Medigap part G or Medicare Advantage for 84 yr old mother?

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anonyx
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Medigap part G or Medicare Advantage for 84 yr old mother?

Post by anonyx »

I'm trying to make some sense out of Medicare for my 84-year-old mother.

She was living independently in Michigan for years but now she's living with me (rent free) in New York State.

She hasn't been to a doctor in years and is taking no meds so her current out-of-pocket medical expenses are 0 but I'm worried about expenses if she should need major medical care in the future. Her life savings are under $50K and her only income is a skimpy Social Security check.

She has Medicare Parts A and B of course, and was automatically signed up for a Part D subscription plan, for which her contribution to premiums is $0.

My plan, unless someone talks me out of it, is to sign her up for a Part G medigap plan with a high deductible. It would cost her slightly under $60 per month in premiums and the main advantage, as far as I can see, is that it would put a cap on annual out-of-pocket expenses.

I've heard some negative things about Medicare Advantage plans. From what I've read so far, the disadvantages to a Medicare Advantage plan seem to be that:

She would be limited to doctors and clinics within the particular Medicare Advantage system;
If she were to move back to Michigan or to some other state (a possibility) she would be out of the system so her medical care elsewhere might not be covered?;
Since Medicare Advantage is profit-driven, people often get turned down for medical procedures that they want;
If Medicare Advantage doesn't work out well for her, there can be some difficulty in going back to Medicare?'

I would greatly appreciate any constructive comments or opinions as to whether opting for the Part G medigap plan with high deductible would be a bad idea and why. Or if anyone has a better plan. Thank you.
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dodecahedron
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Re: Medigap part G or Medicare Advantage for 84 yr old mother?

Post by dodecahedron »

I live in NY and have experience taking advantage of NY's very flexible laws, so the good news is that as a NY resident she is not locked into any particular choice. At a minimum, she will have the ability to change plans (without underwriting!) at least once a year (and possibly even more frequently--read on for details.)

Plan G-HD plus Traditional Medicare (plus some kind of separate Part D drug coverage) could be a good way to start out. Once she has had medical evaluation and her prospective treatment needs (if any) are clearer, you might think about switching to a $0 premium Medicare Advantage plan that includes drug coverage.

At least in much of Upstate NY, there is at least one excellent five-star Medical Advantage PPO, with a huge and inclusive network. With a five-star plan, there is a special rule that allows a patient to switch INTO that plan any time during the year, not just during the Annual Enrollment Period that generally applies to Medicare Advantage plans.

Also, if her income is under $75K, check into free supplementary EPIC coverage, which is a NY free program supplementing whatever drug coverage she has (and reducing her out-of-pocket costs.) The program has a simple application, can reduce drug costs, and ALSO gives even more flexibility about switching OUT OF any Medicare Advantage plan any time during the year.

Example: I chose a $0 premium Medicare Advantage PPO including drug coverage at age 65. I also signed up for EPIC. I switched to a different zero premium MA PPO at 66 during the Annual Enrollment Period (because a new one came along that I liked better). Three months later, in March 2020, I worried about the prospect of a new unknown disease and thought I might be wanting to get treatment out of state (either because hospitals might be too crowded in NY or because I would be caring for elderly relatives who live out of state) so I was able to switch (on 3 weeks notice!) from the Medicare PPO to a high-deductible Plan F plus traditional Medicare effective April 1, 2020. I stayed on that plan for a year and a half (fortunately needing no medical care other than routine preventive and vaccines), then decided to switch back to the five-star MA PPO with 0 premium, effective Nov 1, 2021.

I had the confidence to select my five-star PPO because I have a lot of physician friends who say they like dealing with it and essentially any doc in the area who accepts *any* insurance participates in the PPO.

But if I were moving to a new place where I didn't know about my medical needs and I didn't know about how the MA plans were viewed by local providers, I would start out the way you suggest for your mother, a high-deductible Medigap plus traditional Medicare (and of course a drug Part D and EPIC, if she qualifies.) She can switch later when she has more info.
egrets
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Re: Medigap part G or Medicare Advantage for 84 yr old mother?

Post by egrets »

The people being turned down was what made Medicare Advantage an immediate no go for me. I had enough of that when I was younger and had employee health insurance.

I have AARP Medigap Plan F (which I think is just like Plan G except G has a small deductible), Plan F I think is closed to new members, I am staying with it because I am happy not to have to track even the deductible stuff.

I can see any doctor who accepts Medicare. I live in Rhode Island near Boston with its magnificent medical establishment. In the well over ten years I've had Medicare, I only ran across two doctors who didn't take it. I've been hospitalized once and have never had to pay a dime for anything but the part of prescription costs that Plan D doesn't cover. My Plan D is AARP also, and they have been asked for probably 3-4 approvals for meds not in their formulary and they covered all those, approval within 1-2 days.
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dodecahedron
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Re: Medigap part G or Medicare Advantage for 84 yr old mother?

Post by dodecahedron »

egrets wrote: Sat Dec 04, 2021 11:49 am I have AARP Medigap Plan F (which I think is just like Plan G except G has a small deductible), Plan F I think is closed to new members, I am staying with it because I am happy not to have to track even the deductible stuff.
Plan F is closed to people who *recently* became eligible for Medicare (i.e., folks who turned 65 in the last couple years.)

Plan F is not closed to folks like the OP's mom, who is 84.

One alternative to consider is Plan F-HD. In many parts of NY, Globe Insurance is the cheapest Plan F-HD and Plan G-HD provider and actually charges the same premium ($57 per month) for both plans. Here is a table of the rates for all plans and providers in all regions of NY.
Last edited by dodecahedron on Sat Dec 04, 2021 11:55 am, edited 1 time in total.
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arcticpineapplecorp.
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Re: Medigap part G or Medicare Advantage for 84 yr old mother?

Post by arcticpineapplecorp. »

how much would a part G plan without a high deductible be? My mom (NJ) has a part G and has no deductible except medicare $203 this year. Her costs are contained that way.

reason I'm asking is if she has a high deductible, but doesn't sound like she has the resources to pay a high deductible for many years, why wouldn't you want to contain costs as much as possible by getting a part g with a higher monthly premium and lower out of pocket costs.

the purpose of insurance is to have another bear the risk you're not willing/able to bear. If she doesn't have the resources, I wouldn't consider a high deductible plan.

Yes, it may result in a higher premium, but that's all she should pay (after her medicare deductible is reached, $233 in 2022).

you could also look at a plan N which might have a lower monthly premium, but have more copays so you have to weigh how many doctors a month she sees and if that makes the G better than the N plan.
Last edited by arcticpineapplecorp. on Sat Dec 04, 2021 11:57 am, edited 1 time in total.
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egrets
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Re: Medigap part G or Medicare Advantage for 84 yr old mother?

Post by egrets »

dodecahedron wrote: Sat Dec 04, 2021 11:53 am
egrets wrote: Sat Dec 04, 2021 11:49 am I have AARP Medigap Plan F (which I think is just like Plan G except G has a small deductible), Plan F I think is closed to new members, I am staying with it because I am happy not to have to track even the deductible stuff.
Plan F is closed to people who *recently* became eligible for Medicare (i.e., folks who turned 65 in the last couple years.)

Plan F is not closed to folks like the OP's mom, who is 84.
Oh, thanks. I didn't know that.
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dodecahedron
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Re: Medigap part G or Medicare Advantage for 84 yr old mother?

Post by dodecahedron »

anonyx wrote: Sat Dec 04, 2021 11:20 am If she were to move back to Michigan or to some other state (a possibility) she would be out of the system so her medical care elsewhere might not be covered?;
If she establishes residency in NY and buys a plan in NY, she has lots of flexibility if she later moves to another state (whether Michigan or any other), because moving her permanent residence is a qualifying reason for open enrollment in general in any state.

Now, if she just *travels*, say, to visit friends in Michigan for an extended period but does not actually establish residence there, a NY-based Medigap plus traditional Medicare would serve her better than a NY-based Medicare Advantage plan. The MA coverage for such a visit would be limited to emergency or urgent care, while the traditional Medicare plus Medigap fully covers her anywhere in the US.
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Re: Medigap part G or Medicare Advantage for 84 yr old mother?

Post by egrets »

Just as a data point, my AARP Medigap Plan F cost me $3210 for this year, I have always paid a lump sum annually, just for convenience and I get a tiny discount for doing that. For next year, for reasons unknown, they have changed so that we lump sum people could only pay for the first 5 months at once, for me a total of $1137. They haven't announced the premiums for the remaining seven months, but note that ($1137/5)*12 = $2728, so I don't know why they suddenly appear to be lowering costs. (I'm 78.)
Last edited by egrets on Sat Dec 04, 2021 12:11 pm, edited 1 time in total.
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dodecahedron
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Re: Medigap part G or Medicare Advantage for 84 yr old mother?

Post by dodecahedron »

arcticpineapplecorp. wrote: Sat Dec 04, 2021 11:55 am how much would a part G plan without a high deductible be? My mom (NJ) has a part G and has no deductible except medicare $203 this year. Her costs are contained that way.
The non-high-deductible plans G and F can be relatively expensive in NY. Check out this link to the prices for all plans and providers in all regions:

https://www.dfs.ny.gov/system/files/doc ... evised.pdf

However, Medigap plans can be changed every month in NY. If she develops something expensive, mom can switch from Plan G-HD to straight Plan G on less than a month's notice. (That flexibility is one reason the non-high-deductible plans are relatively expensive. Economists call the phenomenon adverse selection.)
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dodecahedron
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Re: Medigap part G or Medicare Advantage for 84 yr old mother?

Post by dodecahedron »

Further point: OP, I looked at your posting history. It is clear your mother's financial resources are very limited. NY has some generous assistance plans for people in her circumstances. They may well cover her Part B premiums and Part D premiums.
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Re: Medigap part G or Medicare Advantage for 84 yr old mother?

Post by bobcat2 »

anonyx wrote: Sat Dec 04, 2021 11:20 am I'm trying to make some sense out of Medicare for my 84-year-old mother.

She hasn't been to a doctor in years ...
I believe the most important thing your mother needs to do is see a doctor - soon!

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anonyx
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Re: Medigap part G or Medicare Advantage for 84 yr old mother?

Post by anonyx »

Thank you to all those who have responded, particularly dodecahedron, you’ve made a lot of excellent points and have been very helpful!!

Dodecahedron:

I will check out the leads that you provided, thank you. EPIC rings a bell, but I can’t remember if I looked into it before or not. My understanding is that my mom’s savings, though not much, are still enough to disqualify her for Medicaid.

Plan F- HD sounds good, if available, First I’d heard it was no longer offered, and then I figured that she should still be eligible for it due to her age, but I got a runaround trying to apply for it on the Excellus website. I’m not very familiar with the other insurers offering it. Humana seems to get even worse customer reviews than Excellus. I’d consider Globe Insurance if they’re reliable and have decent customer service?


Arcticpineapplecorp:

Premiums for Plan G without a high deductible would be hundreds of dollars per month ($203.17 - $463.75) which is quite a large percentage of my mother’s total income. If her out-of-pocket healthcare expenses continue to be low for a while, then it seems to be spending a lot unnecessarily at this point.


Bobcat2:

Today my focus is on getting her health insurance set up. My mother wouldn’t voluntarily go to the doctor when she was on her own (and the pandemic has been a factor since she came to NY.) My mom’s family were extreme hillbillies who tended to avoid doctors in general. (If anyone’s curious as to how well that's worked out for them, they could ask my mother’s mother. She’s still living. :) )
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arcticpineapplecorp.
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Re: Medigap part G or Medicare Advantage for 84 yr old mother?

Post by arcticpineapplecorp. »

dodecahedron wrote: Sat Dec 04, 2021 12:33 pm Further point: OP, I looked at your posting history. It is clear your mother's financial resources are very limited. NY has some generous assistance plans for people in her circumstances. They may well cover her Part B premiums and Part D premiums.

don't her resources need to be around $7000 less to qualify for buy in?

She said she has less than $50k, but didn't say she had $7000 or less. Perhaps she will in the near future, then getting part b paid for by the state and other coinsurance/deductibles would be a help.
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Re: Medigap part G or Medicare Advantage for 84 yr old mother?

Post by bobcat2 »

anonyx wrote: Sat Dec 04, 2021 2:03 pm
Bobcat2: My mom’s family were extreme hillbillies who tended to avoid doctors in general. (If anyone’s curious as to how well that's worked out for them, they could ask my mother’s mother. She’s still living. :) )
I had an uncle who smoked a pack of cigarettes a day and lived into his 90s. So following a similar line of reasoning to yours, it seems everyone should smoke a lot. :wink:

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Re: Medigap part G or Medicare Advantage for 84 yr old mother?

Post by spectec »

—>. (If anyone’s curious as to how well that's worked out for them, they could ask my mother’s mother. She’s still living. :) ). <—

Looks like you’ve done the most important thing you can do to increase your odds of living a very long life - arrange to be born to ancestors who tend to live a long time.
Don't gamble; take all your savings and buy some good stock and hold it till it goes up, then sell it. If it don't go up, don't buy it. - Will Rogers
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Re: Medigap part G or Medicare Advantage for 84 yr old mother?

Post by Big Dog »

egrets wrote: Sat Dec 04, 2021 12:08 pm Just as a data point, my AARP Medigap Plan F cost me $3210 for this year, I have always paid a lump sum annually, just for convenience and I get a tiny discount for doing that. For next year, for reasons unknown, they have changed so that we lump sum people could only pay for the first 5 months at once, for me a total of $1137. They haven't announced the premiums for the remaining seven months, but note that ($1137/5)*12 = $2728, so I don't know why they suddenly appear to be lowering costs. (I'm 78.)
I realize that you prefer to avoid the hassle of a deductible but that hassle is likely costing you money. In my SoCal zip code, a Plan F is ~$400 more than Plan G, so net of the deductible is still ~$200 more.

Also, might not hurt to check around for other insurers. Again, in my zip, the AARP plan (F or G) is significantly more than other insurers for the same Plan letter.
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Re: Medigap part G or Medicare Advantage for 84 yr old mother?

Post by celia »

anonyx wrote: Sat Dec 04, 2021 11:20 am She has Medicare Parts A and B of course, and was automatically signed up for a Part D subscription plan, for which her contribution to premiums is $0.
When you are turning 65, you are eligible to sign up for anything, no questions asked and no-one can be denied. But after you've been on Medicare, your previous coverage may limit what you can change to. In particular, the above quoted part sounds like she's currently on a Medicare Advantage plan, so, in most states, medical underwriting will be required before a Medigap plan would accept her, although NY residents sound like their rules may be different.

Open Enrollment closes December 7, so there isn't much time left to change plans (unless NY has other rules). I think AARP United HealthCare has the easiest underwriting questions. (AARP is just a corporate sponsor. United HealthCare is the insurer.) Since very few Medigap plans have an included drug plan, she will also need to pay for one (compared to the one provided by the Medicare Advantage plan I assume she is on). Changing to a Medigap plan means she will have to pay monthly premiums for:
Medicare Part B ($170.10 / mo)
Medigap (aka Supplemental) plan
Medicare drug plan

Even if she is on a Medicare Advantage plan and can't get on a Medigap plan, she will be eligible to join a different Medicare Advantage plan if she moves again. Or she can change by December 7.
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Re: Medigap part G or Medicare Advantage for 84 yr old mother?

Post by dodecahedron »

celia wrote: Sat Dec 04, 2021 10:54 pm
anonyx wrote: Sat Dec 04, 2021 11:20 am She has Medicare Parts A and B of course, and was automatically signed up for a Part D subscription plan, for which her contribution to premiums is $0.
When you are turning 65, you are eligible to sign up for anything, no questions asked and no-one can be denied. But after you've been on Medicare, your previous coverage may limit what you can change to. In particular, the above quoted part sounds like she's currently on a Medicare Advantage plan, so, in most states, medical underwriting will be required before a Medigap plan would accept her, although NY residents sound like their rules may be different.
NY rules are quite indeed quite different, much more flexibility than most other states, as I described above. Insurance companies are not permitted to require underwriting of new applicants for health insurance in NY.

Also, in general, anywhere in the country, moving and changing your permanent residence can give you special enrollment options to switch your coverage within 2 months of moving if your old coverage is not valid in your new residential region.
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dodecahedron
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Re: Medigap part G or Medicare Advantage for 84 yr old mother?

Post by dodecahedron »

arcticpineapplecorp. wrote: Sat Dec 04, 2021 6:05 pm
dodecahedron wrote: Sat Dec 04, 2021 12:33 pm Further point: OP, I looked at your posting history. It is clear your mother's financial resources are very limited. NY has some generous assistance plans for people in her circumstances. They may well cover her Part B premiums and Part D premiums.

don't her resources need to be around $7000 less to qualify for buy in?

She said she has less than $50k, but didn't say she had $7000 or less. Perhaps she will in the near future, then getting part b paid for by the state and other coinsurance/deductibles would be a help.
For full Medicaid coverage, there is a resource test that would likely disqualify OP's mother, but NY has at least three additional programs for Medicare beneficiaries that would not provide full Medicaid but only have an income test (no asset test) and would pay for Part B premiums, see QMB, SLMB, and QI on this page.
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Re: Medigap part G or Medicare Advantage for 84 yr old mother?

Post by dodecahedron »

anonyx wrote: Sat Dec 04, 2021 2:03 pm Thank you to all those who have responded, particularly dodecahedron, you’ve made a lot of excellent points and have been very helpful!!

Dodecahedron:

I will check out the leads that you provided, thank you. EPIC rings a bell, but I can’t remember if I looked into it before or not. My understanding is that my mom’s savings, though not much, are still enough to disqualify her for Medicaid.

Plan F- HD sounds good, if available, First I’d heard it was no longer offered, and then I figured that she should still be eligible for it due to her age, but I got a runaround trying to apply for it on the Excellus website. I’m not very familiar with the other insurers offering it. Humana seems to get even worse customer reviews than Excellus. I’d consider Globe Insurance if they’re reliable and have decent customer service?
I had Globe Plan F-HD for 18 months without actually needing it (thanks to good health and not having anything other than routine preventive care during that period) so I can't say much about their claims processing service, but I am quite pleased with the independent agent I used to sign up for that service. I feel confident that if I ever had a problem with a claim for any carrier he signed me up for, he would go to bat in making sure it was handled properly. NYS insurance department is also a resource to invoke.

My agent represents multiple carriers, including Globe. He was really knowledgeable about all my options and helped me both when I switched into Globe and 18 months later when I decided to switch out of Globe. There is no fee to Medicare beneficiaries for using an independent broker to sign up for a Medicare Advantage or Supplement and/or Part D policy. (Their commissions are paid by the insurance carriers and using an independent broker will not increase your premium.) I will send you a link to his website in a PM. He is licensed throughout NY (and in several other states as well, though not Michigan.)
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arcticpineapplecorp.
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Re: Medigap part G or Medicare Advantage for 84 yr old mother?

Post by arcticpineapplecorp. »

dodecahedron wrote: Sun Dec 05, 2021 9:54 am
arcticpineapplecorp. wrote: Sat Dec 04, 2021 6:05 pm
dodecahedron wrote: Sat Dec 04, 2021 12:33 pm Further point: OP, I looked at your posting history. It is clear your mother's financial resources are very limited. NY has some generous assistance plans for people in her circumstances. They may well cover her Part B premiums and Part D premiums.

don't her resources need to be around $7000 less to qualify for buy in?

She said she has less than $50k, but didn't say she had $7000 or less. Perhaps she will in the near future, then getting part b paid for by the state and other coinsurance/deductibles would be a help.
For full Medicaid coverage, there is a resource test that would likely disqualify OP's mother, but NY has at least three additional programs for Medicare beneficiaries that would not provide full Medicaid but only have an income test (no asset test) and would pay for Part B premiums, see QMB, SLMB, and QI on this page.
good to know. thanks. this would be much easier if there weren't 50 different rules!
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