High deductible Plan G medigap

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nanameg
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High deductible Plan G medigap

Post by nanameg » Mon Jun 08, 2020 5:01 pm

We’re researching Medicap plans and it seems a high deductible Plan G is the best value for us. The only carrier of this plan in our city is Mutual of Omaha according to the Medicare website. We live in Ct.

Has anyone used this plan and/ or this insurance company?

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cheese_breath
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Re: High deductible Plan G medigap

Post by cheese_breath » Mon Jun 08, 2020 5:14 pm

I have plan G, but not the deductible. The only difference is I pay higher premiums with almost no deductibles.

I don't have MofA, but I believe some others here do. What's your concern? If it's which procedures are covered, Medicare decides that and the Medigap providers can't change it.
The surest way to know the future is when it becomes the past.

kaneohe
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Re: High deductible Plan G medigap

Post by kaneohe » Mon Jun 08, 2020 5:50 pm

You may want to consider future use of this plan. If you start to get serious medical expenses and want to change plans to avoid the high deductible.............typically you are allowed to move to lesser plans but not higher plans so possibly moving to G might be difficult. Check the details for your state.

drjazz
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Re: High deductible Plan G medigap

Post by drjazz » Mon Jun 08, 2020 7:45 pm

I recently signed up for High Deductible plan g in Pennsylvania, United American; $43/month by far the least expensive plan available in my area. It (and several other plans) were NOT listed on the medicare.gov website; I went through a broker who told me that the site was slow to include all available plans. I think that Plan G is the best option for most people; regular vs high deductible depends on whether you’d prefer higher premiums vs being on the hook for $2300 annual deductible; I suggest you contact a broker who handles medicare supplemental insurance in your state; as far as I know the commission is paid by the insurance company so it won’t increase your premium.

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nanameg
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Re: High deductible Plan G medigap

Post by nanameg » Mon Jun 08, 2020 8:22 pm

drjazz wrote:
Mon Jun 08, 2020 7:45 pm
I recently signed up for High Deductible plan g in Pennsylvania, United American; $43/month by far the least expensive plan available in my area. It (and several other plans) were NOT listed on the medicare.gov website; I went through a broker who told me that the site was slow to include all available plans. I think that Plan G is the best option for most people; regular vs high deductible depends on whether you’d prefer higher premiums vs being on the hook for $2300 annual deductible; I suggest you contact a broker who handles medicare supplemental insurance in your state; as far as I know the commission is paid by the insurance company so it won’t increase your premium.
Thanks ...our broker told us there is “ no high deductible plan G” and suggested we get Medicare Advantage. When he explained Medicare Advantage it seemed way too complicated.When things sound complicated I know I’m losing money.

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FIREchief
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Re: High deductible Plan G medigap

Post by FIREchief » Mon Jun 08, 2020 8:28 pm

nanameg wrote:
Mon Jun 08, 2020 8:22 pm
drjazz wrote:
Mon Jun 08, 2020 7:45 pm
I recently signed up for High Deductible plan g in Pennsylvania, United American; $43/month by far the least expensive plan available in my area. It (and several other plans) were NOT listed on the medicare.gov website; I went through a broker who told me that the site was slow to include all available plans. I think that Plan G is the best option for most people; regular vs high deductible depends on whether you’d prefer higher premiums vs being on the hook for $2300 annual deductible; I suggest you contact a broker who handles medicare supplemental insurance in your state; as far as I know the commission is paid by the insurance company so it won’t increase your premium.
Thanks ...our broker told us there is “ no high deductible plan G” and suggested we get Medicare Advantage. When he explained Medicare Advantage it seemed way too complicated.When things sound complicated I know I’m losing money.
Sounds like you need a new broker.
I am not a lawyer, accountant or financial advisor. Any advice or suggestions that I may provide shall be considered for entertainment purposes only.

khh
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Re: High deductible Plan G medigap

Post by khh » Mon Jun 08, 2020 8:52 pm

nanameg wrote:
Mon Jun 08, 2020 8:22 pm
drjazz wrote:
Mon Jun 08, 2020 7:45 pm
I recently signed up for High Deductible plan g in Pennsylvania, United American; $43/month by far the least expensive plan available in my area. It (and several other plans) were NOT listed on the medicare.gov website; I went through a broker who told me that the site was slow to include all available plans. I think that Plan G is the best option for most people; regular vs high deductible depends on whether you’d prefer higher premiums vs being on the hook for $2300 annual deductible; I suggest you contact a broker who handles medicare supplemental insurance in your state; as far as I know the commission is paid by the insurance company so it won’t increase your premium.
Thanks ...our broker told us there is “ no high deductible plan G” and suggested we get Medicare Advantage. When he explained Medicare Advantage it seemed way too complicated.When things sound complicated I know I’m losing money.
This CT government site shows several companies, including Mutual of Omaha, offering high deductible plan G =>

https://portal.ct.gov/CID/Life-And-Heal ... e-Policies

drjazz
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Re: High deductible Plan G medigap

Post by drjazz » Mon Jun 08, 2020 9:03 pm

Mutual of Omaha is a good company but this is one area where all that counts is the premium, how they set/raise rates, and (probably least important) the company’s stability (if they go bust you will be allowed to switch to the same plan with another company wihout medical underwriting). There is no problem with them analyzing/rejecting claims; once medicare approves it they will automatically pay the balance that medicare did not pay. So if you can find a less expensive plan there is little reason not to go with it. HIgh deductible G is a relatively new product so may not show up on medicare.gov and perhaps some brokers databases. I suggest trying another broker and/or contacting your states SHIPP (free medicare counseling, look on their dept of insurance website); you could contact United American and ask if they write policies in your state/get a referral to an agent.
Medicare Advantage is a completely different product. It includes prescriptions ( so no need for a Plan D policy) and has lower premiums but will typically have a limited network of doctors and hospitals and may restrict procedures, medications, etc. They can make major changes in coverage in the future at their discretion and you will have little or no recourse (for example they could bump one of your medications into a higher/more costly tier or kick it off their formulary). In my opinion it’s a roach motel....you can switch out of it to traditional medicare for up to a year without penalty but after that if you want to switch you will be subject to medical underwriting, penalties on your plan d, etc. I suggest reading Medicare for Dummies which is really essential to understanding how to navigate medicare. Good luck!

Spirit Rider
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Re: High deductible Plan G medigap

Post by Spirit Rider » Mon Jun 08, 2020 9:04 pm

FIREchief wrote:
Mon Jun 08, 2020 8:28 pm
nanameg wrote:
Mon Jun 08, 2020 8:22 pm
Thanks ...our broker told us there is “ no high deductible plan G” and suggested we get Medicare Advantage. When he explained Medicare Advantage it seemed way too complicated.When things sound complicated I know I’m losing money.
Sounds like you need a new broker.
In all fairness to the broker. 2020 is the first year Plan G high deductible is being sold and maybe none of the broker's insurance carriers offer Plan G high deductible. although if they are going to be in that business they should know all the possible plans that are available.

Not all insurance carriers offer Plan G high deductible. In fact only 3 out the 20 insurance carriers in my state offer Plan G high deductible and surprisingly Mutual of Omaha is not one of them. This indicates that an individual insurance carrier can offer a different selection of plan options state to state.

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cheese_breath
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Re: High deductible Plan G medigap

Post by cheese_breath » Mon Jun 08, 2020 9:41 pm

nanameg wrote:
Mon Jun 08, 2020 8:22 pm
drjazz wrote:
Mon Jun 08, 2020 7:45 pm
I recently signed up for High Deductible plan g in Pennsylvania, United American; $43/month by far the least expensive plan available in my area. It (and several other plans) were NOT listed on the medicare.gov website; I went through a broker who told me that the site was slow to include all available plans. I think that Plan G is the best option for most people; regular vs high deductible depends on whether you’d prefer higher premiums vs being on the hook for $2300 annual deductible; I suggest you contact a broker who handles medicare supplemental insurance in your state; as far as I know the commission is paid by the insurance company so it won’t increase your premium.
Thanks ...our broker told us there is “ no high deductible plan G” and suggested we get Medicare Advantage. When he explained Medicare Advantage it seemed way too complicated.When things sound complicated I know I’m losing money.
Maybe what he means (without saying it directly) is none of the providers he deals with offers high deductible plan G. It's premature to say you'd lose money on MA, but you need to understand what you're getting into. You can change to a MA plan later when you learn more about them if you wish. Personally I prefer medigap, but there are many here who have MA plans.
The surest way to know the future is when it becomes the past.

saver007
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Re: High deductible Plan G medigap

Post by saver007 » Mon Jun 08, 2020 9:55 pm

Google "Connecticut Monthly Medicare Supplement rates for Standardized Plans" , you will see monthly cost of all medigap plans in CT

InMyDreams
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Re: High deductible Plan G medigap

Post by InMyDreams » Tue Jun 09, 2020 12:27 am

nanameg wrote:
Mon Jun 08, 2020 8:22 pm
When things sound complicated I know I’m losing money.
+1
There's a BH for you :)

Northern Flicker
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Re: High deductible Plan G medigap

Post by Northern Flicker » Tue Jun 09, 2020 12:40 am

nanameg wrote:
Mon Jun 08, 2020 8:22 pm
drjazz wrote:
Mon Jun 08, 2020 7:45 pm
I recently signed up for High Deductible plan g in Pennsylvania, United American; $43/month by far the least expensive plan available in my area. It (and several other plans) were NOT listed on the medicare.gov website; I went through a broker who told me that the site was slow to include all available plans. I think that Plan G is the best option for most people; regular vs high deductible depends on whether you’d prefer higher premiums vs being on the hook for $2300 annual deductible; I suggest you contact a broker who handles medicare supplemental insurance in your state; as far as I know the commission is paid by the insurance company so it won’t increase your premium.
Thanks ...our broker told us there is “ no high deductible plan G” and suggested we get Medicare Advantage. When he explained Medicare Advantage it seemed way too complicated.When things sound complicated I know I’m losing money.
I think the main problem with Advantage plans is that you cannot switch back to traditional medicare part B plus medigap without medical underwriting (unless there are no Advantage plans where you live). If what is available changes, you thus could end up locked in to a set of mediocre choices down the road.
Risk is not a guarantor of return.

Spirit Rider
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Re: High deductible Plan G medigap

Post by Spirit Rider » Tue Jun 09, 2020 7:23 am

Northern Flicker wrote:
Tue Jun 09, 2020 12:40 am
I think the main problem with Advantage plans is that you cannot switch back to traditional medicare part B plus medigap without medical underwriting (unless there are no Advantage plans where you live). If what is available changes, you thus could end up locked in to a set of mediocre choices down the road.
As has been pointed out, the same issue is true with high deductible Medicare Supplement plans. You will be subject to medical underwriting to change both types of plans.

Medicare Supplement high deductible ($2,340) and especially Medicare Advantage ($6,700/10,000 max OOP) plans can become far more costly with significant medical issues. Then it would be prohibitively expense to change plans assuming you even can with medical underwriting.

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cheese_breath
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Re: High deductible Plan G medigap

Post by cheese_breath » Tue Jun 09, 2020 8:54 am

Northern Flicker wrote:
Tue Jun 09, 2020 12:40 am
...I think the main problem with Advantage plans is that you cannot switch back to traditional medicare part B plus medigap without medical underwriting ...
The "plus medigap" is the rub. You can go back to part B, but it's the medigap that might require the underwriting. Fail that and you could be on the hook for the 20% part B doesn't cover.
The surest way to know the future is when it becomes the past.

rivercrosser
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Re: High deductible Plan G medigap

Post by rivercrosser » Tue Jun 09, 2020 11:21 am

You can't predict the future. Went on medicare this past February. I was tempted to go with an advantage plan. Ended up going with a regular plan G and basic part D. Didn't think I had any major health problems. Wasn't taking any prescriptions, hadn't been to a doctor for years. About a month ago I had a ER visit with a kidney stone, then couple weeks later a heart attack and a stent. Looks like doctors and pills from here on out. The plan G is working out good for me.

Northern Flicker
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Re: High deductible Plan G medigap

Post by Northern Flicker » Tue Jun 09, 2020 12:55 pm

Spirit Rider wrote:
Tue Jun 09, 2020 7:23 am
Northern Flicker wrote:
Tue Jun 09, 2020 12:40 am
I think the main problem with Advantage plans is that you cannot switch back to traditional medicare part B plus medigap without medical underwriting (unless there are no Advantage plans where you live). If what is available changes, you thus could end up locked in to a set of mediocre choices down the road.
As has been pointed out, the same issue is true with high deductible Medicare Supplement plans. You will be subject to medical underwriting to change both types of plans.

Medicare Supplement high deductible ($2,340) and especially Medicare Advantage ($6,700/10,000 max OOP) plans can become far more costly with significant medical issues. Then it would be prohibitively expense to change plans assuming you even can with medical underwriting.
This is a cost issue, but Advantage plans could also have a host of other problems like narrowing of provider networks, or the only acceptable Advantage providers leaving a market.
Risk is not a guarantor of return.

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nanameg
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Re: High deductible Plan G medigap

Post by nanameg » Tue Jun 09, 2020 1:22 pm

khh wrote:
Mon Jun 08, 2020 8:52 pm
nanameg wrote:
Mon Jun 08, 2020 8:22 pm
drjazz wrote:
Mon Jun 08, 2020 7:45 pm
I recently signed up for High Deductible plan g in Pennsylvania, United American; $43/month by far the least expensive plan available in my area. It (and several other plans) were NOT listed on the medicare.gov website; I went through a broker who told me that the site was slow to include all available plans. I think that Plan G is the best option for most people; regular vs high deductible depends on whether you’d prefer higher premiums vs being on the hook for $2300 annual deductible; I suggest you contact a broker who handles medicare supplemental insurance in your state; as far as I know the commission is paid by the insurance company so it won’t increase your premium.
Thanks ...our broker told us there is “ no high deductible plan G” and suggested we get Medicare Advantage. When he explained Medicare Advantage it seemed way too complicated.When things sound complicated I know I’m losing money.
This CT government site shows several companies, including Mutual of Omaha, offering high deductible plan G =>

https://portal.ct.gov/CID/Life-And-Heal ... e-Policies
Thank you!

So much for our broker...” there is not high deductible plan G”

TheDDC
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Re: High deductible Plan G medigap

Post by TheDDC » Tue Jun 09, 2020 1:57 pm

rivercrosser wrote:
Tue Jun 09, 2020 11:21 am
You can't predict the future. Went on medicare this past February. I was tempted to go with an advantage plan. Ended up going with a regular plan G and basic part D. Didn't think I had any major health problems. Wasn't taking any prescriptions, hadn't been to a doctor for years. About a month ago I had a ER visit with a kidney stone, then couple weeks later a heart attack and a stent. Looks like doctors and pills from here on out. The plan G is working out good for me.
+1

In my mom's case, she had Mutual of Omaha plan F (all inclusive) - $0 deductible. The premiums were fairly high for a single person, but Mutual of Omaha was a good company to deal with when I had to call customer service. Keep in mind the Plan F/G benefit is pretty much defined universally. Only the costs are different between insurers. On Halloween night 2018 mom went from living on her own to "medical nightmare" requiring medical intervention on a daily basis in a split second. Had she been on Medicare Advantage she would have not had a good financial picture as she would be a life beneficiary to the medical-industrial complex as I like to call it.

I didn't know there was an HD Plan G. Good to know, but I probably still wouldn't take it since, as was mentioned, medical underwriting is required if you ever had a situation where the deductible was too high and you wanted to go with a lower deductible plan. That's a road to nowhere. If you have enough assets in tax advantage space then it may be worth it to do HD Plan G, but plan accordingly. I also don't know how much those deductibles can increase.

-TheDDC
Rules to wealth building: 90-100% VTSAX piled high and deep, 0-10% VIGAX tilt, 0% given away to banks, minimize amount given to medical-industrial complex

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nanameg
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Re: High deductible Plan G medigap

Post by nanameg » Tue Jun 09, 2020 7:52 pm

Thanks everyone for your replies...I’ll do some more research based on the leads you’ve given.

Spirit Rider
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Re: High deductible Plan G medigap

Post by Spirit Rider » Tue Jun 09, 2020 9:16 pm

The ideal candidate for a high-deductible Medicare Supplement Plan is someone with a large HSA account balance to self-insure the deductible. Medicare Supplement Plan premiums are not an HSA qualified medical expense, but out-of-pocket costs until the deductible is met are.

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FIREchief
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Re: High deductible Plan G medigap

Post by FIREchief » Tue Jun 09, 2020 9:45 pm

Spirit Rider wrote:
Mon Jun 08, 2020 9:04 pm
FIREchief wrote:
Mon Jun 08, 2020 8:28 pm
nanameg wrote:
Mon Jun 08, 2020 8:22 pm
Thanks ...our broker told us there is “ no high deductible plan G” and suggested we get Medicare Advantage. When he explained Medicare Advantage it seemed way too complicated.When things sound complicated I know I’m losing money.
Sounds like you need a new broker.
In all fairness to the broker. 2020 is the first year Plan G high deductible is being sold and maybe none of the broker's insurance carriers offer Plan G high deductible. although if they are going to be in that business they should know all the possible plans that are available.

Not all insurance carriers offer Plan G high deductible. In fact only 3 out the 20 insurance carriers in my state offer Plan G high deductible and surprisingly Mutual of Omaha is not one of them. This indicates that an individual insurance carrier can offer a different selection of plan options state to state.
If he's an insurance broker, he should have fully understood the situation with Plan G high deductible, and explained it to his client. The poster also didn't indicate that this broker gave any rational for the blanket recommendation to get Medicare Advantage. There's no one size fits all answer. That said, I feel confident in stating that if money is not a concern, than everybody will be "safer" to just start with a Medigap plan.
I am not a lawyer, accountant or financial advisor. Any advice or suggestions that I may provide shall be considered for entertainment purposes only.

rivercrosser
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Re: High deductible Plan G medigap

Post by rivercrosser » Tue Jun 09, 2020 10:38 pm

Spirit Rider wrote:
Tue Jun 09, 2020 9:16 pm
The ideal candidate for a high-deductible Medicare Supplement Plan is someone with a large HSA account balance to self-insure the deductible. Medicare Supplement Plan premiums are not an HSA qualified medical expense, but out-of-pocket costs until the deductible is met are.
I'm going to use up my HSA on wife and mine part b and part d premiums, deductibles, dental etc.

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Re: High deductible Plan G medigap

Post by happychineseboy » Wed Jun 10, 2020 2:56 pm

The problem with medigap (Medicare Supplement) is that it no longer is allowed to include drug coverage.
You would have to get a separate Medicare Part D plan, you would also have to pay your Medicare Part B premium.

The nice thing about Medicare Advantage (Medicare Part C) is that you can find a plan that rolls Part A, B, and D together into a single plan. There are some Medicare Advantage plans that have low or even no premium (however you would have to see in-network doctors to make the most of the plan). The government pays the insurance companies to provide Part A and B coverage to their members, and insurance companies leverage their physician/hospital networks and pharmacy benefit managers to lower costs and turn a profit. Medicare Advantage has been a huge money maker for insurance companies.

Medicare Supplement (medigap) was dealt a massive blow when Part D was invented and took away drug coverage from future Med Supp plans.

But anyways I recommend medigap to high utilizers because you can basically go anywhere that accepts Medicare and get treated (and Medicare/Medigap will cover your treatment). Medicare Advantage is usually a better deal if you aren't a heavy utilizer and can stay in-network for most/all of your care.

You can also enroll in a lower premium medigap plan while you are younger (relatively) and then switch to plan G during open enrollment, this usually won't require medical underwriting.

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FIREchief
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Re: High deductible Plan G medigap

Post by FIREchief » Wed Jun 10, 2020 5:01 pm

happychineseboy wrote:
Wed Jun 10, 2020 2:56 pm
You can also enroll in a lower premium medigap plan while you are younger (relatively) and then switch to plan G during open enrollment, this usually won't require medical underwriting.
Are you sure about this?
I am not a lawyer, accountant or financial advisor. Any advice or suggestions that I may provide shall be considered for entertainment purposes only.

kaneohe
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Re: High deductible Plan G medigap

Post by kaneohe » Wed Jun 10, 2020 5:09 pm

FIREchief wrote:
Wed Jun 10, 2020 5:01 pm
happychineseboy wrote:
Wed Jun 10, 2020 2:56 pm
You can also enroll in a lower premium medigap plan while you are younger (relatively) and then switch to plan G during open enrollment, this usually won't require medical underwriting.
Are you sure about this?
have my doubts about this too.........don't think there's even an annual enrollment for Medigap plans.
Some states have an annual period when you can switch........but this is only to an equal or lesser plan.
You can't upgrade w/o underwriting.

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cheese_breath
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Re: High deductible Plan G medigap

Post by cheese_breath » Wed Jun 10, 2020 5:20 pm

FIREchief wrote:
Wed Jun 10, 2020 5:01 pm
happychineseboy wrote:
Wed Jun 10, 2020 2:56 pm
You can also enroll in a lower premium medigap plan while you are younger (relatively) and then switch to plan G during open enrollment, this usually won't require medical underwriting.
Are you sure about this?
Depends on what state you live in.
The surest way to know the future is when it becomes the past.

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celia
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Re: High deductible Plan G medigap

Post by celia » Wed Jun 10, 2020 5:56 pm

nanameg wrote:
Mon Jun 08, 2020 8:22 pm
Thanks ...our broker told us there is “ no high deductible plan G” and suggested we get Medicare Advantage. When he explained Medicare Advantage it seemed way too complicated.When things sound complicated I know I’m losing money.
Medicare Advantage is the cheapest and simplest way to go if you can live with an HMO and have a decent doctor group that is part of the HMO network. You are restricted to doctors within your group or to outside referrals that they approve. So if the medical group has a specialist you don't like, that means they won't give you a referral to a different doctor for that specialty (since they are already paying for the specialist they have). That may also mean you might have to drop some of your current doctors unless they are already part of the medical group.

Probably the largest well-known HMO is Kaiser Permanente. But I've heard that their drug formulary doesn't include some drugs, thus their doctors aren't supposed to prescribe those drugs. What a shame it would be if the drug that would be best for you can't even be discussed by your doctor.

Another thing to consider is if you (will) need to see a doctor that a specialist might refer you to. We've had a couple of instances of that where we were referred to a more-specialized specialist at a teaching hospital. In our area, the teaching hospital won't see HMO patients that were referred to them as the HMOs take too long to pay them. But we have no problem making our own appointments to see the teaching hospital specialists since we have Medigap plans.
Last edited by celia on Wed Jun 10, 2020 6:16 pm, edited 1 time in total.

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FIREchief
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Re: High deductible Plan G medigap

Post by FIREchief » Wed Jun 10, 2020 6:01 pm

celia wrote:
Wed Jun 10, 2020 5:56 pm
Medicare Advantage is the cheapest way to go if you can live with an HMO and have a decent doctor group that is part of the network. You are restricted to doctors within your group or to outside referrals that they approve. So if the medical group has a specialist you don't like, that means they won't give you a referral to a different doctor for that specialty (since they are already paying for the specialist they have). That may also mean you might have to drop some of your current doctors unless they are already part of the medical group.
My concern is that I could choose the best MA plan in my area (and one that currently "works for me") and over five to ten years have them diminish networks/coverages to the point where I would have been better off with a Medigap plan. It's the unknown/uncontrollable future that concerns me. If I go Medigap and decide ten years later I would be better off with MA, than I simply change. I can't do the opposite in my state. Cheapest isn't always optimal, and certainly isn't always best.
Probably the largest well-known HMO is Kaiser Permanente. But I've heard that their drug formulary doesn't include some drugs, thus their doctors aren't supposed to prescribe those drugs. What a shame it would be if the drug that would be best for you can't be prescribed by your Kaiser doctor.
Why can't a Kaiser doctor prescribe a drug that isn't on their forumulary?
I am not a lawyer, accountant or financial advisor. Any advice or suggestions that I may provide shall be considered for entertainment purposes only.

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FIREchief
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Re: High deductible Plan G medigap

Post by FIREchief » Wed Jun 10, 2020 6:11 pm

cheese_breath wrote:
Wed Jun 10, 2020 5:20 pm
FIREchief wrote:
Wed Jun 10, 2020 5:01 pm
happychineseboy wrote:
Wed Jun 10, 2020 2:56 pm
You can also enroll in a lower premium medigap plan while you are younger (relatively) and then switch to plan G during open enrollment, this usually won't require medical underwriting.
Are you sure about this?
Depends on what state you live in.
Yes, and I believe that it is the vast minority of states where this is possible (about 6 out of 50).
I am not a lawyer, accountant or financial advisor. Any advice or suggestions that I may provide shall be considered for entertainment purposes only.

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celia
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Re: High deductible Plan G medigap

Post by celia » Wed Jun 10, 2020 7:02 pm

FIREchief wrote:
Wed Jun 10, 2020 6:01 pm
Why can't a Kaiser doctor prescribe a drug that isn't on their formulary?
Kaiser is not just "insurance coverage", but medical groups and hospitals and pharmacies. Why would their pharmacies carry something that their "insurance" wouldn't cover? And if the patient took the prescription to CVS, CVS won't accept Kaiser coverage, also leaving the patient to pay full price (or use a discount card). But I guess the doctor could write such a prescription after informing the patient about the non-coverage.

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FIREchief
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Re: High deductible Plan G medigap

Post by FIREchief » Wed Jun 10, 2020 7:05 pm

celia wrote:
Wed Jun 10, 2020 7:02 pm
FIREchief wrote:
Wed Jun 10, 2020 6:01 pm
Why can't a Kaiser doctor prescribe a drug that isn't on their formulary?
Kaiser is not just "insurance coverage", but medical groups and hospitals and pharmacies. Why would their pharmacies carry something that their "insurance" wouldn't cover? And if the patient took the prescription to CVS, CVS won't accept Kaiser coverage, also leaving the patient to pay full price (or use a discount card). But I guess the doctor could write such a prescription after informing the patient about the non-coverage.
Exactly my point. A lot of prescription insurance is useless.
I am not a lawyer, accountant or financial advisor. Any advice or suggestions that I may provide shall be considered for entertainment purposes only.

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celia
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Re: High deductible Plan G medigap

Post by celia » Wed Jun 10, 2020 7:11 pm

FIREchief wrote:
Wed Jun 10, 2020 6:11 pm
cheese_breath wrote:
Wed Jun 10, 2020 5:20 pm
FIREchief wrote:
Wed Jun 10, 2020 5:01 pm
happychineseboy wrote:
Wed Jun 10, 2020 2:56 pm
You can also enroll in a lower premium medigap plan while you are younger (relatively) and then switch to plan G during open enrollment, this usually won't require medical underwriting.
Are you sure about this?
Depends on what state you live in.
Yes, and I believe that it is the vast minority of states where this is possible (about 6 out of 50).
Holy cow! I just found a page that shows the different Medicare variations for each state:
https://www.medicarefaq.com/faqs/state- ... are-rules/

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nanameg
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Re: High deductible Plan G medigap

Post by nanameg » Wed Jun 10, 2020 7:16 pm

celia wrote:
Wed Jun 10, 2020 5:56 pm
nanameg wrote:
Mon Jun 08, 2020 8:22 pm
Thanks ...our broker told us there is “ no high deductible plan G” and suggested we get Medicare Advantage. When he explained Medicare Advantage it seemed way too complicated.When things sound complicated I know I’m losing money.
Medicare Advantage is the cheapest and simplest way to go if you can live with an HMO and have a decent doctor group that is part of the HMO network. You are restricted to doctors within your group or to outside referrals that they approve. So if the medical group has a specialist you don't like, that means they won't give you a referral to a different doctor for that specialty (since they are already paying for the specialist they have). That may also mean you might have to drop some of your current doctors unless they are already part of the medical group.

Probably the largest well-known HMO is Kaiser Permanente. But I've heard that their drug formulary doesn't include some drugs, thus their doctors aren't supposed to prescribe those drugs. What a shame it would be if the drug that would be best for you can't even be discussed by your doctor.

Another thing to consider is if you (will) need to see a doctor that a specialist might refer you to. We've had a couple of instances of that where we were referred to a more-specialized specialist at a teaching hospital. In our area, the teaching hospital won't see HMO patients that were referred to them as the HMOs take too long to pay them. But we have no problem making our own appointments to see the teaching hospital specialists since we have Medigap plans.
I’m confused....you say Medicare Advantage plans are the cheapest ( maybe) simplest ( definitely not) way to go ...but u have a medigap plan?

Or am I misunderstanding what you’ve said?

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cheese_breath
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Re: High deductible Plan G medigap

Post by cheese_breath » Wed Jun 10, 2020 7:21 pm

nanameg wrote:
Wed Jun 10, 2020 7:16 pm
celia wrote:
Wed Jun 10, 2020 5:56 pm
nanameg wrote:
Mon Jun 08, 2020 8:22 pm
Thanks ...our broker told us there is “ no high deductible plan G” and suggested we get Medicare Advantage. When he explained Medicare Advantage it seemed way too complicated.When things sound complicated I know I’m losing money.
Medicare Advantage is the cheapest and simplest way to go if you can live with an HMO and have a decent doctor group that is part of the HMO network. You are restricted to doctors within your group or to outside referrals that they approve. So if the medical group has a specialist you don't like, that means they won't give you a referral to a different doctor for that specialty (since they are already paying for the specialist they have). That may also mean you might have to drop some of your current doctors unless they are already part of the medical group.

Probably the largest well-known HMO is Kaiser Permanente. But I've heard that their drug formulary doesn't include some drugs, thus their doctors aren't supposed to prescribe those drugs. What a shame it would be if the drug that would be best for you can't even be discussed by your doctor.

Another thing to consider is if you (will) need to see a doctor that a specialist might refer you to. We've had a couple of instances of that where we were referred to a more-specialized specialist at a teaching hospital. In our area, the teaching hospital won't see HMO patients that were referred to them as the HMOs take too long to pay them. But we have no problem making our own appointments to see the teaching hospital specialists since we have Medigap plans.
I’m confused....you say Medicare Advantage plans are the cheapest ( maybe) simplest ( definitely not) way to go ...but u have a medigap plan?

Or am I misunderstanding what you’ve said?
They're the cheapest as far as premiums, but they may not always provide as good coverage.
The surest way to know the future is when it becomes the past.

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celia
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Re: High deductible Plan G medigap

Post by celia » Wed Jun 10, 2020 9:51 pm

nanameg wrote:
Wed Jun 10, 2020 7:16 pm
celia wrote:
Wed Jun 10, 2020 5:56 pm
nanameg wrote:
Mon Jun 08, 2020 8:22 pm
Thanks ...our broker told us there is “ no high deductible plan G” and suggested we get Medicare Advantage. When he explained Medicare Advantage it seemed way too complicated.When things sound complicated I know I’m losing money.
Medicare Advantage is the cheapest and simplest way to go if you can live with an HMO and have a decent doctor group that is part of the HMO network....

Another thing to consider is if you (will) need to see a doctor that a specialist might refer you to. We've had a couple of instances of that where we were referred to a more-specialized specialist at a teaching hospital. In our area, the teaching hospital won't see HMO patients that were referred to them as the HMOs take too long to pay them. But we have no problem making our own appointments to see the teaching hospital specialists since we have Medigap plans.
I’m confused....you say Medicare Advantage plans are the cheapest ( maybe) simplest ( definitely not) way to go ...but u have a medigap plan?

Or am I misunderstanding what you’ve said?
I disagreed with you on Medicare Advantage (HMO) being complicated, but it is cheap. But we don't have it since it doesn't meet our needs. A Medigap (PPO) plan [and a Drug plan] work for us instead. We have the complicated situation.

Since I was already getting long-winded, I stopped before mentioning that we like to travel. When we need to see a doctor within the U.S., we can go to almost any doctor and it is covered the same without having to notify anyone. If you were to be on a Medicare Advantage plan, you (or the service provider?) would have to notify your HMO.

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cheese_breath
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Re: High deductible Plan G medigap

Post by cheese_breath » Wed Jun 10, 2020 10:35 pm

During the six months beginning the day of DW's stroke she was hospitalized four times for periods of a week or more, taken to hospital emergency rooms twice but not admitted, and used up 98 of the 100 day maximum Medicare skilled nursing allocation. I don't have the figures handy, but as I recall the cost was over $500,000. Medicare paid 80%, and her plan N medigap policy paid the other 20%. And never once did I have to ask if the hospitals, physicians, technicians or nursing homes were 'in network'.
The surest way to know the future is when it becomes the past.

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cheese_breath
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Re: High deductible Plan G medigap

Post by cheese_breath » Thu Jun 11, 2020 8:59 am

happychineseboy wrote:
Wed Jun 10, 2020 2:56 pm
...Medicare Supplement (medigap) was dealt a massive blow when Part D was invented and took away drug coverage from future Med Supp plans....
Have you compared the coverage in a medigap plan to the same drugs in the part D plans? DW and I both had medigap plan C policies with prescription 'coverage' included. But it was really nothing more than a discount plan. When I compared our medigap 'coverage' to the part D plans there was no contest. Part D was the better choice even with the premiums included. We decided to go with the part D instead of the medigap 'coverage'.

edit: Also, I seem to recall it didn't cover all DWs drugs. Par D provides you the choice of broader coverage if you're willing to pay a higher premium.
The surest way to know the future is when it becomes the past.

happychineseboy
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Re: High deductible Plan G medigap

Post by happychineseboy » Thu Jun 11, 2020 9:10 am

kaneohe wrote:
Wed Jun 10, 2020 5:09 pm
FIREchief wrote:
Wed Jun 10, 2020 5:01 pm
happychineseboy wrote:
Wed Jun 10, 2020 2:56 pm
You can also enroll in a lower premium medigap plan while you are younger (relatively) and then switch to plan G during open enrollment, this usually won't require medical underwriting.
Are you sure about this?
have my doubts about this too.........don't think there's even an annual enrollment for Medigap plans.
Some states have an annual period when you can switch........but this is only to an equal or lesser plan.
You can't upgrade w/o underwriting.
Hey guys, thanks for fact checking me. I had to do a bit of googling and this is what I found:

A handful of states have looser regulations than the federal rules – California, Connecticut, Maine, Massachusetts, Missouri, New York, and Oregon – and allow retirees to move more freely among various Medigap plans, though the states also have their own restrictions.

So it appears I happen to live in a state where there is no issue moving between medigap plans.

Choose your medigap plans carefully!

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FIREchief
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Re: High deductible Plan G medigap

Post by FIREchief » Thu Jun 11, 2020 9:51 am

happychineseboy wrote:
Thu Jun 11, 2020 9:10 am
kaneohe wrote:
Wed Jun 10, 2020 5:09 pm
FIREchief wrote:
Wed Jun 10, 2020 5:01 pm
happychineseboy wrote:
Wed Jun 10, 2020 2:56 pm
You can also enroll in a lower premium medigap plan while you are younger (relatively) and then switch to plan G during open enrollment, this usually won't require medical underwriting.
Are you sure about this?
have my doubts about this too.........don't think there's even an annual enrollment for Medigap plans.
Some states have an annual period when you can switch........but this is only to an equal or lesser plan.
You can't upgrade w/o underwriting.
Hey guys, thanks for fact checking me. I had to do a bit of googling and this is what I found:

A handful of states have looser regulations than the federal rules – California, Connecticut, Maine, Massachusetts, Missouri, New York, and Oregon – and allow retirees to move more freely among various Medigap plans, though the states also have their own restrictions.

So it appears I happen to live in a state where there is no issue moving between medigap plans.

Choose your medigap plans carefully!
Thank you for clarifying that for other readers of the thread. I would suggest that the main area where great care is required is the decision of medigap vs MA for anybody in a state where future changes are limited. Medigap G vs Medigap G high deductible is just a financial roll of the dice. I can afford the high deductible if many issues show up, so will probably just go with the high deductible option.
I am not a lawyer, accountant or financial advisor. Any advice or suggestions that I may provide shall be considered for entertainment purposes only.

Spirit Rider
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Change from Plan F HD - Plan G HD without medical underwriting

Post by Spirit Rider » Thu Jun 11, 2020 10:34 am

I have a question about Plan F -> Plan G and Plan F high deductible -> Plan G high deductible and medical underwriting in 2020. There were discussions last year about the 2015 MACRA prohibition on new enrollees with eligibility beginning 1/1/20 being sold Plan C, Plan F and Plan F high deductible.

There was some reasoned concerned on those plans about a long term "death spiral" on "Issue Age" policies. I.e. With a fixed pool of aging policy holders, there was the distinct possibly of increased premiums especially after several years. That ever increasing average age and accompanying risk pool would increase premiums. The death spiral would happen when the people who could pass medical underwriting start changing plans due to the increased premiums, leaving only the sicker policy holders who couldn't. Whether this will actually happen was a matter of much debate.

At least until recently where they "could" require medical underwriting, it was the policy of many insurance carriers not to do so if the policy holder was switching to "lower" coverage. There was some anecdotal reports last year that CSRs of certain insurance carriers with such a policy were saying that that policy might be changing starting in 2020.

Bottom Line: Did anyone receive any confirmation that in fact this policy change has taken place. Has anyone for 2020 changed from Plan F -> Plan G or Plan F high deductible -> Plan G high deductible "without" medical underwriting in a state that allows medical underwriting for such a change. It would be useful if you could indicate the circumstances and the carrier.

This would be valuable information for current Plan F and Plan F HD policy holders, whether they believe there is any reason to change or not.

gtg970g
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Re: Change from Plan F HD - Plan G HD without medical underwriting

Post by gtg970g » Thu Jun 11, 2020 11:05 am

Spirit Rider wrote:
Thu Jun 11, 2020 10:34 am
I have a question about Plan F -> Plan G and Plan F high deductible -> Plan G high deductible and medical underwriting in 2020. There were discussions last year about the 2015 MACRA prohibition on new enrollees with eligibility beginning 1/1/20 being sold Plan C, Plan F and Plan F high deductible.

There was some reasoned concerned on those plans about a long term "death spiral" on "Issue Age" policies. I.e. With a fixed pool of aging policy holders, there was the distinct possibly of increased premiums especially after several years. That ever increasing average age and accompanying risk pool would increase premiums. The death spiral would happen when the people who could pass medical underwriting start changing plans due to the increased premiums, leaving only the sicker policy holders who couldn't. Whether this will actually happen was a matter of much debate.

At least until recently where they "could" require medical underwriting, it was the policy of many insurance carriers not to do so if the policy holder was switching to "lower" coverage. There was some anecdotal reports last year that CSRs of certain insurance carriers with such a policy were saying that that policy might be changing starting in 2020.

Bottom Line: Did anyone receive any confirmation that in fact this policy change has taken place. Has anyone for 2020 changed from Plan F -> Plan G or Plan F high deductible -> Plan G high deductible "without" medical underwriting in a state that allows medical underwriting for such a change. It would be useful if you could indicate the circumstances and the carrier.

This would be valuable information for current Plan F and Plan F HD policy holders, whether they believe there is any reason to change or not.
"Old" Plan F policyholders will be caught in a plan with no (or very few) new entrants which will lead to higher rate increases. Many insurance carriers are introducing "fresh" plan F rates which will be almost entirely underwritten since the plan is now cutoff to everyone except those already Medicare eligible as of 1/1/2020. A good agent/broker should be able to tell you whether or not a plan was introduced before or after 1/1/2020. Healthy people enrolled in a Plan F would be well served by re-shopping their policy for a plan G or "fresh" plan F.

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cheese_breath
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Re: High deductible Plan G medigap

Post by cheese_breath » Thu Jun 11, 2020 11:21 am

DW and I both had plan C with BCBS Michigan, and we got out over three years ago. I changed to Transamerica plan G. I had to fill out a simple one page questionnaire, but that was all. DW had many ailments even before her stroke and would not have been able to pass underwriting, but BCBS did allow her to downgrade to plan N.
The surest way to know the future is when it becomes the past.

TravelforFun
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Re: High deductible Plan G medigap

Post by TravelforFun » Fri Jun 12, 2020 12:19 am

rivercrosser wrote:
Tue Jun 09, 2020 11:21 am
You can't predict the future. Went on medicare this past February. I was tempted to go with an advantage plan. Ended up going with a regular plan G and basic part D. Didn't think I had any major health problems. Wasn't taking any prescriptions, hadn't been to a doctor for years. About a month ago I had a ER visit with a kidney stone, then couple weeks later a heart attack and a stent. Looks like doctors and pills from here on out. The plan G is working out good for me.
Lucky you. Time to head for Vegas.

TravelforFun

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nanameg
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Re: High deductible Plan G medigap

Post by nanameg » Sat Jun 27, 2020 3:56 pm

I’m about ready to go ahead with high deductible plan G. It’s less than 1/2 the price of plan G and we’ve been on high deductible plans as a requirement for our HSA for years without any problems. Even though I developed breast cancer in the interim it all went smoothly. I don’t have a fear about high deductible plans.

Am I missing anything?

kaneohe
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Re: High deductible Plan G medigap

Post by kaneohe » Sat Jun 27, 2020 4:23 pm

nanameg wrote:
Sat Jun 27, 2020 3:56 pm
I’m about ready to go ahead with high deductible plan G. It’s less than 1/2 the price of plan G and we’ve been on high deductible plans as a requirement for our HSA for years without any problems. Even though I developed breast cancer in the interim it all went smoothly. I don’t have a fear about high deductible plans.

Am I missing anything?
sounds like you have some experience so probably not. The hi deductible for G possibly may be higher than your hi deductible for your HSA plan tho. Appears to be $2340 vs $1350 for HSA high deductible (latter is 2019 and may be higher now).

If your rates are anything like mine, I pay slightly less than $180/mo. for regular G. If you paid $80/mo for hi G,
you would save $1200 /yr on premiums at the risk of having to pay $2142 more OOP for a serious illness (difference in deductibles. I'm guessing that the rates you are looking at are less (you're younger) so your savings/mo. would also be less so you OOP $ would be higher?

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dodecahedron
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Re: High deductible Plan G medigap

Post by dodecahedron » Sat Jun 27, 2020 4:27 pm

nanameg wrote:
Sat Jun 27, 2020 3:56 pm
I’m about ready to go ahead with high deductible plan G. It’s less than 1/2 the price of plan G and we’ve been on high deductible plans as a requirement for our HSA for years without any problems. Even though I developed breast cancer in the interim it all went smoothly. I don’t have a fear about high deductible plans.

Am I missing anything?
Have you done comparison shopping of all plans offered by all carriers in your area?

Do you have a shopping tool available that shows you the price of all Medigap plans in your area?

Here is my shopping tool on the NYS gov website. I can put in any zipcode in NY and see the prices of all plans available to someone in my zipcode. For example in my area (try 12345, which is not my zip but close enough to show my choices) and you will see that the Plan F-HD and Plan G-HD premiums are identical for all carriers in my area that offer them, so I figured I might as well go with Plan F-HD at Globe, the least expensive company. Cost is $57/month.

Hopeful, CT offers you a similar shopping tool.

Like you, I am used to high deductible plans and I have a substantial HSA balance which can be used for any out of pocket costs. Also, like you, I live in a state which allows me to switch Medigap plans without underwriting in the future if another plan becomes relatively more attractive in the future.

Also, do you have a plan picked out for your Part D prescription drug coverage? You need that as well. Since I do not currently take any drugs and hope to remain healthy enough to continue to avoid them, I went with the least expensive plan D, from Humana at $13/month.

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Re: High deductible Plan G medigap

Post by Spirit Rider » Sat Jun 27, 2020 5:14 pm

kaneohe wrote:
Sat Jun 27, 2020 4:23 pm
The hi deductible for G possibly may be higher than your hi deductible for your HSA plan tho. Appears to be $2340 vs $1350 for HSA high deductible (latter is 2019 and may be higher now).
You are referring to the minimum HDHP deductible allowed (2020 = $1400). The 2020 maximum HDHP out-of-pocket limit is $6900. The majority of ACA HDHP's are > $2340. In my zip code the HDHP deductibles are $2800 - $5400. All the amounts are assuming self-only plan, which all Medigap plans are.

kaneohe
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Re: High deductible Plan G medigap

Post by kaneohe » Sat Jun 27, 2020 6:20 pm

Spirit Rider wrote:
Sat Jun 27, 2020 5:14 pm
kaneohe wrote:
Sat Jun 27, 2020 4:23 pm
The hi deductible for G possibly may be higher than your hi deductible for your HSA plan tho. Appears to be $2340 vs $1350 for HSA high deductible (latter is 2019 and may be higher now).
You are referring to the minimum HDHP deductible allowed (2020 = $1400). The 2020 maximum HDHP out-of-pocket limit is $6900. The majority of ACA HDHP's are > $2340. In my zip code the HDHP deductibles are $2800 - $5400. All the amounts are assuming self-only plan, which all Medigap plans are.
thanks for that important info,Spirit Rider. Would certainly be an important factor in making the decision.

Lalamimi
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Re: High deductible Plan G medigap

Post by Lalamimi » Sat Jun 27, 2020 7:39 pm

We have Plan G through Mutual of Omaha. Had not seen anything about a High Deductible option. M of O has been good. The broker commission is paid through your premium, so I assume if you go straight through M of O it might be less? I used Boomer Benefits and DH used a local broker 5 months before me in 2018. Both suggested M of O. and they give a slight discount since we are both covered.

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