Final approach to Medicare – age 64

[ModifiedDuration]

Just quickly looking at your numbers, if the difference between Plan G and Plan G-HD premiums is $2,280 a year and the difference in maximum out-of-pocket is $2,617 ($2,870 less the $257 Part B deductible), then Plan G-HD can only cost you $337 in a “bad”year and Plan G-HD should be an easy decision (unless you have health issues right now).

I would have been saving over $2,000 each year in your situation and if I would hit the Plan G-HD maximum out-of-pocket each and every year from here on in, I would be able to cover the $337 maximum exposure till I was over 90 years old.

[FreddieFIRE]

That being said, my opinion is that you're basing some of your assumptions based on grammar school math when at the very least, you need multivariable or stochastic calculus given the number of variables and unknowns. Even then, you can ask any economist how accurate your "guess" would be.

Which assumptions are you referring to? Which guesses? This post is confusing.

[FreddieFIRE]

Just quickly looking at your numbers, if the difference between Plan G and Plan G-HD premiums is $2,280 a year and the difference in maximum out-of-pocket is $2,617 ($2,870 less the $257 Part B deductible), then Plan G-HD can only cost you $337 in a “bad”year and Plan G-HD should be an easy decision (unless you have health issues right now).

I would have been saving over $2,000 each year in your situation and if I would hit the Plan G-HD maximum out-of-pocket each and every year from here on in, I would be able to cover the $337 maximum exposure till I was over 90 years old.

Thanks. That is what I was thinking, but it's reassuring to know that other knowledgeable posters are seeing things the same way. It is actually somewhat baffling that they would be selling any regular Plan G in my area because of this. But, I'm sure us Bogleheads are in a very small minority that actually run the numbers and set the emotions aside. Agents likely love those other guys.

I'm starting to understand why there are many more companies offering Plan G in my area than Plan G-HD.

[ModifiedDuration]

That being said, my opinion is that you're basing some of your assumptions based on grammar school math when at the very least, you need multivariable or stochastic calculus given the number of variables and unknowns. Even then, you can ask any economist how accurate your "guess" would be.

Which assumptions are you referring to? Which guesses? This post is confusing.

I think that you have done a great job of researching, putting thought into this, and analyzing the subject.

You have put in a lot more time and effort than most people have and are certainly on the right track.

[Svensk Anga]

A comment was also made that the pool in G-HD plans are "healthier". I would appreciate a citation for that claim. If this is true, then the OP doesn't have to worry about dead pools.

Maybe healthier isn't the right metric. The right metric is likelihood of escalating claims. The insurer's costs go up immediately when someone on G starts experiencing more medical intervention. For an insured on G-HD, the first part of the rising costs is borne by the insured, not the company. My understanding is that a substantial majority of those on G-HD do not meet the high deductible. Everyone on G (and N) will drive up claims as their health deteriorates, assuming they blow through the $257 Part B deductible. Not so with G-HD.

It could be that a lot of those on G-HD draw minimal insurance benefits until near the end of life and then only for a few years. That is, over a say 20-year Medicare experience, they are mostly extremely profitable to the insurance company for 15 years or so and then a drag for the last 5 and in a fair number of cases, maybe not at all. If you are not hospitalized, it is pretty hard to max out the high deductible on Part B charges alone.

[Small Change]

This is a great discussion.

I’m also leaning toward G-HD as I approach age 65.

But two things have me on the fence:

First, I wonder how I, at 85 or 90, would be able to or want to manage the paperwork and paying of my co-pays/deductibles.

Second, United American and Globe Life, sister companies, offer a Reserve Fund Annuity that can seamlessly pay deductibles and co-pays. It’s been discussed in some other threads. I’m not aware of any other G-HD provider offering a similar autopay system. But Globe Life Inc., the parent of United American and Globe Life, has had some recent business controversies, discussed in other threads, and that gives me pause.

I believe I would save money with G-HD. But going with a respected G provider (with a good reputation on issue of deadpools), rather than a G-HD plan, would be so…easy. My old self might appreciate that two decades from now.

[GaryA505]

First, I wonder how I, at 85 or 90, would be able to or want to manage the paperwork and paying of my co-pays/deductibles.

I've thought about that as well, but I figure there will be other bills that will have to be paid so there's no escaping that problem anyway.

[Ret2018]

Second, United American and Globe Life, sister companies, offer a Reserve Fund Annuity that can seamlessly pay deductibles and co-pays. It’s been discussed in some other threads. I’m not aware of any other G-HD provider offering a similar autopay system. But Globe Life Inc., the parent of United American and Globe Life, has had some recent business controversies, discussed in other threads, and that gives me pause.

FYI, the Reserve Fund Annuity is not offered in all states, eg New Hampshire. For the states in which it is offered, it looks like a good solution to the task of managing deductables and co-pays.

[printer86]

We are not yet at Medicare age, but getting closer each year (early 60's). One thing that has me leaning toward using the high deductible Plan-G is that we have accumulated a fairly significant HSA balance and need a place to spend those funds.

HSA funds cannot be used to pay Med-Sup premiums, but they can be used to pay our share of the annual deductible. By going this route, I think we have our post 65 medical expenses already covered.

[ModifiedDuration]

We are not yet at Medicare age, but getting closer each year (early 60's). One thing that has me leaning toward using the high deductible Plan-G is that we have accumulated a fairly significant HSA balance and need a place to spend those funds.

HSA funds cannot be used to pay Med-Sup premiums, but they can be used to pay our share of the annual deductible. By going this route, I think we have our post 65 medical expenses already covered.

Many people with large HSA balances get Plan G-HD for the reasons you stated.

You can use your HSA for Part B and Part D premiums (including IRMAA), deductibles, copays, and coinsurance, as well as dental, vision, and hearing expenses.

In addition, besides long-term care insurance (within IRS guidelines), you can use your HSA balance for any actual long-term care expenses incurred.

Also, over-the counter pain medicine (such as Tylenol, Advil, Nuprin), allergy medicine (such as Allegra and Zyrtec), and cold/cough medicine (such as NyQuil and Halls cough drops) can be charged to an HSA account.

Just not Medicare Supplement Plan premiums.

[Svensk Anga]

This is a great discussion.

I’m also leaning toward G-HD as I approach age 65.

But two things have me on the fence:

First, I wonder how I, at 85 or 90, would be able to or want to manage the paperwork and paying of my co-pays/deductibles.

Second, United American and Globe Life, sister companies, offer a Reserve Fund Annuity that can seamlessly pay deductibles and co-pays. It’s been discussed in some other threads. I’m not aware of any other G-HD provider offering a similar autopay system. But Globe Life Inc., the parent of United American and Globe Life, has had some recent business controversies, discussed in other threads, and that gives me pause.

I believe I would save money with G-HD. But going with a respected G provider (with a good reputation on issue of deadpools), rather than a G-HD plan, would be so…easy. My old self might appreciate that two decades from now.

I like the Reserve Fund Annuity to simplify things when they become hard to manage. There is a limitation. They allow only $20,000 lifetime contribution. If you draw on this starting at 65, there may not be much left at 85, 90 when you really could use it. I think it is best funded later in life. They guarantee only 3% return, so I would not fund it all at once.

[GaryA505]

This is a great discussion.

I’m also leaning toward G-HD as I approach age 65.

But two things have me on the fence:

First, I wonder how I, at 85 or 90, would be able to or want to manage the paperwork and paying of my co-pays/deductibles.

Second, United American and Globe Life, sister companies, offer a Reserve Fund Annuity that can seamlessly pay deductibles and co-pays. It’s been discussed in some other threads. I’m not aware of any other G-HD provider offering a similar autopay system. But Globe Life Inc., the parent of United American and Globe Life, has had some recent business controversies, discussed in other threads, and that gives me pause.

I believe I would save money with G-HD. But going with a respected G provider (with a good reputation on issue of deadpools), rather than a G-HD plan, would be so…easy. My old self might appreciate that two decades from now.

I like the Reserve Fund Annuity to simplify things when they become hard to manage. There is a limitation. They allow only $20,000 lifetime contribution. If you draw on this starting at 65, there may not be much left at 85, 90 when you really could use it. I think it is best funded later in life. They guarantee only 3% return, so I would not fund it all at once.

What happens to the money if you don't spend it on the deductible?

[kd2008]

I like the Reserve Fund Annuity to simplify things when they become hard to manage. There is a limitation. They allow only $20,000 lifetime contribution. If you draw on this starting at 65, there may not be much left at 85, 90 when you really could use it. I think it is best funded later in life. They guarantee only 3% return, so I would not fund it all at once.

What happens to the money if you don't spend it on the deductible?

It goes to your estate after you die or to your designated beneficiary. There is a form for that I believe you can fill out send it to them.

[kd2008]

This is a great discussion.

I’m also leaning toward G-HD as I approach age 65.

But two things have me on the fence:

First, I wonder how I, at 85 or 90, would be able to or want to manage the paperwork and paying of my co-pays/deductibles.

Second, United American and Globe Life, sister companies, offer a Reserve Fund Annuity that can seamlessly pay deductibles and co-pays. It’s been discussed in some other threads. I’m not aware of any other G-HD provider offering a similar autopay system. But Globe Life Inc., the parent of United American and Globe Life, has had some recent business controversies, discussed in other threads, and that gives me pause.

I believe I would save money with G-HD. But going with a respected G provider (with a good reputation on issue of deadpools), rather than a G-HD plan, would be so…easy. My old self might appreciate that two decades from now.

I like the Reserve Fund Annuity to simplify things when they become hard to manage. There is a limitation. They allow only $20,000 lifetime contribution. If you draw on this starting at 65, there may not be much left at 85, 90 when you really could use it. I think it is best funded later in life. They guarantee only 3% return, so I would not fund it all at once.

This is why I believe... I would use my HSA to reimburse myself...atleast till I am 75 yrs old or so and am handling things well. Once 80 and above, definitely would like the reserve annuity to do it automatically.

[FreddieFIRE]

First, I wonder how I, at 85 or 90, would be able to or want to manage the paperwork and paying of my co-pays/deductibles.

I've thought about that as well, but I figure there will be other bills that will have to be paid so there's no escaping that problem anyway.

That's my thinking as well. Even with Plan G, won't the first $257 be invoiced and have to be paid as bill(s)? There will also be credit card bills, utilities, etc. I'm fortunate to have two nearby, responsible adult children who can and will serve as DPOA to at least look over my shoulder on such things. Having served as DPOA, paying routine bills is probably the least intrusive/burdensome task to ask somebody to help out with. Also, there is the argument that retaining such "responsibilities" may help to keep one's mind active and thinking. Loss of routine can be a significant contributor to onset and advancement of dementia. I've seen this personally. Of course, that's outside the scope of this discussion/forum.

[walkinwood]

I'd like to hear from those of you who do have Plan G-HD - just how onerous is the paperwork associated with the deductible?
Are there ways to automate these payments? From an HSA?

[FreddieFIRE]

I'd like to hear from those of you who do have Plan G-HD - just how onerous is the paperwork associated with the deductible?
Are there ways to automate these payments? From an HSA?

Isn't it just normal bills from medical providers until the deductible is met? What else were you thinking? I would like to hear about this as well if it's something else.

[ModifiedDuration]

I'd like to hear from those of you who do have Plan G-HD - just how onerous is the paperwork associated with the deductible?
Are there ways to automate these payments? From an HSA?

In my case, there has been very little paperwork.

My bloodwork has been covered 100% by Medicare, as has my vaccinations and colonoscopies. Nothing to do there.

I usually have 5 to 8 doctor visits a year, which are processed by Medicare and then by my Supplement.

The doctor usually bills about $250, the Medicare-approved rate is about $125, I pay the first $257 (the Part B deductible) and after that pay about $25 for each doctor office visit.

I get the bill from the doctor and just pay it on-line.

The bills have been so small that I am just saving them to file with my HSA all at once.

It has been very easy.

[GaryA505]

I'd like to hear from those of you who do have Plan G-HD - just how onerous is the paperwork associated with the deductible?
Are there ways to automate these payments? From an HSA?

In my case, there has been very little paperwork.

My bloodwork has been covered 100% by Medicare, as has my vaccinations and colonoscopies. Nothing to do there.

I usually have 5 to 8 doctor visits a year, which are processed by Medicare and then by my Supplement.

The doctor usually bills about $250, the Medicare-approved rate is about $125, I pay the first $257 (the Part B deductible) and after that pay about $25 for each doctor office visit.

I get the bill from the doctor and just pay it on-line.

The bills have been so small that I am just saving them to file with my HSA all at once.

It has been very easy.

The complaint we see sometimes is that the doctor bills Medicare but fails to bill the supplement, then sends the bill (20%) to the patient that should have gone first to the supplement.

[ModifiedDuration]

In my case, there has been very little paperwork.

My bloodwork has been covered 100% by Medicare, as has my vaccinations and colonoscopies. Nothing to do there.

I usually have 5 to 8 doctor visits a year, which are processed by Medicare and then by my Supplement.

The doctor usually bills about $250, the Medicare-approved rate is about $125, I pay the first $257 (the Part B deductible) and after that pay about $25 for each doctor office visit.

I get the bill from the doctor and just pay it on-line.

The bills have been so small that I am just saving them to file with my HSA all at once.

It has been very easy.

The complaint we see sometimes is that the doctor bills Medicare but fails to bill the supplement, then sends the bill (20%) to the patient that should have gone first to the supplement.

After Medicare pays, Medicare (not the doctor) forwards the bill to your Supplement Plan.

I have heard of doctors sending a bill before the Medicare Supplement Plan processes it.

I would just wait until the Supplement Plan processes the bill, although with a Plan G-HD it really wouldn’t matter unless you were near the $2,870 maximum out-of-pocket.

[GaryA505]

The complaint we see sometimes is that the doctor bills Medicare but fails to bill the supplement, then sends the bill (20%) to the patient that should have gone first to the supplement.

After Medicare pays, Medicare (not the doctor) forwards the bill to your Supplement Plan.

I have heard of doctors sending a bill before the Medicare Supplement Plan processes it.

I would just wait until the Supplement Plan processes processes the bill, although with a Plan G-HD it really wouldn’t matter unless you were near the $2,870 maximum out-of-pocket.

I think that's the problem, that the doctor bills the patient before the Medicare Supplement Plan processes their part.

[krisSA]

Sorry, duplicate post

[krisSA]

On way to avoid to mostly avoid this is by sticking with a big national carrier such as UHC ,UA,Bankers life/Conseco or even the BCBS plan but even some big name national companies especially MOO are notorious for continually opening new books of business.

Thank you. These are the companies that issue G-HD policies in my state:

Ace Property and Casualty Insurance Company
Aetna Health and Life Insurance Company
Cigna National Health Insurance Company
Cigna National Health Insurance Company (Standard II)
Federal Life Insurance Company
Globe Life and Accident Insurance Company (Direct to Consumer)
Humana (Humana Insurance Company)
Humana Achieve (CompBenefits Insurance Company)
Medico Insurance Company (Preferred)
Medico Insurance Company (Standard I)
Medico Insurance Company (Standard II)
MedMutual Protect
Mutual of Omaha (Mutual of Omaha Insurance Company)
New Era Life Insurance Company
Physicians Select Insurance Company
Physicians Select Insurance Company (With Preventive and Fitness Benefits)
United American Insurance Company
Washington National Insurance Company
Washington National Insurance Company (Substandard)
Woodmen Of The World Life Insurance Society

All are issue age pricing. The monthly premiums range from $44 to $78. I'm fine with any of those.

The same list of companies are offered in my area and I am thinking of going with Physician Select as that is the only company that offers the Fitness Benefits. Also they offer the option to convert to Plan G (without underwriting) after two years if someone desires. The other option is United American as it seems to have good reviews here. What is benefit of going with United American if the company is same as Globe Life? The premium for Globe is less than United American

[FreddieFIRE]

The same list of companies are offered in my area and I am thinking of going with Physician Select as that is the only company that offers the Fitness Benefits. Also they offer the option to convert to Plan G (without underwriting) after two years if someone desires. The other option is United American as it seems to have good reviews here. What is benefit of going with United American if the company is same as Globe Life? The premium for Globe is less than United American

I have the same question, and I believe that the answer is "there is no advantage in going with United American if it is the same as Globe Life." My impression is that the United American brand is sold through commissioned brokers and the Globe Life is direct purchase, cheaper due to the lack of commissions. I would certainly be interested in hearing from somebody with additional information on this.

Would you really choose one provider over another simply because of the fitness facility perks? I'm not suggesting that would be bad, just curious. I'm looking for the best long-term insurer of healthcare needs (which may be impossible to predict).

[krisSA]

I read good reviews here about Physician Select few weeks ago, I have no personal experience with any of these companies

[krisSA]

How difficult is it to switch G-HD plans if one is not happy with any particular company? Do we have to go through the underwriting process, as with Plan G?

[Svensk Anga]

How difficult is it to switch G-HD plans if one is not happy with any particular company? Do we have to go through the underwriting process, as with Plan G?

G-HD does not make a difference when switching companies. One would still have to pass underwriting.

[ModifiedDuration]

How difficult is it to switch G-HD plans if one is not happy with any particular company? Do we have to go through the underwriting process, as with Plan G?

Medicare makes all the decisions regarding healthcare.

A Medicare Supplement plan just pays its share after Medicare processes the bill and pays.

If Medicare pays, the Medicare Supplement Plan pays.

If Medicare doesn’t pay, the Medicare Supplement Plan doesn’t pay.

The only reason to not be unhappy with a Medicare Supplement Plan is the premium.

Plan G-HD usually has very small annual premium increases and that would really be the only reason to switch insurers.

In some states, you can switch insurers without underwriting (usually around your birthday).

If you don’t live in one of this states, you would have to go through underwriting to switch Plan G-HD insurers.

[tj]

This is a great discussion.

I’m also leaning toward G-HD as I approach age 65.

But two things have me on the fence:

First, I wonder how I, at 85 or 90, would be able to or want to manage the paperwork and paying of my co-pays/deductibles.

Second, United American and Globe Life, sister companies, offer a Reserve Fund Annuity that can seamlessly pay deductibles and co-pays. It’s been discussed in some other threads. I’m not aware of any other G-HD provider offering a similar autopay system. But Globe Life Inc., the parent of United American and Globe Life, has had some recent business controversies, discussed in other threads, and that gives me pause.

I believe I would save money with G-HD. But going with a respected G provider (with a good reputation on issue of deadpools), rather than a G-HD plan, would be so…easy. My old self might appreciate that two decades from now.

What "business controversies"?

[ModifiedDuration]

This is a great discussion.

I’m also leaning toward G-HD as I approach age 65.

But two things have me on the fence:

First, I wonder how I, at 85 or 90, would be able to or want to manage the paperwork and paying of my co-pays/deductibles.

Second, United American and Globe Life, sister companies, offer a Reserve Fund Annuity that can seamlessly pay deductibles and co-pays. It’s been discussed in some other threads. I’m not aware of any other G-HD provider offering a similar autopay system. But Globe Life Inc., the parent of United American and Globe Life, has had some recent business controversies, discussed in other threads, and that gives me pause.

I believe I would save money with G-HD. But going with a respected G provider (with a good reputation on issue of deadpools), rather than a G-HD plan, would be so…easy. My old self might appreciate that two decades from now.

What "business controversies"?

This has nothing to do with Globe Life or United American’s Medicare Supplement policies, but last April, a firm, Fuzzy Panda Research (that really is their name), took a large short position in Globe Life and then issued a report alleging that a sales agency (the Arias Agency) and other sales agencies that sold Globe Life policies had engaged in fraud and that there were kickbacks to Globe Life employees.

The stock took an immediate big hit in April, but after the Wall Street folks who follow the company (and know Globe Life and its business a lot better than we do) looked into it, Globe Life’s stock price has recovered and is now higher than it was in April.

[krisSA]

Medicare makes all the decisions regarding healthcare.

A Medicare Supplement plan just pays its share after Medicare processes the bill and pays.

If Medicare pays, the Medicare Supplement Plan pays.

If Medicare doesn’t pay, the Medicare Supplement Plan doesn’t pay.

The only reason to not be unhappy with a Medicare Supplement Plan is the premium.

Plan G-HD usually has very small annual premium increases and that would really be the only reason to switch insurers.

In some states, you can switch insurers without underwriting (usually around your birthday).

If you don’t live in one of this states, you would have to go through underwriting to switch Plan G-HD insurers.

Thanks for the reassuring response.
One final question: How's Physician Select G-HD Plan (offered by Physician Mutual) compared to United American? I'll appreciate any input. Thanks

[tj]

The fact that Physicians Mutual started up a new subsidiary - Physicians Select - after previously using Physicians Life and Physicians Mutual is somewhat concerning.

[ModifiedDuration]

Medicare makes all the decisions regarding healthcare.

A Medicare Supplement plan just pays its share after Medicare processes the bill and pays.

If Medicare pays, the Medicare Supplement Plan pays.

If Medicare doesn’t pay, the Medicare Supplement Plan doesn’t pay.

The only reason to not be unhappy with a Medicare Supplement Plan is the premium.

Plan G-HD usually has very small annual premium increases and that would really be the only reason to switch insurers.

In some states, you can switch insurers without underwriting (usually around your birthday).

If you don’t live in one of this states, you would have to go through underwriting to switch Plan G-HD insurers.

Thanks for the reassuring response.
One final question: How's Physician Select G-HD Plan (offered by Physician Mutual) compared to United American? I'll appreciate any input. Thanks

I’m certainly familiar with Physicians Mutual and their Innovative product (as well as Physicians Life) and have heard good things about them.

Physicians Select is relatively new, having been formed in 2022. I’m really not that familiar with them, other than to recall that in at least in one state, they were charging $10 a month extra for the option that included a gym membership.

United American has for years been offering the option with their Plan G-HD policies to move to Plan G at the end of two years.

My thought is that United American has been the leader in the high-deductible arena for years and is known for low, stable premiums.

Physicians Select is relatively new to the market, so there is no premium increase history to look at, but I do understand the attraction of the gym membership.

[bolete]

This has been a very thorough discussion, just thought I’d offer up Plan N, which seems like a near ideal plan for bogleheads who don’t anticipate too many visits. It’s fairly inexpensive, and the main risk exposure is modest visit copays, less risk than g hd. I found in Virginia Mutual of Omaha has had a plan N for at least 5 years, and raised the rate 8% total over those years. It also has theoretical reasons to have a healthier population than plan g. All for 82/month at age 65. I’m surprised more people don’t choose plan N.

[krisSA]

I’m certainly familiar with Physicians Mutual and their Innovative product (as well as Physicians Life) and have heard good things about them.

Physicians Select is relatively new, having been formed in 2022. I’m really not that familiar with them, other than to recall that in at least in one state, they were charging $10 a month extra for the option that included a gym membership.

United American has for years been offering the option with their Plan G-HD policies to move to Plan G at the end of two years.

My thought is that United American has been the leader in the high-deductible arena for years and is known for low, stable premiums.

Physicians Select is relatively new to the market, so there is no premium increase history to look at, but I do understand the attraction of the gym membership.

Thanks, United American it is, decision made. I know I still have to do my homework

[FreddieFIRE]

This has been a very thorough discussion, just thought I’d offer up Plan N, which seems like a near ideal plan for bogleheads who don’t anticipate too many visits. It’s fairly inexpensive, and the main risk exposure is modest visit copays, less risk than g hd. I found in Virginia Mutual of Omaha has had a plan N for at least 5 years, and raised the rate 8% total over those years. It also has theoretical reasons to have a healthier population than plan g. All for 82/month at age 65. I’m surprised more people don’t choose plan N.

Do you have any concerns with Plan N not paying Part B excess charges?

I just compared monthly premiums for Plan N vs. Plan G-HD with Globe Life (UA) as the provider. $170 per month versus $58. That's $1344 per year (plus the co-pays), which would be a large chunk of the HD deductible. And it would hit every year. It doesn't sound like it would be advantageous for my situation in my state. That said, thanks for posting that.

[Small Change]

What "business controversies"?

This has nothing to do with Globe Life or United American’s Medicare Supplement policies, but last April, a firm, Fuzzy Panda Research (that really is their name), took a large short position in Globe Life and then issued a report alleging that a sales agency (the Arias Agency) and other sales agencies that sold Globe Life policies had engaged in fraud and that there were kickbacks to Globe Life employees.

The stock took an immediate big hit in April, but after the Wall Street folks who follow the company (and know Globe Life and its business a lot better than we do) looked into it, Globe Life’s stock price has recovered and is now higher than it was in April.

There also have been reports of an SEC inquiry, a Justice Department investigation and a data breach. I’m not sure of the status of these things.

[walkinwood]

In my case, there has been very little paperwork.

My bloodwork has been covered 100% by Medicare, as has my vaccinations and colonoscopies. Nothing to do there.

I usually have 5 to 8 doctor visits a year, which are processed by Medicare and then by my Supplement.

The doctor usually bills about $250, the Medicare-approved rate is about $125, I pay the first $257 (the Part B deductible) and after that pay about $25 for each doctor office visit.

I get the bill from the doctor and just pay it on-line.

The bills have been so small that I am just saving them to file with my HSA all at once.

It has been very easy.

The complaint we see sometimes is that the doctor bills Medicare but fails to bill the supplement, then sends the bill (20%) to the patient that should have gone first to the supplement.

I guess this would be a problem with any supplement plan - not just the G-HD.

By my calculations, given the premium, deductible & max out of pocket that the OP provided, you'll need an annual medical expense of more than $11,657 for the Plan G to come out ahead of Plan G-HD in any given year.

I hadn't considered G-HD until reading this thread - I was leaning towards G. Now, I think it is the one that will fit our needs best. Thank you all for your contribution to this thread.

[Svensk Anga]

This has been a very thorough discussion, just thought I’d offer up Plan N, which seems like a near ideal plan for bogleheads who don’t anticipate too many visits. It’s fairly inexpensive, and the main risk exposure is modest visit copays, less risk than g hd. I found in Virginia Mutual of Omaha has had a plan N for at least 5 years, and raised the rate 8% total over those years. It also has theoretical reasons to have a healthier population than plan g. All for 82/month at age 65. I’m surprised more people don’t choose plan N.

Do you have any concerns with Plan N not paying Part B excess charges?

I just compared monthly premiums for Plan N vs. Plan G-HD with Globe Life (UA) as the provider. $170 per month versus $58. That's $1344 per year (plus the co-pays), which would be a large chunk of the HD deductible. And it would hit every year. It doesn't sound like it would be advantageous for my situation in my state. That said, thanks for posting that.

N was more competitive with G-HD in Florida, $1050/year difference between best carriers for each. We were seriously considering N for DW. I think excess charges are not currently an issue as they are very uncommon. But ideally, (and especially in an issue age state) one wants to have a plan they can stick with for life. Who knows what the landscape looks like in 2 decades, when medical costs are likely mounting. My understanding is there is little to gain for the provider chasing excess charges. It is an administrative hassle and I think slower cash flow. I could guess that the more providers are squeezed by stingy Medicare rates, the more incentive there is to implement some system in the future to expedite the excess charges revenue stream. It's not a deciding factor but just another factor in the weighing of options.

We are going with United American G-HD for DW despite her being a fairly heavy user of medical services. I've got to believe G-HD will look even better than N in a decade or two.

[GAAP]

I would just wait until the Supplement Plan processes processes the bill, although with a Plan G-HD it really wouldn’t matter unless you were near the $2,870 maximum out-of-pocket.

That's good advice for any health insurance. I have never paid a healthcare bill until after verifying against the EOB from the insurance provider. As executor for my mother's estate, I did the same thing.

[Northern Flicker]

Death spirals may become more common once all baby boomers are on Medicare, a status that is not far away. Then new enrollments will be smaller in number in proportion to existing enrollments. Medigap pools will increasingly skew older and less healthy. This will enhance the incentive to offer new pools to new enrollees to be able to offer a competitive premium to them.

If a Medigap plan became too expensive from death spirals or whatever, you still have the ability to switch to an Advantage plan down the road as one option, so this is not a reason to pick Advantage now if you otherwise prefer Medigap.

[cks]

That being said, my opinion is that you're basing some of your assumptions based on grammar school math when at the very least, you need multivariable or stochastic calculus given the number of variables and unknowns. Even then, you can ask any economist how accurate your "guess" would be.

Which assumptions are you referring to? Which guesses? This post is confusing.

Let's talk about the biggest risk: what is your projection for inflation/deductible for 2025, 2030, 2035, and 2040?

What is your projection for G premiums given that they are more influenced by state rules and regulations and not necessarily CPI for the same years?

[Svensk Anga]

Which assumptions are you referring to? Which guesses? This post is confusing.

Let's talk about the biggest risk: what is your projection for inflation/deductible for 2025, 2030, 2035, and 2040?

What is your projection for G premiums given that they are more influenced by state rules and regulations and not necessarily CPI for the same years?

The Part A and G-HD high deductibles are indexed to CPI-U, so up 2.7% from 2024 to 2025. So not a problem for a SS and TIPS funded retirement.
The Part B deductible is determined by some opaque formula and went up 7.1% this year. That is a high inflation rate but on a small dollar amount, now $257/year. I expect medical costs to keep this inflating faster than CPI.

This video (from Giardini Medicare https://www.youtube.com/watch?v=WL0tOghpTOM ) claims that premium increases have been 6.5%/year for G, 4.5%/year for N, and 2.5%/year for G-HD. This discussion starts at about minute 14. It is not too clear over what period they calculated, but it might only be since 2020.

This web site ( https://blog.newhorizonsmktg.com/how-to ... lients4687 ) has G at 6% and N at 3.5%, roughly in line with Giardini.

I would expect more of the same. High users flock to G so it has the highest pressure on rates. Healthier folks or folks so cheap that a $20 copay keeps them from going to the doctor use N and so has a more restrained pressure on premiums. G-HD premiums are somewhat restrained by the growth in the high deductible raising the hurdle before the insurance company starts paying claims. Maybe G-HD folks are healthier. Maybe they pick G-HD because they know they tend toward minimal use of medical services. Our agent claimed that a lot of folks of limited means pick G-HD for the low premium when they want to avoid Advantage plans. They thought these folks might help drive premium increases, but I suspect that is just salesperson talk. (G-HD commission was 36% of what they could get for selling N.)

Plan G starting at the highest rate and escalating at the highest rate makes it look like a budget buster a decade or two out. Add in the dead pool potential and it looks even riskier.

[FreddieFIRE]

Which assumptions are you referring to? Which guesses? This post is confusing.

Let's talk about the biggest risk: what is your projection for inflation/deductible for 2025, 2030, 2035, and 2040?

What is your projection for G premiums given that they are more influenced by state rules and regulations and not necessarily CPI for the same years?

What does any of this have to do with this thread?

[FreddieFIRE]

Plan G starting at the highest rate and escalating at the highest rate makes it look like a budget buster a decade or two out. Add in the dead pool potential and it looks even riskier.

This all makes perfect sense. Thanks.

[walkinwood]

I checked the SERFF system to see how many G-HD policies were sold in my state by Globe Insurance & the numbers were tiny (just 29 in 2023).

Is this a concern?
My understanding is insurance companies have to pool their policies by state. ie, they don't have a nationwide pool. Is that correct?

Here is a video on using the SERFF system to search for information on policies / companies
https://youtu.be/j66oGQqz2Mc?si=Rbbg1c-6bL9AFeNA

[tj]

I checked the SERFF system to see how many G-HD policies were sold in my state by Globe Insurance & the numbers were tiny (just 29 in 2023).

Is this a concern?
My understanding is insurance companies have to pool their policies by state. ie, they don't have a nationwide pool. Is that correct?

Here is a video on using the SERFF system to search for information on policies / companies
https://youtu.be/j66oGQqz2Mc?si=Rbbg1c-6bL9AFeNA

I don't see why why your perception would be something that is mandated. At the end of the day, they ARE diversified nationwide and to them it might not be worth the cost of filing rate increases in your state if there are only 29 people they can squeeze more $$$ out of.

[GaryA505]

I checked the SERFF system to see how many G-HD policies were sold in my state by Globe Insurance & the numbers were tiny (just 29 in 2023).

Is this a concern?
My understanding is insurance companies have to pool their policies by state. ie, they don't have a nationwide pool. Is that correct?

Here is a video on using the SERFF system to search for information on policies / companies
https://youtu.be/j66oGQqz2Mc?si=Rbbg1c-6bL9AFeNA

I don't see why why your perception would be something that is mandated. At the end of the day, they ARE diversified nationwide and to them it might not be worth the cost of filing rate increases in your state if there are only 29 people they can squeeze more $$$ out of.

This is something I've wondered about too.

And if they're going to only get 29 policies in a particular state, why do they even bother to offer the plan in that state? At what point is the pool "too small"?