Medigap Insurance Plans

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rennman100
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Medigap Insurance Plans

Post by rennman100 »

I am looking at Medicare Gap Insurance plans. I am looking to be protected from the uncapped 20% Medicare co-pay (a kind of catastrophic insurance), High Deductible F seems to work for that.

BUT given that Plans F and C go away in 2020, Hi-F goes away too. I have read that a High Deductible G is coming but I don't find any info about when and what it might be.

I am concerned about being left in a closed plan which, from prior experience, seems to lead to overly large premium increases as the pool gets older and sicker.

Since it seems you can "downgrade" to a lower plan but not upgrade (without underwriting), I could well get stuck in Hi-F.

Other than changing to Medicare Advantage, the sign-up window at turning 65 seems the main opportunity to choose a plan, and the choice will more or less stand for maybe 30 years - the whole process seems rather stressful to me.

Any ideals about being in a plan that will be closed? Any info on Hi-G? General advice?

Separate question - any feedback on the frequency medical providers charge what is termed "Medicare excess charges" (which F covers)?

Thanks in advance.
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dm200
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Re: Medigap Insurance Plans

Post by dm200 »

rennman100 wrote:I am looking at Medicare Gap Insurance plans. I am looking to be protected from the uncapped 20% Medicare co-pay (a kind of catastrophic insurance), High Deductible F seems to work for that.
BUT given that Plans F and C go away in 2020, Hi-F goes away too. I have read that a High Deductible G is coming but I don't find any info about when and what it might be.
I am concerned about being left in a closed plan which, from prior experience, seems to lead to overly large premium increases as the pool gets older and sicker.
Since it seems you can "downgrade" to a lower plan but not upgrade (without underwriting), I could well get stuck in Hi-F.
Other than changing to Medicare Advantage, the sign-up window at turning 65 seems the main opportunity to choose a plan, and the choice will more or less stand for maybe 30 years - the whole process seems rather stressful to me.
Any ideals about being in a plan that will be closed? Any info on Hi-G? General advice?
Separate question - any feedback on the frequency medical providers charge what is termed "Medicare excess charges" (which F covers)?
Thanks in advance.
Have you eliminated a Medicare Advantage (or the similar Medicare Cost) plan from consideration?
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dodecahedron
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Re: Medigap Insurance Plans

Post by dodecahedron »

In some areas (including mine in NY), there is an intriguing Medicare Medical Savings Account (MSA) high deductible plan.

It is technically a Medicare Advantage plan but is a POS-plan that will cover me at any provider in the country who accepts Medicare, there are no restrictions about networks, no referrals needed to see specialists, etc.

Features:

1) no monthly premium (though of course I have to maintain Part A/Part B coverage)
2) $6,700 annual deductible (which is also the OOP max, no messing around with coinsurance/copays)
3) the plan annually deposits $1,800 into my Medical Savings Account, which can be used taxfree to pay for any tax deductible medical expenses and unneeded balances in which can be rolled forward as many years until needed.

By contrast, a high-deductible Plan F would have an OOP max/deductible of $2,200 and the cheapest one in my state costs $53/month.

But, as you point out, Plan F (and presumably its high deductible variant) are scheduled to go the way of the dinosaur in a few years, meaning that anyone grandfathered into it can stay in it but will be pooled into an older and older population.

On the other hand, I get the sense that the Medicare MSA plan may be the wave of the future. For sure, nobody is talking about ending it.

At least in my state (NY), I have the luxury of not being locked in. As long as I maintain either some form of Medigap/Medicare Advantage coverage, I can switch into any available plan every year without being subject to underwriting. (Of course, there's no free lunch. Our Plan F premiums are probably some of the highest in the country, anywhere from $270/month to $448/month, depending on carrier.)

I won't reach 65 until next year, but watching this topic and gathering info. Since I have already accumulated a substantial HSA balance, some form of high deductible plan makes sense.
Spirit Rider
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Re: Medigap Insurance Plans

Post by Spirit Rider »

rennman100 wrote:BUT given that Plans F and C go away in 2020, Hi-F goes away too. I have read that a High Deductible G is coming but I don't find any info about when and what it might be.
I don't know where you received this information.

Hi-deductible plan F is not going away. Only plans that pay coverage before a deductible or co-pay (Plans C & F). In fact the law does not mention plans by name, only disallows new enrollment starting in 2020 in plans with first dollar coverage.
robertalpert
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Re: Medigap Insurance Plans

Post by robertalpert »

F will only be closed off to new people. If you're in F, you can stay as long as your carrier still has an F.

I personally like plan-G the best; but there is no guaranteed issue if you are changing. But if you are VERY healthy, It could be a good time to change to G.

Unless there is Kaiser Permanente in your city, --- would stay clear of advantage plans.
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Steelersfan
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Re: Medigap Insurance Plans

Post by Steelersfan »

robertalpert wrote:F will only be closed off to new people. If you're in F, you can stay as long as your carrier still has an F.

I personally like plan-G the best; but there is no guaranteed issue if you are changing. But if you are VERY healthy, It could be a good time to change to G.

Unless there is Kaiser Permanente in your city, --- would stay clear of advantage plans.
The fear is that without new enrollees, F plans will get increasingly expensive since the population will get older and need more, expensive medical care. I'm in F now and believe that states or the federal government will do something to fix this in due course. But there's no guarantees of that. If I was getting a Medigap plan now I could certainly buy a G plan instead.
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legio XX
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Re: Medigap Insurance Plans

Post by legio XX »

Spirit Rider wrote:I don't know where you received this information.
Hi-deductible plan F is not going away. Only plans that pay coverage before a deductible or co-pay (Plans C & F). In fact the law does not mention plans by name, only disallows new enrollment starting in 2020 in plans with first dollar coverage.
Oh great! Should have known they would do this since Plan F has been working for me :oops:

But, now I am a bit confused as to what the actual cost is for Hi-deductible F. I decided against that plan to avoid the temptation to skip something "routine" that could come back to bite me. F is expensive (currently $279 which hurts in the 15% bracket), but once you shell out the premium you usually don't see bills. So, the deductible is only one part of the OOP total? I think I would have been hit for well over $6K if I had hi-deductible the year I crashed and crunched in the gym? As it was the nice metalwork and all the OT only cost a few $$, so I was glad I was covered.

Now I'll have to shop again . . . :annoyed Ah bleeeep!

Vic
Spirit Rider
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Re: Medigap Insurance Plans

Post by Spirit Rider »

The 2017 deductible for the Plan F - high deductible, is $2,200. That is the OOP total.

The difference in premiums is usually close to this and in some cases even higher. For example, Plan F $279/month, Plan F high deductible $79/month. Even if you use the entire deductible, you save $200/year. Even with the smallest difference you would have to use the full deductible every year to lose money. You would have to have > $10K in part B negotiated charges every year.
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legio XX
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Re: Medigap Insurance Plans

Post by legio XX »

Spirit Rider,

Thanks. I'll start looking at hi-deductibles again. $2200 is not so bad when offset by lower premiums in "good" years. Went on full M'care about six years ago when my employer's plan went through the roof. Used not-routine services twice, so - given the discipline to stash the premium $$ - I'd likely be ahead with a decent medical emergency kitty building. Something to consider.

As usual, food for thought in this group.

Vic
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dm200
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Re: Medigap Insurance Plans

Post by dm200 »

robertalpert wrote:F will only be closed off to new people. If you're in F, you can stay as long as your carrier still has an F.
I personally like plan-G the best; but there is no guaranteed issue if you are changing. But if you are VERY healthy, It could be a good time to change to G. Unless there is Kaiser Permanente in your city, --- would stay clear of advantage plans.
We are very, very pleased with the Kaiser Medicare plan (Washington DC area).

I know several folks who are also very happy with the Humana Medicare Advantage plan in this area as well.
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celia
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Re: Medigap Insurance Plans

Post by celia »

rennman100 wrote:BUT given that Plans F and C go away in 2020, Hi-F goes away too. I have read that a High Deductible G is coming but I don't find any info about when and what it might be.
Plan F and C will not be offered to new subscribers but the people currently in them can stay. However, the average age and health in those groups will only get worse faster than those on other plans, because no "healthy" 65-yo will be able to join. High-deductible F will stay.

Go to the website for your state's Insurance Commissioner (or whatever your state calls it) to see what carriers sell what plans in your area.
BBBob
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Re: Medigap Insurance Plans

Post by BBBob »

robertalpert wrote:I personally like plan-G the best; but there is no guaranteed issue if you are changing. But if you are VERY healthy, It could be a good time to change to G.
I thought you could change plans without medical underwriting during open enrollment each year, so long as the new plan had a lower level of benfitis than the old plan: e.g., switching from "F" to "G". Not true???
Spirit Rider
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Re: Medigap Insurance Plans

Post by Spirit Rider »

BBBob wrote:
robertalpert wrote:I personally like plan-G the best; but there is no guaranteed issue if you are changing. But if you are VERY healthy, It could be a good time to change to G.
I thought you could change plans without medical underwriting during open enrollment each year, so long as the new plan had a lower level of benfitis than the old plan: e.g., switching from "F" to "G". Not true???
A few states have rules that allow changing without medical underwriting and there are some insurers that allow you to downgrade without medical underwriting, but there is no federal guaranteed right to change without medical underwriting.
robertalpert
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Re: Medigap Insurance Plans

Post by robertalpert »

BBBob wrote:
robertalpert wrote:I personally like plan-G the best; but there is no guaranteed issue if you are changing. But if you are VERY healthy, It could be a good time to change to G.
I thought you could change plans without medical underwriting during open enrollment each year, so long as the new plan had a lower level of benfitis than the old plan: e.g., switching from "F" to "G". Not true???

I believe only plan F has guaranteed accessibility under certain circumstances -- for example if you have an advantage plan and change your residence to a different county.

But Plan G does not participate at all in guaranteed issue except for extremely limited circumstances:
When you first turn age-65
Or If your current carrier goes out of business
Or If you move to a different state

Otherwise, Plan G is not guaranteed. But if you are VERY healthy, then you perhaps become accepted with underwriting process anytime.
Carl53
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Re: Medigap Insurance Plans

Post by Carl53 »

What is the best way to wade through the deciding what options you might have and then selecting the best choice?
Topic Author
rennman100
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Re: Medigap Insurance Plans

Post by rennman100 »

Truly great info. Thanks.

dodecahedron. The MSA-type plan that you have in NY unfortunately isn't available here in CA. But I changed my Mom who lives in Austin, TX to something that sounds similar (Senior Care (Cost) and the features are as you describe). It was a great change for her and cheaper & better than the plan she was on. I'd love that option but I don't have it. I agree with you and suggest that people not yet signed up check to see if this option is available where they live and evaluate it to see if it works for them.

spiritrider. Thanks. I agree that policy types are not named and are defined as those that offer coverage for the Part B deductible. I had to dive into this issue and though it seems like a technicality it could occur in a Hi-F that you meet all your $2200 deductible on a hospital stay and so later the Hi-F would cover your Part B deductible. Unlikely to occur but not impossible. I'd love to be wrong, so please let me know.

BBBob. As spiritrider wrote, you have very limited options to change during open enrollment without underwriting. If you are on a G plan, for example, you can change the insurer for another G plan, but not to another plan. You can always change to Medicare Advantage. There is an option that you can "downgrade" but I don't know the rules for what plan is a downgrade from what other plan. This is very different from the ACA where you are free to change every enrollment period.
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rennman100
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Re: Medigap Insurance Plans

Post by rennman100 »

Others: Yes, many people in Medicare Advantage love it and it does seem an option to be considered. My problem is that I've had problems with the HMO in my area and so reject the option, not because I don't like the program but because I don't like the HMO.

Others: Yes, agree those in F or C can stay. They do not need to move to a new plan.

I am concerned about the premium increases of signing up for a plan that will not take new enrollees after 2020. This will make the plan participates older and most likely sicker over time.

My understanding of insurance premiums is not that they are determined by the pool of all those covered under that insurer, but rather the premiums are determined on a plan by plan basis and on a county by county basis. So a plan with a older/sicker pool may have higher increases than a plan with a wider pool as an open plan is continually signing up new 65 year olds. Likewise a county with a sicker population (apparently such things are possible) may also have higher increases. You may not be able to do much about the county you live in but you can control the plan you sign up for.

Will the government come to the aid of those “stuck” in F or C plans? I’ve seen that suggested. For me this is nothing to be banked on but it might come down to your risk tolerance.

Others: Yes, G looks like a very intriguing option. For my location, it seems that most of the G providers are insurers writing health insurance that I've never heard of like Colonial Penn, Continental Life, Gerber Life, Loyal American and Physicians Mutual.

Can people comment on their G providers?
beardsworth
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Re: Medigap Insurance Plans

Post by beardsworth »

Anyone who wishes to use that search box at the top of the Bogleheads page, looking for the terms Medigap, Medigap F, Medigap G, Medicare supplement, etc., will find many other conversations on this subject.
Topic Author
rennman100
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Re: Medigap Insurance Plans

Post by rennman100 »

beardsworth: yes, I agree the search box is your friend. I confess to doing this and finding some good stuff. What I didn't do was search medigap f or medigap g but only searched medigap. I expected medigap would be the most general term and catch all the others but this didn’t seem to happen for me. And from my search many of the threads were old like 2011, 2010, 2013.

But going for medigap f or g, I found more recent and very useful threads. I include a few links. First is G and second F. Some of these are quite recent. Thanks for your help.

viewtopic.php?t=201138

viewtopic.php?t=212449
robertalpert
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Re: Medigap Insurance Plans

Post by robertalpert »

rennman100 wrote: Can people comment on their G providers?
Here in Ohio, I am enrolled in plan G with Medical Mutual of Ohio. It's the best carrier I found within Ohio, But one needs to be an Ohio resident to enroll.
Zott
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Re: Medigap Insurance Plans

Post by Zott »

Carl53 wrote:What is the best way to wade through the deciding what options you might have and then selecting the best choice?
Go to the link below at Medicare.gov, put in your zip code and a summary of plans available in your area will come up. You can click on the link that lists all companies which offer a specific plan in our area. You may then wish to visit that company's website to get more detail.

You will have to decide which way to go based upon your opinion of your health, and most importantly, your ability to handle the monthly premium and the financial risks involved.

https://www.medicare.gov/find-a-plan/qu ... -home.aspx
Almost there
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Re: Medigap Insurance Plans

Post by Almost there »

Thank you Zott for the internet connection to:
That was quite helpful.

Last December I changed from United Healthcare to Aetna. Aetna offered Plan N for $23 less. Though I stayed with Plan N, I had to undergo underwriting in December 2016 (3 days before I fell while playing pickle ball and breaking my right wrist). I was invoiced by United in January for x-ray $63.15 and ER visit $39.85 and the surgeon just invoiced me $20.00 for my first office visit. I visited PT doctor 15 times (and Aetna paid for Medicare recommended charges) and I was never invoiced by them.

So far I have been pleased with Plan N. When I compared Plans F, G + N via the Medicare Plan Finder, the one noticeable difference was:
Medicare Part B Excess Charges (above Medicare-approved amounts):
Both Plans F + G indicate: what Medigap pays: 100%
Plan N indicates: $0

Could someone please explain to me what Medicare part B Excess Charges are?
Also I live in Arizona and my deductible is $183. Would the deductible and/or premiums be higher for F or G?
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dm200
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Re: Medigap Insurance Plans

Post by dm200 »

Others: Yes, many people in Medicare Advantage love it and it does seem an option to be considered. My problem is that I've had problems with the HMO in my area and so reject the option, not because I don't like the program but because I don't like the HMO.
Yes.. My Medicare plan is with an HMO that we were very, very happy with over the decades.
Grasshopper
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Re: Medigap Insurance Plans

Post by Grasshopper »

Almost there wrote:Thank you Zott for the internet connection to:
That was quite helpful.

Last December I changed from United Healthcare to Aetna. Aetna offered Plan N for $23 less. Though I stayed with Plan N, I had to undergo underwriting in December 2016 (3 days before I fell while playing pickle ball and breaking my right wrist). I was invoiced by United in January for x-ray $63.15 and ER visit $39.85 and the surgeon just invoiced me $20.00 for my first office visit. I visited PT doctor 15 times (and Aetna paid for Medicare recommended charges) and I was never invoiced by them.

So far I have been pleased with Plan N. When I compared Plans F, G + N via the Medicare Plan Finder, the one noticeable difference was:
Medicare Part B Excess Charges (above Medicare-approved amounts):
Both Plans F + G indicate: what Medigap pays: 100%
Plan N indicates: $0

Could someone please explain to me what Medicare part B Excess Charges are?
Also I live in Arizona and my deductible is $183. Would the deductible and/or premiums be higher for F or G?
I live in AZ I have "F" as "G" isn't available from BCBS in my county, there is no deductible with them. I don't pay anything extra for any procedure that Medicare covers......so far.

A Medicare Part B excess charges are the cost difference between the Medicare-approved insurance payment amount for a medical service and the amount your health care provider typically charges for that service. Medicare Part B excess charges only occur if your doctor does not accept Medicare assignment.
Spirit Rider
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Re: Medigap Insurance Plans

Post by Spirit Rider »

There are three classes of medical providers:
  1. Participating provider accepting assignment: This provider will accept all Medicare direct payment amounts. You will only be subject to deductibles, co-insurance and co-payments subject to your Medigap plan if any.
  2. Non-participating provider: This provider accepts direct Medicare payment, but not the Medicare payment amounts. You may be subject to "excess charges", but those charges may not exceed 115% of 95% of the Medicare allowed amount. These may or may not be covered by your Medigap plan and are not permitted in CT, MA, MN, NY, OH, PA, RI and VT.
  3. Op-out or private contract provider: These providers accept no direct Medicare reimbursement and neither Medicare nor your Medigap plan will pay any portion of any bills from them.
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celia
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Re: Medigap Insurance Plans

Post by celia »

Steelersfan wrote:The fear is that without new enrollees, F plans will get increasingly expensive since the population will get older and need more, expensive medical care. I'm in F now and believe that states or the federal government will do something to fix this in due course. But there's no guarantees of that. If I was getting a Medigap plan now I could certainly buy a G plan instead.
No, they are not going to "fix" anything since this ***IS*** the "fix" they came up with for controlling the payout of claims. They assumed that if the patient has some "skin in the game", they will use medical services more judiciously. If everything is "free" after you pay your premium, there is no incentive to limit how many times you see doctors and request their services.

rennman100 wrote:Others: Yes, G looks like a very intriguing option. For my location, it seems that most of the G providers are insurers writing health insurance that I've never heard of like Colonial Penn, Continental Life, Gerber Life, Loyal American and Physicians Mutual.

Can people comment on their G providers?
When I was looking for a Medigap provider, several bogleheads indicated you should just go with the one with the lowest premium. They all have to pay out or Medicare would no longer let them be a provider. I ended up going with a Medigap plan with a provider I had never heard of . To select a provider, I first went to my state's Department of Insurance website and looked at the Medigap premium for my age and zip for each carrier. Although the data is slightly out-of-date, I looked at the 5 or so carriers with the lowest premium and checked out their credit-worthiness (ability to pay future claims) at http://www.AMBest.com. This is a rating company for comparing insurers and registration to do searches is free (for individuals who don't search very often???). Then I went with the one that had a good rating AND lower premiums.
my name
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Re: Medigap Insurance Plans

Post by my name »

Varies greatly by state, insurer, zip code. For reasons below, I chose Plan N. The premium is dirt cheap, for one thing.

NY has some interesting protections. You do not have underwriting with Medigap plan changes, but premiums for F and such are very high. They also limit excess charges to 5% which matches the rate reduction Medicare pays to doctors charging this, so it is a "wash".

Examples in my state. The big insurer, bc/bs, has no underwriting if joining or switching to a new Medigap plan as long as you have had credible coverage. Their application has no medical questions. Another, Aetna, has underwriting if you upgrade or downgrade to their own N plan.

Plans G and N have the same benefits as Plan F (pays everything that Medicare covers and does not pay), except G and N have the Part B deductible. BUT many insurers may not offer 1 or both of these plans in your zip code.

Plan N also has the following (and why I chose it over high deductible F, which is not offered by most insurers):

- up to $20 copay on office visit. The premium is about $1000 less than F and G (which are not much difference in premium). I have seen a million doctors this year and will still save hundreds of dollars with plan N.

- a $50 copay if you use the emergency room and are not admitted. Really rare, if ever happens. They want to encourage you to see a doctor or go to urgent care. I used it once, when I had long term gastro problems - they gave me an IV and sent me home.

- excess charges. I live in the NY metro area (NJ) and NEVER had this charge in the 4 years with plan N. Explained to me by an agent, only rarely do specialists in urban areas charge this. Consider doctors are increasing becoming employed by hospitals and medical centers and they have a blanket "no excess". Worse case, you are in an accident and at the ER a doctor treats you who does not accept Medicare rates. Policy is they at most can charge you with the excess (15%) cost above Medicare rates. Would rarely if ever happen, and overall would not be that bad. Always ask a doctor or facility if they accept Medicare rates when making an appointment. If not, you can go elsewhere. You can see anyone in the USA who accepts Medicare. I never had this happen.

NO to Medicare Advantage plans. The $0 or low premium may be attractive, but the out-of-pocket cap is $6700 a year, I see no insurer with less. You pay for everything with copay or worse coshare (uncapped percentage), like 20% or whatever on top of premium. So the plans are good while you are younger and healthy, but older can be very costly and you can't get into a Medigap plan later due to underwriting - you are denied or it is a very expensive premium. Also these are HMO PPO plans and have an often limited network. If you leave your zip code location, it is like traveling overseas with only emergency coverage or, with a PPO type you may be able to be covered but pay out of network costs which can be very high. PPO premiums are higher because of this added coverage.

You can change Medigap plan any month, just know the underwriting rules for your own zip code. Open enrollment in Fall is only for Medicare Advantage and Part D Rx plans that anyone can join without underwriting.

Consider the above, but with respect to what is offered in your zip code. For cost and rating, the best tool is Medicare.gov. Compare the premium (at an insurer's website) over time/age.
my name
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Re: Medigap Insurance Plans

Post by my name »

I should add that if you are in a Medigap plan, there are rules where you can change plan with guaranteed coverage (no underwriting). Situations include you move, a plan closes, and more.

Read up at Medicare.gov, or do a Goggle search for some other articles. Note other websites are often selling something, or pushing an insurance type product where they get a fee for ads or number of website visitors, etc.
montanagirl
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Re: Medigap Insurance Plans

Post by montanagirl »

rennman100 wrote:Others: Yes, many people in Medicare Advantage love it and it doe

I am concerned about the premium increases of signing up for a plan that will not take new enrollees after 2020. This will make the plan participates older and most likely sicker over time.

Others: Yes, G looks like a very intriguing option. For my location, it seems that most of the G providers are insurers writing health insurance that I've never heard of like Colonial Penn, Continental Life, Gerber Life, Loyal American and Physicians Mutual.

Can people comment on their G providers?
I am switching from F to G with Equitable Life out of Salt Lake. I have been with them 2 years. They have been very good to work with and actually more accessible than my own state's Blue Cross Blue Shield. Highly recommend.
miles monroe
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Re: Medigap Insurance Plans

Post by miles monroe »

i'm going with G as F is going away.

the interesting thing is that the only difference between G and F is you have to pay the $183 deductible with G. works out to roughly $15 a month. yet the monthly premium difference for BCBS in my state is $57. go figure...
my name
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Re: Medigap Insurance Plans

Post by my name »

miles monroe wrote:i'm going with G as F is going away.

the interesting thing is that the only difference between G and F is you have to pay the $183 deductible with G. works out to roughly $15 a month. yet the monthly premium difference for BCBS in my state is $57. go figure...
Each zip code differs. G and N are virtually the same, just compare the difference in premium and see how many office visits on Plan N would erase the difference. For me, N wins. Same benefits as F, in 2012 cost about $210 I think, where N was at $98.

Premium of each zip code differs due to the risk pool of people, what plan an insurer wants to offer or not, or to influence people to buy. It is clear my insurer wants to sell N, as premiums for G and F are so much higher. Perhaps because with N people do share the office visit cost, even if tiny, so they make it worthwhile to do so with that low premium.
Almost there
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Re: Medigap Insurance Plans

Post by Almost there »

my name wrote:
Examples in my state. The big insurer, bc/bs, has no underwriting if joining or switching to a new Medigap plan as long as you have had credible coverage. Their application has no medical questions. Another, Aetna, has underwriting if you upgrade or downgrade to their own N plan.

Plans G and N have the same benefits as Plan F (pays everything that Medicare covers and does not pay), except G and N have the Part B deductible. BUT many insurers may not offer 1 or both of these plans in your zip code.

Plan N also has the following (and why I chose it over high deductible F, which is not offered by most insurers):

- up to $20 copay on office visit. The premium is about $1000 less than F and G (which are not much difference in premium). I have seen a million doctors this year and will still save hundreds of dollars with plan N.

- a $50 copay if you use the emergency room and are not admitted. Really rare, if ever happens. They want to encourage you to see a doctor or go to urgent care. I used it once, when I had long term gastro problems - they gave me an IV and sent me home.

- excess charges. I live in the NY metro area (NJ) and NEVER had this charge in the 4 years with plan N. Explained to me by an agent, only rarely do specialists in urban areas charge this. Consider doctors are increasing becoming employed by hospitals and medical centers and they have a blanket "no excess". Worse case, you are in an accident and at the ER a doctor treats you who does not accept Medicare rates. Policy is they at most can charge you with the excess (15%) cost above Medicare rates. Would rarely if ever happen, and overall would not be that bad. Always ask a doctor or facility if they accept Medicare rates when making an appointment. If not, you can go elsewhere. You can see anyone in the USA who accepts Medicare. I never had this happen.

NO to Medicare Advantage plans. The $0 or low premium may be attractive, but the out-of-pocket cap is $6700 a year, I see no insurer with less. You pay for everything with copay or worse coshare (uncapped percentage), like 20% or whatever on top of premium. So the plans are good while you are younger and healthy, but older can be very costly and you can't get into a Medigap plan later due to underwriting - you are denied or it is a very expensive premium. Also these are HMO PPO plans and have an often limited network. If you leave your zip code location, it is like traveling overseas with only emergency coverage or, with a PPO type you may be able to be covered but pay out of network costs which can be very high. PPO premiums are higher because of this added coverage.

You can change Medigap plan any month, just know the underwriting rules for your own zip code. Open enrollment in Fall is only for Medicare Advantage and Part D Rx plans that anyone can join without underwriting.
Premium of each zip code differs due to the risk pool of people, what plan an insurer wants to offer or not, or to influence people to buy. It is clear my insurer wants to sell N, as premiums for G and F are so much higher. Perhaps because with N people do share the office visit cost, even if tiny, so they make it worthwhile to do so with that low premium.
4 years ago I signed up with the Advantage plan while living in NJ. When I moved to Arizona I chose Medigap (with United Healthcare) and Plan N for 2016. Had 2 surgeries (removal of bad veins on both legs and repairing my wrist after a fall) and paid just once for the each office visit and the deductible. Last December after speaking with Ashley at Senior Savings Network (located on the East coast), she recommended changing to Aetna (for 2018) which dropped my monthly premium by $23. And, yes, I had to go through underwriting. Never quite understood why until I read the posts here.
miles monroe
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Re: Medigap Insurance Plans

Post by miles monroe »

amazing how the premiums vary based on location and insurer. i checked the BCBS difference between G and N and it was only $20 a month - conincidentally what the office visit co pay is.

yet for AARP the difference between F (no G in my area) and N was significant enough that thot should be given to N if someone was otherwise considering F.

the only thing i know for sure is that this medicare stuff is a whole lot more confusing than it should be.
miles monroe
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Re: Medigap Insurance Plans

Post by miles monroe »

while we're at it -- anyone know how accurate the medicare drug Part D cost estimates are?
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dm200
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Re: Medigap Insurance Plans

Post by dm200 »

Regarding drug coverage, many Medicare Advantage or Medicare Cost plans include drug coverage. My MC plan (Kaiser $25 per month premium) includes prescription drugs.
jebmke
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Re: Medigap Insurance Plans

Post by jebmke »

miles monroe wrote:the only thing i know for sure is that this medicare stuff is a whole lot more confusing than it should be.
Who knew health care was so complicated?
When you discover that you are riding a dead horse, the best strategy is to dismount.
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dm200
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Re: Medigap Insurance Plans

Post by dm200 »

jebmke wrote:
miles monroe wrote:the only thing i know for sure is that this medicare stuff is a whole lot more confusing than it should be.
Who knew health care was so complicated?
I think making it so complicated is, to a degree at least, intentional to make more money/profit for certain entities.
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Doom&Gloom
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Re: Medigap Insurance Plans

Post by Doom&Gloom »

jebmke wrote:
miles monroe wrote:the only thing i know for sure is that this medicare stuff is a whole lot more confusing than it should be.
Who knew health care was so complicated?
:)
Almost there
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Re: Medigap Insurance Plans

Post by Almost there »

Keeping people in the dark and one shouldn't be allowed to think which Plan one chooses. Very sad.
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Sheepdog
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Re: Medigap Insurance Plans

Post by Sheepdog »

rennman100 wrote:Others: Yes, many people in Medicare Advantage love it and it does seem an option to be considered. My problem is that I've had problems with the HMO in my area and so reject the option, not because I don't like the program but because I don't like the HMO.
I don't like HMOs either. Medicare Advantage plans are not all HMOs. There are PPOs also (Preferred Providers). My wife and I have those. We can see any physician, but their preferred in network providers are lower cost. We have had no difficulty. For example, my wife had an emergency condition in March, she went to an out of network hospital, had treatments by out of network physicians. Her billings totaled $33,745. Her out of pocket cost (her deductible) was $153.
She has a Humana Choice Advantage Regional PPO. I have Anthem BC/BS Mediblue Access Regional PPO Advantage.
They cover our prescription costs as well Each one is savings us over $2000 annually in medical costs or over $4000 a year for this couple.
We previously had Medicare plus Medigap plans and the costs of insurance (including Part D prescription) were going up rapidly with age. The change to the Advantage plans was excellent.
Time is the school in which we learn, time is the fire in which we burn.~ Delmore Schwartz
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FrugalInvestor
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Re: Medigap Insurance Plans

Post by FrugalInvestor »

After some back-and-forth I chose G.

First I decided to pay extra for the simplicty of F over other plans like high deductible F that I was leaning toward earlier. I decided that I like the idea of a reduction of paperwork in our later years - and am willing to pay for it. But F is going away soon so the insured pool must age disproportionately (no new entrants) which seems to be a recipie for higher rate increases.

So I decided on G which, especially in our state where F has been the most popular choice, should become the plan of choice with more young'ns joining the pool. Recordkeeping seems simple with just the $183 deductible to track and premium savings are substantially more than that.

I considered N but am not confident that excess charges won't become more common as doctors possibly get further squeezed on reimbursements.
Last edited by FrugalInvestor on Sun May 28, 2017 5:19 pm, edited 2 times in total.
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inbox788
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Re: Medigap Insurance Plans

Post by inbox788 »

On a related note, anyone with HSA, what Medigap are you choosing if any?
Is it still correct that HSA can be used to pay for Medicare premiums, but not Medigap?
Does it make sense to load up HSA if you buy Medigap?
HSA vs MSA?
http://www.hsaconnect.com/hsa-health-sa ... ccount.php
Last edited by inbox788 on Sun May 28, 2017 4:57 pm, edited 1 time in total.
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dm200
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Re: Medigap Insurance Plans

Post by dm200 »

I don't like HMOs either. Medicare Advantage plans are not all HMOs.
Also, there are two general types of HMOs. Over the decades, I have been in several of each type. One type (Kaiser is an example) is where the HMO has its own facilities and the most providers/physicians are owned/controlled by the HMO.

The other type of HMO is a tight network of Phyicians/providers in their own practices.

Having been is 2 or 3 of the first type of HMO (currently Kaiser), I actually prefer this type of HMO for my health/medical care and insurance. I certainly understand, though, that opinions and experiences may be different.
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dodecahedron
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Re: Medigap Insurance Plans

Post by dodecahedron »

inbox788 wrote: Is it still correct that HSA can be used to pay for Medicare premiums, but not Medigap? Yes, Medicare premiums (including B and D as well as Medicare Advantage premiums)are all eligible HSA expenses but Medigap (aka "Medicare Supplement") premiums are not.
Does it make sense to load up HSA if you buy Medigap?
HSA vs MSA? Even if you buy Medigap, you can use your HSA balances for your Medicare Parts B and D, as well as dental, vision, and long term care. And of course, many Medigap policies have deductibles, copays, etc.
and you can use your HSA funds for those.
I am still over a year away from Medicare so I have yet to decide on whether to go with Medicare Advantage or Medigap. One thing I am considering is a Medicare Advantage/MSA Plan. It is a PPO (so I can go to any physician or hospital who accepts Medicare anywhere in the country) and it has zero monthly premiums and a high deductible, but they deposit $1,800 annually into a Medical Savings Account (MSA), which works somewhat like an HSA but just in a bank account (no option to invest in mutual funds). It is not available everywhere but we are fortunate to have that option available in Upstate NY.
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