Medigap Plans are very popular in general because they play an essential financially protective role in all your medical costs. Without one of these supplemental plans, your only medical coverage would be what Medicare pays. More specifically, without a Medigap plan, you could have quite a mountain of out-of-pocket costs. As you may remember, Medigap plans pick up the “gaps” in medical costs not covered by Medicare Part A (inpatient stays and treatments) and Part B (outpatient visits and treatments).
How does this affect me?
Let me help you see this in terms of how it would affect you. Take, for example, this year. In 2019, for any hospitalization or inpatient treatment, without a Medigap plan you would be responsible for the $1364 deductible and copays, as well as charges made above what Medicare Part A and B agree to pay (termed “excess” charges). Here’s another example: If you need to be in a skilled nursing facility for more than 21 days (up to 100 days), you would be responsible for $167.50 per day copayment. That’s $3,417.50. And don’t forget, without a Medigap plan, you would also be responsible for the Part B deductible — $185.00 (outpatient doctors’ visits and treatments) plus 20% copay for all charges for every visit.
When a doctor charges more than what Medicare allows, you, the patient, would have to pay the excess. You can see how quickly your medical out-of-pocket expenses would escalate.
Why are Medigap plans popular in general? The most sobering risk of not having a supplemental plan to Medicare is that basic Medicare has no maximum out-of-pocket limit. What that means is that there is no point at which you would get to stop paying your copays and have your medical insurance pick up the ongoing costs. So, for example, for someone with a chronic condition with ongoing regular treatments (such as frequent emergency room visits for asthma, cancer treatments, or regular dialysis) the patient would be responsible for 20% of every treatment given. Again you can see that your out-of-pocket costs can skyrocket rapidly.
So Medigap plans are popular because they control these extra costs and give you the freedom to go to any Medicare provider of your choice. Currently, there are 10 different plans, although one of them, Plan F, will no longer be available for new enrollees at the end of this year. Medigap plans are named alphabetically A – J. That doesn’t, however, mean they are in order of popularity or best benefits. In most states, Medigap plans are standardized to cover certain costs. Beyond the standardized coverage, each plan offers a slightly different package of shared costs and benefits of the nine (9) possible benefits that could be offered. And of course, the basic monthly premium to get the plan differs.
WHICH PLAN HAS BEEN MOST POPULAR?
Simply put, the answer is Medigap Plan F. Fifty-five percent (55%) of those who purchase a Medigap Plan end up choosing Plan F (or it’s high-deductible version). Why has it been the most popular? Its top-of-the-line reputation and resulting popularity come from its excellent coverage of costs. Of the nine (9) benefits Medigap plans offer, Plan F covers the maximum allowed for all nine of them.
The Cadillac Plan
Plan F has also been popular because it pays benefits from the day you pay your first premium – – no waiting period. Your share in Medicare-covered medical costs is taken care of by Medigap Plan F from the first day you sign on for the plan. In practical terms, this means you never have to pay out-of-pocket co-pays if you meet the criteria of using healthcare providers who accept Medicare patients and the fee Medicare allows.
Unfortunately, Plan F will no longer be available to newly eligible
Medicare beneficiaries after December 31, 2019. If you have
Plan F already, or if you are able to purchase Medigap Plan F before
the end of 2019, you will be able to continue with this popular and
excellent-coverage plan into 2020.
Although popular, the downside to Medigap Plan F is that in order to provide this excellent coverage, the monthly premiums for Plan F are higher than the premiums for other plans. And this monthly premium for Medigap Plan F is going up in 2020. For this reason, primarily, popularity is shifting away from Medigap Plan F.
MEDIGAP PLAN G IS BECOMING MOST POPULAR
The growing popularity of Medigap Plan G is because it is very similar to Medigap Plan F. It only has one difference from Plan F — one less benefit. If you choose Plan G, you get eight (8) of the 9 benefits. The one benefit Plan G does not cover for you is the Medicare Part B deductible.
Before you panic, let’s take a look at what this means for your pocketbook. For 2019 this is $185.00. In comparison to pre-Medicare insurance with a high-deductible plan (often $5000-$6000 a year for the deductible), this Medicare deductible of $185 per year can seem insignificant. On a limited retirement income, however, it is something to consider. Remember that once you’ve met your Medicare Part B deductible, all the other costs are covered by Medigap Plan G.
Another important consideration that plays a role in the growing popularity of Medigap Plan G is the issue of the monthly premium. With Plan G, even though you pay $185 out-of-pocket for the deductible for Medicare Part B (out-patient doctors’ visits and treatments), the amount you pay for the monthly premium for the plan is lower (in some cases significantly so) compared to Plan F premiums.
Compare Plan F
Consider this: For Plan F, depending on your state and the carrier from whom you purchase your Medigap plan, the monthly premium can be as low as $159 each month or as high as $450 each month (that’s in New York). The average for Medigap Plan F is $236 per month. I anticipate that the premium for Plan F will increase rapidly. Due to no new healthy people entering into the plan. However, this is just opinion and only time will be able to tell if it becomes true. Please don’t let this scare you into not purchasing Plan F.
Compare Plan G
Now consider Medigap Plan G premiums. Premiums for Medigap Plan G range from $98 per month to $140 (for males; it is slightly lower for females) depending on the insurance carrier from whom you purchase the plan. Now let’s do the math using the lowest carrier’s premiums: Plan F @ $159 per month and Plan G @ $98/mo. (Rates vary in different zip codes). The difference is that you are paying $61 less each month for Plan G. That means that in a little over 3 months, you will have saved yourself the entire cost of your deductible. So yes, Plan F covers the deductible, but as stated above, you pay much more for the premiums than you would need to pay for the deductible.
Even though these plans have been the most popular, your circumstances and medical needs may not make them the best plan for you. The differences in premiums and provided coverage are important to consider. It is also important to consider how often you need to access medical care and what treatments you may need. Matching a plan to your needs is a much better way to avoid surprises and unexpected costs when it comes to medical expenses than simply choosing the most popular plan.
What’s Best For Me?
You should use the expertise of a highly experienced and sought after independent insurance broker. They will help you sort through the differences of each plan, which plans best match your medical needs and financial circumstances, and your comfort level. Call today for an appointment: Brian Gruss 352-508-4221