Medicare: G vs G Prime

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tm3
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Medicare: G vs G Prime

Post by tm3 »

I'm starting Medicare soon, and am going with A, B, D, and as a supplement either G or G Prime. The difference is

G: $1200 annual premium, $200 deductible
G Prime: $400 annual premium, $2300 deductible

So under G there is the potential of paying a total in a given year of $1400, while under G Prime the total is $2700. The certainty, of course, is that under G an additional $800 premium will be paid annually.

Interestingly, only a handful of companies offer G Prime while a bunch offer G.

I'm not going to be hurt by either an ongoing $800/year additional premium or a periodic deductible payment of $2300. So, why do I bother bringing this up? Well, A) I am a Boglehead, B) Once a supplemental plan is chosen, it cannot be changed without underwriting, and C) an $800 savings is, well, $800.

Thoughts/comments? Am I missing something?
Silk McCue
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Re: Medicare: G vs G Prime

Post by Silk McCue »

My only concern is that you MIGHT decide to not go see a Dr when you should because you know it will cost you a bunch of money if you chose Prime. We are all human and make stupid decisions over money. Not having to hesitate to have a concern checked out may keep you healthier.

Cheers
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Eagle33
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Re: Medicare: G vs G Prime

Post by Eagle33 »

Remember you only get 1 chance to choose a medigap plan without underwriting. Choose wisely.
Rocket science is not “rocket science” to a rocket scientist, just as personal finance is not “rocket science” to a Boglehead.
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GerryL
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Re: Medicare: G vs G Prime

Post by GerryL »

tm3 wrote: Thu Dec 12, 2019 1:32 pm I'm starting Medicare soon, and am going with A, B, D, and as a supplement either G or G Prime. The difference is

G: $1200 annual premium, $200 deductible
G Prime: $400 annual premium, $2300 deductible

So under G there is the potential of paying a total in a given year of $1400, while under G Prime the total is $2700. The certainty, of course, is that under G an additional $800 premium will be paid annually.

Interestingly, only a handful of companies offer G Prime while a bunch offer G.

I'm not going to be hurt by either an ongoing $800/year additional premium or a periodic deductible payment of $2300. So, why do I bother bringing this up? Well, A) I am a Boglehead, B) Once a supplemental plan is chosen, it cannot be changed without underwriting, and C) an $800 savings is, well, $800.

Thoughts/comments? Am I missing something?
It sounds like G Prime is a G HD plan. Is that correct?
I did the same calculation when I selected an F-HD plan at the start of my Medicare enrollment five years ago. My premium is 1/3 to 1/4 the cost of the F plan. I do not need a lot of medical care. I rarely even hit the Medicare deductible, so I have been pocketing a lot of savings on premiums, with little out-of-pocket expense for the 20% that Medicare doesn't cover.

In Oregon we can change our Medigap plan in our birth month to a plan with the same or lower benefits. My insurer just announced a G HD plan for 2020, and I am thinking of switching if the premiums are lower.
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Re: Medicare: G vs G Prime

Post by drawpoker »

tm3 wrote: Thu Dec 12, 2019 1:32 pm supplement either G or G Prime.
G: $1200 annual premium, $200 deductible
G Prime: $400 annual premium, $2300 deductible
Where is the name "G Prime" coming from? Isn't this the High-Deduct-G supplement plan? The new one that starts in January to replace the High-Deduct F? (Since HD-F can no longer be sold to people enrolling in Medicare for the first time)

I am curious to know if the insurers are being allowed to use a different name for HD-G. Seems to me it is just going to cause confusion.
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tm3
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Re: Medicare: G vs G Prime

Post by tm3 »

Silk McCue wrote: Thu Dec 12, 2019 2:18 pm My only concern is that you MIGHT decide to not go see a Dr when you should because you know it will cost you a bunch of money if you chose Prime. We are all human and make stupid decisions over money. Not having to hesitate to have a concern checked out may keep you healthier.

Cheers
That is a good thing to keep in mind.
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tm3
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Re: Medicare: G vs G Prime

Post by tm3 »

Eagle33 wrote: Fri Dec 13, 2019 12:15 am Remember you only get 1 chance to choose a medigap plan without underwriting. Choose wisely.
Hence, my posing the question to what I believe is a board containing a number of thoughtful people.
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tm3
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Re: Medicare: G vs G Prime

Post by tm3 »

GerryL wrote: Fri Dec 13, 2019 1:33 am
tm3 wrote: Thu Dec 12, 2019 1:32 pm I'm starting Medicare soon, and am going with A, B, D, and as a supplement either G or G Prime. The difference is
It sounds like G Prime is a G HD plan. Is that correct?
I did the same calculation when I selected an F-HD plan at the start of my Medicare enrollment five years ago. My premium is 1/3 to 1/4 the cost of the F plan. I do not need a lot of medical care. I rarely even hit the Medicare deductible, so I have been pocketing a lot of savings on premiums, with little out-of-pocket expense for the 20% that Medicare doesn't cover.

In Oregon we can change our Medigap plan in our birth month to a plan with the same or lower benefits. My insurer just announced a G HD plan for 2020, and I am thinking of switching if the premiums are lower.
Yes G Prime is HD, I believe it replaces F HD but I don't know all the old (or new) labels.

It sounds like you are in the same boat as me, and made the decision that I am leaning towards ie G Prime (high deductible). $800 or so delta annually adds up, and I don't have any chronic conditions (however, one could pop up any time).
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tm3
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Re: Medicare: G vs G Prime

Post by tm3 »

drawpoker wrote: Fri Dec 13, 2019 2:32 pm
tm3 wrote: Thu Dec 12, 2019 1:32 pm supplement either G or G Prime.
G: $1200 annual premium, $200 deductible
G Prime: $400 annual premium, $2300 deductible
Where is the name "G Prime" coming from? Isn't this the High-Deduct-G supplement plan? The new one that starts in January to replace the High-Deduct F? (Since HD-F can no longer be sold to people enrolling in Medicare for the first time)

I am curious to know if the insurers are being allowed to use a different name for HD-G. Seems to me it is just going to cause confusion.
Yes G Prime is HD. From what I can tell, it is essentially the same as F-HD.

I have no idea why the name was changed. To keep us confused?
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Munir
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Re: Medicare: G vs G Prime

Post by Munir »

A significant factor in making such a choice is whether you currently, or expect to in the future, based on your family history and general medical condition, to be a high or low user of the system. If it is a high user, choose the lower deductible. It may cost more in the short term but pay off in the longer term. The higher cost user in dollar terms can be a frequent user of the system with many office/ER visits or having a few very expensive procedures. A Boglehead can have more peace of mind with a lower deductible than being too frugal and worrying about it while trying to be to be too thrifty with a higher deductible.
PS: your personality type can be a factor too in making such decisions.
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Re: Medicare: G vs G Prime

Post by Spirit Rider »

tm3 wrote: Fri Dec 13, 2019 5:02 pm Yes G Prime is HD. From what I can tell, it is essentially the same as F-HD.
From a practical point of view it is almost always effectively the same as Plan F-HD. Bear with me as this is a little convoluted.

The difference is that the Part B deductible can not be paid by Plan G-HD. In most cases you are going to pay the Part B deductible before reaching the plan deductible. However, the possibility exists that you could exceed the plan deductible with non-Part B medical expenses (Multiple Part A deductibles, Part A coinsurance, Skilled Nursing Facility Care Coinsurance, etc...), before the Part B deductible has been met. Under Plan F-HD, medical expenses before the Part B deductible is met, will be paid because the plan deductible has been met. Under Plan G-HD, medical expenses before the Part B deductible is met, will not be paid even though the plan deductible has been met, because the Part B deductible has not.
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GerryL
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Re: Medicare: G vs G Prime

Post by GerryL »

Munir wrote: Fri Dec 13, 2019 6:05 pm A significant factor in making such a choice is whether you currently, or expect to in the future, based on your family history and general medical condition, to be a high or low user of the system. If it is a high user, choose the lower deductible. It may cost more in the short term but pay off in the longer term. The higher cost user in dollar terms can be a frequent user of the system with many office/ER visits or having a few very expensive procedures. A Boglehead can have more peace of mind with a lower deductible than being too frugal and worrying about it while trying to be to be too thrifty with a higher deductible.
PS: your personality type can be a factor too in making such decisions.
Yes, an HD plan (F or G) has a higher deductible, but it is essentially an out-of-pocket cap that is lower than most (all?) Advantage plan caps. Each person needs to make a decision based on their own circumstances (and, yes, personality type), but they should consider whether they can comfortably cover the deductible in the years they may need more care. In the age-range I have reached, I would actually be paying more in premiums for the F plan ($2592) than the 2020 deductible ($2340). My F-HD premium for 2020 will be $576.
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Re: Medicare: G vs G Prime

Post by drawpoker »

Spirit Rider wrote: Fri Dec 13, 2019 6:32 pm

..In most cases you are going to pay the Part B deductible before reaching the plan deductible. However, the possibility exists that you could exceed the plan deductible with non-Part B medical expenses (Multiple Part A deductibles, Part A coinsurance, Skilled Nursing Facility Care Coinsurance, etc...), before the Part B deductible has been met......
You mentioned this scenario before in another thread. I didn't understand it then, and I don't understand any more now. :confused

How could any Medicare beneficiary rack up that much in Part A charges, hospitalizations, SNF days, etc. without a plethora of physicians (coming under Part B) involved first? Since Medicare won't pay any part of their share of Part B until the annual Part B deductible is met, just one doc visit and maybe an x-ray is going to easily top $198.

I can't see anyone getting admitted to a hospital without first an ER visit, scan or other imaging procedure (Part B) with alarming results thus necessitating immediate care. Or getting into car accident, shot in street crime, near-drowning in your pool, wife poisons you. The docs (Part B) at the hospital, clinic, wherever you are taken have their protocols on how you are evaluated, order surgery, whatever.

How would the scenario you describe work? What I am missing here?
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Re: Medicare: G vs G Prime

Post by sandramjet »

Since I am not yet at Medicare age, I am not familiar with all the plans and parts, so pardon my newbie question ... if you choose the Prime plan with high deductible, does that include medication costs or just doctor visits, hospital stays etc. That is, if you have a condition that requires regular medications but not necessarily lots of doctor visits, would you end up paying more because the medication costs fall under the deductible?
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Re: Medicare: G vs G Prime

Post by drawpoker »

Chemo, and other drugs administered in a doctor's office, come under Part B Medicare.

The regular prescriptions you get at a drugstore come under Part D. So you need to either buy a separate Part D plan, or join MA and get your coverage for that within your MA.
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Re: Medicare: G vs G Prime

Post by GerryL »

sandramjet wrote: Fri Dec 13, 2019 8:08 pm Since I am not yet at Medicare age, I am not familiar with all the plans and parts, so pardon my newbie question ... if you choose the Prime plan with high deductible, does that include medication costs or just doctor visits, hospital stays etc. That is, if you have a condition that requires regular medications but not necessarily lots of doctor visits, would you end up paying more because the medication costs fall under the deductible?
As you get closer to Medicare eligibility, go out and get the most recent edition of Medicare for Dummies at the local library or buy your own copy. It is a great resource that clarifies many of the mysteries of this complex program. It doesn't just copy and paste the words that are on the official Medicare site but rephrases and presents the info in a more understandable way.
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Re: Medicare: G vs G Prime

Post by Spirit Rider »

drawpoker wrote: Fri Dec 13, 2019 7:55 pm
Spirit Rider wrote: Fri Dec 13, 2019 6:32 pm ..In most cases you are going to pay the Part B deductible before reaching the plan deductible. However, the possibility exists that you could exceed the plan deductible with non-Part B medical expenses (Multiple Part A deductibles, Part A coinsurance, Skilled Nursing Facility Care Coinsurance, etc...), before the Part B deductible has been met......
You mentioned this scenario before in another thread. I didn't understand it then, and I don't understand any more now. :confused

How could any Medicare beneficiary rack up that much in Part A charges, hospitalizations, SNF days, etc. without a plethora of physicians (coming under Part B) involved first? Since Medicare won't pay any part of their share of Part B until the annual Part B deductible is met, just one doc visit and maybe an x-ray is going to easily top $198.

I can't see anyone getting admitted to a hospital without first an ER visit, scan or other imaging procedure (Part B) with alarming results thus necessitating immediate care. Or getting into car accident, shot in street crime, near-drowning in your pool, wife poisons you. The docs (Part B) at the hospital, clinic, wherever you are taken have their protocols on how you are evaluated, order surgery, whatever.

How would the scenario you describe work? What I am missing here?
You can speculate all you want. Under the legislation it doesn't matter if is likely to happen, only that the possibility it could happen.
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Re: Medicare: G vs G Prime

Post by drawpoker »

Spirit Rider wrote: Fri Dec 13, 2019 9:08 pm You can speculate all you want. Under the legislation it doesn't matter if is likely to happen, only that the possibility it could happen.
What legislation? Doing away with first-dollar coverage in Medicare plans? What does that have to do with it?

Sorry, am just not getting the basics for your theory here. It is just not possible under the circumstances you describe. Not possible.
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Re: Medicare: G vs G Prime

Post by dodecahedron »

drawpoker wrote: Fri Dec 13, 2019 7:55 pm
Spirit Rider wrote: Fri Dec 13, 2019 6:32 pm

..In most cases you are going to pay the Part B deductible before reaching the plan deductible. However, the possibility exists that you could exceed the plan deductible with non-Part B medical expenses (Multiple Part A deductibles, Part A coinsurance, Skilled Nursing Facility Care Coinsurance, etc...), before the Part B deductible has been met......
You mentioned this scenario before in another thread. I didn't understand it then, and I don't understand any more now. :confused

How could any Medicare beneficiary rack up that much in Part A charges, hospitalizations, SNF days, etc. without a plethora of physicians (coming under Part B) involved first? Since Medicare won't pay any part of their share of Part B until the annual Part B deductible is met, just one doc visit and maybe an x-ray is going to easily top $198.

I can't see anyone getting admitted to a hospital without first an ER visit, scan or other imaging procedure (Part B) with alarming results thus necessitating immediate care. Or getting into car accident, shot in street crime, near-drowning in your pool, wife poisons you. The docs (Part B) at the hospital, clinic, wherever you are taken have their protocols on how you are evaluated, order surgery, whatever.

How would the scenario you describe work? What I am missing here?
How about: you have a stroke towards the end of one calendar year and are treated in the ER and have a ton of Part B stuff, possibly including ¨Observation Days.¨ The docs determine you should be admitted to a ¨Rehab Facility¨ and they send you off in an ambulance to that facility where you languish without further physician attention for the next 90 days. Assume the ambulance departs before midnight Dec 31 and arrives in the wee hours of January 1.

(Yes, I am pretty sure the docs are supposed to be checking in on you during your 90 day stay in rehab, but I would not be surprised if there are not some neglected patients.)
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Re: Medicare: G vs G Prime

Post by drawpoker »

dodecahedron wrote: Fri Dec 13, 2019 9:32 pm How about: you have a stroke towards the end of one calendar year and are treated in the ER and have a ton of Part B stuff, possibly including ¨Observation Days.¨ The docs determine you should be admitted to a ¨Rehab Facility¨ and they send you off in an ambulance to that facility where you languish without further physician attention for the next 90 days. Assume the ambulance departs before midnight Dec 31 and arrives in the wee hours of January 1.

Nope, won't work. You can't go directly from the ER, or with observation days, to rehab, you have to spend 3 days as an inpatient (Part A) before Medicare covers any rehab days.

Think Spirit rider is under impression the law did away with first-dollar coverage because of some loophole where his scenario could happen. But, that wasn't it, the law was changed because the belief was people with Plan F would drive up health care costs. Not having any skin in the game, no OOP, they would be running to the doc, or ER, over minor things. That required only 2 aspirin or a Band-aide :wink:
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dodecahedron
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Re: Medicare: G vs G Prime

Post by dodecahedron »

drawpoker wrote: Fri Dec 13, 2019 9:38 pm
dodecahedron wrote: Fri Dec 13, 2019 9:32 pm How about: you have a stroke towards the end of one calendar year and are treated in the ER and have a ton of Part B stuff, possibly including ¨Observation Days.¨ The docs determine you should be admitted to a ¨Rehab Facility¨ and they send you off in an ambulance to that facility where you languish without further physician attention for the next 90 days. Assume the ambulance departs before midnight Dec 31 and arrives in the wee hours of January 1.

Nope, won't work. You can't go directly from the ER, or with observation days, to rehab, you have to spend 3 days as an inpatient (Part A) before Medicare covers any rehab days.
I understand that there is a three-day rule, but extrapolating from audits, Medicare has determined statistically that large numbers of folks in Medicare-covered rehab did not in fact satisfy that three-day rule. Lots of clueless patients did not know whether they were in observation or inpatient status prior to admission.

But getting back to my scenario, you could even have your three days as inpatient in the prior calendar year before they stuff you into an ambulance shortly before midnight on New Yearś Eve to go to rehab. You then spend the next 90 days there. Days 60 through 90 get billed at coinsurance rates that could max out your high deductible Medigap.
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Re: Medicare: G vs G Prime

Post by drawpoker »

dodecahedron wrote: Fri Dec 13, 2019 9:56 pm .....have your three days as inpatient in the prior calendar year before they stuff you into an ambulance shortly before midnight on New Yearś Eve to go to rehab. You then spend the next 90 days there. Days 60 through 90 get billed at coinsurance rates that could max out your high deductible Medigap.
From your own link, Medicare rules are nobody gets to go to a SNF for rehab without a concurrent medically necessary "yes" from a M.D. (Part B) Do you really believe that because of the New Year holiday corresponding with the admission to the SNF, that 20 days (its 20, not 30, that are "free" before the Part A co-insurance kicks in) could elapse without this patient seeing house physician, having blood drawn, PT/OT evaluation, et al, and all other associated Part B care charges?

Not just far-fetched, impossible any way you slice it.
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Re: Medicare: G vs G Prime

Post by dodecahedron »

drawpoker wrote: Fri Dec 13, 2019 10:30 pm
dodecahedron wrote: Fri Dec 13, 2019 9:56 pm .....have your three days as inpatient in the prior calendar year before they stuff you into an ambulance shortly before midnight on New Yearś Eve to go to rehab. You then spend the next 90 days there. Days 60 through 90 get billed at coinsurance rates that could max out your high deductible Medigap.
From your own link, Medicare rules are nobody gets to go to a SNF for rehab without a concurrent medically necessary "yes" from a M.D. (Part B) Do you really believe that because of the New Year holiday corresponding with the admission to the SNF, that 20 days (its 20, not 30, that are "free" before the Part A co-insurance kicks in) could elapse without this patient seeing house physician, having blood drawn, PT/OT evaluation, et al, and all other associated Part B care charges?

Not just far-fetched, impossible any way you slice it.
Number of free days depends on whether rehab is in a Skilled Nursing Facility (SNF) or in a specialized rehab facility, but my understanding from folks who work in Skilled Nursing Facilities is that it is easy for patients to languish without physician attention for long periods of time. According to this, a physician or his delegate (e.g., nurse-practitioner) is supposed to visit a patient in Medicare-covered rehab at least once every 30 days.

But letś say everybody works completely according to Medicare rules and also stipulate that your rehab will be in a SNF. You have your stroke in early December, you spend at least three days inpatient, you are discharged to rehab in an SNF on Dec 11. You have an issue on Dec 28 such that the supervising doc is called in to evaluate you. By January 1, you have run out of free days, but the doc is not required to visit again until the end of January. Your SNF coinsurance will hit your OOP max before you incur any Part B charges.
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Re: Medicare: G vs G Prime

Post by drawpoker »

dodecahedron wrote: Fri Dec 13, 2019 10:37 pm Number of free days depends on whether rehab is in a Skilled Nursing Facility or in a specialized rehab facility, but my understanding from folks who work in Skilled Nursing Facilities is that it is easy for patients to languish without physician attention for long periods of time.
Sure, that is mostly those who are there under long-term placement in nursing home. Not short-term rehab stints. (Most SNF have X no. of beds designated for LTSS, X no. for short-term rehab.

You can be dam sure, for those for rehab, the physicians are going to be billing (file Medicare) just to cover their tracks, make sure in case CMS decides to audit that particular facility. Keep all documentation nicely in place, even if they don't actually see the patient.

So, that brings right back, going round and round on this. Part B charges are easily going to top $198. Not long after the New Year has rung in.
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Re: Medicare: G vs G Prime

Post by dodecahedron »

drawpoker wrote: Fri Dec 13, 2019 10:49 pm
dodecahedron wrote: Fri Dec 13, 2019 10:37 pm Number of free days depends on whether rehab is in a Skilled Nursing Facility or in a specialized rehab facility, but my understanding from folks who work in Skilled Nursing Facilities is that it is easy for patients to languish without physician attention for long periods of time.
Sure, that is mostly those who are there under long-term placement in nursing home. Not short-term rehab stints. (Most SNF have X no. of beds designated for LTSS, X no. for short-term rehab.

You can be dam sure, for those for rehab, the physicians are going to be billing (file Medicare) just to cover their tracks, make sure in case CMS decides to audit that particular facility. Keep all documentation nicely in place, even if they don't actually see the patient.

So, that brings right back, going round and round on this. Part B charges are easily going to top $198. Not long after the New Year has rung in.
But the docs only need to bill once every 30 days to generate the paperwork to establish Medicare compliance. If the doc billed for seeing a patient at the SNF in late December, he does not need to generate another bill until the end of January. Meanwhile, the patient in rehab hit their OOP max.

This is of course an unlikely alignment of the stars, but given the millions of folks covered under Medicare, it would not surprise me if there have not been some patients who would have hit their OOP max before their Part B deductible. (However, I understand that relatively few folks actually choose high deductible Medigap plans so this all remains quite hypothetical.)
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Re: Medicare: G vs G Prime

Post by drawpoker »

dodecahedron wrote: Fri Dec 13, 2019 10:37 pm ....have your stroke in early December, you spend at least three days inpatient, you are discharged to rehab in an SNF on Dec 11. You have an issue on Dec 28 such that the supervising doc is called in to evaluate you. By January 1, you have run out of free days, but the doc is not required to visit again until the end of January. Your SNF coinsurance will hit your OOP max before you incur any Part B charges.
Nope, nice try, but that won't work either.

In order for Medicare to pay for any rehab it requires documentation that there is medically indicated likelihood that the rehab care will make your condition better. Not just stay the same.

For that hypothetical case/patient of your's who was admitted to SNF for rehab on Dec. 11 - the OT/PT/Cardio/whichever provider (Part B) would not be allowed to go "until the end of January" without documenting (filing with Medicare) the progress of the poor soul.

Again, way over $198 in Part B claims. And they haven't reached the next January holiday, MLK Day :!:
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Re: Medicare: G vs G Prime

Post by BostonBoy »

Eagle33 wrote: Fri Dec 13, 2019 12:15 am Remember you only get 1 chance to choose a medigap plan without underwriting. Choose wisely.

/quote]

Not true in Florida for United Healthcare. I went from UHC Plan F to their Plan G. No underwriting needed.
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Re: Medicare: G vs G Prime

Post by Spirit Rider »

drawpoker wrote: Fri Dec 13, 2019 9:26 pm
Spirit Rider wrote: Fri Dec 13, 2019 9:08 pm You can speculate all you want. Under the legislation it doesn't matter if is likely to happen, only that the possibility it could happen.
What legislation? Doing away with first-dollar coverage in Medicare plans? What does that have to do with it?
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). It is the reason why Plan C, Plan F and High Deductible Plan F can not be sold effective 1/1/2020 to newly eligible Medicare beneficiaries.
Sorry, am just not getting the basics for your theory here. It is just not possible under the circumstances you describe. Not possible.
It is not theory it is MACRA law and regulations. You can say it is not possible all you want, but CMS disagrees with you. Who do you think is right. Here is a direct quote from Model 651 Medicare Regulations

"High Deductible Plan G is the same as the High Deductible Plan F except that where annual out-of-pocket expenses are met with Medicare Part A expenses only, any subsequent Medicare Part B deductible expense may not be paid for with the High Deductible Plan G."

The law, regulations and facts matter. Your opinion of what is or is not possible is irrelevant.
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Re: Medicare: G vs G Prime

Post by drawpoker »

Spirit Rider wrote: Sat Dec 14, 2019 12:29 am It is not theory it is MACRA law and regulations. You can say it is not possible all you want, but CMS disagrees with you. Who do you think is right. Here is a direct quote from Model 651 Medicare Regulations

"High Deductible Plan G is the same as the High Deductible Plan F except that where annual out-of-pocket expenses are met with Medicare Part A expenses only, any subsequent Medicare Part B deductible expense may not be paid for with the High Deductible Plan G." .....
That is exactly the same boilerplate language CMS uses for the regular Plan G! Cutting thru all the gumbmint official-sounding lingo, they are just repeating that Plan HD-G, just like G, will not pay for the annual Part B deductible under any circumstances.

"From a practical point of view it is almost always effectively the same as Plan F-HD. Bear with me as this is a little convoluted. The difference is that the Part B deductible can not be paid by Plan G-HD."


Difference? No difference. Nothing new under the sun here.

Edit: Just noticed need to correct mixing up the terms here. Sentence should have read "repeating that Plan HD-G, just like G, will not pay Part B expense under any circumstances until the annual Part B deductible is met". Sorry, that's what I get for typing at 1 in the morning :oops:
Last edited by drawpoker on Sat Dec 14, 2019 12:37 pm, edited 2 times in total.
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tm3
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Re: Medicare: G vs G Prime

Post by tm3 »

GerryL wrote: Fri Dec 13, 2019 6:50 pm
Munir wrote: Fri Dec 13, 2019 6:05 pm A significant factor in making such a choice is whether you currently, or expect to in the future, based on your family history and general medical condition, to be a high or low user of the system.
Yes, an HD plan (F or G) has a higher deductible, but it is essentially an out-of-pocket cap that is lower than most (all?) Advantage plan caps. Each person needs to make a decision based on their own circumstances (and, yes, personality type), but they should consider whether they can comfortably cover the deductible in the years they may need more care. In the age-range I have reached, I would actually be paying more in premiums for the F plan ($2592) than the 2020 deductible ($2340). My F-HD premium for 2020 will be $576.
That is one of my concerns -- that the G rates will get jacked up to the point that they are eventually close to or higher than the G Prime deductible. It's currently $1200 vs $2300, but it is my understanding that the rates incrementally increase along with one's age.
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tm3
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Re: Medicare: G vs G Prime

Post by tm3 »

tm3 wrote: Sat Dec 14, 2019 11:28 am
That is one of my concerns -- that the G rates will get jacked up to the point that they are eventually close to or higher than the G Prime deductible. It's currently $1200 vs $2300, but it is my understanding that the rates incrementally increase along with one's age.
Comparing the current rate schedules, BCBS, G is $1300 for a 65yo and $3000 for a 75yo. G Prime is $490 and $580.

It seems odd to me that the percentage increase of G is so much more, and also that relatively few companies offer G Prime compared to G.
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Re: Medicare: G vs G Prime

Post by drawpoker »

tm3 wrote: Sat Dec 14, 2019 11:43 am
It seems odd to me that the percentage increase of G is so much more, and also that relatively few companies offer G Prime compared to G.
Give them time. Remember, HD-G (or Prime as it being called) is brand new, roll-out in January.
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Re: Medicare: G vs G Prime

Post by tm3 »

tm3 wrote: Sat Dec 14, 2019 11:43 am
tm3 wrote: Sat Dec 14, 2019 11:28 am It's currently $1200 vs $2300, but it is my understanding that the rates incrementally increase along with one's age.
Comparing the current rate schedules, BCBS, G is $1200 for a 65yo and $3000 for a 75yo. G Prime is $490 and $580.
OK while looking at the rate tables and how the G costs increase so much more with advancing age than the G Prime costs (similar to F and F HD), I decided to run some totals. At today's rates, 11 years of coverage age 65 to 75, G total cost is $22,800 and G Prime total $5800 for a delta of $17,000. Dividing by the delta in deductible (G $200 and GP $2300 ie $2100) yields 8.1 (17,000/2100 = 8.1). So it seems to me that if one is insured under GP and hits their max deductible 9 of 11 years, G would have been the better deal -- otherwise GP ends up being lower in cost. And, lacking an established chronic medical condition at the start of coverage, hitting the max GP deductible in 9 of 11 years seems pretty unlikely.

What am I missing?
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Re: Medicare: G vs G Prime

Post by drawpoker »

tm3 wrote: Sat Dec 14, 2019 11:43 am Comparing the current rate schedules, BCBS, G is $1300 for a 65yo and $3000 for a 75yo. G Prime is $490 and $580.
It seems odd to me that the percentage increase of G is so much more......
Think you are misinterpreting the age tables here. That rate that is shown for the 75-year old does not represent a 65-yr old who started out at $1,300 ten years earlier and that is how the rates progressed over the years. Not at all.

The rates shown by the insurers in their tables broken down by age show the prices for someone buying that Plan for the first time. Either under open enrollment or guaranteed issue rates. If you are looking at the BC/BS plans, they should show additional tables by age for Level 1, 2 and 3 (these are for those who don't fall under open enrollment or G.I> )

Just because the concept of no underwriting at initial enrollment is available to anyone starting Medicare at whatever age -- it does not mean the insurers are required to offer the same low rate to a 70-something as they are for a 65-year old. That 75-yr old is not required to answer any health questions. But, strictly because of age, that person will pay more than the 65-year old when starting out.

I don't have anything recent but pulled out my old BC/BS rate table from 2014. Back then, a 65-year male buying Plan G from them paid $141 a month ($1,692). A 75-yr old would have paid $212, or $2,544 (this is east coast where our rates are much higher than most of the midwestern states, Far West)

If you can buy Plan G today for $108 from one of the Baby Blues that is a bargain, IMO

I can't give you a history of price increases for G from 65 to 75 with my BC/BS. Maybe someone here with G who keeps good records can. However, I can give you a history for Plan F from 65 to 71.

I started out at $1,884 a year. Am now paying $2,820 (thru May of 2020). An increase of 49.7% but, amortized over the six years, works out to approx. 8.2% on average per year.

Higher than I would have liked, yes. But actually lower than others' experience. And the raging bull market has certainly helped soften the blow :D

(Reason for buying F over G back then was because the diff. in premiums was only very slight, after taking into account paying for the Part B deductible, the price was only around $15 a year more for F. Am sure that picture has changed since)
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Re: Medicare: G vs G Prime

Post by LookinAround »

drawpoker wrote: Sun Dec 15, 2019 3:14 pm Think you are misinterpreting the age tables here. That rate that is shown for the 75-year old does not represent a 65-yr old who started out at $1,300 ten years earlier and that is how the rates progressed over the years. Not at all.
@drawpoker
I'm not so sure that's true. There are 3 different ways policies can be rated though most are "attained age" rated. BCBS plans in IL are "attained age" and I'm guessing all BCBS med supplement plans are "attained age". For "attained age" plans, everyone in the plan of the same age all pay the same premium. I'd refer you to medicare.gov itself

https://www.medicare.gov/supplements-ot ... p-policies

They give an attained age example:
"Mrs. Anderson is 65. She buys a Medigap policy and pays a $120 monthly premium. Her premium will go up each year.
> At 66, her premium goes up to $126.
> At 67, her premium goes up to $132.
> At 72, her premium goes up to $165.

Mr. Dodd is 72. He buys the same Medigap policy as Mrs. Anderson. He pays a $165 monthly premium. His premium is higher than Mrs. Anderson’s because it’s based on his current age. Mr. Dodd’s premium will go up every year.
> At 73, his premium goes up to $171.
> At 74, his premium goes up to $177"

Back to my comments: In their example Mr. Dodd buys at age 72 and pays the same premium as Mrs. Anderson when she reaches 72

If you say you're seeing different numbers perhaps call BCBS and check why. e.g UHC plans in IL are "community based" which means, in theory, everyone in the same UHC plan should pay the same rate regardless of age. BUT UHC plays games with giving a discount when you buy your plan (your discount then declines each successive year). Discount rates start people when buying can be vary year to year.

So, I think is good to check everyone is comparing apples to apples. Maybe @drawpoker and @tm3 can check how your policies are rated
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Re: Medicare: G vs G Prime

Post by drawpoker »

Correct, there are three distinct methods to sell Medigap plans - attained age (most common) issue-age (best buy) and community rated (AARP most all over the country)
The OP seemed to be taking the charts for G Plan for ages 65 and 75 and trying to extropolate from that a projection of what Plan G would cost over the next 11 years. At least that was I understood he was attempting to do from the post.

My point - was to show that relying on that was flawed, and would not work if he wanted to come up with a realistic dollar amount of the premium cost over that eleven year span.

Speaking of apples - did you notice anything odd about the example of Ms. Anderson and Mr. Dodd given by Medicare dot guv?
For Ms. Anderson they show a range of 7 years. From age 65 to 72. But, for poor Mr. Dodd, they show only a range of from age 72, when he bought his policy, to age 74. Two years, not seven. Why not use the same yardstick as for Ms. Anderson? Because they have to be simplistic, present things in easy to understand format. But, biggest reason is the metrics won't support anything beyond that. Meaning, can someone take the prices at age 65, and accurately figure what it will cost for me at age 75? Nope.

No generalizations can be made about BC/BS plans. Or any Medigap providers for that matter. It is all very state specific. , and the fine points vary among the carriers.

For ex: BC/BS here uses attained age for all Plans - but only for G the increases due to age are stated to be annual. For all other plans, the age increases are bracketed within five year increments, not annually. Another ex: Everence uses issue-age method for all the plans it sells in my state except for Plan N. That one goes by attained age. Go figure :?

To muddy the waters more, more and more insurers are now offering not just 5%, or 10%, discounts for multi-household. Here, maybe elsewhere, we are seeing as high as 12% discount from several companies if both parts of a couple sign with same company. That represents a huge change from past years.
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Re: Medicare: G vs G Prime

Post by LookinAround »

@drawpoker

I'm not going to go through your post doing a point by point but I will say this
drawpoker wrote: Mon Dec 16, 2019 12:11 am Meaning, can someone take the prices at age 65, and accurately figure what it will cost for me at age 75? Nope.
You're absolutely right. A 65 year old looking a today's tables doesn't know what they'll pay at 75. They could only be certain of how much a 75yo would pay in 2020.

However, that doesn't mean tm3's rate breakdown is without merit. I just think one should look at those numbers a different way.
  • In the coming years, the rates for plan G will very most likely grow faster then rates for a G-HD plan
That means your annual savings calculation based on THIS year's tables would indicate the minimum savings you'd realize as rates increase in the future (with G rates going up as fast or faster then G-HD rates)

So I think the bottom line analysis then becomes subjective. Going with a G-HD plan comes with risk and benefits.
  • One should also look at the numbers from a "worst case" scenario loss point of view
  • Is one willing to take the risk (based on their health, family health, etc) with a G-HD plan?
  • And, more important, are they in a financial position to take the hit if the worst case scenario happens
@tm3
I'm curious. What state are you in? Are you sure they call it a G "prime" plan? I only wonder because
> If I google for medicare G prime, the only hit i get is this thread! :)
> Medicare usually uses consistent naming so I wonder why create confusion creating a new name for G-HD?
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Re: Medicare: G vs G Prime

Post by drawpoker »

LookinAround wrote: Mon Dec 16, 2019 10:19 am
[*]One should also look at the numbers from a "worst case" scenario loss point of view
But isn't that exactly the way one should view buying any type of insurance? Insuring yourself (and your assets) against the worst case?

You insure your house, pay premiums. Because if your house burns to the ground, you want to be able to rebuild, put it back, and furnish it just like it was, right? Does anyone take out H.O. insurance thinking, oh, I don't need to pay that much, most likely the only thing that will happen is hail might damage the roof, I might have a burglary, just minor things, nothing major, so I''ll save some money here.

Or choosing the liability coverage on your car insurance. You say the state minimum limit should be fine, nothing to worry about there. Even tho your own research, and the agent, tells you in this day and age state-mandated minimums are woefully too little. Should you hit a large SUV containing 7 occupants, most of whom killed when vehicle goes over guardrail and bursts into flames on impact. While colliding with 2 more vehicles below.

Then there's life insurance, I really need this amount....but...

Well, you get the idea. Just in yesterday's Sunday newspaper supplement "Parade" there was an article reporting one in 15 people will receive a lung cancer diagnosis. I had no idea the number was that high.

I never ceases to amaze me. When a BH thread about saving money by choosing Medicare Advantage is right alongside another thread. Discussing the value of buying umbrella policies. :? :?

With the notable exception of life insurance, if you make a mistake, realize you are under-insured, you can go back and make changes. With Medicare, nope, that door shuts (except in the handful of states previously mentioned that follow diff rules) because of medical underwriting.
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Re: Medicare: G vs G Prime

Post by LookinAround »

drawpoker wrote: Mon Dec 16, 2019 1:19 pm But isn't that exactly the way one should view buying any type of insurance? Insuring yourself (and your assets) against the worst case?
OK. So we're in violent agreement. :)

On a separate note to BH'ers:
Even in states w/o laws preventing medical underwriting don't assume it's not possible. Check with someone who'd know. Case in point: I live in Chicagoland, IL. I have UHC Plan F. It seemed every carrier required underwriting (including UHC) if I switched to Plan G. But when talking with a local insurance agent I found BCBS in IL does not! Compairing their premiums today to UHC, BCBS is a bit higher but not that much (in the hundreds) till approaching age 80. Even then, at todays rates at approaching 80, we're talking only 1 - 2K more annually.

Of course, things vary state-to-state and year-to-year so your mileage may vary.
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Re: Medicare: G vs G Prime

Post by oldcomputerguy »

This topic is now in the Personal Finance forum (insurance).
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Re: Medicare: G vs G Prime

Post by drawpoker »

LookinAround wrote: Mon Dec 16, 2019 1:41 pm .....Case in point: Chicagoland, IL......seemed every carrier required underwriting .... when talking with a local insurance agent I found BCBS in IL does not! ......Of course, things vary state-to-state and year-to-year so your mileage may vary.
Underwriting among the various Baby Blues does vary widely. Incidentally, isn't Illinois one of the states where the Medicare market is broken down by regions? (Like NY) For Chicago, the BC/BS Plan G might not require underwriting, but downstate, would folks get the same terms?

In Maryland all BC/BS plans do underwriting after initial enrollment period is gone.

(When I tried to hunt down where the name "G Prime" was coming from - found a Medicare insurance co. based in Ohio with similar name.

https://www.primetimechoices.com/plan-g.html
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Re: Medicare: G vs G Prime

Post by Morgan Dollar 1921 »

Your mileage may vary state to state and person to person, I have a year of "F" under my belt and could not be happier, one agent wanted me to go "N", but as I read the coverage in Ohio, I paid co-pays that did not go towards my deductible. Then I also had deductible to pay. My first year's increase as very affordable, like 7 or 8%. I was so surprised after years of 12 to 23% in my group, I have forgotten the amount.
Many said I should go "G" to avoid the shrinking group which should increase premiums as well, as we mature, and members of the group join the past generations. I know what I pay in premiums and what my expenses are otherwise, (pretty much zero). I did have a blood test that the lab tech warned me was not MediCare covered, but someone made it go away as either the lab or the Doctor or the hospital wiped out the charge on my EOB.
Maybe they knew having an "F" plan, I did not want any additional costs :confused
The OSHIP staff told me I can always downshift, but could never upshift after I engaged a plan. Good Luck. :sharebeer
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Re: Medicare: G vs G Prime

Post by LookinAround »

@Morgan Dollar 21

Not to dissuade you if F is really what you want. But consider one more thing
  • The only difference between F and G: Plan F pays your Part B deductible: $198 in 2020
  • Compare next year's annual premium for Plan F vs. the annual premium for G. If Plan F is costing you more then $198 for the year, you're paying more in premiums then you're receiving in benefit. That excess difference will only increase each coming year. (In my case, I'd be overypaying many hundred dollars only to save $198. Why overpay? So I'm switching)
Just throwing it out there for your consideration
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Re: Medicare: G vs G Prime

Post by chalet »

Morgan Dollar 1921 wrote: Mon Dec 16, 2019 10:03 pm
Many said I should go "G" to avoid the shrinking group which should increase premiums as well,

.....

The OSHIP staff told me I can always downshift, but could never upshift after I engaged a plan.

that sounds like a good option, if the price increases a lot due to a "closed group".
you could downshift to another plan which is still open.
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Re: Medicare: G vs G Prime

Post by Morgan Dollar 1921 »

LookinAround wrote: Tue Dec 17, 2019 12:17 am @Morgan Dollar 21

Not to dissuade you if F is really what you want. But consider one more thing
  • The only difference between F and G: Plan F pays your Part B deductible: $198 in 2020
  • Compare next year's annual premium for Plan F vs. the annual premium for G. If Plan F is costing you more then $198 for the year, you're paying more in premiums then you're receiving in benefit. That excess difference will only increase each coming year. (In my case, I'd be overypaying many hundred dollars only to save $198. Why overpay? So I'm switching)
Just throwing it out there for your consideration
I think it is $216 difference in my case,($216 minus $185 deductible/$31). I appreciate your insight and agree, I am overpaying slightly, and believe it was $31 for the year total last year, I sold a lot of Corvette & Cadillac parts in 41 years at GM dealers, but I never bought or desired the Cadillac luxury ever in my life, was an Olds guy for years (comfort with thrift), I watched my father's health slide from age 75 to his passing at 99, he was on his feet until the last few weeks, but those health bills are a certain for most as we age, it is usually a case of not IF, but when. I am very happy with the "F" plan and typically when the government is taking something away it is not because it saves you money. I bought the Cadillac of Medi-gap coverages, I believe. They have a plan I believe. I suspect the deductible will change, and a lot. That was a proposed option in last year's budget proposal. A friend of mine mentioned proposed changes to TriCare on facebook, I dug down, and found the proposal of percentage or larger deductibles in the range of $750. IF that happens and they hold to the F plan paying the deductible, the value will increase on the F plan for at least a year or two, I suspect the premium would have to catch up to that benefit in the span of a year or two. There never really is a free ride. It is very, very difficult to give health care insurance, Medicare, and Medi-gap or Part D advice each individual's health and finances are as varied as the states we live in. I did change Part D plans for 2020. It is now to late to switch for me. My Deductible often happens early in the year and in one lump sum, as it will in 2020. It is so comforting to know that almost always all of the bill is paid, when I leave the office. All the best.
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Re: Medicare: G vs G Prime

Post by jimkinny »

I have F HD.

I don't hesitate to seek care based upon the HD. These are all supplemental plans and Medicare A + B set the prices and pay most of the cost. I have never even come close to meeting my deductible under the HD plan but my out of pocket costs are still fairly low due to Medicare pricing and payments. I have read that the regular plan F users make more frequent doc visits. You may need/want that. If I had a chronic health issue then I might like that also and be willing to pay a higher premium.

I have come to think that the insurance companies likely know what they are doing and in the long run, a high deductible plan likely doesn't save much money, if at all. I am think of those last years of life when my medical expenses will go up. But, it seems that I like the lower premiums for now and am satisfied with the HD plan.
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