Medicare/Medigap Plan N vs G in Long Island (NY)

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pandahouse
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Joined: Thu Nov 10, 2016 6:15 pm

Medicare/Medigap Plan N vs G in Long Island (NY)

Post by pandahouse »

I'm in the process of helping my mom setup her medicare in her initial enrollment period and she's settled on A/B/D with either plan N or G. Originally, I leaned towards signing her up for G but after speaking to a few brokers in New York, a few surprisingly recommended plan N with Empire BCBS as they state the medicare excess charges don't need to be insured against in New York if she's only getting care in NY. The price difference is about $78/mo on the lowest N vs G plan with BCBS.

Reading online I see some reference NY as allowing a lower excess charge than 15% while others say it's not allowed. :confused
N does seem like a better deal if there's really no need to insure against excess charges.

Are the brokers pushing for N in lieu of G correct for Long Island, New York residents in this case?

Thanks!

Edit: Found a very knowledgeable broker that confirmed NYS has a max 5% medicare excess charge allowed. We decided on plan N after considering that over 96% of doctors accept medicare rates/assignment.
Last edited by pandahouse on Fri Dec 10, 2021 9:33 am, edited 1 time in total.
diy60
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Re: Medicare/Medigap Plan N vs G in Long Island (NY)

Post by diy60 »

pandahouse wrote: Sat Dec 04, 2021 7:19 am I'm in the process of helping my mom setup her medicare in her initial enrollment period and she's settled on A/B/D with either plan N or G. Originally, I leaned towards signing her up for G but after speaking to a few brokers in New York, a few surprisingly recommended plan N with Empire BCBS as they state the medicare excess charges don't need to be insured against in New York if she's only getting care in NY. The price difference is about $78/mo on the lowest N vs G plan with BCBS.

Reading online I see some reference NY as allowing a lower excess charge than 15% while others say it's not allowed. :confused
N does seem like a better deal if there's really no need to insure against excess charges.

Are the brokers pushing for N in lieu of G correct for Long Island, New York residents in this case?

Thanks!
When I typed "which states prohibit excess charges" into Google search, the very first hit listed the 8 states that prohibit excess charges. The other difference between G and N is that patients can be asked to pay a $20 office copay in N. There could be a few other minor differences, but N is a good plan. Good luck.
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cheese_breath
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Re: Medicare/Medigap Plan N vs G in Long Island (NY)

Post by cheese_breath »

diy60 wrote: Sat Dec 04, 2021 7:25 am
pandahouse wrote: Sat Dec 04, 2021 7:19 am I'm in the process of helping my mom setup her medicare in her initial enrollment period and she's settled on A/B/D with either plan N or G. Originally, I leaned towards signing her up for G but after speaking to a few brokers in New York, a few surprisingly recommended plan N with Empire BCBS as they state the medicare excess charges don't need to be insured against in New York if she's only getting care in NY. The price difference is about $78/mo on the lowest N vs G plan with BCBS.

Reading online I see some reference NY as allowing a lower excess charge than 15% while others say it's not allowed. :confused
N does seem like a better deal if there's really no need to insure against excess charges.

Are the brokers pushing for N in lieu of G correct for Long Island, New York residents in this case?

Thanks!
When I typed "which states prohibit excess charges" into Google search, the very first hit listed the 8 states that prohibit excess charges. The other difference between G and N is that patients can be asked to pay a $20 office copay in N. There could be a few other minor differences, but N is a good plan. Good luck.
You could also be on the hook for a $50 emergency room copay if not admitted to the hospital. But Plan N is still a good one. I had DW downgraded from C to N just a few months before her stroke. 3 1/2 years in nursing homes, and I never had any problems with the Plan N benefits.
The surest way to know the future is when it becomes the past.
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Eagle33
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Re: Medicare/Medigap Plan N vs G in Long Island (NY)

Post by Eagle33 »

diy60 wrote: Sat Dec 04, 2021 7:25 am
pandahouse wrote: Sat Dec 04, 2021 7:19 am I'm in the process of helping my mom setup her medicare in her initial enrollment period and she's settled on A/B/D with either plan N or G. Originally, I leaned towards signing her up for G but after speaking to a few brokers in New York, a few surprisingly recommended plan N with Empire BCBS as they state the medicare excess charges don't need to be insured against in New York if she's only getting care in NY. The price difference is about $78/mo on the lowest N vs G plan with BCBS.

Reading online I see some reference NY as allowing a lower excess charge than 15% while others say it's not allowed. :confused
N does seem like a better deal if there's really no need to insure against excess charges.

Are the brokers pushing for N in lieu of G correct for Long Island, New York residents in this case?

Thanks!
When I typed "which states prohibit excess charges" into Google search, the very first hit listed the 8 states that prohibit excess charges. The other difference between G and N is that patients can be asked to pay a $20 office copay in N. There could be a few other minor differences, but N is a good plan. Good luck.
How does it work if your resident of a state that prohibit excess charges and while traveling the US get injured in a state that allows excess charges? Can the doctor in that other state bill you for the excess charges incurred while in that other state?
ModifiedDuration
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Re: Medicare/Medigap Plan N vs G in Long Island (NY)

Post by ModifiedDuration »

Eagle33 wrote: Sat Dec 04, 2021 10:19 pm How does it work if your resident of a state that prohibit excess charges and while traveling the US get injured in a state that allows excess charges? Can the doctor in that other state bill you for the excess charges incurred while in that other state?
Yes, if you get medical treatment in a state that allows excess charges, you would be liable for any excess charges billed.
diy60
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Re: Medicare/Medigap Plan N vs G in Long Island (NY)

Post by diy60 »

ModifiedDuration wrote: Sun Dec 05, 2021 6:24 am
Eagle33 wrote: Sat Dec 04, 2021 10:19 pm How does it work if your resident of a state that prohibit excess charges and while traveling the US get injured in a state that allows excess charges? Can the doctor in that other state bill you for the excess charges incurred while in that other state?
Yes, if you get medical treatment in a state that allows excess charges, you would be liable for any excess charges billed.
Excess charges are very rare, something like 3% of all Medicare billing throughout the US, and the amount is capped. Classic case of fearmongering by the insurance companies.
JackoC
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Re: Medicare/Medigap Plan N vs G in Long Island (NY)

Post by JackoC »

diy60 wrote: Sun Dec 05, 2021 11:50 am
ModifiedDuration wrote: Sun Dec 05, 2021 6:24 am
Eagle33 wrote: Sat Dec 04, 2021 10:19 pm How does it work if your resident of a state that prohibit excess charges and while traveling the US get injured in a state that allows excess charges? Can the doctor in that other state bill you for the excess charges incurred while in that other state?
Yes, if you get medical treatment in a state that allows excess charges, you would be liable for any excess charges billed.
Excess charges are very rare, something like 3% of all Medicare billing throughout the US, and the amount is capped. Classic case of fearmongering by the insurance companies.
I don't know whether insurance companies are fearmongering but it's clear from their own prices they don't view coverage of excess charges as likely to cost them much. You can see that by comparing Plan D and G; D is basically G without excess charge coverage. When I priced that recently (looking to start Medicare this coming year) the leading provider in our state (NJ) prices D and G only $0.34/month different, whereas they price G and N $40.22/month different. IOW the premium savings with N comes almost entirely from having to make doctor's office and ER fixed per visit copay's with N that you don't have to with G, not about excess charges.

G High Deductible is another option to explore if the $2,490 deductible (for 2022) is manageable. Where I am the cost is ~60% less, $1200/yr less than regular G. I guess I'll incur $2.5k annual of out of pocket well under 1/2 the time as long as my health stays anywhere near as good as now, and I can afford to lose that game if I guess wrong (keeping in mind it's deducible basically on 20% of Part B costs after Part B's own deductible of a couple $100, so you have to have ~12.4k in bills/yr to owe $2.5k out of pocket on the supplment plan).
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