I'm having a hard time deciding if I should pick Medigap Plan G or Plan N because of my history

[single2019]

Likely it is a crap ton of paperwork and not worth the employee dollars to chase pennies. It seems to me this is the allure of many docs to opt into Medicare; bill Medicare and you’re done and know you will get paid.

You're probably right. Also, I believe when a service provider doesn't agree to Medicare assignment, they agree to accept 95% of the Medicare approved amount as full payment, thus the maximum excess to the patient is 9.25%, not 15% (1.15 x 0.95 = 1.0925). But 15% excess payments is a great fear mongering marketing ploy used by insurance companies since only about 1% of providers charge excess (I don't have a source citation, just remember reading that not to long ago). Also, in 8 states it is illegal to charge excess billing.

As of 2013 providers who don't accept assignment are reimbursed 78% of the medicare approved rate instead of 80% and plan G or F do not cover this 2%.

https://www.cms.gov/outreach-and-educat ... dalone.pdf

From what I remember “sequestration” in 2013 was temporary and providers were later reimbursed.
It no longer is in effect.

https://crsreports.congress.gov/product/pdf/R/R45106

Says in your source after suspending for Covid "Beginning July 1, 2022, the full 2% sequester was re-implemented. "

“As I understand”, sequestration is a tool that is available in case of budget impasse and is currently not implemented.

[cashmoney]

You're probably right. Also, I believe when a service provider doesn't agree to Medicare assignment, they agree to accept 95% of the Medicare approved amount as full payment, thus the maximum excess to the patient is 9.25%, not 15% (1.15 x 0.95 = 1.0925). But 15% excess payments is a great fear mongering marketing ploy used by insurance companies since only about 1% of providers charge excess (I don't have a source citation, just remember reading that not to long ago). Also, in 8 states it is illegal to charge excess billing.

As of 2013 providers who don't accept assignment are reimbursed 78% of the medicare approved rate instead of 80% and plan G or F do not cover this 2%.

https://www.cms.gov/outreach-and-educat ... dalone.pdf

From what I remember “sequestration” in 2013 was temporary and providers were later reimbursed.
It no longer is in effect.

https://crsreports.congress.gov/product/pdf/R/R45106

Says in your source after suspending for Covid "Beginning July 1, 2022, the full 2% sequester was re-implemented. "

“As I understand”, sequestration is a tool that is available in case of budget impasse and is currently not implemented.

I don't have any recent first hand examples but i know a few years ago people who used the Mayo Clinic in N. Fl ( before they started accepting assignment) had to pony up the 2% even if they had plan F/G

[FinIndyGal]

Thanks everyone for all of your helpful advice and opinions. I also spoke to a SHINE counselor on the phone. Maybe I'm overthinking this, but I'm curious if anyone has ever had this type of experience with them.

What bothered me is I felt that he was constantly promoting Federal Life Insurance. He kept saying that they're the cheapest, and they haven't had a price increase for three years, but he admitted they've only been in the market for five years. He only mentioned a handful of other companies and most were the most expensive (like Florida Blue), which he compared to Federal Life. He told me to not get hung up on little things and to look at the big picture because if I go with the cheapest plan now, it will be a long time before their increases will catch up with the more expensive plans and in the meantime I'll be paying heavy premiums for those. He also thinks that I should go with Plan N even though I've had melanoma. He said there aren't any customer service issues, and I'd need more than 24 visits a year to equal the cost of Plan G and all the benefits are the same except the ER and doctor visits.

He never mentioned AARP/United Healthcare until I brought them up, but he agreed there isn't much difference between their Plan G ($190) and Plan N ($162). He said there's no guarantee that I'll still make the right decision if I go with them because in 2023 their rates increased 6%, 4.9% in 2022, 5.1% in 2021, 2.7% in 2020, 1.9% in 2019, 0% in 2017 and 5% in 2015. He said their average increase going back to 2013 is 2.8%, but I'll be paying more than the cheapest, which is Plan N with Federal Life. When I said there's not a big difference between Federal Life and AARP/UHC, he said $162 is a $35/month difference, but he was comparing Plan N and never said that Plan G with AARP/UHC is only $18 more than Federal Life!

I checked Medicare.gov again later, and Wellcare (Centene) is actually the cheapest Plan G ($168), and Federal Life is the second ($172). The first four companies for Plan N are the same price ($127), and Federal Life is #2 on the list.

What really made me leery is when I realized that Federal Life is in a suburb of Chicago, which ironically is his area code. I assumed he was in my county or near me.

This is the only thread I could find on Bogleheads that mentions Federal Life. Is it true that they're a company of Mutual of Omaha (I wasn't able to confirm this anywhere)?
viewtopic.php?t=410268

I was about to sign up with AARP/UHC Plan G because I'm down to the wire, but I thought I'd first check to see if any of the companies below are considered reputable in this industry since several people in that thread said to go with the lowest price offered with a reputable company.

Wellcare (Centene) ($168)
Federal Life Insurance Company ($172)
LifeShield National Insurance Company ($172)
American Home Life Insurance Company ($172) (? new to the market)
GPM Health and Life Insurance Company ($172) (? highest rate increases in the market)
Woodmen Of The World Life Insurance Society ($174)
AFLAC ($175) (? new to Medicare supplements)
Mutual of Omaha (United World Life Insurance Company) ($176) (high rate increases)
Humana Achieve (CompBenefits Insurance Company) ($177)
American Benefit Life Insurance Company ($182)
Allstate Health Solutions ($186)(? a new carrier)
Wisconsin Physicians Service Insurance Corporation ($188)
Ace Property and Casualty Insurance Company ($189) (? newer to Medicare Supplements)

AARP/UHC ($190) is only $22 more than the cheapest Plan G, and the highest Plan G premium is $224.

Thank you!

[tj]

Federal Life doesn't appear to have any affiliation with Mutual of Omaha, no.

https://www.federallife.com/company-history/

UHC likely includes a gym membership. Will you utilize that?

[FinIndyGal]

Federal Life doesn't appear to have any affiliation with Mutual of Omaha, no.

https://www.federallife.com/company-history/

UHC likely includes a gym membership. Will you utilize that?

I previously tried and couldn't confirm that Federal Life is affiliated with Mutual of Omaha so thanks for confirming that it doesn't appear that they are connected. Someone on that 8/23 thread seems to think they are. Regardless, I can't find any reviews for Federal Life on Medicare broker or other sites like I normally can with other providers so I feel this isn't a good sign.

I've always exercised so the gym membership with UHC would normally be a great perk for me. The problem is that I'm looking for my new construction home and the types of communities that I'm looking at generally have fitness rooms, which you pay for in your HOA dues.

[diy60]

Federal Life doesn't appear to have any affiliation with Mutual of Omaha, no.

https://www.federallife.com/company-history/

UHC likely includes a gym membership. Will you utilize that?

I previously tried and couldn't confirm that Federal Life is affiliated with Mutual of Omaha so thanks for confirming that it doesn't appear that they are connected. Someone on that 8/23 thread seems to think they are. Regardless, I can't find any reviews for Federal Life on Medicare broker or other sites like I normally can with other providers so I feel this isn't a good sign.

I've always exercised so the gym membership with UHC would normally be a great perk for me. The problem is that I'm looking for my new construction home and the types of communities that I'm looking at generally have fitness rooms, which you pay for in your HOA dues.

In some States UHC has been rolling out an additional block (pool) without all the perks at a lower premium. Check to see if they offer this in your State.

[FinIndyGal]

If anyone has some examples of the types of problems that can arise that would require an agent's assistance later (other than the company raising their premiums a significant amount), I'd greatly appreciate and welcome them. I'm still struggling with this because several people commented that they've never had an issue with UHC AARP after they started their supplemental plan.

Here is what Boomer Benefits says their Client Service Team can help with.

It’s really not issues with your Medigap insurer, but more Medicare issues in general:

“Claim research and resolution [denied claims, claims coded incorrectly by the service provider, etc.], drug exceptions, Medicare appeals, annual rate shopping, and much more”

https://boomerbenefits.com/client-service-team/

Thank you! I really appreciate you giving the examples and link. I don't get the annual rate shopping since we're pretty much stuck for life with a Medigap provider unless medical underwriting won't be an issue. I recently spoke with a SHINE Counselor and was also curious if he thought I should sign up directly with AARP/UHC or go through a local agent (versus a national broker) in case I have issues later. It makes more sense to me now knowing that it’s really not issues with your Medigap insurer, but more Medicare issues in general because the SHINE guy insisted that there are no customer service issues. He said he's been doing this for 13 years and nobody has ever come back and said their company didn't do what they were supposed to do and you won't have any interaction with most supplement plans.

I still wonder how often those other problems actually occur. This is how he said the process works: The doctor, hospital, blood work/labs, etc., sends the claim to Medicare and then Medicare automatically sends the claim to the supplement plan and the supplement plan makes payment according to the plan you have. The supplement company will send a statement that they paid $X. If you have a Plan N, your only responsibility is to pay $20 at every doctor visit regardless of the type of doctor and most doctors now collect that up front before the doctor sees you so that's the end of your paperwork. The only other payment you have to make with a Plan N is $50 if you go to the Emergency Room unless you're admitted, but if not, the ER will most likely send you a bill later because ER's aren't set up to take cash. This is the only other paperwork, which you most likely won't have every day. Again, this is from the SHINE guy's perspective, but he never mentioned anything about denied claims, etc.

[FinIndyGal]

If she knows she is going with UHC then she may want to search for agents here https://www.myuhcagent.com .You can get a brief bio on agents (Look for Platinum Premier Producers) in your area including the number of years agent has been selling UHC products which is the biggest indicator that agent will still be active for years to come.Some agents listed here are captive to UHC and some are local independent agents. The big online agencies like Boomers and some others mentioned here have revolving door of agents .

My hypothesis was that a big agency like Boomer Benefits has the customer service staff to deal with any issues to service the policy if needed, whereas independent agent might not want to or have the capacity to deal with that sort of thing after the sale is closed.

Ideally you want the person that answers the phone to be the active agent that actually enrolled you and who will most likely remember who you are when you call so you can get to the point of the question much quicker- not a random agent who is handling customer service for the agency.
service for an " orphaned account" at the agency.

Unfortunately a lot of UHC customer service is now handled in the Philippine's etc. so even a very basic question or request can turn into a 10 minute phone call.UHC agents with the Platinum Premier Producer status get quick access to stateside UHC customer service agents and can handle most issues for you without you also being on the phone.Also if you are dealing directly with the agent that enrolled you have leverage because that agents renewal commissions depends on keeping you happy for many years after the sale.


disclaimer licensed agent

Thanks so much to everyone for all of your additional perspectives and opinions. Bogleheads always give me so much to think about.

I love cashmoney's suggestion to call a local UHC agent and found there are seven Platinum Premier Producers out of 50 agents within 15 miles of my zip. My dilemma is that I'm looking for my new construction home after unfortunately selling my house and moving south over three years ago. I recently came back to where I lived for 28 years, but I'm concerned about the lack of new or even resale homes here and will probably soon start checking out even more Florida cities, so I don't know where I'm ultimately going to end up. Does hiring a local UHC agent still make sense in this situation, and if so, can or should I change agents if I hire one here but ultimately move to another part of Florida? When I think of it this way, it seems like calling a big national agency like Boomer Benefits would be better, and perhaps they can also help when I'm no longer able to deal with things like the Part D prescriptions aspect of Medicare. I need to call and hire one of them sooner rather than later so everything is set up by 2/1/24. Apparently I can also sign myself up via the link that tj was so nice to provide, but my guess is an agent will probably be able to do it faster since they do it every day.

If anyone has some examples of the types of problems that can arise that would require an agent's assistance later (other than the company raising their premiums a significant amount), I'd greatly appreciate and welcome them. I'm still struggling with this because several people commented that they've never had an issue with UHC AARP after they started their supplemental plan.

If you do use an agent everything else being equal it is better to use an agent whose Resident State of Licensure is the state you live in because they are going to be most familiar with plans,underwriting guidelines,formularies etc of the state they do most or all of their business in.When you use a call center agency you will be assigned an agent who is licensed in your state but may not write that much business there.This is especially true for people who are shopping for MA and part D plans.Also if you use a local agent you can usually reach them after 5pm and weekends whereas any back office support for call center agencies is usually M-F 9-5pm

The most common things as a licenced agent i get calls from AARP UHC medigap policyholders are:
coordination of benefits issues
claim denied because non medicare covered test was ordered or wrong code used
change of banking information or payment method
update address
calls to complain about the annual rate increase in June.

Most people with the AARP UHC supplement never need to talk to the home office( part D whole different story) and none of these things require an agents help but it can make it much easier to get resolution if issues do arrive especially the first two and who do you think is more motivated to make sure everything is resolved quickly -the overseas customer service rep or the local agent who is earning renewal commission from UHC for a service commitment to policyholders.

I just re-read all of your replies about hiring a local agent. I truly appreciate your time providing this incredible information. I still wonder how frequently problems occur, but you make so many convincing arguments that my next step is to figure out what agent I'm going to use if I decide to do so (at this point I think I am). I'm a little hesitant because I'm a hands-on person and problem solver. I'm not sure how I feel about involving a third party with claims resolution, etc., if on the rare occasion a problem occurs. I guarantee I'll be on top of any situation much faster and will be more detailed than anyone else about something that can affect me financially. It sort of seems like a waste of time to call an agent to relay those things when I can just call directly, but I also don't have a crystal ball to know what my future self will be like when I'm much older or how capable I'll be to handle those things on my own later, so I understand what you're saying and appreciate all your knowledge.

I do have a question about something the SHINE Counselor said last week because it's been bugging me. He said a local agent is only with you when they get commission, and if you're on a Medicare Advantage plan, they want to keep you because they keep getting commission. He said it's like any insurance agent - they keep collecting some commission as long as you have the policy, but with a regular Medigap policy, they only get a one-time commission. Is this true?

[FinIndyGal]

Federal Life doesn't appear to have any affiliation with Mutual of Omaha, no.

https://www.federallife.com/company-history/

UHC likely includes a gym membership. Will you utilize that?

I previously tried and couldn't confirm that Federal Life is affiliated with Mutual of Omaha so thanks for confirming that it doesn't appear that they are connected. Someone on that 8/23 thread seems to think they are. Regardless, I can't find any reviews for Federal Life on Medicare broker or other sites like I normally can with other providers so I feel this isn't a good sign.

I've always exercised so the gym membership with UHC would normally be a great perk for me. The problem is that I'm looking for my new construction home and the types of communities that I'm looking at generally have fitness rooms, which you pay for in your HOA dues.

In some States UHC has been rolling out an additional block (pool) without all the perks at a lower premium. Check to see if they offer this in your State.

Thank you so much for this fantastic information. I'll definitely look into this because I'd rather not pay for basically two gym memberships.

[tj]

If anyone has some examples of the types of problems that can arise that would require an agent's assistance later (other than the company raising their premiums a significant amount), I'd greatly appreciate and welcome them. I'm still struggling with this because several people commented that they've never had an issue with UHC AARP after they started their supplemental plan.

Here is what Boomer Benefits says their Client Service Team can help with.

It’s really not issues with your Medigap insurer, but more Medicare issues in general:

“Claim research and resolution [denied claims, claims coded incorrectly by the service provider, etc.], drug exceptions, Medicare appeals, annual rate shopping, and much more”

https://boomerbenefits.com/client-service-team/

Thank you! I really appreciate you giving the examples and link. I don't get the annual rate shopping since we're pretty much stuck for life with a Medigap provider unless medical underwriting won't be an issue. I recently spoke with a SHINE Counselor and was also curious if he thought I should sign up directly with AARP/UHC or go through a local agent (versus a national broker) in case I have issues later. It makes more sense to me now knowing that it’s really not issues with your Medigap insurer, but more Medicare issues in general because the SHINE guy insisted that there are no customer service issues. He said he's been doing this for 13 years and nobody has ever come back and said their company didn't do what they were supposed to do and you won't have any interaction with most supplement plans.

I still wonder how often those other problems actually occur. This is how he said the process works: The doctor, hospital, blood work/labs, etc., sends the claim to Medicare and then Medicare automatically sends the claim to the supplement plan and the supplement plan makes payment according to the plan you have. The supplement company will send a statement that they paid $X. If you have a Plan N, your only responsibility is to pay $20 at every doctor visit regardless of the type of doctor and most doctors now collect that up front before the doctor sees you so that's the end of your paperwork. The only other payment you have to make with a Plan N is $50 if you go to the Emergency Room unless you're admitted, but if not, the ER will most likely send you a bill later because ER's aren't set up to take cash. This is the only other paperwork, which you most likely won't have every day. Again, this is from the SHINE guy's perspective, but he never mentioned anything about denied claims, etc.

See the second paragraph in this post:

viewtopic.php?p=7363662#p7363662

[placeholder]

I don't get the annual rate shopping since we're pretty much stuck for life with a Medigap provider unless medical underwriting won't be an issue.

It's important to know your state law especially if there is a birthday or anniversary rule for changing providers.

Again, this is from the SHINE guy's perspective, but he never mentioned anything about denied claims, etc.

I don't know that a gap provider can deny a claim that medicare approved.

[cashmoney]

My hypothesis was that a big agency like Boomer Benefits has the customer service staff to deal with any issues to service the policy if needed, whereas independent agent might not want to or have the capacity to deal with that sort of thing after the sale is closed.

Ideally you want the person that answers the phone to be the active agent that actually enrolled you and who will most likely remember who you are when you call so you can get to the point of the question much quicker- not a random agent who is handling customer service for the agency.
service for an " orphaned account" at the agency.

Unfortunately a lot of UHC customer service is now handled in the Philippine's etc. so even a very basic question or request can turn into a 10 minute phone call.UHC agents with the Platinum Premier Producer status get quick access to stateside UHC customer service agents and can handle most issues for you without you also being on the phone.Also if you are dealing directly with the agent that enrolled you have leverage because that agents renewal commissions depends on keeping you happy for many years after the sale.


disclaimer licensed agent

Thanks so much to everyone for all of your additional perspectives and opinions. Bogleheads always give me so much to think about.

I love cashmoney's suggestion to call a local UHC agent and found there are seven Platinum Premier Producers out of 50 agents within 15 miles of my zip. My dilemma is that I'm looking for my new construction home after unfortunately selling my house and moving south over three years ago. I recently came back to where I lived for 28 years, but I'm concerned about the lack of new or even resale homes here and will probably soon start checking out even more Florida cities, so I don't know where I'm ultimately going to end up. Does hiring a local UHC agent still make sense in this situation, and if so, can or should I change agents if I hire one here but ultimately move to another part of Florida? When I think of it this way, it seems like calling a big national agency like Boomer Benefits would be better, and perhaps they can also help when I'm no longer able to deal with things like the Part D prescriptions aspect of Medicare. I need to call and hire one of them sooner rather than later so everything is set up by 2/1/24. Apparently I can also sign myself up via the link that tj was so nice to provide, but my guess is an agent will probably be able to do it faster since they do it every day.

If anyone has some examples of the types of problems that can arise that would require an agent's assistance later (other than the company raising their premiums a significant amount), I'd greatly appreciate and welcome them. I'm still struggling with this because several people commented that they've never had an issue with UHC AARP after they started their supplemental plan.

If you do use an agent everything else being equal it is better to use an agent whose Resident State of Licensure is the state you live in because they are going to be most familiar with plans,underwriting guidelines,formularies etc of the state they do most or all of their business in.When you use a call center agency you will be assigned an agent who is licensed in your state but may not write that much business there.This is especially true for people who are shopping for MA and part D plans.Also if you use a local agent you can usually reach them after 5pm and weekends whereas any back office support for call center agencies is usually M-F 9-5pm

The most common things as a licenced agent i get calls from AARP UHC medigap policyholders are:
coordination of benefits issues
claim denied because non medicare covered test was ordered or wrong code used
change of banking information or payment method
update address
calls to complain about the annual rate increase in June.

Most people with the AARP UHC supplement never need to talk to the home office( part D whole different story) and none of these things require an agents help but it can make it much easier to get resolution if issues do arrive especially the first two and who do you think is more motivated to make sure everything is resolved quickly -the overseas customer service rep or the local agent who is earning renewal commission from UHC for a service commitment to policyholders.

I just re-read all of your replies about hiring a local agent. I truly appreciate your time providing this incredible information. I still wonder how frequently problems occur, but you make so many convincing arguments that my next step is to figure out what agent I'm going to use if I decide to do so (at this point I think I am). I'm a little hesitant because I'm a hands-on person and problem solver. I'm not sure how I feel about involving a third party with claims resolution, etc., if on the rare occasion a problem occurs. I guarantee I'll be on top of any situation much faster and will be more detailed than anyone else about something that can affect me financially. It sort of seems like a waste of time to call an agent to relay those things when I can just call directly, but I also don't have a crystal ball to know what my future self will be like when I'm much older or how capable I'll be to handle those things on my own later, so I understand what you're saying and appreciate all your knowledge.

I do have a question about something the SHINE Counselor said last week because it's been bugging me. He said a local agent is only with you when they get commission, and if you're on a Medicare Advantage plan, they want to keep you because they keep getting commission. He said it's like any insurance agent - they keep collecting some commission as long as you have the policy, but with a regular Medigap policy, they only get a one-time commission. Is this true?

Shine counselors are unbiased but most have never actually sold medicare insurance so take what they say with a grain of salt.I have actually enrolled 3 Shine counselors in Medicare plans over the years and was not completely impressed with their knowledge of plans-especially MA.Advantage commissions are standardized and all plan have to pay lifetime level renewals which in most states is 25.50 per month whereas med supp commissions ( usually based on the premium) can vary between insurance company based on state,age of person,whether it is a guarantee issue policy etc and typically renewals will pay between 30.00- 60.00 monthly renewal commissions ( unless it is a hi ded plan) for the first 6 to 10 years then drop down after that to aprox 10.00-20.00. monthly lifetime.Either scenario an agent has motivation to keep the client happy.Under current rules the medicare supplement companies can offer agents bonuses,trips and perks for certain production levels,for underwritten policies etc but medicare advantage plans are not allowed to do this

[ModifiedDuration]

Again, this is from the SHINE guy's perspective, but he never mentioned anything about denied claims, etc.

I don't know that a gap provider can deny a claim that medicare approved.

You are correct. A Medigap provider cannot deny a claim that Medicare has approved.

[tj]

Again, this is from the SHINE guy's perspective, but he never mentioned anything about denied claims, etc.

I don't know that a gap provider can deny a claim that medicare approved.

You are correct. A Medigap provider cannot deny a claim that Medicare has approved.

They can't deny it, but they can still be incompetent in processing claims, such as this horror story:

viewtopic.php?p=7363662#p7363662

[FinIndyGal]

My wife and I have been on UHC/AARP Plan N since we started Medicare at age 65. We will be 71/72 respectively this year. I wasn't fully aware of the differences in Plan N and Plan G when we signed up, and if we had it to do over again we would go with Plan G (not HD G). The coverage with N has been great and the premiums where we live are modest at $147 and $151 in 2024. We have separate HRA's from separate former employers that cover all premiums so the cost of N or G premiums was less of a concern.

So why a preference for Plan G? Mostly psychological. Providers who accept Plan N have the option of billing the patient for excess charges, and some of ours have required them, although most don't. It's largely the specialists that my wife uses that require the payment of extra charges. Thankfully her surgeon, anesthesiologist, and hospital didn't bill excess charges because she had two outpatient knee replacements within 12 months that were $55k each. If I remember correctly, excess charges can be 15% of what is not covered by Medicare and your supplement plan. Medicare and our Plan N covered about 1/4 of the cost of each surgery. Still, we got no bill for either one.

My wife also gets infusions of a very expensive drug with a retail cost of around 75k a year, and which is covered by Part B and Plan N. We have received no bills for extra charges in the 8 months she has been doing the infusions, but once again, Medicare and Plan N pay only about 1/4 of the cost listed on the bill. What if the infusion center decides they aren't getting enough back and need to start billing the extra charges for Plan N patients?

The psychological issue is the unknown cost of extra charges for every medical appointment or procedure. Sure, most don't charge it, but you can see what the total bill is when the it arrives online or by snail ail, and you can see how much is covered by the same method from Medicare Part B and your supplement plan. With the spiraling costs of healthcare, some providers may decide to start requiring the payment of extra charges, and neither my wife nor I could pass underwriting in order to upgrade to G at this point, not particularly because we are unhealthy, but because of previous misdiagnosis by doctors who were covering their bases. For instance, my wife was diagnosed with COPD by a previous doctor, a diagnosis that was proven wrong by her current PCP. That diagnosis alone would cause her to fail underwriting. That was confirmed by two sources who are brokers who knew we wouldn't be using their services.

To the OP, I think you are wise to go with Plan G.

Thanks for giving us real-world examples of why you'd choose Plan G instead of N now if you could do it over again. Given ModifiedDuration's clarification about excess charges, do you still feel this way? Regardless, I plan to go with Plan G because it's etched in my mind how paranoid I was when I was in the hospital in 2019 for the first time in my life. I drove the nurses crazy by constantly telling them that they needed to make sure that the anesthesiologist and anyone else involved in my care needed to be in-network with my plan. They assured me every time that I don't have to worry, but I later discovered that one of the anesthesiologists (out of four surgeries) wasn't, which was a big hassle later. One thing I know for sure now that I didn't know then is you don't have control of things when you're in the hospital and they're about to take you into surgery. This was a major stressor on top of everything else that I was dealing with.

Sorry, I missed this question. For what it's worth I would still choose Plan G if I was able to do it over again. The main reason is that I don't like the possibility of having extra charges assessed at the discretion of the provider, even at 15% of Medicare approved amounts. That introduces an element of uncertainty which nags at me. If my wife or I were to contract cancer, for instance, 15% of Medicare approved amounts might be significant.

I also don't like the restriction of being locked into a plan with no possibility of changing due to underwriting. This restriction exists on every plan to some degree however.

While it's impossible to avoid nasty surprises, I normally do my best to avoid them.

I want to thank all of the Bogleheads who took the time to provide so much valuable information and your opinions on this important topic. It really is amazing how much I learn on a daily basis from this awesome forum. Before I started my research, I never imagined that signing up for a Medigap policy would be so stressful and exhausting, but it's done now. I'm now officially enrolled in Plan G with AARP/UHC. I didn't feel comfortable with any of the companies on the list that were cheaper, mainly because they're too new to the industry or I didn't recognize their names.

And like you, vested1, I'm also proactive and try to avoid surprises so thanks for confirming again that you'd go with Plan G if you had it to do all over again.

[FinIndyGal]

Ideally you want the person that answers the phone to be the active agent that actually enrolled you and who will most likely remember who you are when you call so you can get to the point of the question much quicker- not a random agent who is handling customer service for the agency.
service for an " orphaned account" at the agency.

Unfortunately a lot of UHC customer service is now handled in the Philippine's etc. so even a very basic question or request can turn into a 10 minute phone call.UHC agents with the Platinum Premier Producer status get quick access to stateside UHC customer service agents and can handle most issues for you without you also being on the phone.Also if you are dealing directly with the agent that enrolled you have leverage because that agents renewal commissions depends on keeping you happy for many years after the sale.


disclaimer licensed agent

Thanks so much to everyone for all of your additional perspectives and opinions. Bogleheads always give me so much to think about.

I love cashmoney's suggestion to call a local UHC agent and found there are seven Platinum Premier Producers out of 50 agents within 15 miles of my zip. My dilemma is that I'm looking for my new construction home after unfortunately selling my house and moving south over three years ago. I recently came back to where I lived for 28 years, but I'm concerned about the lack of new or even resale homes here and will probably soon start checking out even more Florida cities, so I don't know where I'm ultimately going to end up. Does hiring a local UHC agent still make sense in this situation, and if so, can or should I change agents if I hire one here but ultimately move to another part of Florida? When I think of it this way, it seems like calling a big national agency like Boomer Benefits would be better, and perhaps they can also help when I'm no longer able to deal with things like the Part D prescriptions aspect of Medicare. I need to call and hire one of them sooner rather than later so everything is set up by 2/1/24. Apparently I can also sign myself up via the link that tj was so nice to provide, but my guess is an agent will probably be able to do it faster since they do it every day.

If anyone has some examples of the types of problems that can arise that would require an agent's assistance later (other than the company raising their premiums a significant amount), I'd greatly appreciate and welcome them. I'm still struggling with this because several people commented that they've never had an issue with UHC AARP after they started their supplemental plan.

If you do use an agent everything else being equal it is better to use an agent whose Resident State of Licensure is the state you live in because they are going to be most familiar with plans,underwriting guidelines,formularies etc of the state they do most or all of their business in.When you use a call center agency you will be assigned an agent who is licensed in your state but may not write that much business there.This is especially true for people who are shopping for MA and part D plans.Also if you use a local agent you can usually reach them after 5pm and weekends whereas any back office support for call center agencies is usually M-F 9-5pm

The most common things as a licenced agent i get calls from AARP UHC medigap policyholders are:
coordination of benefits issues
claim denied because non medicare covered test was ordered or wrong code used
change of banking information or payment method
update address
calls to complain about the annual rate increase in June.

Most people with the AARP UHC supplement never need to talk to the home office( part D whole different story) and none of these things require an agents help but it can make it much easier to get resolution if issues do arrive especially the first two and who do you think is more motivated to make sure everything is resolved quickly -the overseas customer service rep or the local agent who is earning renewal commission from UHC for a service commitment to policyholders.

I just re-read all of your replies about hiring a local agent. I truly appreciate your time providing this incredible information. I still wonder how frequently problems occur, but you make so many convincing arguments that my next step is to figure out what agent I'm going to use if I decide to do so (at this point I think I am). I'm a little hesitant because I'm a hands-on person and problem solver. I'm not sure how I feel about involving a third party with claims resolution, etc., if on the rare occasion a problem occurs. I guarantee I'll be on top of any situation much faster and will be more detailed than anyone else about something that can affect me financially. It sort of seems like a waste of time to call an agent to relay those things when I can just call directly, but I also don't have a crystal ball to know what my future self will be like when I'm much older or how capable I'll be to handle those things on my own later, so I understand what you're saying and appreciate all your knowledge.

I do have a question about something the SHINE Counselor said last week because it's been bugging me. He said a local agent is only with you when they get commission, and if you're on a Medicare Advantage plan, they want to keep you because they keep getting commission. He said it's like any insurance agent - they keep collecting some commission as long as you have the policy, but with a regular Medigap policy, they only get a one-time commission. Is this true?

Shine counselors are unbiased but most have never actually sold medicare insurance so take what they say with a grain of salt.I have actually enrolled 3 Shine counselors in Medicare plans over the years and was not completely impressed with their knowledge of plans-especially MA.Advantage commissions are standardized and all plan have to pay lifetime level renewals which in most states is 25.50 per month whereas med supp commissions ( usually based on the premium) can vary between insurance company based on state,age of person,whether it is a guarantee issue policy etc and typically renewals will pay between 30.00- 60.00 monthly renewal commissions ( unless it is a hi ded plan) for the first 6 to 10 years then drop down after that to aprox 10.00-20.00. monthly lifetime.Either scenario an agent has motivation to keep the client happy.Under current rules the medicare supplement companies can offer agents bonuses,trips and perks for certain production levels,for underwritten policies etc but medicare advantage plans are not allowed to do this

Thank you - this was very helpful information. I'm now enrolled in Plan G with AARP/UHC. However, since you weren't impressed with the knowledge of SHINE counselors, I'm curious if anyone has feedback on some of these other statements that the guy said to me:

1. If a company is new and gets out of the business, you have a right to get another company without medical underwriting so I shouldn't have that concern. Allstate Health got into Medicare about five years ago, and they're not going anywhere.

2. Companies can raise their prices anytime during the year. Most will do it around your start/effective/anniversary date, but every company has different dates.

3. He gave me the rate increases for several companies, which were kind of all over the place, but said there's no way of telling how rate increases will go.

4. If I'm that worried about my history of melanoma, go with Plan G, but he thinks I'm worrying for no good reason because it's already been five years. There will always be some company that will sell you a plan later, but how much it will cost is the question. It depends on the company and health condition. Most companies look back two years (Federal Life) and some five years (AARP/UHC) and some forever. They'll say we can sell you a policy because you had this disease more than two years ago or if it's been five years or some won't sell you a policy if you have this condition.

5. Medicare rules changed recently, and there is no longer a surprise billing if you go to a place that's covered by Medicare. If they bring in someone who is not a Medicare provider, they can only charge you the Medicare rate and not charge you excess charges so these are recent changes that are still happening.

[mnmac1]

"Re: I'm having a hard time deciding if I should pick Medigap Plan G or Plan N because of my history
Post by AnnetteLouisan » Sun Jan 14, 2024 8:01 pm

On almost everything, I go with the least expensive.
On important things, I go high end. Health is the most important of the important things, as I see it.

My mom was in the hospital for a week recently. Medicare reduced the hospital charges from $58k to 9k, paid 7.5k and her supplemental insurance paid the rest. Mom’s portion out of pocket (obviously she paid into it for 50 years)? $0."


This was the reply that struck me as being the most important for me. I.E. insuring against unknown potentially crippling medical costs. Why build a portfolio and then watch it get burned down by unforeseen medical expenses?

Paying $280-$300/month seems reasonable to remediate that risk.

just my .2 cents

[ModifiedDuration]

"Re: I'm having a hard time deciding if I should pick Medigap Plan G or Plan N because of my history
Post by AnnetteLouisan » Sun Jan 14, 2024 8:01 pm

On almost everything, I go with the least expensive.
On important things, I go high end. Health is the most important of the important things, as I see it.

My mom was in the hospital for a week recently. Medicare reduced the hospital charges from $58k to 9k, paid 7.5k and her supplemental insurance paid the rest. Mom’s portion out of pocket (obviously she paid into it for 50 years)? $0."


This was the reply that struck me as being the most important for me. I.E. insuring against unknown potentially crippling medical costs. Why build a portfolio and then watch it get burned down by unforeseen medical expenses?

Paying $280-$300/month seems reasonable to remediate that risk.

just my .2 cents

Whether the person had Plan G or Plan N, the out-of-pocket for the hospital stay would have been the same -
zero.

[goaties]

"Re: I'm having a hard time deciding if I should pick Medigap Plan G or Plan N because of my history
Post by AnnetteLouisan » Sun Jan 14, 2024 8:01 pm

On almost everything, I go with the least expensive.
On important things, I go high end. Health is the most important of the important things, as I see it.

My mom was in the hospital for a week recently. Medicare reduced the hospital charges from $58k to 9k, paid 7.5k and her supplemental insurance paid the rest. Mom’s portion out of pocket (obviously she paid into it for 50 years)? $0."


This was the reply that struck me as being the most important for me. I.E. insuring against unknown potentially crippling medical costs. Why build a portfolio and then watch it get burned down by unforeseen medical expenses?

Paying $280-$300/month seems reasonable to remediate that risk.

just my .2 cents

Whether the person had Plan G or Plan N, the out-of-pocket for the hospital stay would have been the same -
zero.

So am I understanding this correctly? The chargemaster price for the hospital stay was $58K. The Medicare-approved price for the hospital stay was $9K. So the 20% which one would have to pay for that stay was a paltry $1800?? I can barely get a plumber to come to my house for that money! Do we really need Medigap at all? I know I've asked this question before, but I really think it deserves consideration.

[dodecahedron]

"Re: I'm having a hard time deciding if I should pick Medigap Plan G or Plan N because of my history
Post by AnnetteLouisan » Sun Jan 14, 2024 8:01 pm

On almost everything, I go with the least expensive.
On important things, I go high end. Health is the most important of the important things, as I see it.

My mom was in the hospital for a week recently. Medicare reduced the hospital charges from $58k to 9k, paid 7.5k and her supplemental insurance paid the rest. Mom’s portion out of pocket (obviously she paid into it for 50 years)? $0."


This was the reply that struck me as being the most important for me. I.E. insuring against unknown potentially crippling medical costs. Why build a portfolio and then watch it get burned down by unforeseen medical expenses?

Paying $280-$300/month seems reasonable to remediate that risk.

just my .2 cents

Whether the person had Plan G or Plan N, the out-of-pocket for the hospital stay would have been the same -
zero.

So am I understanding this correctly? The chargemaster price for the hospital stay was $58K. The Medicare-approved price for the hospital stay was $9K. So the 20% which one would have to pay for that stay was a paltry $1800?? I can barely get a plumber to come to my house for that money! Do we really need Medigap at all? I know I've asked this question before, but I really think it deserves consideration.

Keep in mind that 1800 is just the bill from the hospital, which essentially covers room, board, nursing care, and overhead of the all the technology and physical plant. Every physician who is involved in your diagnosis or treatment will send you a separate bill for their services: surgeon, asst surgeon, anesthesiologist, asst anesthesiologist, radiologist, pathologist, etc. And if its for something like a stroke, you might need months of outpatient physical therapy, speech therapy, and occupational therapy after you come home.

“Need” is hard to define but a plan G-HD (available in my state for $60, less in other states) provides priceless peace of mind when I am facing a stressful medical situation by guaranteeing my worst case out of pocket exposure for all Part A and Part B services is $2,800 per year in out of pocket costs.

[ModifiedDuration]

"Re: I'm having a hard time deciding if I should pick Medigap Plan G or Plan N because of my history
Post by AnnetteLouisan » Sun Jan 14, 2024 8:01 pm

On almost everything, I go with the least expensive.
On important things, I go high end. Health is the most important of the important things, as I see it.

My mom was in the hospital for a week recently. Medicare reduced the hospital charges from $58k to 9k, paid 7.5k and her supplemental insurance paid the rest. Mom’s portion out of pocket (obviously she paid into it for 50 years)? $0."


This was the reply that struck me as being the most important for me. I.E. insuring against unknown potentially crippling medical costs. Why build a portfolio and then watch it get burned down by unforeseen medical expenses?

Paying $280-$300/month seems reasonable to remediate that risk.

just my .2 cents

Whether the person had Plan G or Plan N, the out-of-pocket for the hospital stay would have been the same -
zero.

So am I understanding this correctly? The chargemaster price for the hospital stay was $58K. The Medicare-approved price for the hospital stay was $9K. So the 20% which one would have to pay for that stay was a paltry $1800?? I can barely get a plumber to come to my house for that money! Do we really need Medigap at all? I know I've asked this question before, but I really think it deserves consideration.

There is no 20% for Part A (hospitalization), just a $1,632 Part A deductible.

After that, Part A covers the entire bill while you are in the hospital - room, tests, procedures, operating room charges, supplies, medications related to your hospitalization, etc.

Part B covers physician services and outpatient services and there you would have to pay 20% of the Medicare-approved rate if you do not have a Medicare Supplement.

So, when you are in the hospital, you would get separate bills from the physicians (surgeons, anesthesiologists, radiologists, oncologists, etc.) that you would owe 20% (at the Medicare-approved rate) if you did not have a Medicare Supplement.

In addition, if you have outpatient procedures and surgery, such as a hip or knee replacement, you would owe 20% (at the Medicare-approved rate) without a Medicare Supplement.

20% of Medivac, too.

But, the show stopper is chemotherapy. Without a Medicare Supplement, you would owe 20% of a chemotherapy bill that can go right into six figures.

The answer is to get Plan G-HD, which is essentially catastrophe insurance.

I am currently spending $43 a month on my Plan G-HD, which has a maximum out-of-pocket of $2,800.

So, Medicare pays its 80% upfront for Part B expenses and I pay 20% of the low Medicare-approved rate until I hit $2,800 out-of-pocket.

I have been saving about $1,500 a year vs Plan G.

When you go the doctor and they bill $250 and then Medicare approves $125, so you pay $25 out-of-pocket, it is hard to run up a big bill.

Especially when you consider that all my blood work has been covered 100%, my vaccinations 100%, colonoscopy 100% (as long as no polyps are found), it is hard to run up a big bill with Plan G-HD.

Basically, to hit the $2,800 maximum out-of-pocket, I would need to be hospitalized (I would have to pay the $1,632 Part A deductible) or have some really big Part B expense, like chemotherapy.

Plan G-HD is inexpensive catastrophe insurance.

[mnmac1]

I may be misunderstanding the plan documents (BCBS of MN) as far as the out of pocket (OOP) maximum is concerned for Plan N for Minnesota.
This is the plan with the $20 and $50 copayments. This plan would run around $178/month.
The maximum oop box is shaded gray and the notes say 'coverage not provided for that plan or benefit'.

I take that to mean that one's oop max is unlimited whereas the "Extended Basic Medicare Select (Extended Basic Select Blue) plan has a max oop of $1000. This plan would run around $282/month.

I see in the plan docs that the plan F hi deductible runs about $78/month and the deductible would be $2700. So after one puts out $2700 then the plan benefits would start paying.

decisions, decisions!

[montanagirl]

Thanks everyone for all of your helpful advice and opinions. I also spoke to a SHINE counselor on the phone. Maybe I'm overthinking this, but I'm curious if anyone has ever had this type of experience with them.

What bothered me is I felt that he was constantly promoting Federal Life Insurance. He kept saying that they're the cheapest, and they haven't had a price increase for three years, but he admitted they've only been in the market for five years. He only mentioned a handful of other companies and most were the most expensive (like Florida Blue), which he compared to Federal Life. He told me to not get hung up on little things and to look at the big picture because if I go with the cheapest plan now, it will be a long time before their increases will catch up with the more expensive plans and in the meantime I'll be paying heavy premiums for those. He also thinks that I should go with Plan N even though I've had melanoma. He said there aren't any customer service issues, and I'd need more than 24 visits a year to equal the cost of Plan G and all the benefits are the same except the ER and doctor visits.

He never mentioned AARP/United Healthcare until I brought them up, but he agreed there isn't much difference between their Plan G ($190) and Plan N ($162). He said there's no guarantee that I'll still make the right decision if I go with them because in 2023 their rates increased 6%, 4.9% in 2022, 5.1% in 2021, 2.7% in 2020, 1.9% in 2019, 0% in 2017 and 5% in 2015. He said their average increase going back to 2013 is 2.8%, but I'll be paying more than the cheapest, which is Plan N with Federal Life. When I said there's not a big difference between Federal Life and AARP/UHC, he said $162 is a $35/month difference, but he was comparing Plan N and never said that Plan G with AARP/UHC is only $18 more than Federal Life!

I checked Medicare.gov again later, and Wellcare (Centene) is actually the cheapest Plan G ($168), and Federal Life is the second ($172). The first four companies for Plan N are the same price ($127), and Federal Life is #2 on the list.

What really made me leery is when I realized that Federal Life is in a suburb of Chicago, which ironically is his area code. I assumed he was in my county or near me.

This is the only thread I could find on Bogleheads that mentions Federal Life. Is it true that they're a company of Mutual of Omaha (I wasn't able to confirm this anywhere)?
viewtopic.php?t=410268

I was about to sign up with AARP/UHC Plan G because I'm down to the wire, but I thought I'd first check to see if any of the companies below are considered reputable in this industry since several people in that thread said to go with the lowest price offered with a reputable company.

Wellcare (Centene) ($168)
Federal Life Insurance Company ($172)
LifeShield National Insurance Company ($172)
American Home Life Insurance Company ($172) (? new to the market)
GPM Health and Life Insurance Company ($172) (? highest rate increases in the market)
Woodmen Of The World Life Insurance Society ($174)
AFLAC ($175) (? new to Medicare supplements)
Mutual of Omaha (United World Life Insurance Company) ($176) (high rate increases)
Humana Achieve (CompBenefits Insurance Company) ($177)
American Benefit Life Insurance Company ($182)
Allstate Health Solutions ($186)(? a new carrier)
Wisconsin Physicians Service Insurance Corporation ($188)
Ace Property and Casualty Insurance Company ($189) (? newer to Medicare Supplements)

AARP/UHC ($190) is only $22 more than the cheapest Plan G, and the highest Plan G premium is $224.

Thank you!

My late friend who was an independent insurance agent would study up all the offerings in our srea each year and recommend what he thought were the best deals for medigap and Advantage plans.

And it was different every year. The market is just like that. The big names might not have the best prices but for medigap at least the products are all the same.

[Leesbro63]

Is supplement Plan G-HD available in Pennsylvania? It seems NOT, but I’d like to confirm.

By the way, this has been a great thread that I found yesterday, as I start tuning into age 65 in early 2025.

[tj]

Is supplement Plan G-HD available in Pennsylvania? It seems NOT, but I’d like to confirm.

By the way, this has been a great thread that I found yesterday, as I start tuning into age 65 in early 2025.

Of course it is. Why wouldn't it be? Searching medicare.gov for a random Philadelphia zip code shows 21 insurers offer it.

[cheese_breath]

They look like they are basically the same plan with the same coverage, difference being lower premium for N, but with the added copay for visits. Both require the standard $240 deductible. After the deductible plan G you have no further added expenses for physician charges. If you have plan N, you have a copay for every physician charge. If you don't go to the doctor much then plan N is a better choice. If you use alot of services then plan G is a better choice. But you never know if it is going to be a good year or a really bad year in advance. If you want piece of mind, then plan G makes more sense.

Plan N co-pays apply to initial diagnostic Doctor visits, only. Follow up visits are exempt from co-pays....

Must have changed since DW was a Part N patient. I paid copays for every one of her specialist visits.

[urban]

They look like they are basically the same plan with the same coverage, difference being lower premium for N, but with the added copay for visits. Both require the standard $240 deductible. After the deductible plan G you have no further added expenses for physician charges. If you have plan N, you have a copay for every physician charge. If you don't go to the doctor much then plan N is a better choice. If you use alot of services then plan G is a better choice. But you never know if it is going to be a good year or a really bad year in advance. If you want piece of mind, then plan G makes more sense.

Plan N co-pays apply to initial diagnostic Doctor visits, only. Follow up visits are exempt from co-pays....

Must have changed since DW was a Part N patient. I paid copays for every one of her specialist visits.

Probably it depends on a particular medical shop. This year I had a few visits to the specialists, was NOT charged any copay with my plan N.

[cashmoney]

Thanks everyone for all of your helpful advice and opinions. I also spoke to a SHINE counselor on the phone. Maybe I'm overthinking this, but I'm curious if anyone has ever had this type of experience with them.

What bothered me is I felt that he was constantly promoting Federal Life Insurance. He kept saying that they're the cheapest, and they haven't had a price increase for three years, but he admitted they've only been in the market for five years. He only mentioned a handful of other companies and most were the most expensive (like Florida Blue), which he compared to Federal Life. He told me to not get hung up on little things and to look at the big picture because if I go with the cheapest plan now, it will be a long time before their increases will catch up with the more expensive plans and in the meantime I'll be paying heavy premiums for those. He also thinks that I should go with Plan N even though I've had melanoma. He said there aren't any customer service issues, and I'd need more than 24 visits a year to equal the cost of Plan G and all the benefits are the same except the ER and doctor visits.

He never mentioned AARP/United Healthcare until I brought them up, but he agreed there isn't much difference between their Plan G ($190) and Plan N ($162). He said there's no guarantee that I'll still make the right decision if I go with them because in 2023 their rates increased 6%, 4.9% in 2022, 5.1% in 2021, 2.7% in 2020, 1.9% in 2019, 0% in 2017 and 5% in 2015. He said their average increase going back to 2013 is 2.8%, but I'll be paying more than the cheapest, which is Plan N with Federal Life. When I said there's not a big difference between Federal Life and AARP/UHC, he said $162 is a $35/month difference, but he was comparing Plan N and never said that Plan G with AARP/UHC is only $18 more than Federal Life!

I checked Medicare.gov again later, and Wellcare (Centene) is actually the cheapest Plan G ($168), and Federal Life is the second ($172). The first four companies for Plan N are the same price ($127), and Federal Life is #2 on the list.

What really made me leery is when I realized that Federal Life is in a suburb of Chicago, which ironically is his area code. I assumed he was in my county or near me.

This is the only thread I could find on Bogleheads that mentions Federal Life. Is it true that they're a company of Mutual of Omaha (I wasn't able to confirm this anywhere)?
viewtopic.php?t=410268

I was about to sign up with AARP/UHC Plan G because I'm down to the wire, but I thought I'd first check to see if any of the companies below are considered reputable in this industry since several people in that thread said to go with the lowest price offered with a reputable company.

Wellcare (Centene) ($168)
Federal Life Insurance Company ($172)
LifeShield National Insurance Company ($172)
American Home Life Insurance Company ($172) (? new to the market)
GPM Health and Life Insurance Company ($172) (? highest rate increases in the market)
Woodmen Of The World Life Insurance Society ($174)
AFLAC ($175) (? new to Medicare supplements)
Mutual of Omaha (United World Life Insurance Company) ($176) (high rate increases)
Humana Achieve (CompBenefits Insurance Company) ($177)
American Benefit Life Insurance Company ($182)
Allstate Health Solutions ($186)(? a new carrier)
Wisconsin Physicians Service Insurance Corporation ($188)
Ace Property and Casualty Insurance Company ($189) (? newer to Medicare Supplements)

AARP/UHC ($190) is only $22 more than the cheapest Plan G, and the highest Plan G premium is $224.

Thank you!

My understanding is that MOO is the Third Party Administrator and reinsurer for Federal Life.Not sure about Illinois but in many states UHC allows switching between G and N without underwriting while maintaining entry age band most other plans don't.Also UHC is rolling out there lower cost UHIFCA plans without the extra wellness benefits to more states so check if that is available there yet.

[ModifiedDuration]

Is supplement Plan G-HD available in Pennsylvania? It seems NOT, but I’d like to confirm.

By the way, this has been a great thread that I found yesterday, as I start tuning into age 65 in early 2025.

Yes, Plan G-HD is available in Pennsylvania.

I would recommend United American. They are the big player in the high-deductible arena and known for low, stable rates.

I recently helped a 65 year old female friend in Pennsylvania get a policy with them for $32 a month.

[rgs]

As someone researching the Gap plans ahead of my Q1 enrollment into Medicare, I found this thread to be super helpful. My views on the 3 plans kept changing over and over as I read the entire thread (and still leaves me undecided ). I am relatively certain that I would want to go with either G or N or HD G.

Here is my summary - let me know please if I got any of this wrong (as well as offer your views/opinions/comments/editorials )

• Plan G offers the peace of mind (against any surprises) and has a higher premium than the other 2

• Plan N offers similar benefits (with the caveat of the co-pay and the excess charge of 15% of the Medicare approved amount) but has a slightly lesser premium than G.

• Plan G HD has the smallest premium of the 3 but is more of an "inexpensive catastrophe insurance"

The unknowns are

• we don't know what our exact medical needs would be in the 5 - 20 years (and perhaps beyond, assuming one lives past 85) but fair to assume our medical demands would be higher.

• And none of the plans are immune to the "closed block of business" a.k.a dead pool, leaving the sicker pool with a larger premium. And once in this pool, not so easy to switch without underwriting (even within the same Gap plan - as in between insurers in say, Plan G)?

• "Community" or "Issue age" pricing are preferred over "Attained Age" but starting out of the gate at age 65, both community and issue age have a larger premium compared to attained age.

• And regardless of the pricing type, all of the insurance companies can (and do) raise the premium (either age + inflation or just inflation)

For good measure I took the AARP UHC "community plan" in my state (SC) for G & N and took United American (attained) premiums and assumed a conservative 6% hike YOY, then applied this for the 3 plans (where the 1st row is the starting premium). What is not stated here but I am going to assume that neither the co-pay cap in N or the deductible limit in HD G will NOT constant till the 85th year.

--------------G N HD G
-----------$141 $98 $39
2025 65 $149 $104 $41
2026 66 $158 $110 $44
2027 67 $168 $117 $46
2028 68 $178 $124 $49
2029 69 $188 $131 $52
2030 70 $200 $139 $55
2031 71 $212 $147 $59
2032 72 $224 $156 $62
2033 73 $238 $166 $66
2034 74 $252 $175 $70
2035 75 $267 $186 $74
2036 76 $283 $197 $78
2037 77 $300 $209 $83
2038 78 $318 $222 $88
2039 79 $337 $235 $93
2040 80 $358 $249 $99
2041 81 $379 $264 $105
2042 82 $402 $280 $111
2043 83 $426 $296 $118
2044 84 $451 $314 $125
2045 85 $479 $333 $133

[Bcdkgf]

We selected G, a few years ago and were surprised by a squamous cell carcinoma earlier this month on my DH's ear. He has had several precancerous lesions removed from his face earlier this year, so we were not surprised. He grew up on a farm in Florida. Plan G will defiantly mitigate expenses and cover Mohs surgery with the dermatologist and reconstructing the ear with the plastic surgeon.

[single2019]

As someone researching the Gap plans ahead of my Q1 enrollment into Medicare, I found this thread to be super helpful. My views on the 3 plans kept changing over and over as I read the entire thread (and still leaves me undecided ). I am relatively certain that I would want to go with either G or N or HD G.

Here is my summary - let me know please if I got any of this wrong (as well as offer your views/opinions/comments/editorials )

• Plan G offers the peace of mind (against any surprises) and has a higher premium than the other 2

• Plan N offers similar benefits (with the caveat of the co-pay and the excess charge of 15% of the Medicare approved amount) but has a slightly lesser premium than G.

• Plan G HD has the smallest premium of the 3 but is more of an "inexpensive catastrophe insurance"

The unknowns are

• we don't know what our exact medical needs would be in the 5 - 20 years (and perhaps beyond, assuming one lives past 85) but fair to assume our medical demands would be higher.

• And none of the plans are immune to the "closed block of business" a.k.a dead pool, leaving the sicker pool with a larger premium. And once in this pool, not so easy to switch without underwriting (even within the same Gap plan - as in between insurers in say, Plan G)?

• "Community" or "Issue age" pricing are preferred over "Attained Age" but starting out of the gate at age 65, both community and issue age have a larger premium compared to attained age.

• And regardless of the pricing type, all of the insurance companies can (and do) raise the premium (either age + inflation or just inflation)

For good measure I took the AARP UHC "community plan" in my state (SC) for G & N and took United American (attained) premiums and assumed a conservative 6% hike YOY, then applied this for the 3 plans (where the 1st row is the starting premium). What is not stated here but I am going to assume that neither the co-pay cap in N or the deductible limit in HD G will NOT constant till the 85th year.

--------------G N HD G
-----------$141 $98 $39
2025 65 $149 $104 $41
2026 66 $158 $110 $44
2027 67 $168 $117 $46
2028 68 $178 $124 $49
2029 69 $188 $131 $52
2030 70 $200 $139 $55
2031 71 $212 $147 $59
2032 72 $224 $156 $62
2033 73 $238 $166 $66
2034 74 $252 $175 $70
2035 75 $267 $186 $74
2036 76 $283 $197 $78
2037 77 $300 $209 $83
2038 78 $318 $222 $88
2039 79 $337 $235 $93
2040 80 $358 $249 $99
2041 81 $379 $264 $105
2042 82 $402 $280 $111
2043 83 $426 $296 $118
2044 84 $451 $314 $125
2045 85 $479 $333 $133

I picked AARP UHC plan N. In my area nobody that accepts Medicare, charges excess (15%). The copay of $20 for plan N is only for physician visits and is coded in law. I could easily afford plan G. Plan N was a financial decision.

[rgs]

I picked AARP UHC plan N. In my area nobody that accepts Medicare, charges excess (15%). The copay of $20 for plan N is only for physician visits and is coded in law. I could easily afford plan G. Plan N was a financial decision.

Thank you!