Medigap Provider Decision Help Please for 65 YO

[MrRE]

Hi All
All your insights would be greatly appreciated while I pick a Medigap provider.

Here is my situation:
I just got Medicare A & B so I have time to get Medigap guaranteed (without underwriting concerns).

(Update: fyi... yes... I do want to get Medigap as soon as possible mainly in case I get Covid in particular.
Also I will be getting Part D prescription coverage as soon as possible too in case I get Covid in particular and to avoid late penalty.
Otherwise I'm totally healthy and take no prescriptions.
I will be checking to see what prescriptions Covid patients have to take to price my Part D.
But that is for another topic that I will post elsewhere on picking a Part D provider.)

My state does not provide the ability to switch to Medigap guaranteed at any time like NY does.

So my decision will probably be a long term commitment. So I'm trying to make a well-informed decision.

I think I want either Plan G - High Deductible (HD) or maybe regular Plan G.

My main challenge is picking a Plan G or G-HD insurance company.


I already read most of the Boglehead Medigap topics posted.

I have yet to contact any insurance brokers/agents.
I already know about boomerbenefits.com and a few others that people here have mentioned or I found myself.

I read these books: Maximize Your Medicare, Medicare for Dummies, Welcome to Medicare.

I know about: State SHIP help and data, State Dept. of Insurance Medigap rates data, A.M. ratings, NIAC data, and SERFF data.
I'm starting to get and use the data for comparison purposes.

I know about the 3 policy pricing rate categories (Attained-Age-rated, Issued-Age-rated, Community-rated).
https://www.medicare.gov/supplements-ot ... p-policies

Unfortunately in my state, all companies offer only Attained Age Pricing for Plan G-HD.
https://www.medicare.gov/medigap-supple ... 22&lang=en
(To preserve my privacy, the link above is not for my zipcode but I picked it because it has the same data as my zipcode so I can share it safely.)

But some companies offer the two other pricing for Plan G policies (non-HD)
(Issue-Age-rated Pricing, Community-rated Pricing).
https://www.medicare.gov/medigap-supple ... 22&lang=en
(To preserve my privacy, the link above is not for my zipcode but I picked it because it has the same data as my zipcode so I can share it safely.)

Below is a picture of 2022 rate data for my age from my state's website.
I got it here:
https://www.state.nj.us/humanservices/d ... ale_65.pdf
I also found historical data for 2017 and 2021 on archive.org.
https://web.archive.org/web/20170813210 ... ale_65.pdf
https://web.archive.org/web/20210325014 ... ale_65.pdf

First I show companies that offer
both Plan G and Plan G - High Deductible sorted by G-HD.




Here are all the companies for Plan G and G-HD sorted by Plan G.




I'm starting to look at individual company provided data where available.
Here is a picture of Amerihealth rates (G and G-HD and their other plans too so please ignore them):




As you can see above, I'm first just looking mainly at the data to see what it shows.

I'm trying to get historical data but my state doesn't provide it.
I did find 2017 and 2021 data in archive.org as mentioned above.

I tried looking at data resources people mentioned in other posts here but it isn't easy to get the company rate data.

I realize that historical data doesn't guarantee future trends.
But it can help me see how companies behave over time.

I've been looking for consumer review sites too for Medigap companies but haven't had much luck.
I realize that all Plan G's and G-HDs are the same.

I'm mainly concerned about finding a company that is reliable and tends to have low rates.


I realize an agent/broker can access databases and provide data I want.
I probably will contact them soon to get whatever they can provide.

Eventually I will probably pick the lowest cost Plan G-HD company that isn't ruled out due to bad reviews or bad historical trends.

Any insights on picking a reliable Medigap company based on data and consumer reviews would be greatly appreciated.

[bradinsky]

DW & I chose the G plan & started out with United Healthcare/AARP. At about 2 years in, we switched to a regional provider - Medical Mutual of Ohio. UHC did a fine job paying all bills without any hesitation. We only switched because Medical Mutual offered us the same G plan at a very significant savings. If you have some medical issues, I believe the G plan offers the most bang for the buck.

[MrRE]

DW & I chose the G plan & started out with Humana/AARP. At about 2 years in, we switched to a regional provider - Medical Mutual of Ohio. Humana did a fine job paying all bills without any hesitation. We only switched because Medical Mutual offered us the same G plan at a very significant savings. If you have some medical issues, I believe the G plan offers the most bang for the buck.

Thanks. I thought that all AARP policies were provided by UnitedHealthcare.

[bradinsky]

DW & I chose the G plan & started out with Humana/AARP. At about 2 years in, we switched to a regional provider - Medical Mutual of Ohio. Humana did a fine job paying all bills without any hesitation. We only switched because Medical Mutual offered us the same G plan at a very significant savings. If you have some medical issues, I believe the G plan offers the most bang for the buck.

Thanks. I thought that all AARP policies were provided by UnitedHealthcare.

I’m so sorry! It should have stated United Health Care. I was reading an article about Humana earlier. Once again, very sorry about that!

[MrRE]

DW & I chose the G plan & started out with Humana/AARP. At about 2 years in, we switched to a regional provider - Medical Mutual of Ohio. Humana did a fine job paying all bills without any hesitation. We only switched because Medical Mutual offered us the same G plan at a very significant savings. If you have some medical issues, I believe the G plan offers the most bang for the buck.

Thanks. I thought that all AARP policies were provided by UnitedHealthcare.

I’m so sorry! It should have stated United Health Care. I was reading an article about Humana earlier. Once again, very sorry about that!

It's okay. I do that too sometimes. Funny how the mind locks in on words that start with same letter.

[Zanmar]

NJ here also. I went with Mutual of Omaha. Recommended by Boomer Benefits. There is a household discount available. My cost is $55 per month.
My Part D is Silver Scripts for $7 per month. I have no prescriptions so went with the cheapest Rx plan.

[ModifiedDuration]

I wouldn’t bother with reviews much.

Unlike regular healthcare insurance, there is nothing for a Medigap insurance company to approve or deny.

If the charge was approved by Medicare it is paid by the Medigap insurance company. End of story.

In addition, the whole billing process is seamless. The provider bills Medicare. Medicare processes and pays the provider. Medicare forwards the bill to your Medigap insurance company. Your Medigap insurance company processes and pays the provider.

One thing you don’t hear much about is service problems with Medigap insurance companies.

[ModifiedDuration]

The SERFF data might give you historical information. But, I guess you already checked that for New Jersey.

I am a big fan of the HD plans.

If your health is good now, I might take a look at the cost for the G-HD plans at the various insurance companies at age 65, 70, 75, 80, and 85 and see what jumps out.

Usually, United American has the lowest prices over the various ages for G-HD. They are the big player in the market.

I have United American G-HD and am very pleased with it.

Also, if your Medicare Parts A and B are effective now, consider signing up for a Medigap policy right away. You don’t want a major medical event to occur now and you do not have a Medigap policy in place.

As mentioned above, consider a Part D plan. Even if you’re not taking any prescriptions now, it’s worth it to get an inexpensive plan just to get the Catastrophic Coverage, get it now because you can only add it once a year at the Fall Enrollment period (and you never know during the year when you might need it), and to avoid the late enrollment penalty at a later date.

If you don’t have a Part D plan and have to go through a prescription course of treatment for cancer it can easily run into the tens of thousands of dollars….and GoodRx isn’t going to help much.

By the way, if you want to read another book, consider Medicare Demystified. It’s written by a physician and has some useful insights.

[buckeye7983]

Hi All
All your insights would be greatly appreciated while I pick a Medigap provider.

Eventually I will probably pick the lowest cost Plan G-HD company that isn't ruled out due to bad reviews or bad historical trends.

Any insights on picking a reliable Medigap company based on data and consumer reviews would be greatly appreciated.

Great thread! How does one research historical rate increases for the insurance companies?

[Lalamimi]

We started out with Mutual of Omaha, recommended by a broker for my husband, then by Boomer Benefits for me 3 yrs ago. Then someone mentioned Aetna was cheaper - and we switched last May. Premiums just went up about $5. All Plan Gs are the same, it just depends what a broker is signed up to offer. I actually got the Aetna off Aetna.com though a broker handles it. We started with Silver Scripts for $25 each for Plan D, then switched to one that is $6.90 each. We only take minimum drugs, so its fine for now. We use GoodRX for anything that is more than $15.

[Agent 99]

I am in the same boat and have been agonizing over whether I should go with G or G-HD.

Regarding the insurance provider my impression and stated above is that with Medigap the insurance co has no decisions to make. Unlike Medicare Advantage where the company is managing the “care” all the Medigap providers have to do is pay out the plan contracted amount (between the insured) to the health care provider. That remaining amount is dictated by the Medicare approved rates for the procedure. With Medicare Advantage the insurance company runs the insured’s healthcare dictating who, what and where one can go and pull those delay, deny and other well known stunts to avoid paying.

Based on the above I think that most of the reviews of the insurance companies likely come from Medicare Advantage customers who do suffer the indignities of bad behaviors by the insurance companies.

One of the underhanded things I have run into with getting on-line gap quotes is that when I review the plan documentation it appears that I am being quoted a “modified” version of the plan g’s. Both Humana and BCBS have two categories that are basically termed standard and preferred. Buried and I mean buried is the definition that preferred means only going with preferred BCBS Medicare providers in my state. I haven’t confirmed the Humana definition but I’m pretty sure that they are playing the same game. The lowest price plan is their preferred option and that’s what is presented on-line. If I wanted to stick to their plan providers and only get care in SC I wouldn’t be paying for a gap plan! I caution those who are looking at the plans to read the gory details. I’ve enclosed the Humana booklet for SC with the rate tables for these two categories plus the rates vs age attainment if interested for comparison. https://www.humana-medicare.com/Benefit ... -1_122.pdf

I have also learned that some providers have perks. If I am correct in reading the Humana documentation Medigappers will get the silver sneakers benefit (free health club membership), 24 hour tele nurse, discounted vision and dental if go to one of their providers and some other stuff. The other choices available to me don’t have these. I do have to confirm if these are connected to both the standard and preferred versions though.

On drugs I am considering not getting a plan. I do take meds but I have discovered that I can get my drugs rather cheaply directly from pharmacies without using my gold standard insurance coverage I have now. GoodRx is also a resource for getting the best price on drugs. For example, under my current plan I pay $21 for 90 day supply but I pay half that from a pharmacy. In addition I will post separately an article I found here that spelled out the drug situation extremely well.

The article explains the penalty for not signing up for drugs. It is not a big surcharge. The insurance companies scare us into believing it will be a major cost.

[Agent 99]

This is the article I referred to in my earlier post.

https://truecostofhealthcare.org/medica ... insurance/

[ModifiedDuration]

Hi All
All your insights would be greatly appreciated while I pick a Medigap provider.

Eventually I will probably pick the lowest cost Plan G-HD company that isn't ruled out due to bad reviews or bad historical trends.

Any insights on picking a reliable Medigap company based on data and consumer reviews would be greatly appreciated.

Great thread! How does one research historical rate increases for the insurance companies?

Being that your username is “buckeye”, I assume that you are a big University of Michigan fan, so here is how to get historical rate increases in Michigan.

Just kidding.

To get historical rate information in Ohio you could use the SERFF system (System for Electronic Rate and Form Filing):

https://filingaccess.serff.com/sfa/home/OH

It’s not intuitive and a bit difficult to figure out, though.

Just for fun, here is United American’s Plan F - high deductible rate history in Ohio:

Rate decreases starting in 2011 of 25%, 5%, 10%,and 12%, with no rate changes since then.

[diy60]

Contact your state's SHIP office. My local office provided me with an up-to-date computer printout (almost 100 pages) of rate and financial ranking. Pick 4 or 5 of the top 1/3, give them each a call. I did this and immediately eliminated 3 because I couldn't understand their broken English call center reps. In the end, your talking about what, maybe a difference of 10K to 20K total lifetime difference in total premium payout. Certainly not pocket change, but I've made much costlier mistakes in my investment journey. Best of luck.

[buckeye7983]

To get historical rate information in Ohio you could use the SERFF system (System for Electronic Rate and Form Filing):

https://filingaccess.serff.com/sfa/home/OH

It’s not intuitive and a bit difficult to figure out, though.

Just for fun, here is United American’s Plan F - high deductible rate history in Ohio:

Rate decreases starting in 2011 of 25%, 5%, 10%,and 12%, with no rate changes since then.

MD-

Thank you very much for this link. I poked around and think I have most of it figured out. I'm pretty sure that I should look at the "Rate" filing forms. I am confused about what "Subtype of Insurance" should be chosen if one is interested in finding info on the typical Medigap Plan G. Thanks again!

[ModifiedDuration]

To get historical rate information in Ohio you could use the SERFF system (System for Electronic Rate and Form Filing):

https://filingaccess.serff.com/sfa/home/OH

It’s not intuitive and a bit difficult to figure out, though.

Just for fun, here is United American’s Plan F - high deductible rate history in Ohio:

Rate decreases starting in 2011 of 25%, 5%, 10%,and 12%, with no rate changes since then.

MD-

Thank you very much for this link. I poked around and think I have most of it figured out. I'm pretty sure that I should look at the "Rate" filing forms. I am confused about what "Subtype of Insurance" should be chosen if one is interested in finding info on the typical Medigap Plan G. Thanks again!

If you mean “Type of Insurance”, you can go with MS05I and MS08I.

Then, when you get to the page that says Filing Information for the company you are interested in, scroll down to Supporting Documentation and click on “Rate Filing -History of Rate Adjustments” for Medicare Plan G. That should give you historical rate information.

Let me know if that helps.

[buckeye7983]

If you mean “Type of Insurance”, you can go with MS05I and MS08I.

Then, when you get to the page that says Filing Information for the company you are interested in, scroll down to Supporting Documentation and click on “Rate Filing -History of Rate Adjustments” for Medicare Plan G. That should give you historical rate information.

Let me know if that helps.

MD-

Very helpful! Thanks again!

[MrRE]

Status update on me choosing a Medigap provider....

I'm still very stuck.


I can't pick a plan or an insurance company because:

- The Medigap market so complicated (company rates and rate structures)

- Future rates are so unpredictable

- Historic rates are so difficult to find and difficult to interpret their causes

- Outline of Coverage files with rate data by age are difficult to get often

- Brokers/agents just seem to want to sell certain policies and don't give much price history, if any

- It's very difficult to tell how "friendly" the companies are to deal with (customer service people, portal (if they have one), or snail mail)

- Inflation long term possibility is making the decision harder


Here is what I learned so far that makes the decision difficult for me...

Medigap might be a bad choice for a healthy person:

- Medigap is shown to be more expensive overall than Medicare Advantage for most people over time.

- So Medigap seems like it might be a bad choice for me because I'm healthy and expect to be long term.

- The main reason I want Medigap is to avoid network restrictions and to have a maximum out of pocket rather than Original Medicare unlimited 20% co-insurance.

- Medicare Advantage has a maximum out of pocket but due to network uncertainty one could still have to pay a lot for "out of network" costs that one cannot control and that doesn't count toward the Medicare Advantage maximum out of pocket limit.

- Medigap policy holders tend to have higher medical costs than Medicare Advantage policy holders because either:
1) they paid their premium and have little or no cost-sharing pressure or plan cost management restrictions so they get excess medical care
2) they picked Medigap because they have ongoing high medical bills


So Medigap seems to attract two opposite types of people into their insurance plan pools:

1) people willing to pay a lot more than Medicare Advantage so they avoid Medicare Advantage plans restrictions and complexity
2) people who have big medical bills and can get Medigap guaranteed initially without underwriting

If enough people in a Medigap plan suddenly have big medical problems for multiple years, then the state will allow rate increases that can last for multiple years. Then you have to find another Medicap company in your area with lower rates that has lenient underwriting questions. Or you can use the one-time trick of getting a Medicare Advantage plan on limited-trial use basis and then switching to an allowed Medigap plan.

Medigap companies can have lower loss ratios and thus pay less out for claims.
Individual policies only have to have 65% loss ratio or higher.
Group policies have to have 75% loss ratio or higher.
Edit update: Group policies that are mass-marketed may only need to have 65% loss ratio or higher.
The advantage of being in a group Medigap policy is you could possibly get more payback or lower rates because the minimum loss ratio is higher.
(Side note: I'm not sure if AARP UHC Medigap is a group policy or not. You have to be in AARP to get the policy but I'm unsure if that makes it a group policy.)
Edit update: AARP-UHC Medigap is a group insurance that is called a certificate rather than a policy.
See later posts here for details below.

Medicare Advantage plans seem to be unfairly subsidized by Medicare according to some reports.
Medigap policies are not subsidized by Medicare.


Medigap rates can be affected by many things:
Medigap companies can close a plan to new people so then the population gets older and the claims go up and so do the rates.

Medigap companies have competition from outside the industry because any company can easily get into the Medigap business because it doesn't require network management and care management like Medicare Advantage does.
So there is a lot of competition that is driving rates down due to competitive pressures even though claims are going up.

Medigap rates can be lowered to pull in new healthy entrants.
That makes it hard to find a company that will keep rates low ongoing.

Medigap rate curves differ as one ages for some companies.
Some companies have flat sections of their rate curves.

It is very time consuming to get rate history.
Causes of rate history are complicated. Good rate history doesn't necessarily show which company or policy in a region is lower cost over the long term.


Picking a COMPANY can be very complicated:
- My State's Div. of Aging's SHIP web page only has latest rates for 65 yo, no historical rate data
- My State's Div. of Banking and Insurance (DOBI) only has financials on some companies and it's very difficult to interpret
- Some companies are privately held and don't publish financial reports so have to rely on reports they give to my State
- Some companies don't have ratings by A. M. Best or Weiss Ratings or other rating services
- NAIC.org data is time-consuming to piece together and interpret (financial, complaint, loss-ratio, market share, policy holder counts)
- SERFF is very very difficult to use to get rate history if it has any at all
- Weiss Ratings doesn't provide rate history
- CMS might have rate history but the data is available only for experts who can piece it all together
- Rate history doesn't explain why rates changed


Picking a PLAN can be very complicated:

- Inflation is making Plan G-High Deductible perhaps less advantageous because the plan deductible will go up and up along with high inflation
- Plan G seems to be attracting more and more people who have major long term medical bills now that Plan F is closed to certain applicants
- Plan G has little cost-sharing pressure other than first-dollar costs Part B deductible etc.


Here are the companies and plans I am considering at this point:

- Plan G-High deductible (my first preference, but I have inflation concerns)





- Plan G (but I am concerned it will draw in too many high claim policy holders for reasons I mentioned above)





- Plan N (no data curves ready yet)

I like that Plan N has cost-sharing pressure built-in to keep costs down.
But I don't like that it won't pay doctor's "excess charges" no matter how rare.


My main strategy is to:
- Pick a company that has a large pool of people in the plan so the rates won't change by just a small number of people suddenly having big medical bills ongoing
- Pick a company that is in the insurance business long-term and not just trying to make a quick buck and sell-off to another company
- Pick a company with strong financial status
- Pick a plan that won't draw in people with large ongoing medical bills or a tendency to get excessive medical care (like Plan G)
- Pick a company that doesn't have overly lenient underwriting restrictions
- Pick a company that doesn't have a reputation for "gaming the system" by closing policies to new entrants and letting rates rise drastically and then also create a new low policy in another branch of their huge corporate structure and offer low rates to pull in new customers.
- Pick a company with a history of appropriate loss ratios in my State (using NAIC.org data)

Edit corrections: NAIC.org, AARP-UHC is group insurance so issues a certificate rather than a policy.

[WillRetire]

OP:
You are raising good questions. There are tradeoffs. Medigap plan G whose premiums are "community-rated" is a great choice. It gives you the most protection you can buy, and it protects you from the highest % premium increases when you reach your 80s & beyond. If you can afford it now, you will probably be able to afford it in your later years. Premium increases will be on par with healthcare inflation. Ask the provider what the annual increases *in the base rate* have been for the past 5-10 years. In our state the base premium % increases have averaged 4% per year.

Worry less about overpaying now, and more about having great coverage later when you need it, & protection against super-high % increases when you are very elderly and possibly frail or sick. It is a lot easier to drop "down" to lesser coverage than it is to go up.

An anecdote: An elderly relative picked a Plan F 2 decades ago with pricing that was attained-age. At age 85 he felt he could not afford the premiums for both he and his wife. He switched to a $0 premium advantage plan because of that. He hopes his good health continues to the end. "Hope" is not a good planning strategy. Perhaps if his original plan was "community-rated", the increases would have been more affordable.

Good luck!
[edited misspelling]

[tunafish]

I think the OP should have a nice warm cup of cocoa and then sign up for AARP/UHC Plan G and Plan D.

Otherwise he or she is going to put themselves in the hospital with a bad case of overanalyzing stress.

I would never get a Medicare Advantage plan ad go back to being scr*wed over by an insurance company that is trying to cover as little as possible. Been there in pre-Medicare days with employer provided insurance. I've been on Medicare/AARP Medigap Plan F/AARP Plan D for something like 12-13 years and have not regretted it.

That includes countless doctors' visits, a two day stay in the hospital, several outpatient procedures, lots of imaging, lots of meds and except for the prescription copays, not a nickle out of my pocket. Plan G is Plan F with some sort of minor initial copay or deductible or somesuch. Plan F is not open to new enrollment.

I see first class doctors in my home state and doctors at the first class Boston hospitals.

I worry about a lot of things, but with this setup, health insurance is not one of them.

[ModifiedDuration]

Kudos for all the work that you have done.

A few thoughts:

Two of the companies that play the start with low rates, close pool, increase rates are Mutual of Omaha (and its subsidiaries) and Aetna, especially Mutual of Omaha. Buyer beware.

The inflation that you fear in the G-HD deductible figure should also impact (and then be reflected in) the pricing of G Plans. High inflation would impact both plans - one in the increased deductible (which mitigates the need for increased premiums) and the other in higher premiums.

For whatever reason, I see that you left out of your G-HD chart the big player in the HD field, United American, who usually has the lowest rates over the long term (and doesn’t play any of the “start with low premiums and then jack them up” games).

There is no way for you to know, at this point in time, how things will shake out in the future. All you can do is your due diligence and then just make a decision.

I would suggest you getting in touch with one of the owner’s of Medicare Nationwide, Jackson Edwards (who is very knowledgeable and a straight shooter), but I know that he would suggest a G-HD plan for you, particularly because you are in good health, and I don’t know if that is what you really want.

If you want to spend some money, you can sign-up for CSG Actuarial’s tool, which insurance agents use. The Silver Plan might give you some of the historical pricing information you are looking for. I have not used it, but have heard of some people who used it and found it to be helpful and, if I remember correctly, were able to sign-up for just a month for $30.

As the G-HD policies have only existed a few years, you could use F-HD as a proxy for historical price increases by the various companies:

https://www.csgactuarial.com/software/m ... r/pricing/

[nvboglehead]

You are not considering Plan N, which also has a lower deductible. G is absorbing the "guarantee issue" population and others who have more health issues. Its premiums will likely be increasing faster than Plan N. This link explains the matter.

https://www.youtube.com/watch?v=HrcXl614js0

This same broker got me into high deductible Plan G with United American. It is a sensible choice for someone with few medical issues.

Dale

[MrRE]

Kudos for all the work that you have done.

A few thoughts:

Two of the companies that play the start with low rates, close pool, increase rates are Mutual of Omaha (and its subsidiaries) and Aetna, especially Mutual of Omaha. Buyer beware.

The inflation that you fear in the G-HD deductible figure should also impact (and then be reflected in) the pricing of G Plans. High inflation would impact both plans - one in the increased deductible (which mitigates the need for increased premiums) and the other in higher premiums.

For whatever reason, I see that you left out of your G-HD chart the big player in the HD field, United American, who usually has the lowest rates over the long term (and doesn’t play any of the “start with low premiums and then jack them up” games).

There is no way for you to know, at this point in time, how things will shake out in the future. All you can do is your due diligence and then just make a decision.

I would suggest you getting in touch with one of the owner’s of Medicare Nationwide, Jackson Edwards (who is very knowledgeable and a straight shooter), but I know that he would suggest a G-HD plan for you, particularly because you are in good health, and I don’t know if that is what you really want.

If you want to spend some money, you can sign-up for CSG Actuarial’s tool, which insurance agents use. The Silver Plan might give you some of the historical
Pricing information you are looking for. I have not used it, but have heard of some people who used it and found it to be helpful and, if I remember correctly, were able to sign-up for just a month for $30.

As the G-HD policies have only existed a few years, you could use F-HD as a proxy for historical price increases by the various companies:

https://www.csgactuarial.com/software/m ... r/pricing/

Thank you for the kudos and the suggestions.

I am very suspicious of Mutual of O.... as you said because I've seen similar comments in many other places.


I left out United American even though they were on my list because

they don't seem to have a customer portal and
they seem to make people process out of pocket claims with US mail:
https://www2.unitedamerican.com/file-a-claim
https://bestcompany.com/health-insuranc ... ce-company

I realize that most claims usually flow from the medical service provider to Medicare
then from there to the Medigap company.

But in some cases I think that claims might need to be posted by the person insured due to out of pocket charges covered.

So I'd really prefer a company that has a portal that I can log into and see my status and upload claims if I have any out of pocket charges that would be covered.


Thank you especially for the CSG idea.
I noticed that a lot of organizations that create Medigap reports use CSG data to create those reports. So as you said, 1-month sign-up might provide historical data Plan G that I've been looking for. And as you said I could use Plan F-HD data also to give insights on likely trends for Plan G-HD, which is only a few years old. Also, in the future after I get Medigap, when my Medigap rates eventually go up drastically, I could use CSG again to find an alternative provider perhaps.


Overall I realize there is very little I or anyone can predict or control.

So finding a stable company with a good overall reputation that is easy to do business with online is most important to me.

For the Plan choice, I'll probably go with G-HD because because I also don't think inflation is going to be that much of a special issue for the same reasons you said. And I think G-HD's deductible will keep away people who create high costs. I just hope that G-HD continues to be offered over time. I'm concerned that companies might drop it because of low demand or high costs to manage the claim flow yet inability to charge high rates.

Thanks again for the ideas and feedback

[ModifiedDuration]

I respect all the work that you have done here, so I feel you deserve a response.

If you decide to go with G-HD, then you might want to consider getting in touch with Jackson Edwards at Medicare Nationwide.

With his years of experience, he knows so much more about this stuff than you or I will ever know and he loves the HD plans. It is nice to have someone so knowledgeable answer all your questions and confirm your thinking. He can also help steer you away from insurance companies that play games with their premiums.

In true Bogleheads fashion, it is worth noting that his services don’t cost you anything, as his commission is paid by the insurance company.

Also, you mention that you could use CSG Actuarial in the future when you have the eventual dramatic increase in premiums.

Well, that might not be the case with a G-HD. In my state, the Plan F-HD premiums by my carrier have not increased in 14 or 15 years. In fact, during that time period they have reduced premiums 4 times. The reason being that F-HD (and G-HD) plans have a built-in “increase” each year in the form of a higher deductible.

Jackson told me that most HD plans have no increase due to inflation from one year to the next, or just $1 or $2 a month.

I don’t want to belabor the United American point, because you should do what you are comfortable with, but all my billings have been totally seamless - from service provider to Medicare to United American to finally getting a bill from the service provider.

I have not had to get involved in the process at all.

In fact, I just logged into my account at the United American customer portal and under Claims, United American says:

“Note: If you participate in the Automatic Claim Filing [which I think everyone does] your Part B claims will be automatically sent to us by Medicare.”

Based on my experience, what I have heard from others, and my discussions with Jackson Edwards, your concern about wanting the ability to file claims online is not really warranted.

Finally, you mentioned that hopefully the insurance companies continue to offer G-HD in the future. Well, since the HD plans are United American’s “bread and butter”, if any insurance company is likely to offer G-HD in the future, it’s United American.

However, you have done so much work on this that if anyone has earned the right to do what they are most comfortable with and, therefore, eliminate United American from consideration, it is you.

(OK, I lied - I did belabor the United American point.)

[MrRE]

You are not considering Plan N, which also has a lower deductible. G is absorbing the "guarantee issue" population and others who have more health issues. Its premiums will likely be increasing faster than Plan N. This link explains the matter.

https://www.youtube.com/watch?v=HrcXl614js0

This same broker got me into high deductible Plan G with United American. It is a sensible choice for someone with few medical issues.

Dale

Thanks Actually I am considering Plan N as I mentioned, but only very reluctantly due to no coverage for "excess charges" which can be rare, but they can be expensive if they happen for a major health issue and you can't easily control the provider choices. I hope my State eventually bans "excess charges" like others have.


I realize people are moving into N to avoid guarantee issue high risk population moving into G.


Overall, I want to have my cake and eat it too. By that I mean, have relatively low rates compared to other plans and yet not have to pay "excess charges".


So my strategy I think is to go with G-HD
because that will keep rates low by keeping away people who don't like high plan deductible.
Yet with G-HD, I get to keep my coverage for "excess charges",
so I don't have to worry about that nuance even though it might be rare.

[MrRE]

UPDATED MANUALLY SO IGNORE TIME STAMP ABOVE.

Post by ModifiedDuration » Sun May 01, 2022 5:03 pm

I respect all the work that you have done here, so I feel you deserve a response.

If you decide to go with G-HD, then you might want to consider getting in touch with Jackson Edwards at Medicare Nationwide.

With his years of experience, he knows so much more about this stuff than you or I will ever know and he loves the HD plans. It is nice to have someone so knowledgeable answer all your questions and confirm your thinking. He can also help steer you away from insurance companies that play games with their premiums.

In true Bogleheads fashion, it is worth noting that his services don’t cost you anything, as his commission is paid by the insurance company.

Also, you mention that you could use CSG Actuarial in the future when you have the eventual dramatic increase in premiums.

Well, that might not be the case with a G-HD. In my state, the Plan F-HD premiums by my carrier have not increased in 14 or 15 years. In fact, during that time period they have reduced premiums 4 times. The reason being that F-HD (and G-HD) plans have a built-in “increase” each year in the form of a higher deductible.

Jackson told me that most HD plans have no increase due to inflation from one year to the next, or just $1 or $2 a month.

I don’t want to belabor the United American point, because you should do what you are comfortable with, but all my billings have been totally seamless - from service provider to Medicare to United American to finally getting a bill from the service provider.

I have not had to get involved in the process at all.

In fact, I just logged into my account at the United American customer portal and under Claims, United American says:

“Note: If you participate in the Automatic Claim Filing [which I think everyone does] your Part B claims will be automatically sent to us by Medicare.”

Based on my experience, what I have heard from others, and my discussions with Jackson Edwards, your concern about wanting the ability to file claims online is not really warranted.

Finally, you mentioned that hopefully the insurance companies continue to offer G-HD in the future. Well, since the HD plans are United American’s “bread and butter”, if any insurance company is likely to offer G-HD in the future, it’s United American.

However, you have done so much work on this that if anyone has earned the right to do what they are most comfortable with and, therefore, eliminate United American from consideration, it is you.

(OK, I lied - I did belabor the United American point.)
Last edited by ModifiedDuration on Sun May 01, 2022 5:28 pm, edited 4 times in total.

Thank you

I see now that I made some incorrect assumptions about United American. So they do have a customer portal. Great.


This is very helpful because trustworthy detailed company reputation information like you gave above is very difficult to find otherwise.


I also was thinking about Philadelphia American for G-HD
because they have very very low rates as shown in the plot above.
But I can't find similar company reputation information.
So I don't know if I can trust them.
I think someone here said they tried them.
Okay, now I found the link, it's here
viewtopic.php?t=338957


Perhaps I'll try the broker lead too.

It's been very difficult for me to find someone who will bother quoting G-HD plans because the premium is so low so the commissions are low.


Thanks again

[ModifiedDuration]

I am not familiar with Philadelphia American, but I see that didn’t prevent me from chiming in on the thread you referenced!

You mentioned having problems finding an agent who was willing to quote G-HD.

First time that I spoke to Jackson Edwards at Medicare Nationwide I had him on the phone for a very long time with a myriad of questions.

I apologized for taking up so much of his time for such a small commission.

He said, “Don’t worry about the commission.”

Yeah, that impressed me.

He told me that they have grown the business through referrals and they usually end up keeping clients for a very long time (basically, until they pass away).

He is a very big proponent of the HD plans.

[MrRE]

I am not familiar with Philadelphia American, but I see that didn’t prevent me from chiming in on the thread you referenced!

You mentioned having problems finding an agent who was willing to quote G-HD.

First time that I spoke to Jackson Edwards at Medicare Nationwide I had him on the phone for a very long time with a myriad of questions.

I apologized for taking up so much of his time for such a small commission.

He said, “Don’t worry about the commission.”

Yeah, that impressed me.

He told me that they have grown the business through referrals and they usually end up keeping clients for a very long time (basically, until they pass away).

He is a very big proponent of the HD plans.

Thanks. I looked at the Medicare Nationwide website here:

https://medicarenationwide.com/omaha-in ... ny-review/
https://medicarenationwide.com/aetna-me ... ny-review/

but there Medicare Nationwide claims that Mutual of Omaha and Aetna both have stable rates (4.5 stars out of 5).
So I don't think I can trust Medicare Nationwide.
They might be just saying that to sell policies.
It would be nice if someone could prove it.


I found this interesting YouTube Video where an Agent explains to other Agents the best insurance companies.

https://www.youtube.com/watch?v=19QrmR7YUaA

He agreed with you that both Mutual of Omaha and Aetna are known for bigger rate increases.
So I would trust him more.

He likes United HealthCare the best.
He claims they have steady rate increases.
He also said UHC doesn't play games with offerings policies under different company affiliate names.
(I mean like offering a plan as Mutual of Omaha and then closing the plan to new people and then offering a new plan as Omaha Insurance etc, Omaha this, Omaha that, etc).


I also looked into CSGActuarial.com, but they seem to only provide a recent rate history update.

https://www.csgactuarial.com/software/m ... r/pricing/

If any Bogleheads have experience using a CSGActuarial.com subscription or some other way to get long-term Medigap rate history, please share your insights. SERFF.com doesn't have rate history data in my State for companies I am looking at.

I know that rate history is very complicated. I realize you can never know the reasons why rates went up for a company's plan X in a specific county. But there must be some way to see which companies tend to raise rates more than others in a region for a plan. I just want to avoid those that tend to raise rates the most.

If that's not available, then I'm stuck with having to just pick a plan that is least likely to attract people with high medical claims. Like plan N.

[InMyDreams]

OP, like me, you are in a state that does not allow you to move to another MediGap without underwriting. So, IMO, the choice I made is the one that I will live with barring regulatory or legislative changes.

I chose NOT to go with attained age. Nonetheless, UHC's "discounted" community-rating pricing seems very similar to attained age.

In my zip, there were only two companies offering community-rating or issue-age-rating in Plan G. My parents had used the company offering issue-age. Having dealt with that company on their behalf, I was not willing to go with that company. I was left with one company.

I also chose Plan G over G-HD because I want simplicity. While I can now handle a system of small bills that are the bits and pieces left over from the Medicare billing while working my way thru the high deductible, what about in 10 or 20 years or more? Simplicity is good, so I went with Plan G.

I think you'll do fine. You've done a lot of work.

[Wolfpacker]

To: Original Poster

I just read through this whole thread. Very interesting information from all posters. Impressive analysis by OP (but paralysis by analysis?)
I went with HD with Mutual of Omaha (Omaha Insurance Co. is their Medigap Div.). Glad I did. No regrets.
Pricing is fair and top quality company -- and A+ rated by A.M. Best

OP: Please post and let us know what your decision was.

[cashmoney]

I am in the same boat and have been agonizing over whether I should go with G or G-HD.

Regarding the insurance provider my impression and stated above is that with Medigap the insurance co has no decisions to make. Unlike Medicare Advantage where the company is managing the “care” all the Medigap providers have to do is pay out the plan contracted amount (between the insured) to the health care provider. That remaining amount is dictated by the Medicare approved rates for the procedure. With Medicare Advantage the insurance company runs the insured’s healthcare dictating who, what and where one can go and pull those delay, deny and other well known stunts to avoid paying.

Based on the above I think that most of the reviews of the insurance companies likely come from Medicare Advantage customers who do suffer the indignities of bad behaviors by the insurance companies.

One of the underhanded things I have run into with getting on-line gap quotes is that when I review the plan documentation it appears that I am being quoted a “modified” version of the plan g’s. Both Humana and BCBS have two categories that are basically termed standard and preferred. Buried and I mean buried is the definition that preferred means only going with preferred BCBS Medicare providers in my state. I haven’t confirmed the Humana definition but I’m pretty sure that they are playing the same game. The lowest price plan is their preferred option and that’s what is presented on-line. If I wanted to stick to their plan providers and only get care in SC I wouldn’t be paying for a gap plan! I caution those who are looking at the plans to read the gory details. I’ve enclosed the Humana booklet for SC with the rate tables for these two categories plus the rates vs age attainment if interested for comparison. https://www.humana-medicare.com/Benefit ... -1_122.pdf

I have also learned that some providers have perks. If I am correct in reading the Humana documentation Medigappers will get the silver sneakers benefit (free health club membership), 24 hour tele nurse, discounted vision and dental if go to one of their providers and some other stuff. The other choices available to me don’t have these. I do have to confirm if these are connected to both the standard and preferred versions though.

On drugs I am considering not getting a plan. I do take meds but I have discovered that I can get my drugs rather cheaply directly from pharmacies without using my gold standard insurance coverage I have now. GoodRx is also a resource for getting the best price on drugs. For example, under my current plan I pay $21 for 90 day supply but I pay half that from a pharmacy. In addition I will post separately an article I found here that spelled out the drug situation extremely well.

The article explains the penalty for not signing up for drugs. It is not a big surcharge. The insurance companies scare us into believing it will be a major cost.

I don't believe they are hiding anything it is just very confusing .The Humana Preferred or Standard has to with underwriting.Preferred rates are for non smokers who can answer all health questions no.Standard is for smokers or for those who can't answer No all the questions .Everyone with a guarantee issue ( turning 65 etc) will get Preferred rate unless they are a smoker.The BCBS has a Standard Medicare Supplement and Select medicare supplement as do many other medigap carriers.A Standard Medicare Supplement( not to be confused with Standardized )has no network whereas a Select medicare supplement will have a hospital network.The Select will have a lower premium and stipulate that you must use network hospitals unless it is an emergency.Goodrx is great for generics but is not going help you with the brand names that can be very expensive and sometimes there is no alternative.

I see you are in SC.You may want to look at the new plans AARP/UHC is rolling out in some states including SC that carve out some wellness benefits like gym membership but have lower premiums and bigger household discounts.Looks like the AARP UHICA (united health care insurance company of america) plan N is about 20% lower premium than the legacy AARP UHC plans .

disclaimer licensed agent.

[Supergrover]

To: Original Poster

I just read through this whole thread. Very interesting information from all posters. Impressive analysis by OP (but paralysis by analysis?)

OP: Please post and let us know what your decision was.

I agree, This IS a very informative thread. Wow!

[Katietsu]

On drugs I am considering not getting a plan. I do take meds but I have discovered that I can get my drugs rather cheaply directly from pharmacies without using my gold standard insurance coverage I have now. GoodRx is also a resource for getting the best price on drugs. For example, under my current plan I pay $21 for 90 day supply but I pay half that from a pharmacy. In addition I will post separately an article I found here that spelled out the drug situation extremely well.

The article explains the penalty for not signing up for drugs. It is not a big surcharge. The insurance companies scare us into believing it will be a major cost.

The article failed miserably to address the reason one gets insurance, coverage for an unexpected event. My seemingly very healthy in law for instance, was diagnosed with a blood disorder at 65. The medication was $12,000 a month. Would your plan be to hope you can hold out until January?

That article also states that choosing a drug plan before you know what drug you need is basically useless because the plans all have their own formularies. While drug plans can choose which drugs to cover, they can not choose which diseases to cover. So it is a bit disingenuous to imply that a Part D plan will not cover drug treatment for your newly diagnosed heart disease or whatever other condition you might develop. You just might need to use company A’s drug instead of company B’s.

Instead of no plan, get the cheapest Plan D. I do not worry about insurance for $10 a month drugs, worry about the drugs that are 100 times or more that price.

[bradinsky]

On drugs I am considering not getting a plan. I do take meds but I have discovered that I can get my drugs rather cheaply directly from pharmacies without using my gold standard insurance coverage I have now. GoodRx is also a resource for getting the best price on drugs. For example, under my current plan I pay $21 for 90 day supply but I pay half that from a pharmacy. In addition I will post separately an article I found here that spelled out the drug situation extremely well.

The article explains the penalty for not signing up for drugs. It is not a big surcharge. The insurance companies scare us into believing it will be a major cost.

The article failed miserably to address the reason one gets insurance, coverage for an unexpected event. My seemingly very healthy in law for instance, was diagnosed with a blood disorder at 65. The medication was $12,000 a month. Would your plan be to hope you can hold out until January?

That article also states that choosing a drug plan before you know what drug you need is basically useless because the plans all have their own formularies. While drug plans can choose which drugs to cover, they can not choose which diseases to cover. So it is a bit disingenuous to imply that a Part D plan will not cover drug treatment for your newly diagnosed heart disease or whatever other condition you might develop. You just might need to use company A’s drug instead of company B’s.

Instead of no plan, get the cheapest Plan D. I do not worry about insurance for $10 a month drugs, worry about the drugs that are 100 times or more that price.

+1 Our daughter has been an infusion RN for 15 years. Stories of $25K per month chemo shots are frightening!

[ModifiedDuration]

+1 Our daughter has been an infusion RN for 15 years. Stories of $25K per month chemo shots are frightening!

The service that your daughter is providing would be covered under Medicare Part B (physicians and outpatient services) of Traditional Medicare.

Someone who has Traditional Medicare would be responsible for 20% of the Medicare-approved cost of this treatment, which could be a very substantial amount.

The high cost of chemotherapy is one of the key reasons to get a Medicare Supplement (Medigap) plan.

[reddison]

To the OP:

You have done an incredible job of researching the options. Forgive me if this has been stated because I didn't read thru everything as carefully as I could have. I am also a do it yourselfer and am in the process of signing up for the first time. I just scheduled an appointment with a Medicare specialist adviser who was recommended to me by two different, unrelated people. She has worked in this area for over 20 years and is very familiar with all of the ins and outs you are describing. In our phone conversation she mentioned that she knows which carriers most people choose, and the pattern of rate increases for the various carriers over time, etc. Each September before open enrollment you provide her company with your particular list of prescriptions and they check them with all of the Part D providers to see who has the best coverage, as it changes over time. There is no fee for her services as they are compensated by the insurance companies. While I have researched it all to a far lesser degree than you have, I think it makes sense to go to someone in your area who specializes in this. Just my two cents worth...

[InMyDreams]

+1 Our daughter has been an infusion RN for 15 years. Stories of $25K per month chemo shots are frightening!

Only $25k? Maybe, per type of chemo, after MCare makes its reduction to contractual price.

I would hang two or three brand name drugs in a treatment, plus any drugs to pre-treat against side effects. Repeat every three or four weeks, depending on regimen. One drug was 6-digits per dose cost, tho it was only given twice.

Yes, those drugs were covered under Part B.

There are oral chemo drugs that are brand name and quite expensive. I believe they are covered under MCare Part D.

My MCare Part D coverage is $6.90 per month. Keeps my foot in the door at a reasonable cost, while giving me a resemblance of protection from unexpected crazy drug costs.

[Agent 99]

On drugs I am considering not getting a plan. I do take meds but I have discovered that I can get my drugs rather cheaply directly from pharmacies without using my gold standard insurance coverage I have now. GoodRx is also a resource for getting the best price on drugs. For example, under my current plan I pay $21 for 90 day supply but I pay half that from a pharmacy. In addition I will post separately an article I found here that spelled out the drug situation extremely well.

The article explains the penalty for not signing up for drugs. It is not a big surcharge. The insurance companies scare us into believing it will be a major cost.

The article failed miserably to address the reason one gets insurance, coverage for an unexpected event. My seemingly very healthy in law for instance, was diagnosed with a blood disorder at 65. The medication was $12,000 a month. Would your plan be to hope you can hold out until January?

That article also states that choosing a drug plan before you know what drug you need is basically useless because the plans all have their own formularies. While drug plans can choose which drugs to cover, they can not choose which diseases to cover. So it is a bit disingenuous to imply that a Part D plan will not cover drug treatment for your newly diagnosed heart disease or whatever other condition you might develop. You just might need to use company A’s drug instead of company B’s.

Instead of no plan, get the cheapest Plan D. I do not worry about insurance for $10 a month drugs, worry about the drugs that are 100 times or more that price.

After many more days of analyzing the options I will do just what you recommended in your last sentence. I will go with the cheapest Plan D for now. Thanks for the advice

[Agent 99]

I am in the same boat and have been agonizing over whether I should go with G or G-HD.

Regarding the insurance provider my impression and stated above is that with Medigap the insurance co has no decisions to make. Unlike Medicare Advantage where the company is managing the “care” all the Medigap providers have to do is pay out the plan contracted amount (between the insured) to the health care provider. That remaining amount is dictated by the Medicare approved rates for the procedure. With Medicare Advantage the insurance company runs the insured’s healthcare dictating who, what and where one can go and pull those delay, deny and other well known stunts to avoid paying.

Based on the above I think that most of the reviews of the insurance companies likely come from Medicare Advantage customers who do suffer the indignities of bad behaviors by the insurance companies.

One of the underhanded things I have run into with getting on-line gap quotes is that when I review the plan documentation it appears that I am being quoted a “modified” version of the plan g’s. Both Humana and BCBS have two categories that are basically termed standard and preferred. Buried and I mean buried is the definition that preferred means only going with preferred BCBS Medicare providers in my state. I haven’t confirmed the Humana definition but I’m pretty sure that they are playing the same game. The lowest price plan is their preferred option and that’s what is presented on-line. If I wanted to stick to their plan providers and only get care in SC I wouldn’t be paying for a gap plan! I caution those who are looking at the plans to read the gory details. I’ve enclosed the Humana booklet for SC with the rate tables for these two categories plus the rates vs age attainment if interested for comparison. https://www.humana-medicare.com/Benefit ... -1_122.pdf

I have also learned that some providers have perks. If I am correct in reading the Humana documentation Medigappers will get the silver sneakers benefit (free health club membership), 24 hour tele nurse, discounted vision and dental if go to one of their providers and some other stuff. The other choices available to me don’t have these. I do have to confirm if these are connected to both the standard and preferred versions though.

On drugs I am considering not getting a plan. I do take meds but I have discovered that I can get my drugs rather cheaply directly from pharmacies without using my gold standard insurance coverage I have now. GoodRx is also a resource for getting the best price on drugs. For example, under my current plan I pay $21 for 90 day supply but I pay half that from a pharmacy. In addition I will post separately an article I found here that spelled out the drug situation extremely well.

The article explains the penalty for not signing up for drugs. It is not a big surcharge. The insurance companies scare us into believing it will be a major cost.

I don't believe they are hiding anything it is just very confusing .The Humana Preferred or Standard has to with underwriting.Preferred rates are for non smokers who can answer all health questions no.Standard is for smokers or for those who can't answer No all the questions .Everyone with a guarantee issue ( turning 65 etc) will get Preferred rate unless they are a smoker.The BCBS has a Standard Medicare Supplement and Select medicare supplement as do many other medigap carriers.A Standard Medicare Supplement( not to be confused with Standardized )has no network whereas a Select medicare supplement will have a hospital network.The Select will have a lower premium and stipulate that you must use network hospitals unless it is an emergency.Goodrx is great for generics but is not going help you with the brand names that can be very expensive and sometimes there is no alternative.

I see you are in SC.You may want to look at the new plans AARP/UHC is rolling out in some states including SC that carve out some wellness benefits like gym membership but have lower premiums and bigger household discounts.Looks like the AARP UHICA (united health care insurance company of america) plan N is about 20% lower premium than the legacy AARP UHC plans .

disclaimer licensed agent.

So I spent time comparing GoodRx prices against the prices of the companies GoodRx provides discounts for. GoodRX offers a Costco discount but the drug price that Costco charges without GoodRx is less. It wasn’t an across the board pattern with other pharmacies but that was an eye opener.

I posted elsewhere that the BCBS quote includes a “new to medicare” discount that is quite substantial ($20) for plan G. It is guaranteed for a year. After the year the premium goes up by $20 in addition to the other annual increases. Their plan info did not mention this in a way that I believe it should have considering the large increase in year 2. Unfortunately I don’t qualify for household discount - my senior dog doesn’t count! The “new to medicare” discount would sway me to sign up without further research if I didn’t realize that it was temporary.

OP has educated me about the necessity to go deep into my research because over time the rates do skyrocket for some companies. The agents I have spoken to are surprised about how much of the nitty gritty I ask them about. I mentioned bogleheads. I’m not sure if in the long run going through this morass will matter but one thing is for sure - the process should not be this difficult.

[MrRE]

To: Original Poster

I just read through this whole thread. Very interesting information from all posters. Impressive analysis by OP (but paralysis by analysis?)
I went with HD with Mutual of Omaha (Omaha Insurance Co. is their Medigap Div.). Glad I did. No regrets.
Pricing is fair and top quality company -- and A+ rated by A.M. Best

OP: Please post and let us know what your decision was.

I am still gathering data to make my decision.


I have time and I'm in no rush although I'd rather get it over with this month.


I am still in my "One-time only Initial Medigap Open Enrollment Period" of 6 months after my Medicare Part B became effective.


Right now, I'm gathering the data I need to make an evidence-based decision, rather than just pick the lowest price company or pick a company with a name-brand.


I realize I can change companies any time as long as I'm healthy.

I also realize some people just pick the lowest price company that has a flat rate structure for the first few years and also a recent history of no price increases.

Then after they get the policy, if the rates go up and they have been healthy enough, then they can pass the underwriting questions and get a lower price policy somewhere else.

Then they repeat the process if the rates go up too high.

The underwriting questions are not that hard to pass for most companies.


I might use that strategy of just go with the lowest price company now and then switch companies later if prices go up to high to fast.

That is the simplest approach.


It has some risks like... if I were to have sudden health problems that would make me not pass underwriting questions for a new policy company.

Then I would be stuck with the company.




But I'd rather just find a reliable company to stick with long-term that has a low rate increase history for a G-HD plan in my state (NJ).


The tricky part about finding such a company is that...

Plan G-HD is relatively new so there isn't much rate history.

Also there are only just a few large stable companies offering G-HD policies in NJ.

Also only a few have a lot of policy holders in NJ too.

So it limits my choices to some companies that I don't like otherwise.


I'd like to pick a company that has a large number of policy holders in my state.

That way I'm more likely to get into a large "pool" of policy holders and the rates are less likely to go up due to a few policy holders suddenly having huge claims.


So if a company has a very low count of policy-holders in my state for all plans per NAIC.org data, then I probably will avoid that company.

Although there could be exceptions.


It's complicated and there's a lot of uncertainty involved and the situation will be constantly changing.



Most people can't handle the complexity of getting available data, piecing it together, and making rational trade-offs in decisions.

So instead, they just make a somewhat arbitrary decision and hope for the best.


I however like learning about all this and doing the homework because it has a long term impact.


So I want to play the game as smart as I can, even though it's a tough game to play.



Right now I'm learning where to get data from and the key simple things to make a decision.


I just got a trial-subscription at CSGactuarial.com and found they have some rate history data (going back just several years typically). Yay!

Thanks ModifiedDuration! who said....

If you want to spend some money, you can sign-up for CSG Actuarial’s tool, which insurance agents use. The Silver Plan might give you some of the historical pricing information you are looking for. I have not used it, but have heard of some people who used it and found it to be helpful and, if I remember correctly, were able to sign-up for just a month for $30. As the G-HD policies have only existed a few years, you could use F-HD as a proxy for historical price increases by the various companies

csgacturial.com also has a good way to make comparison reports for 5 companies at a time that shows all of the key considerations:

- rates
- rate change history for past few years
- discounts offered
- company ratings
- loss ratios for the State (all their policies)
- policy member-count for the State (all their plans)
- market share ratios (in total all their plans)
- etc.



csgactuarial.com also has the nice feature that if you run just 1 quote for 1 plan, then you can click an export button and get an .XLSX file with tabs for all plans.

That's very convenient. But it doesn't show rates for all ages. Just rates for 5 ages in a quote.

So I found I could run just 5 quotes and get rates for all plans and 5 ages, all at one time
(65-69, 70-74, 75-79, 80-84, 85-89).

That takes just a few minutes!


Then if I am interested in a company, I could plot it's rate structures like I show above.

The plots above I made from OOC files (Outline Of Coverage). But OOC files can be very hard to get even if you contact an agent.


So I see now that I can very quickly get a lot of basic data that I need to compare companies with the best data available.



And what is really cool is that, often just one thing stands out that would make me eliminate a company.


So the data is helpful and can be very easy to use if you know what to look for quickly.



It's going to be a tough choice because my State have so few companies offering Plan G-HD


I eliminated these companies offering G-HD that have too small a number of policy holders in my State:


- Amerihealth NJ
- Banker's Fidelity
- Federal Life
- Philadelphia American
- United American
- United States Fire


I eliminated these companies offering G-HD because they don't even offer a quote anymore at their toll free number or website listed by Medicare.gov:


- Humana (Achieve)
- Humana (Value)

- Colonial Penn is now offering policies though Bankers Fidelity.

But Colonial Penn had very very large rate increases so I'd rather avoid them.

That's too bad, because they are one of the few big companies offering G-HD policies in my State and have a large market share.


The only top share market share companies in my State offering G-HD are only:

- Colonial Penn
- Omaha Ins. Co.


All of the other companies have a tiny market share in the State.


So I have to assume they have a tiny amount of G-HD policy holders.

And that means the chances are higher that their rates could rise if a small number of policy holders have big medical problems.

Then I would have to move to a different company if I can.

So, I might pick Omaha Ins. Co. because of their market share and low rates as a compromise.
Then if Omaha raises rates very high, I can later switch to a better alternative.

Overall I'm not too worried with any G-HD company because their rate curves are so competitive compared to Plan G, as shown in the 2 plots below that I quickly overlaid into one.



Please forgive any typos above. I'm mainly thinking things through while typing. Edit correction: NAIC.org

[tj]

Why does the low market share in the state matter so much?

[Zanmar]

MrRE

Thanks for your informative posts.

Mom is age 86 and her Part G Omaha HD was $87.77 per month in 2021. Its $81.63 in 2022
2021 was the first year for a Plan G for her.
Underwriting questions were straight forward with her having no health issues.

I am 65 and Omaha HD is $55.26 per month.

[MrRE]

Why does the low market share in the state matter so much?

Good question.

Because of HOW my state's Medigap market is TOTALLY DOMINATED by just a FEW companies who are not offering G-HD

per NAIC.org in their latest data report called...

NATIONAL ASSOCIATION OF INSURANCE COMMISSIONERS MEDICARE SUPPLEMENT LOSS RATIOS REPORT.


That report shows how most of the OTHER companies that do offer G-HD have such a TINY TINY market share.


That means a G-HD plan in those companies with a just a TINY market share probably have just HUNDREDS of policy holders in my state, not thousands and thousands.


One reason my state has this situation is that G-HD isn't very popular here it seems.


So in my state, I need to assume it's best to avoid the small market share companies or I'll get put in a riskier small pool of policy holders.


That leaves just the 2 big market share holders that I mentioned:

- Colonial Penn
- Omaha Ins. Co.


So if I want to pick a company plan that probably has a safer, bigger pool of G-HD policy holders,

then it seems I need to pick either Colonial Penn or Omaha Ins. Co.

That's the logic that experts on the web have been saying is important in this situation.


It all boils down to probability and dispersion.


Here is a technical explanation I found at

https://thismatter.com/money/insurance/ ... umbers.htm

"Underwriting Risk and Insurance Premiums

When an insurance company increases the size of its customer base, it increases its underwriting risk because the sample size is greater, and, therefore, there is a greater chance of loss.

But the company also collects more premiums to finance those losses.


In fact, premiums grow faster than the underwriting risk, because the underwriting risk = the square root of n times the standard deviation for the population, and, thus, increases by the square root of the sample size, n, but the premiums grow by n.

Underwriting Risk = n × σs = n × σp/√n = √n × σp


Premiums Collected = n × Amount of Premium

See the website for more technical insights.


If anyone sees any flaw in this logic, please let me know and please explain.

Edit correction: NAIC.org

[tj]

Why does the low market share in the state matter so much?

Good question.

Because of HOW my state's Medigap market is TOTALLY DOMINATED by just a FEW companies who are not offering G-HD

per NAIC.com in their latest data report called...

NATIONAL ASSOCIATION OF INSURANCE COMMISSIONERS MEDICARE SUPPLEMENT LOSS RATIOS REPORT.


That report shows how most of the OTHER companies that do offer G-HD have such a TINY TINY market share.


That means a G-HD plan in those companies with a just a TINY market share probably have just HUNDREDS of policy holders in my state, not thousands and thousands.


One reason my state has this situation is that G-HD isn't very popular here it seems.


So in my state, I need to assume it's best to avoid the small market share companies or I'll get put in a riskier small pool of policy holders.


That leaves just the 2 big market share holders that I mentioned:

- Colonial Penn
- Omaha Ins. Co.


So if I want to pick a company plan that probably has a safer, bigger pool of G-HD policy holders,

then it seems I need to pick either Colonial Penn or Omaha Ins. Co.

That's the logic that experts on the web have been saying is important in this situation.


It all boils down to probability and dispersion.


Here is a technical explanation I found at

https://thismatter.com/money/insurance/ ... umbers.htm

"Underwriting Risk and Insurance Premiums

When an insurance company increases the size of its customer base, it increases its underwriting risk because the sample size is greater, and, therefore, there is a greater chance of loss.

But the company also collects more premiums to finance those losses.


In fact, premiums grow faster than the underwriting risk, because the underwriting risk = the square root of n times the standard deviation for the population, and, thus, increases by the square root of the sample size, n, but the premiums grow by n.

Underwriting Risk = n × σs = n × σp/√n = √n × σp


Premiums Collected = n × Amount of Premium

See the website for more technical insights.


If anyone sees any flaw in this logic, please let me know and please explain.

What if the small market share companies actually attract the more informed consumers and the large market share companies just have larger marketing budgets? I don't think it's necessarily true that the smaller market share companies have an unhealthier pool.

[MrRE]

MrRE

Thanks for your informative posts.

Mom is age 86 and her Part G Omaha HD was $87.77 per month in 2021. Its $81.63 in 2022
2021 was the first year for a Plan G for her.
Underwriting questions were straight forward with her having no health issues.

I am 65 and Omaha HD is $55.26 per month.

Thank you for your kind feedback.

Also thank you for your personal insights.

I just compared your numbers to the data I had from csgacturial.com.

I can see that you are getting the house hold discounted rate.

That's great.


I probably will go with Omaha G-HD too.

It seems like Omaha is my only choice after eliminating all others as explained above.


If anyone else has experience with Omaha Ins. Co. please share it here! Thanks!

-

[peetsperk]

Contact your state's SHIP office. My local office provided me with an up-to-date computer printout (almost 100 pages) of rate and financial ranking. Pick 4 or 5 of the top 1/3, give them each a call. I did this and immediately eliminated 3 because I couldn't understand their broken English call center reps. In the end, your talking about what, maybe a difference of 10K to 20K total lifetime difference in total premium payout. Certainly not pocket change, but I've made much costlier mistakes in my investment journey. Best of luck.

It is actually your state's SHIIP (Senior Health Insurance Information Program). You can schedule one-on-one meeting with an expert in your area. I'm scheduled to meet with them on Tuesday.

[MrRE]

Why does the low market share in the state matter so much?

Good question.

Because of HOW my state's Medigap market is TOTALLY DOMINATED by just a FEW companies who are not offering G-HD

per NAIC.org in their latest data report called...

NATIONAL ASSOCIATION OF INSURANCE COMMISSIONERS MEDICARE SUPPLEMENT LOSS RATIOS REPORT.


That report shows how most of the OTHER companies that do offer G-HD have such a TINY TINY market share.


That means a G-HD plan in those companies with a just a TINY market share probably have just HUNDREDS of policy holders in my state, not thousands and thousands.


One reason my state has this situation is that G-HD isn't very popular here it seems.


So in my state, I need to assume it's best to avoid the small market share companies or I'll get put in a riskier small pool of policy holders.


That leaves just the 2 big market share holders that I mentioned:

- Colonial Penn
- Omaha Ins. Co.


So if I want to pick a company plan that probably has a safer, bigger pool of G-HD policy holders,

then it seems I need to pick either Colonial Penn or Omaha Ins. Co.

That's the logic that experts on the web have been saying is important in this situation.


It all boils down to probability and dispersion.


Here is a technical explanation I found at

https://thismatter.com/money/insurance/ ... umbers.htm

"Underwriting Risk and Insurance Premiums

When an insurance company increases the size of its customer base, it increases its underwriting risk because the sample size is greater, and, therefore, there is a greater chance of loss.

But the company also collects more premiums to finance those losses.


In fact, premiums grow faster than the underwriting risk, because the underwriting risk = the square root of n times the standard deviation for the population, and, thus, increases by the square root of the sample size, n, but the premiums grow by n.

Underwriting Risk = n × σs = n × σp/√n = √n × σp


Premiums Collected = n × Amount of Premium

See the website for more technical insights.


If anyone sees any flaw in this logic, please let me know and please explain.

What if the small market share companies actually attract the more informed consumers and the large market share companies just have larger marketing budgets? I don't think it's necessarily true that the smaller market share companies have an unhealthier pool.

Thanks. Those are totally different issues that are valid to me to and I've been thinking about that already. But I can't use them in my decision making.

Also, they don't override the main fundamental point that small pools are riskier due to the math.
That is the key point I can use for my decision making.


I'm just trying to base my decision on what I can know is more likely with reasonable certainty.


I can guarantee to you that a company that has a tiny total Medigap market share can have a G-HD policy pool no larger than its total market share number.

So for me, it's safer go with a company that has a larger Medigap policy market share. Then it is more likely I will pick a company that COULD have a larger pool of G-HD policy holders. It's not guaranteed. But it's more likely given the lack of other data.

Of course if the company with the larger market share is charging an outrageous rate for G-HD or just entered the market very recently, then I would use those facts in my assessment of the situation of who to pick and who to rule out.

But for the case of all things being roughly equal, I would pick the larger-market share Medigap company to reduce rate-increase risk.

Edit correction: NAIC.org

[MrRE]

Why does the low market share in the state matter so much?

Good question.

Because of HOW my state's Medigap market is TOTALLY DOMINATED by just a FEW companies who are not offering G-HD

per NAIC.org in their latest data report called...

NATIONAL ASSOCIATION OF INSURANCE COMMISSIONERS MEDICARE SUPPLEMENT LOSS RATIOS REPORT.


That report shows how most of the OTHER companies that do offer G-HD have such a TINY TINY market share.


That means a G-HD plan in those companies with a just a TINY market share probably have just HUNDREDS of policy holders in my state, not thousands and thousands.


One reason my state has this situation is that G-HD isn't very popular here it seems.


So in my state, I need to assume it's best to avoid the small market share companies or I'll get put in a riskier small pool of policy holders.


That leaves just the 2 big market share holders that I mentioned:

- Colonial Penn
- Omaha Ins. Co.


So if I want to pick a company plan that probably has a safer, bigger pool of G-HD policy holders,

then it seems I need to pick either Colonial Penn or Omaha Ins. Co.

That's the logic that experts on the web have been saying is important in this situation.


It all boils down to probability and dispersion.


Here is a technical explanation I found at

https://thismatter.com/money/insurance/ ... umbers.htm

"Underwriting Risk and Insurance Premiums

When an insurance company increases the size of its customer base, it increases its underwriting risk because the sample size is greater, and, therefore, there is a greater chance of loss.

But the company also collects more premiums to finance those losses.


In fact, premiums grow faster than the underwriting risk, because the underwriting risk = the square root of n times the standard deviation for the population, and, thus, increases by the square root of the sample size, n, but the premiums grow by n.

Underwriting Risk = n × σs = n × σp/√n = √n × σp


Premiums Collected = n × Amount of Premium

See the website for more technical insights.


If anyone sees any flaw in this logic, please let me know and please explain.

What if the small market share companies actually attract the more informed consumers and the large market share companies just have larger marketing budgets? I don't think it's necessarily true that the smaller market share companies have an unhealthier pool.

Thanks. Those are totally different issues that are valid to me to and I've been thinking about that already. But I can't use them in my decision making.

Also, they don't override the main fundamental point that small pools are riskier due to the math.
That is the key point I can use for my decision making.


I'm just trying to base my decision on what I can know is more likely with reasonable certainty.


I can guarantee to you that a company that has a tiny total Medigap market share can have a G-HD policy pool no larger than its total market share number.

So for me, it's safer go with a company that has a larger Medigap policy market share. Then it is more likely I will pick a company that COULD have a larger pool of G-HD policy holders. It's not guaranteed. But it's more likely given the lack of other data.

Of course if the company with the larger market share is charging an outrageous rate for G-HD or just entered the market very recently, then I would use those facts in my assessment of the situation of who to pick and who to rule out.

But for the case of all things being roughly equal, I would pick the larger-market share Medigap company to reduce rate-increase risk.

Edit correction: NAIC.org

[ModifiedDuration]

Contact your state's SHIP office. My local office provided me with an up-to-date computer printout (almost 100 pages) of rate and financial ranking. Pick 4 or 5 of the top 1/3, give them each a call. I did this and immediately eliminated 3 because I couldn't understand their broken English call center reps. In the end, your talking about what, maybe a difference of 10K to 20K total lifetime difference in total premium payout. Certainly not pocket change, but I've made much costlier mistakes in my investment journey. Best of luck.

It is actually your state's SHIIP (Senior Health Insurance Information Program). You can schedule one-on-one meeting with an expert in your area. I'm scheduled to meet with them on Tuesday.

SHIP is actually the State Health Insurance Assistance Program. You can find the contact information for your state here under “Find Your Local SHIP” on the lower right:

https://www.shiphelp.org/

[MrRE]

Contact your state's SHIP office. My local office provided me with an up-to-date computer printout (almost 100 pages) of rate and financial ranking. Pick 4 or 5 of the top 1/3, give them each a call. I did this and immediately eliminated 3 because I couldn't understand their broken English call center reps. In the end, your talking about what, maybe a difference of 10K to 20K total lifetime difference in total premium payout. Certainly not pocket change, but I've made much costlier mistakes in my investment journey. Best of luck.

It is actually your state's SHIIP (Senior Health Insurance Information Program). You can schedule one-on-one meeting with an expert in your area. I'm scheduled to meet with them on Tuesday.

SHIP is actually the State Health Insurance Assistance Program. You can find the contact information for your state here under “Find Your Local SHIP” on the lower right:

https://www.shiphelp.org/

-


Actually, for some reason, in North Carolina, Arkansas, Iowa, and Louisiana
they call it SHIIP
instead of SHIP.
Go figure!

Also in Ohio they call it OSHIIP!


SHIIP = Seniorsʼ Health Insurance Information Program


And in some states, SHIP is Senior Health Insurance Program (SHIP)

like Illinois.



https://www2.illinois.gov/aging/ship/Pages/default.aspx







I noticed that a while back when I saw some people on the web were calling it SHIIP and others SHIP.

So I searched the SHIP site and noticed some SHIIP exceptions here:

https://www.shiphelp.org/search?query=shiip


https://www.shiphelp.org/about-medicare ... h-carolina




https://www.shiphelp.org/about-medicare ... n/arkansas




https://www.shiphelp.org/about-medicare ... ation/iowa

[


https://www.shiphelp.org/about-medicare ... /louisiana





https://www.shiphelp.org/about-medicare ... ation/ohio




So in Ohio, if you have problems with Medicare, remember to say OSHIIP !

-