changing G plan to N supplement plan?

[rb5505]

hello all. a little background: i recently got the physicians mutual g plan at $172/mo because of their unlimited preventive care rider. but i’ve found that the rider is of little to no value to me compared to other G or N supplement plans coverage. my initial enrollment period where i can change my plan w/o health questions, ends 12/31. after that i would most likely never get approved to make a change, due to health issues. this is why i’m still looking for the best supplement plan fit. i’m currently leaning heavily toward a united healthcare (uhc) N supplement plan. please offer your opinions of why below. thank you.

united healthcare g & n plan costs?
uhc costs $132 for g & $89 for n plan. the g to n $43/mo savings way outweighs the possible $20/visit co-pays for doc visits & emergency room visits. and it’s $83/mo less then my current phy mut g to uhc n. that would easily cover copays each year.

uhc has a much larger pool of customers absorbing costs for lower premium increases. (2.1% average premium increase over the past 10 years for uhc & 10% for phy mut).

any opinions of uhc’s declining discount on their premiums?

there’s a more ill pool of people in a G plan then an N plan, causing greater premium increases. i’ve read lots about G plans going up much faster now, especially more then an n plan.

i’ve heard often that excess charges are rare. i’ve found that all of my doctors are in this approved group.
“Most health care providers have made an agreement with Medicare to accept the Medicare-approved amount for services, which means they can’t bill you for excess charges.”
https://www.medicare.gov/care-compare/...

[gips]

- have you considered g hi deductible? in my state g-hi provides an opportunity to save money and if I end up having a lot of expenses, it’s still less than plan g.
- typical advice is to choose the least expensive provider within a plan. are there less expensive choices in your zip for plan g or n?
- you may want to check if you live in a state which allows changing plans without underwriting

best,

[rb5505]

our states N price of $89/mo is well under the usa average of $111 for an N plan. i’m pretty sure i’d spend less overall with N over a high ded G, mainly because i’d be very likely to hit the $2700/yr deductible too often. thank you for your suggestions.

https://www.google.com/url?sa=t&rct=j&q ... i=89978449

[Tom_T]

[Thread merged into here --admin LadyGeek]

I'm looking at Medigap policies, and originally I was pretty much set on G, but now I'm wondering if N also works. The difference in price, for the provider I am looking at, is $42/month. That's $504/year.

N would charge a $20 copay for primary care doctor or specialist. I'd have to have two per month to match the higher G premium.

I know N does not cover excess charges, but my understanding is that most doctors accept the Medicare amount. I've checked all my doctors and facilities, and they're all covered. We live in NJ, highly populated, plenty of providers and hospitals to choose from.

I'm also looking ahead four years when my wife will be enrolled, so we could be looking at an extra $1000+ a year in G premiums over N, with annual increases, of course. That's a lot of money over 20+ years.

Anyone out there who has made a similar decision? I can afford G, but N seems more cost-effective.

[ramsfan]

Not sure what to tell you, my parents are on Plan G, and other than the annual co-pay, they don't lift a finger to pay for their medical needs, which can be substantial depending on the year.

I don't know enough about this "excess charges" thing, but if that wasn't a factor, N seems like a good choice for you all, as even if you racked up a huge amount of co-pays in a year, say 50, your previous year's savings woudl offset.

Last factor, I am on employer insurance, and I hate paying these co-pays everywhere. You have to log in and pay $7.98 to a lab, $13.78 to a PT, etc... drives me nuts...

[LadyGeek]

I merged Tom_T's thread into a similar discussion.

(Thanks to the member who reported the post and provided a link to this thread.)

[Tom_T]

hello all. a little background: i recently got the physicians mutual g plan at $172/mo because of their unlimited preventive care rider. but i’ve found that the rider is of little to no value to me compared to other G or N supplement plans coverage. my initial enrollment period where i can change my plan w/o health questions, ends 12/31. after that i would most likely never get approved to make a change, due to health issues. this is why i’m still looking for the best supplement plan fit. i’m currently leaning heavily toward a united healthcare (uhc) N supplement plan. please offer your opinions of why below. thank you.

united healthcare g & n plan costs?
uhc costs $132 for g & $89 for n plan. the g to n $43/mo savings way outweighs the possible $20/visit co-pays for doc visits & emergency room visits. and it’s $83/mo less then my current phy mut g to uhc n. that would easily cover copays each year.

uhc has a much larger pool of customers absorbing costs for lower premium increases. (2.1% average premium increase over the past 10 years for uhc & 10% for phy mut).

any opinions of uhc’s declining discount on their premiums?

there’s a more ill pool of people in a G plan then an N plan, causing greater premium increases. i’ve read lots about G plans going up much faster now, especially more then an n plan.

i’ve heard often that excess charges are rare. i’ve found that all of my doctors are in this approved group.
“Most health care providers have made an agreement with Medicare to accept the Medicare-approved amount for services, which means they can’t bill you for excess charges.”
https://www.medicare.gov/care-compare/...

I'm looking at the same choices. I'm beginning to think that N is more cost-effective, especially in my area where there are many providers to choose from. I have considered that G price increases might be higher than N. Also, given that my spouse will join me in Medicare in four years, everything in the equation will be times two.

[nonnie]

I have Plan G and really like it, I am a heavy user and get my monies worth. If you don't think you will be able to change in the future, make sure this is the correct plan for you for the rest of your life.

See if the calculator below is of any help to you:
https://www.nerdwallet.com/article/insu ... lan-g-vs-n

[ModifiedDuration]

our states N price of $89/mo is well under the usa average of $111 for an N plan. i’m pretty sure i’d spend less overall with N over a high ded G, mainly because i’d be very likely to hit the $2700/yr deductible too often. thank you for your suggestions.

https://www.google.com/url?sa=t&rct=j&q ... i=89978449

You do understand that the $2,700 “deductible” for a Plan G-HD is a misnomer, the $2,700 is really the maximum out-of-pocket, correct?

If you have Plan G-HD, you’re coverage for Part B is:

$226 annual deductible, then
20% copay (based on low Medicare-reimbursement rates)
$2,700 maximum out-of-pocket

In other words, 80% of the cost of Part B services are covered by Medicare right off the bat if you have a Medigap high-deductible plan.

(Some procedures, like colonoscopy screenings, are covered 100% by Medicare, so you wouldn’t pay anything with a high-deductible plan.)

After the Part B deductible of $226 (which you would have to pay with a regular Plan G anyway) you are only responsible for 20% of the cost until you hit the $2,700 Plan G-HD annual deductible.

For example, when I go to the doctor for an office visit the Medicare-approved reimbursement rate might be $125, so it only costs me $25.

One would have to have over $12,000 in a year in Part B services at the low Medicare-reimbursement rates before they hit the Plan G-HD $2,700 annual deductible.

The only kicker is that if you admitted to the hospital as an in-patient, you will have a $1,600 Part A deductible (which counts toward the $2,700 maximum out-of-pocket).

The $2,700 figure increases with inflation (tied to CPI-U). This is built-in cost sharing and results in HD premiums either having no annual increase or a minimal annual increase. Up until the last few years, the annual increase in the HD deductible limit was not significant.

[Tom_T]

I have Plan G and really like it, I am a heavy user and get my monies worth. If you don't think you will be able to change in the future, make sure this is the correct plan for you for the rest of your life.

See if the calculator below is of any help to you:
https://www.nerdwallet.com/article/insu ... lan-g-vs-n

Apart from copays and excess charges, N and G are identical.

I would have to pay 25 copays a year for N and G to be the same. Even my late mother in her 90s didn't see a doctor twice a month, every month. And, I'm talking about a $500 difference in annual premiums. What will the difference be at 75? $1000? And times two since my wife will also be enrolled.

Also, learning more about excess charges. They are rare, avoidable, and limited to 9.25% above the Medicare-approved amount.

I definitely understand the appeal of G and have not ruled it out, but N seems like a reasonable alternative.

[bertilak]

I had N and switched to G because I was tired of getting nickeled and dimed by those $20 office visits with Plan N. I wanted to switch from N to G.

Once I started keeping track of those I saw that N wasn't saving me as much as I'd originally figured. I also felt a little guilty about adding to the work of my doctors' billing departments.

Anyway, my insurance (Blue Cross Blue Shield) wouldn't let me switch without underwriting, which I would not get through.

A year or so later, I happened to be looking onto Part D with Humana and they told me that if I switched my supplemental Plan N from BCBS to Humana I could, at the same time, switch Plan N to plan G without underwriting. I'm not sure if they made a mistake or bent the rules to get my business, but it worked.

Maybe you could do something similar. At least ask.

[FrugalInvestor]

I think your reasoning is sound. However, I went with Plan G for a couple of reasons and am very happy that I did.

First, almost immediately after going on Medicare with the G plan I had a very serious illness and (fortunately) ended up at a high profile provider that charged excess charges. They were all paid.

Second, when making my original decision I weighted simplicity of administration heavily. I've seen older people struggle with tasks that I'm sure were very straightforward when they were younger. I want taking care of my bills and particularly my medical bills to be as streamlined as possible as I age. I've found through fairly extensive use that Plan G is about as simple as it can get to administer by the patient.

I would definitely make the same choice again but I also understand that the we all weigh the various considerations differently. It's not an easy choice.

[LookinAround]

<snip>
Also, learning more about excess charges. They are rare, avoidable, and limited to 9.25% above the Medicare-approved amount.

I definitely understand the appeal of G and have not ruled it out, but N seems like a reasonable alternative.

I also agree excess charges are rare (I've never seen one, myself) but, from what i've read, the excess charge limit is 15% above the Medicare-approved amount.

[bertilak]

I've found though fairly extensive use that Plan G is about as simple as it can get to administer.

I mentioned $20 above, but it is not the dollar amount that's important, it's the never ending barrage of things to respond to. Dealing with medical bills was getting old. In the Bogle spirit, I wanted to simplify things. Plan N is just a pain to deal with.

[Tom_T]

<snip>
Also, learning more about excess charges. They are rare, avoidable, and limited to 9.25% above the Medicare-approved amount.

I definitely understand the appeal of G and have not ruled it out, but N seems like a reasonable alternative.

I also agree excess charges are rare (I've never seen one, myself) but, from what i've read, the excess charge limit is 15% above the Medicare-approved amount.

Yes, but because the Medicare amount for non-participating providers is actually reduced by 5%, the ultimate charge is 9.25% higher than the "full" Medicare amount.

[Tom_T]

Thanks for the responses - good points made. I definitely haven't made up my mind. I can afford G, so perhaps it is the best long-term choice. I do get a little nervous about premium increases down the road, but there's no avoiding that.

[CWRadio]

Whatever Medigap (supplement) insurance company you pick for your Medigap plan check to see how many "closed block of business." (deadpool) policies the company has.

This is done because the current book of business have people who have become older and therefore have more illnesses meaning more claims. They close that book and raise the rates to cover the increasing losses. Then, they open a new book with younger, healthier folks and charge a lower premium do to lower claims ratios. After a couple of years, rinse and repeat.

In most states you will be unable to change supplement insurance companies without medical underwriting. A few states have a birthday rules that allows you to change Medigap plans without medical underwriting around your birthday.

[Tom_T]

Whatever Medigap (supplement) insurance company you pick for your Medigap plan check to see how many "closed block of business." (deadpool) policies the company has.

This is done because the current book of business have people who have become older and therefore have more illnesses meaning more claims. They close that book and raise the rates to cover the increasing losses. Then, they open a new book with younger, healthier folks and charge a lower premium do to lower claims ratios. After a couple of years, rinse and repeat.

In most states you will be unable to change supplement insurance companies without medical underwriting. A few states have a birthday rules that allows you to change Medigap plans without medical underwriting around your birthday.

Closed block of business... is that data available?

Also, a third party sent me Medigap quotes, and included in the data is the loss ratio both nationally and in-state. What exactly is that?

[LookinAround]

<snip>
Also, learning more about excess charges. They are rare, avoidable, and limited to 9.25% above the Medicare-approved amount.

I definitely understand the appeal of G and have not ruled it out, but N seems like a reasonable alternative.

I also agree excess charges are rare (I've never seen one, myself) but, from what i've read, the excess charge limit is 15% above the Medicare-approved amount.

Yes, but because the Medicare amount for non-participating providers is actually reduced by 5%, the ultimate charge is 9.25% higher than the "full" Medicare amount.

I follow you. Thanks. Now, as to why the heck the government doesn't simply state excess charge is 9.25% over the medicare approved amount, instead of making one dig through the math, is a mystery. Go figure. I guess cause it's the government.

[tj]

I've found though fairly extensive use that Plan G is about as simple as it can get to administer.

I mentioned $20 above, but it is not the dollar amount that's important, it's the never ending barrage of things to respond to. Dealing with medical bills was getting old. In the Bogle spirit, I wanted to simplify things. Plan N is just a pain to deal with.

Would you feel similar about G HD, then?

[Hebell]

For the same reasons that you cited my husband also went with the N plan. We figured laying out the co-pays can't be that difficult. That's a much more straightforward transaction than percentages. Likewise, we were concerned that the premiums would increase more rapidly with the g plan.

[Tom_T]

Re: copays... isn't that what people on private insurance do? You go to the office, they say you owe a copay, you hand them your credit card, and that's it. I don't see what would be unmanageable about that in the future.

I am concerned about premiums because everywhere you look on the Web, the G plan is touted as the most comprehensive choice, and that is going to attract a larger number of sicker people (if they can afford it.) That's the theory, anyway.

[jj45]

A few states have a birthday rules that allows you to change Medigap plans without medical underwriting around your birthday.

Do you know of a website that lists these rules for each state?

[Tom_T]

A few states have a birthday rules that allows you to change Medigap plans without medical underwriting around your birthday.

Do you know of a website that lists these rules for each state?

https://www.medigap.com/faqs/medicare-b ... derwriting.

[CWRadio]

A few states have a birthday rules that allows you to change Medigap plans without medical underwriting around your birthday.

Do you know of a website that lists these rules for each state?

This may help from Giardini Medicare... Paul
https://docs.google.com/document/d/1thR ... xIMzM/edit

[DSBH]

DW and I qualify for Medicare this year and we decided on plan G, thinking that our annual medical expenses basically consist of the premiums and the part B deductible. As we both signed up for AARP/UHC plan G we got a family (and autopay) discount around 10% off the premiums.

[Sage16]

We went with Plan N. We calculated that we would need to pay 26 co-pays a year to break even with the higher premium for G in our state and insurance company. Our doctors and specialist all accept Medicare costs so the risk of the upcharge that G covers was minimal so it came down to co-pays driving the calculation. It would be nice to avoid the co-pays but the cost difference is enough for this Boglehead to go ahead and deal with it.

[tj]

We went with Plan N. We calculated that we would need to pay 26 co-pays a year to break even with the higher premium for G in our state and insurance company. Our doctors and specialist all accept Medicare costs so the risk of the upcharge that G covers was minimal so it came down to co-pays driving the calculation. It would be nice to avoid the co-pays but the cost difference is enough for this Boglehead to go ahead and deal with it.

It sounds like you can save $520 per year in premium, that's surprising, I haven't seen that kind of savings with N vs G here.

[RetiredDBA]

Sage16

My GF fell and tore 3 rotator cuffs.

1 ER co-pay.
1 GP Doctor co-pay to get a surgeon referral.
1 Surgeon co-pay to x-ray shoulder and get opinion.
5 Physical therapy co-pays requested by Surgeon before surgery approved.
1 Back to Surgeon for surgery approval co-pay.
1 Back to GP Doctor to sign-off on surgery co-pay.
1 Surgery day co-pay.
15 After surgery co-pay for 15 physical therapy visits .
1 Back to Surgeon co-pay to check results and approve 15 more physical therapy sessions.
15 more physical therapy sessions with co-pay.
12 co-pays for chiropractor visit.

54 co-pays for one fall. GF not happy she could have been on plan G.

Best of luck and Stay Healthy

[tj]

Sage16

My GF fell and tore 3 rotator cuffs.

1 ER co-pay.
1 GP Doctor co-pay to get a surgeon referral.
1 Surgeon co-pay to x-ray shoulder and get opinion.
5 Physical therapy co-pays requested by Surgeon before surgery approved.
1 Back to Surgeon for surgery approval co-pay.
1 Back to GP Doctor to sign-off on surgery co-pay.
1 Surgery day co-pay.
15 After surgery co-pay for 15 physical therapy visits .
1 Back to Surgeon co-pay to check results and approve 15 more physical therapy sessions.
15 more physical therapy sessions with co-pay.
12 co-pays for chiropractor visit.

54 co-pays for one fall. GF not happy she could have been on plan G.

Best of luck and Stay Healthy

Yuck. Sounds like even G HD would have been better than N in that scenario, if N has no out of pocket max on it's co-pays?

[Tom_T]

Sage16

My GF fell and tore 3 rotator cuffs.

1 ER co-pay.
1 GP Doctor co-pay to get a surgeon referral.
1 Surgeon co-pay to x-ray shoulder and get opinion.
5 Physical therapy co-pays requested by Surgeon before surgery approved.
1 Back to Surgeon for surgery approval co-pay.
1 Back to GP Doctor to sign-off on surgery co-pay.
1 Surgery day co-pay.
15 After surgery co-pay for 15 physical therapy visits .
1 Back to Surgeon co-pay to check results and approve 15 more physical therapy sessions.
15 more physical therapy sessions with co-pay.
12 co-pays for chiropractor visit.

54 co-pays for one fall. GF not happy she could have been on plan G.

Best of luck and Stay Healthy

That's extreme, but you know, it's not crazy. Definitely something to consider.

[Sage16]

It sounds like you can save $520 per year in premium, that's surprising, I haven't seen that kind of savings with N vs G here.

The difference we faced for our state and choice of insurance company for N vs G premiums was close to $60 a month. So 3 co-pays at $20 a month or a different combo if you throw in ER visits at $50. If we expected to need at least 26 visits we would have decided it was better off to switch to a G plan.

[orlandoman]

Interesting detail on Plan 'N' ... there is up to a $20 co-pay for a doctor visit & $50 at ER if not admitted ... BUT, there is no co-pay at an Urgent Care Center, it has to do the way Urgent Care's are coded.

[tj]

It sounds like you can save $520 per year in premium, that's surprising, I haven't seen that kind of savings with N vs G here.

The difference we faced for our state and choice of insurance company for N vs G premiums was close to $60 a month. So 3 co-pays at $20 a month or a different combo if you throw in ER visits at $50. If we expected to need at least 26 visits we would have decided it was better off to switch to a G plan.

$60/mo for one person? Crazy! It's $32 per month per person here.

[Tom_T]

It sounds like you can save $520 per year in premium, that's surprising, I haven't seen that kind of savings with N vs G here.

The difference we faced for our state and choice of insurance company for N vs G premiums was close to $60 a month. So 3 co-pays at $20 a month or a different combo if you throw in ER visits at $50. If we expected to need at least 26 visits we would have decided it was better off to switch to a G plan.

$60/mo for one person? Crazy! It's $32 per month per person her.

My difference is $50. All depends on where you live.

[tj]

It sounds like you can save $520 per year in premium, that's surprising, I haven't seen that kind of savings with N vs G here.

The difference we faced for our state and choice of insurance company for N vs G premiums was close to $60 a month. So 3 co-pays at $20 a month or a different combo if you throw in ER visits at $50. If we expected to need at least 26 visits we would have decided it was better off to switch to a G plan.

$60/mo for one person? Crazy! It's $32 per month per person here.

My difference is $50. All depends on where you live.

And age, presumably

[Tom_T]

It sounds like you can save $520 per year in premium, that's surprising, I haven't seen that kind of savings with N vs G here.

The difference we faced for our state and choice of insurance company for N vs G premiums was close to $60 a month. So 3 co-pays at $20 a month or a different combo if you throw in ER visits at $50. If we expected to need at least 26 visits we would have decided it was better off to switch to a G plan.

$60/mo for one person? Crazy! It's $32 per month per person here.

My difference is $50. All depends on where you live.

And age, presumably

Well, I'll be 65 in December, so that's the low end of the Medicare age pool.

[yobyot]

[Thread merged into here --admin LadyGeek]

I'm looking at Medigap policies, and originally I was pretty much set on G, but now I'm wondering if N also works. The difference in price, for the provider I am looking at, is $42/month. That's $504/year.

N would charge a $20 copay for primary care doctor or specialist. I'd have to have two per month to match the higher G premium.

I know N does not cover excess charges, but my understanding is that most doctors accept the Medicare amount. I've checked all my doctors and facilities, and they're all covered. We live in NJ, highly populated, plenty of providers and hospitals to choose from.

I'm also looking ahead four years when my wife will be enrolled, so we could be looking at an extra $1000+ a year in G premiums over N, with annual increases, of course. That's a lot of money over 20+ years.

Anyone out there who has made a similar decision? I can afford G, but N seems more cost-effective.

I can't help with the G vs. N question. I live in Massachusetts, which has unique plans (thank goodness).

But you bring up the excess charge question, which is a good one.

Here in Mass., excess charges are banned. However, the UHC/AARP Medigap ("Mass. Core") plan I have specifically excludes excess charges. IOW, if I go out-of-state, I could be subject to excess charges.

But, and I think it's a big but, even excess charges are limited to 15% of the Medicare approved amount. Since Medicare gets substantial discounts (I'm sure you've noticed this from your statements), this could be a relatively small amount and therefore a small risk.

You say you've checked and all your carriers accept Medicare. That does not mean they accept Medicare assignment. You can ask the scheduler, the nurse, the doctor, the medical coder at the provider, even the billing department until you are blue in the face. Not a single one of them can tell you if they accept assignment. To them, the question of "assignment" is the same as "do you accept Medicare?:

I hope that helps you understand the value of the excess charges coverage.

One more thing: I think you are very smart to buy Medigap, whichever plan you buy. Part C ("Advantage") is way too risky, IMHO.

[Tom_T]

[Thread merged into here --admin LadyGeek]

I'm looking at Medigap policies, and originally I was pretty much set on G, but now I'm wondering if N also works. The difference in price, for the provider I am looking at, is $42/month. That's $504/year.

N would charge a $20 copay for primary care doctor or specialist. I'd have to have two per month to match the higher G premium.

I know N does not cover excess charges, but my understanding is that most doctors accept the Medicare amount. I've checked all my doctors and facilities, and they're all covered. We live in NJ, highly populated, plenty of providers and hospitals to choose from.

I'm also looking ahead four years when my wife will be enrolled, so we could be looking at an extra $1000+ a year in G premiums over N, with annual increases, of course. That's a lot of money over 20+ years.

Anyone out there who has made a similar decision? I can afford G, but N seems more cost-effective.

I can't help with the G vs. N question. I live in Massachusetts, which has unique plans (thank goodness).

But you bring up the excess charge question, which is a good one.

Here in Mass., excess charges are banned. However, the UHC/AARP Medigap ("Mass. Core") plan I have specifically excludes excess charges. IOW, if I go out-of-state, I could be subject to excess charges.

But, and I think it's a big but, even excess charges are limited to 15% of the Medicare approved amount. Since Medicare gets substantial discounts (I'm sure you've noticed this from your statements), this could be a relatively small amount and therefore a small risk.

You say you've checked and all your carriers accept Medicare. That does not mean they accept Medicare assignment. You can ask the scheduler, the nurse, the doctor, the medical coder at the provider, even the billing department until you are blue in the face. Not a single one of them can tell you if they accept assignment. To them, the question of "assignment" is the same as "do you accept Medicare?:

I hope that helps you understand the value of the excess charges coverage.

One more thing: I think you are very smart to buy Medigap, whichever plan you buy. Part C ("Advantage") is way too risky, IMHO.

I checked Medicare assignment by looking them up on the medicare.gov list of providers. This tells you if they charge the Medicare-approved amount.

https://www.medicare.gov/care-compare/? ... =Physician

[single2019]

Sage16

My GF fell and tore 3 rotator cuffs.

1 ER co-pay.
1 GP Doctor co-pay to get a surgeon referral.
1 Surgeon co-pay to x-ray shoulder and get opinion.
5 Physical therapy co-pays requested by Surgeon before surgery approved.
1 Back to Surgeon for surgery approval co-pay.
1 Back to GP Doctor to sign-off on surgery co-pay.
1 Surgery day co-pay.
15 After surgery co-pay for 15 physical therapy visits .
1 Back to Surgeon co-pay to check results and approve 15 more physical therapy sessions.
15 more physical therapy sessions with co-pay.
12 co-pays for chiropractor visit.

54 co-pays for one fall. GF not happy she could have been on plan G.

Best of luck and Stay Healthy

I have received conflicting information about plan N copay for physical therapy visits. From your post it appears that you paid copay for those. Does that match other folks’ experience?

[pmindex]

Sage16

My GF fell and tore 3 rotator cuffs.

1 ER co-pay.
1 GP Doctor co-pay to get a surgeon referral.
1 Surgeon co-pay to x-ray shoulder and get opinion.
5 Physical therapy co-pays requested by Surgeon before surgery approved.
1 Back to Surgeon for surgery approval co-pay.
1 Back to GP Doctor to sign-off on surgery co-pay.
1 Surgery day co-pay.
15 After surgery co-pay for 15 physical therapy visits .
1 Back to Surgeon co-pay to check results and approve 15 more physical therapy sessions.
15 more physical therapy sessions with co-pay.
12 co-pays for chiropractor visit.

54 co-pays for one fall. GF not happy she could have been on plan G.

Best of luck and Stay Healthy

I have received conflicting information about plan N copay for physical therapy visits. From your post it appears that you paid copay for those. Does that match other folks’ experience?

I have plan N (Washington state) and have never paid a copay for PT, nor for visits when I’ve only seen a PA rather than an MD. Just had ankle surgery and there was only one $20 copay for the whole process (3 appointments plus X-rays and day surgery).

[cashmoney]

hello all. a little background: i recently got the physicians mutual g plan at $172/mo because of their unlimited preventive care rider. but i’ve found that the rider is of little to no value to me compared to other G or N supplement plans coverage. my initial enrollment period where i can change my plan w/o health questions, ends 12/31. after that i would most likely never get approved to make a change, due to health issues. this is why i’m still looking for the best supplement plan fit. i’m currently leaning heavily toward a united healthcare (uhc) N supplement plan. please offer your opinions of why below. thank you.

united healthcare g & n plan costs?
uhc costs $132 for g & $89 for n plan. the g to n $43/mo savings way outweighs the possible $20/visit co-pays for doc visits & emergency room visits. and it’s $83/mo less then my current phy mut g to uhc n. that would easily cover copays each year.

uhc has a much larger pool of customers absorbing costs for lower premium increases. (2.1% average premium increase over the past 10 years for uhc & 10% for phy mut).

any opinions of uhc’s declining discount on their premiums?

there’s a more ill pool of people in a G plan then an N plan, causing greater premium increases. i’ve read lots about G plans going up much faster now, especially more then an n plan.

i’ve heard often that excess charges are rare. i’ve found that all of my doctors are in this approved group.
“Most health care providers have made an agreement with Medicare to accept the Medicare-approved amount for services, which means they can’t bill you for excess charges.”
https://www.medicare.gov/care-compare/...

In Florida (UHC biggest enrollment state i believe) the UHC plan G annual premium increase was lower than the N increase so the G may be sold harder to healthy people and everybody else because agents get a higher commission on G.BTW UHC in many cases allows switches between their plans without underwriting- the only other plans i am aware that allow that are the some of the Blues- may have something to do with the group certificate contract.BTW the 20.00 co pay is actually 20% up to 20.00 many clients tell me they actually pay 15-18.00 for primary care visit and some tell me their PCP doesn't even bother billing it.

disclaimer licensed agent

[Northern Flicker]

i’ve heard often that excess charges are rare. i’ve found that all of my doctors are in this approved group.

Any practice that accepts original Medicare that I've asked has said that they accept Medicare assignment, which is the term for not billing for excess charges.

The risk is not so much what is happening today, but if some providers stop accepting assignment, it perhaps could snowball to where nobody accepts it. Plan G premiums likely would go up if that scenario were to transpire, so it would not necessarily protect you from that.

Note that the plan G-HD deductible is a deductible for the G-HD plan, but functions as an out-of-pocket max for the combined part B/plan G-HD coverage. My understanding is that it is just the part B deductible ($226 in 2024) and 20% co-insurance for part B services that accumulate to the G-HD deductible ($2700 in 2023), so you would have to accumulate:

$226 + 5 x ($2700 - $226) = $12,596 of part B charges in calendar year 2023 before hitting the G-HD deductible for the year.

[ModifiedDuration]

i’ve heard often that excess charges are rare. i’ve found that all of my doctors are in this approved group.

Any practice that accepts original Medicare that I've asked has said that they accept Medicare assignment, which is the term for not billing for excess charges.

The risk is not so much what is happening today, but if some providers stop accepting assignment, it perhaps could snowball to where nobody accepts it. Plan G premiums likely would go up if that scenario were to transpire, so it would not necessarily protect you from that.

Note that the plan G-HD deductible is a deductible for the G-HD plan, but functions as an out-of-pocket max for the combined part B/plan G-HD coverage. My understanding is that it is just the part B deductible ($226 in 2024) and 20% co-insurance for part B services that accumulate to the G-HD deductible ($2700 in 2023), so you would have to accumulate:

$226 + 5 x ($2700 - $226) = $12,596 of part B charges in calendar year 2023 before hitting the G-HD deductible for the year.

Just to mention, if you are admitted to a hospital as an in- patient, there would be a $1,600 Part A deductible that would count toward the Plan G-HD $2,700 deductible.

In that case, you would need less than $5,000 in Part B expenses to reach the Plan G-HD $2,700 deductible.

[FrugalInvestor]

i’ve heard often that excess charges are rare. i’ve found that all of my doctors are in this approved group.

Any practice that accepts original Medicare that I've asked has said that they accept Medicare assignment, which is the term for not billing for excess charges.

The risk is not so much what is happening today, but if some providers stop accepting assignment, it perhaps could snowball to where nobody accepts it. Plan G premiums likely would go up if that scenario were to transpire, so it would not necessarily protect you from that.

........

The practices charging excess charges are often nationally known major research hospitals. Going to one of these is not an everyday occurance but when you do the problem and the bills can be very large. As a result the excess charges can also be substantial. So yes, a future trend of more practices charging excess charges (not accepting assignment ) is a potential risk, but even today if you have a major illness they can still come into play.

In addition, as I've previously posted, when these situations do occur the last thing the affected person or their caregiver wants (or is physically and mentally able) to do is spend their time and energy dealing with medical provider billing departments.

[Tom_T]

I've decided, after mulling it over, to stick with my original decision to get plan G. I can afford it, and there's a certain comfort in knowing that expenses are largely covered. I can't worry about premium increases. My portfolio should be able to handle it.

I've had a few minor health issues this year, nothing major, all good, but it illustrated to me that health situations can change on a dime even for healthy people once you get into your 60s. It's kind of like having an old car. Things happen.

[Northern Flicker]

i’ve heard often that excess charges are rare. i’ve found that all of my doctors are in this approved group.

Any practice that accepts original Medicare that I've asked has said that they accept Medicare assignment, which is the term for not billing for excess charges.

The risk is not so much what is happening today, but if some providers stop accepting assignment, it perhaps could snowball to where nobody accepts it. Plan G premiums likely would go up if that scenario were to transpire, so it would not necessarily protect you from that.

........

The practices charging excess charges are often nationally known major research hospitals. Going to one of these is not an everyday occurance but when you do the problem and the bills can be very large. As a result the excess charges can also be substantial. So yes, a future trend of more practices charging excess charges (not accepting assignment ) is a potential risk, but even today if you have a major illness they can still come into play.

Plan N premiums are lower, however. I assume it is more or less actuarially neutral.

In addition, as I've previously posted, when these situations do occur the last thing the affected person or their caregiver wants (or is physically and mentally able) to do is spend their time and energy dealing with medical provider billing departments.

Presumably that just means paying the bills. I think an advantage of Plan G is just having everything (other than prescriptions) more or less covered by SS deduction of premiums.

[tj]

Plan N premiums are lower, however. I assume it is more or less actuarially neutral.

Not necessarily. I've seen some insuers where N is higher than G!

Presumably that just means paying the bills. I think an advantage of Plan G is just having everything (other than prescriptions) more or less covered by SS deduction of premiums.

I don't believe Medigap gets paid by SS deduction.

[single2019]

I've decided, after mulling it over, to stick with my original decision to get plan G. I can afford it, and there's a certain comfort in knowing that expenses are largely covered. I can't worry about premium increases. My portfolio should be able to handle it.

I've had a few minor health issues this year, nothing major, all good, but it illustrated to me that health situations can change on a dime even for healthy people once you get into your 60s. It's kind of like having an old car. Things happen.

I am in a similar situation as you and also in NJ. Your original post was in line with my thoughts. What made you change your decision?

[Tom_T]

I've decided, after mulling it over, to stick with my original decision to get plan G. I can afford it, and there's a certain comfort in knowing that expenses are largely covered. I can't worry about premium increases. My portfolio should be able to handle it.

I've had a few minor health issues this year, nothing major, all good, but it illustrated to me that health situations can change on a dime even for healthy people once you get into your 60s. It's kind of like having an old car. Things happen.

I am in a similar situation as you and also in NJ. Your original post was in line with my thoughts. What made you change your decision?

Let's say I have another year like this one, where I have paid or will pay around a dozen copays. That's $240 under plan N, which would cost me around $500 less than G. For around $260 more, I figured I'd rather have the security of plan G. If my budget was tight, maybe I'd choose N.

Of course, not every year will be like this one, but I guess you could say I began thinking of health insurance as, well, insurance, where I don't mind paying more to have better coverage without any worries. Is it the most practical decision financially? Right now, perhaps not.