Dale_G wrote: In addition to being insurance averse, I am also averse to manually paying bills and figuring out EOBs. I do have AARP automatically deduct our Medigap premiums, but I would never allow a healthcare provider to do the same...

Not having to fool with medical bills makes the insurance worthwhile for me.

Dale
If you pay in full for the year, AARP gives you about a 1% discount, and then there is even less stuff to fuss with. Not having to track the copays and so on for tax purposes is also worth something to me; the less hassle the better.
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Re: Is Medigap insurance really needed?

Post by cheese_breath »

fandango wrote:.... Also my understanding is that if you miss the initial enrollment period for Medigap coverage, it be will more costly and difficult to get later.
It could be a LOT more costly. If you're discovered to have a serious medical condition or illness you might not be able to find a Medigap insurer who will accept you.
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Re: Is Medigap insurance really needed?

Post by john94549 »

During my Mom's final illness, I learned (indirectly) that many of the physicians' costs (even if incurred while in the hospital) are Part "B" and not Part "A". For her last week in the hospital before she died, the Part "B" expenses were pushing $100K. So her AARP Medigap was helpful. I think Medigap is money well spent.
Spirit Rider
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Re: Is Medigap insurance really needed?

Post by Spirit Rider »

The two key points have been made separately by previous posters. Combining them shows that it is penny-wise and pound=foolish to go without any Medigap or Medicare Advantage coverage.

1. Medigap premiums can be medically underwritten if you do not enroll during your open enrollment period. Chronic conditions or a significant health event can make this a costly mistake.

2. Nothing says it has to be all or nothing. A Medigap Plan F high deductible (2014=$2140) will have a significantly reduced monthly premium. If you want to self-insure, do this amount, but insure against catastrophic risk.

Sure there are people with enough assets who could self-insure. However, for the vast majority it is about controlling your risks. Isn't that with controlling expenses what this forum is about?
Alan S.
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Re: Is Medigap insurance really needed?

Post by Alan S. »

Medicare Advantage is a valid third option to either just Medicare or Medicare + Medigap.

Both Medicare Advantage and Medigap premiums are rising, but for different reasons. MA is losing the govt subsidy which kept premiums at 0 or very low for many years, and Medigap premiums are rising due to costs which partly come from adverse selection. By adverse selection I mean that seniors who purchase first dollar coverage are more likely to use their insurance more often than those who must pay deductibles or co pays. MA advantage typically includes the Part D RX coverage, which you also must purchase separately if you go with Medicare + Medigap.

MA appears to save considerable premium dollars while seniors remain reasonably healthy and can access a reasonably good network of providers. Right now the problem is that it is very difficult (some exemptions apply) to change over to Medicare to Medigap when you reach the age where hospitalizations are more frequent and health declines, so if you are stuck in MA at that time, you will lose back some or all of the premiums you saved in the earlier years.

The above statements are very broad generalizations. Exceptions are commonplace.
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AAA
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Re: Is Medigap insurance really needed?

Post by AAA »

My understanding is that there is no out-of-pocket limit in traditional Medicare (as opposed to a Medicare Advantage plan). That's what Medigap insurance is for.
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nbseer
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Re: Is Medigap insurance really needed?

Post by nbseer »

OP here... thanks for all the insightful comments.. you've convinced me to get Medigap insurance for my wife.

I live in NJ.. have to choose between United Healthcare and Horizon Blue Cross-Blue shield. Will probably go with Plan N, which seems to be recommended for relatively-healthy people who don't seek much medical treatment.
NYnative
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Re: Is Medigap insurance really needed?

Post by NYnative »

To be consistent with the poster who stated that medigap insurance is unnecessary, one should also not purchase homeowners insurance, car insurance, life insurance or any other kind if insurance. I have owned homes for over 45 years and I estimate I've paid at least $25K in insurance. Up until 2 years ago, my total claims were about $2K. We then suffered severe hail damage to our roof and siding. The total bill for repairs was nearly $29K. So I guess I am about even, but it was a lot easier and less aggravating having that claim 100% covered rather than pulling all that money out of savings. The same is true of car insurance, though claims since my wife and I started driving are probably less than 5% of premiums paid. All that could change tomorrow, the day after that or never.

It's the same with health insurance. Why have it at all? Forget about the law requiring it - the penalty is minute. Now that I'm retired and over 65, money spent is not easily replaced. I'd much rather have insurance, to include some sort of medigap insurance than leave things to chance. As someone else mentioned, for most people, the vast majority of medical costs come in the last part of your life. Of course, you could always pull the plug if you get really sick and need lots of expensive care, but i would prefer to not do that :mrgreen: .
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Kevin M
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Re: Is Medigap insurance really needed?

Post by Kevin M »

About three years until I have to decide, but I think I probably would get medigap or medicare advantage.

With respect to linuxizer's point, I can see in my own behavior that what he says is true. Since switching to a high deductible plan last year to cut my monthly premium almost in half, I have not gone to the doctor when otherwise I probably would have. Also, when I went in for my physical last year, I told my doc that I just wanted a physical, so there are things I might have discussed with him that I didn't. Whenever I think about going to a doctor, I think about the cost. When on the low-deductible plan, I never thought about it. I finally did go see one of my docs recently about something that had been concerning me a bit, and a fair amount of the conversation was about cost.

I'm actually thinking about switching back to a low-deductible plan next year, since I don't want my frugality to result in not getting something checked out that might end up being serious. On the other hand, the maximum annual out of pocket limit eliminates the possibility of the kinds of catastrophic costs that a few folks have mentioned.

Kevin
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riley42
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Re: Is Medigap insurance really needed?

Post by riley42 »

I could only find 2 Medigap plans that have a maximum out of pocket limit stated. For all those who chose Plan F (which appears to be the best plan but does not have a limit), is this a concern at all, or am I missing something and should not worry about that? I know MA plans have limits, but I wanted to go the Medigap route. Thank you...
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Re: Is Medigap insurance really needed?

Post by carolinaman »

1530jesup wrote:
Ron wrote:You don't need it - until you do.
You feeling lucky? :twisted: - Ron
Agree; firstly like our investments, we do not know where our health will be tomorrow. Suddenly needing tests and specialists will push costs to unbelievable levels. The wife and I found out how fortunate we, two healthy people, were to have the coverage
Secondly, when and if you decide to go for gap insurance you will pay a higher premium than what is offered when you are initially eligible.
Even Part D, with all its shortcomings, is a worthwhile purchase.
+1. Also, if you delay getting a Medigap policy when you are first eligible, you will be subject to underwriting, which means the insurance company can deny coverage. So if you wait until you get a serious illness, you may not be able to get a Medigap plan. The probability of getting a serious illness substantially increases as we get older, even for those in good health today.
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Re: Is Medigap insurance really needed?

Post by goaties »

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Last edited by goaties on Sat Nov 19, 2022 11:24 pm, edited 1 time in total.
Ron
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Re: Is Medigap insurance really needed?

Post by Ron »

goaties wrote:Oh wait, doesn't a Medigap policy *replace* Part B?
No, it covers the 20% that Part B and some of Part A charges that basic Medicare does not pay.

You must be enrolled in Part A/B in order to get a Medigap policy. A Medigap policy does not replace Part B.

http://1-800-medigap.com/handbook/

- Ron
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Re: Is Medigap insurance really needed?

Post by kaneohe »

riley42 wrote:I could only find 2 Medigap plans that have a maximum out of pocket limit stated. For all those who chose Plan F (which appears to be the best plan but does not have a limit), is this a concern at all, or am I missing something and should not worry about that? I know MA plans have limits, but I wanted to go the Medigap route. Thank you...
http://www.medicare.gov/supplement-othe ... digap.html

I believe you may be misinterpreting things. See the chart above and the footnote for out of pocket limits:
** After you meet your out-of-pocket yearly limit and your yearly Part B deductible, the Medigap plan pays 100% of covered services for the rest of the calendar year.

When the chart says N/A for out of pocket limits, I believe it means effectively 0......that means the Medigap policy pays once the deductible is met up to the policy limit.
For plan F, foreign travel medical expenses are covered up to some plan max but some other plans (including K,L) don't cover those expenses at all.........so your out of pocket costs
for K,L plans could be the the stated limits before the supplement even starts paying plus all non-covered expenses (like foreign travel medical) . Other plans don't cover Medicare B excess charges so you may have to pay those out of pocket if they apply and again, I believe for K,L those would be in addition to the stated limits.

I may be mistaken but I believe plan F , reputed to be the Cadillac plan, typically will cover all eligible costs that Medicare does not cover except for foreign medical costs exceeding the
max policy limit. Not sure whether you can incur additional out of pocket hospital costs from Pt A in rare cases...........
riley42
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Re: Is Medigap insurance really needed?

Post by riley42 »

Thank you, kaneohe, for your informative reply. As you mentioned in your last sentence, I guess I was worried about when Medigap F pays for an additional lifetime limit of 365 hospital days, and someone is unfortunate enough to use up all those days (and I see a lot of people in my volunteer job who are in long stay hospitals for over a year), then do I understand it that I would then be responsible for all costs after that 365 days is used up? If so, could you just switch to a MA plan at that point where they have max out of pocket limits? Sorry if I am just not understanding and asking a question that has been answered before. Thank you again.
rixer
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Re: Is Medigap insurance really needed?

Post by rixer »

A Plan F Hi Deductible medigap policy cost me $450 per year if paid annually. That comes out to $37.50 per month. It covers everything a regular Plan F does after a $2,100 deductible. Seems reasonable to me.
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Re: Is Medigap insurance really needed?

Post by goaties »

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nisiprius
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Re: Is Medigap insurance really needed?

Post by nisiprius »

Kevin M wrote:...Also, when I went in for my physical last year, I told my doc that I just wanted a physical, so there are things I might have discussed with him that I didn't...
That in itself is interesting, though, because you apparently believe in the "annual physical."

So do I.

But it is one of the things that these days some people are saying as frivolous healthcare overconsumption.
Annual income twenty pounds, annual expenditure nineteen nineteen and six, result happiness; Annual income twenty pounds, annual expenditure twenty pounds ought and six, result misery.
mur44
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Re: Is Medigap insurance really needed?

Post by mur44 »

If your wife's health is good, you can take
one of the following two (2) options:
(1) Take a Medicare Advantage plan with
Prescription Drug coverage until she
is eligible for the retiree health insurance.
Make sure your service providers accept the
plan.
(2) Buy Medigap Plan 'F' High Deductible, which
has low premium. Just add Part 'D' for
drug coverage if your union plan requires it.

The other option is to just stay on Original
Medicare (Parts A and B). Add Part 'D' for
drug coverage if your union plan
requires it.


Disclosure: I am a Certified Volunteer Medicare Counselor from NJ
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