Medigap decision between plan G and G+

[shotgunner]

I am rapidly approaching my six month window to select a Medigap policy to compliment my Medicare Part A and B. I have tried to read as much as I could to help with the decisions regarding Medicare and I have decided I want traditional Medicare vs. Advantage. I live in NH and I am trying to decide between a plan G or a plan G+ high deductible. I am aware that I may have to live with my choice going forward because of underwriting after the six month window closes.

At present I am a very light consumer of medical services, basically an annual physical and occasional screening like a colonoscopy. I do have mild asthma and GERD.

I have a telephone appoint with the NH SHIP representative to go over my choices on 1/4 and I will be working with an insurance agent that is well recommended after that.

The two plans I am considering is a plan G from Anthem BC/BS and a plan G+ from Humana.

Looking at the two plans, G and G+, strictly from the financial point of view I see that Anthem BC/BS plan G premiums would be $1200 more annually than a G+ (HD) plan from Humana. The G+ plan has an annual deductible of $2940 and then it would cover things the same as plan G.

If I go with the Humana G+ plan I would have $1200 of savings in premium that could go towards my $2940 deductible on the plan G+ if I should start racking up medical bills. That would put my out of pocket risk if I start consuming more medical services at $1740 annually ($2940 -$1200). If I don't consume much in the way of medical services as much as $1200 savings in premium stays in my pocket.

Financially speaking am I looking at this correctly?

 

[oldtimer]

Usually there are co-pays with G+ medigap plans. Those will reduce the $1200 premium difference.

 

[REWahoo]

Usually there are co-pays with G+ medigap plans. Those will reduce the $1200 premium difference.

Are you sure about this? My understanding is the only difference between G and G+ plans is the larger deductible that shotgunner pointed out.

 

[finnski1]

We live in NH as well.

DW just started medicare. I'm a few years away.

We also picked the Anthem BCBS Plan G. She is a low to moderate user of insurance but we decided to hedge our bet and pay the higher premium($139/month) to insure against the high end and using up all the deductible. The deductible limits can be reached very quickly with the cost of procedures etc. I think you are looking at it correctly. We just played the potential $1200 savings against the odds of maxing out the deductible. Time will tell.

 

[CardsFan]

We are all low consumers of health care, until we aren't.

Find one suspect freckle, it's skin cancer, now you are on a quarterly schedule for check-ups, samples and biopsies. (Ask me how I know).

Since this happened before Medicare, it was a no brainer for me to go with the low deducible plan.

 

[Dash man]

A good rule of thumb is to get the health plan you want when you’re sick, not the one you want when healthy.
Plan N is another way to save a few bucks on premiums without being stuck in a high deductible situation when health problems arise. There is an up to $20 copay for general office visits, but not for diagnostic or treatment visits, so they generally are minimal. The excess charges are rare since most healthcare providers accept Medicare assignment. I’m in PA, so it not an issue anyway. You can check with your doctors.

 

[harllee]

I got regular Plan G (through AARP United Healthcare). I don't want to mess with high deductibles as I age.

 

[audreyh1]

We pretty much went with the simplest lowest maintenance/record keeping minimal copy/deductible plan available and that was Plan G. AARP United Healthcare. Thinking about our aging selves.

 

[MBSC]

Your calculations are correct. Anthem is a fine choice for G in NH.

Humana has high G+ rates in most states including NH ($62). There is a 6% discount if you buy on their website ($58). Also consider United American ($45). Most Medigap enrollees rarely need to contact the plan, but should the need arise it is a little more difficult to get in touch with UA. However, this is not an issue if the agent writes UA policies. You contact the agent, not the insurer, with any issues and the agent works on your behalf to resolve the problem.

Normally, I would say Plan N splits the difference and should be considered, but rates are HIGH in NH.

There is also the matter of convenience. Some people don't want to deal with the medical bills associated with G+ when they get older so they pick G. I don't know if it's still available, but prior to 2021 United American had an optional annuity that acts like a savings account. You deposit funds and UA automatically pays medical providers the G+ cost share from those funds. You designate a beneficiary to receive unspent funds upon death. Maybe your agent can tell you if it's still available.

Here is an old brochure (pre-G+): https://www.naaip.org/united-american-reserve-fund-annuity.pdf

The deductible limits can be reached very quickly with the cost of procedures etc.

Medicare still pays 80% so the 'deductible' is a MOOP. Due to Medicare's low reimbursement rates, it's difficult for the 20% coinsurance and A/B deductibles to total $2490 unless the person is receiving chemotherapy or has multiple inpatient admissions.

 

[shotgunner]

Your calculations are correct. Anthem is a fine choice for G in NH.

Humana has high G+ rates in most states including NH ($62). There is a 6% discount if you buy on their website ($58). Also consider United American ($45). Most Medigap enrollees rarely need to contact the plan, but should the need arise it is a little more difficult to get in touch with UA. However, this is not an issue if the agent writes UA policies. You contact the agent, not the insurer, with any issues and the agent works on your behalf to resolve the problem.

Normally, I would say Plan N splits the difference and should be considered, but rates are HIGH in NH.

There is also the matter of convenience. Some people don't want to deal with the medical bills associated with G+ when they get older so they pick G. I don't know if it's still available, but prior to 2021 United American had an optional annuity that acts like a savings account. You deposit funds and UA automatically pays medical providers the G+ cost share from those funds. You designate a beneficiary to receive unspent funds upon death. Maybe your agent can tell you if it's still available.

Here is an old brochure (pre-G+): https://www.naaip.org/united-american-reserve-fund-annuity.pdf

Medicare still pays 80% so the 'deductible' is a MOOP. Due to Medicare's low reimbursement rates, it's difficult for the 20% coinsurance and A/B deductibles to total $2490 unless the person is receiving chemotherapy or has multiple inpatient admissions.

Thank you. That is a good tip on buying the G+ from Humana on their website.

I will have to look into the United American. As you may know there are a limited number of insurers offering G+ plans in NH. I wanted to go with a large well known and established insurer, which I think Humana is. The others are, Colonial Penn, Globe, Mutal of Omaha and United American. I am hoping not to have a situation where the insurer goes out of business and stops doing business in NH. I could be wrong but I also think rate increases might be more severe from lesser well known insurers.

As far as hitting the MOOP of $2940, which I know will increase each year just like premiums, without hospitalization one would have to have $14,700 of Part B expenses to reach it. Would something like a precancerous or cancerous freckle/mole situation result in hitting that year after year as one poster mentioned? In my mind I thought hitting it would require something like cancer (internal organ), heart attack stroke or perhaps a condition/disease like Parkinsons but I would be unlikely to hit it with normal use of medical services. Again my thinking is my additional financial exposure in year 1 is really $2940 - $1200 savings in premiums for $1740.

Finally I don't see much if any price break in NH for a full plan G vs. a plan N.

 

[Buckeye]

A good rule of thumb is to get the health plan you want when you’re sick, not the one you want when healthy.
Plan N is another way to save a few bucks on premiums without being stuck in a high deductible situation when health problems arise. There is an up to $20 copay for general office visits, but not for diagnostic or treatment visits, so they generally are minimal. The excess charges are rare since most healthcare providers accept Medicare assignment. I’m in PA, so it not an issue anyway. You can check with your doctors.

My hubby has Plan N. His hip replacement will end up costing us about $300 for Dr. visits pre and post (PCP and surgeon), MRI, surgical clearance appt with all associated tests, actual surgery, 1 day in the hospital, and PT. $203 of the $300 was the 2021 Part B deductible. Plan N rate savings versus G+ in Central FL is $310 but, of course, plan rates differ by locality.

 

[Bamaman]

It's nice to hear that you've been a "light consumer" of medical services in the past. You say that you have light asthma and GERD.

My wife suffered with GERD and light asthma for years, but she had aspirational pneumonia and hospitalization numerous times. She finally had hiatal hernia surgery--problem mostly solved. But her lungs are now very weak, and she wishes she'd had the surgery earlier. Had she addressed the GERD sooner, she might not recent have had recent cardiac problems.

We were very pleased with Plan G, but I knew I needed a new insulin pump and my wife was going to need a Medicare electric wheelchair due to pending mid foot fusion surgery with a 1 year recuperation. We switched to Plan F which takes care of the deductibles on Durable Goods (like the pump and the wheelchair.) Plan F is expensive, but we seldom have to pay any co-pays or deductibles. It's worked well for us, and is good for those that anticipate substantial future expenses and procedures.

 

[shotgunner]

It's nice to hear that you've been a "light consumer" of medical services in the past. You say that you have light asthma and GERD.

My wife suffered with GERD and light asthma for years, but she had aspirational pneumonia and hospitalization numerous times. She finally had hiatal hernia surgery--problem mostly solved. But her lungs are now very weak, and she wishes she'd had the surgery earlier. Had she addressed the GERD sooner, she might not recent have had recent cardiac problems.

We were very pleased with Plan G, but I knew I needed a new insulin pump and my wife was going to need a Medicare electric wheelchair due to pending mid foot fusion surgery with a 1 year recuperation. We switched to Plan F which takes care of the deductibles on Durable Goods (like the pump and the wheelchair.) Plan F is expensive, but we seldom have to pay any co-pays or deductibles. It's worked well for us, and is good for those that anticipate substantial future expenses and procedures.

Thanks. My GERD is well controlled with one OTC Prilosec per day, discussed potential of correcting hiatal hernia with laproscopic surgery and doctor said no to the risk involved vs. it being under control with a small dose of Prilosec. My asthma is mild and requires 1 refill per year of ProAIr rescue inhaler to use when I get into a trigger.

 

[DektolMan]

I'm here in CT where plan G is around $200 per month while G-HD is $55. I picked G-HD as I am healthy & take no prescriptions. We were self employed and use to HD plans & so far have been happy with our decision.

 

[Ian S]

We were very pleased with Plan G, but I knew I needed a new insulin pump and my wife was going to need a Medicare electric wheelchair due to pending mid foot fusion surgery with a 1 year recuperation. We switched to Plan F which takes care of the deductibles on Durable Goods (like the pump and the wheelchair.) Plan F is expensive, but we seldom have to pay any co-pays or deductibles. It's worked well for us, and is good for those that anticipate substantial future expenses and procedures.

I thought the only difference between Plans F and G is that Plan G requires you to pay the Medicare Part B deductible. At least that's the only deductible I've had to pay in the years I've been on Plan G.

 

[audreyh1]

I thought the only difference between Plans F and G is that Plan G requires you to pay the Medicare Part B deductible. At least that's the only deductible I've had to pay in the years I've been on Plan G.

You are correct.

 

[shotgunner]

I thought the only difference between Plans F and G is that Plan G requires you to pay the Medicare Part B deductible. At least that's the only deductible I've had to pay in the years I've been on Plan G.

Plan F is no longer available.

 

[statsman]

I thought the only difference between Plans F and G is that Plan G requires you to pay the Medicare Part B deductible. At least that's the only deductible I've had to pay in the years I've been on Plan G.

It was. Plan F was grandfathered a few years ago - not even sure those grandfathered can still get it today. The problem was a couple of years ago, they spiked the premium costs of Plan F to the point where it was more expensive than Plan G even if you paid the Part B deductible.

Given the medical "surprises" DW had in 2021, she'll be staying on Plan G, rather than switch to G+.

 

[travelover]

Are you sure about this? My understanding is the only difference between G and G+ plans is the larger deductible that shotgunner pointed out.

That is how my F+ plan works. Basically Medicare pays 80% and I pay the remaining 20% until I exceed the deductible. In my case, the savings in premiums = the deductible, so in a good year I come out ahead and in a bad year I break even.

 

[MBSC]

As far as hitting the MOOP of $2940, which I know will increase each year just like premiums, without hospitalization one would have to have $14,700 of Part B expenses to reach it. Would something like a precancerous or cancerous freckle/mole situation result in hitting that year after year as one poster mentioned? In my mind I thought hitting it would require something like cancer (internal organ), heart attack stroke or perhaps a condition/disease like Parkinsons but I would be unlikely to hit it with normal use of medical services.

You are correct. It would need to be an extremely serious medical condition. It's $13,768 in Part B allowed amounts ($2940 - $233 Part B deductible=$2707/.20) excluding preventive and lab which are exempt from cost sharing. Allowed amounts are a fraction of the billed charges. Choose a company you are comfortable with and lets you sleep well.

Again my thinking is my additional financial exposure in year 1 is really $2940 - $1200 savings in premiums for $1740.

The premium difference between G/G+ is $1200 but the OOP difference is $2707 resulting in a $1507 worst case deficit. I missed that in the OP.

 

[shotgunner]

You are correct. It would need to be an extremely serious medical condition. It's $13,768 in Part B allowed amounts ($2940 - $233 Part B deductible=$2707/.20) excluding preventive and lab which are exempt from cost sharing. Allowed amounts are a fraction of the billed charges. Choose a company you are comfortable with and lets you sleep well.
The premium difference between G/G+ is $1200 but the OOP difference is $2707 resulting in a $1507 worst case deficit. I missed that in the OP.

Thank you again. Another way to look at it. I would need to have more than $6000 in allowed charges before the G HD costs me more out of pocket ($1200/.20 = $6000) then the full G plan. Given what you said about allowed costs being a fraction of billed charges I do believe it would take an significant event to exceed that.

The United American plan has an even lower premium $44 a month ($18 less than the Humana I looked at) which changes things more in favor of the G HD. That medical annuity account is attractive if it is still offered. I will discuss this with my agent in the near future.

 

[MBSC]

The G+ plan has an annual deductible of $2940 and then it would cover things the same as plan G.

It's been a rough year for all of us. Let's try this again. The G+ deductible is $2490. The OOP difference between G/G+ is $2257 ($2490-$233). The $1200 premium savings leaves a potential $1057 deficit.

Below is a post where Plan G paid $700 the whole year, which included two Mohs skin cancer surgeries. You would still be $500 to the good with your premium savings.

I live in Redmond WA....two Mohs cancer surgeries and cardio doc visits...My plan G this year only paid out $700 that Medicare did not, but my premiums were $1950/yr, so I did the math and risk and decided to go with the HD Premera Plan G for $564/yr.

 

[shotgunner]

It's been a rough year for all of us. Let's try this again. The G+ deductible is $2490. The OOP difference between G/G+ is $2257 ($2490-$233). The $1200 premium savings leaves a potential $1057 deficit.

Below is a post where Plan G paid $700 the whole year, which included two Mohs skin cancer surgeries. You would still be $500 to the good with your premium savings.

I very much appreciate all your help in this matter. I believe you made a typo, The $1200 premium savings leaves a potential $1507 deficit.

My financial planner agrees with me that given my situation the plan G+ is the way I should go (lacking a crystal ball). So G+ it is.

 

[MBSC]

I very much appreciate all your help in this matter. I believe you made a typo, The $1200 premium savings leaves a potential $1507 deficit.

$2490-$233-$1200=$1057.

The G+ deductible is $2490 (Two-FOUR-Nine-Zero).

Effective January 1, 2022, the annual deductible amount for these three plans is $2,490.

Source: https://www.cms.gov/Medicare/Health-Plans/Medigap/FandJ

 

[shotgunner]

$2490-$233-$1200=$1057.

The G+ deductible is $2490 (Two-FOUR-Nine-Zero).

So I transposed two numbers but for once in a blue moon the correction is in my favor. Yay!