If you have had any interaction with a local agent or maybe a call center, you have likely heard the following phrases: “They’re all the same, get the cheapest one.” Or even, “A G is a G is a G is a G.” While those phrases hold good intentions and may allude to the fact that medigap or Medicare Supplement plans are standardized, they don’t paint the whole picture. Let me explain,
If you have a Guide to Health Insurance for People with Medicare, you can look on page 11. If you have the 2022 Medicare and You book, look at page 76. You will see a beautiful chart that will show you the minimum standards for Medigap plans available this year. Medicare Alphabet displayed on page 11 or 76 depending on the publication you are viewing. Across the top line you will see ABCD FG KLMN Where the heck do you want to begin? The 2 plans in the middle F and G are the most comprehensive. You may notice that those are 2 plans with a star beside them and extra notes on the bottom. If you were born after January 1st, 1955 you are too young for the F plan unless you had a prior permanent disability of over 2 years entitling you to Medicare benefits early. If you are one of those “youngens” looking for the most comprehensive coverage, you are in the right place at least to learn a little more.
The G plan is the most requested plan this year. Did you know that there are actually THREE different G plans? Not all plans are offered in all states by all companies. This is not an endorsement or recommendation of any plan to anyone. There is no one size fits all, this is just a simple overview of how the THREE plan G variations work. DISCLAIMER-I am using round hypothetical numbers that are close to the national averages for the sake of simplicity for premiums. This is not a quote or guarantee it is simply a general description of how these plans work.
Number 1. The standard plan G. The standard plan G has a national average premium of about $150/month. This is the most comprehensive plan currently available. It covers all of the benefits listed on page 11 and page 76 with one small exception, the part B deductible. Some may refer to this as a Cadillac because of how much it covers. The way this plan works is, you pay your monthly premium. You go to the doctor. You are responsible for the Medicare Part B deductible which is $233 this year. That’s it. Beyond that your plan covers all the benefits listed.
Number 2. On the other side of the spectrum, described below the chart by CMS. The high deductible G. The “high” deductible has an average premium of about $50/month. The “high deductible” and I use ear quotes because I actually have a high deductible, my deductible is $5000. This is not a “high deductible” but that is the name. The way that this plan works is, you pay your monthly premium. You go to the doctor. You are responsible for the Medicare Part B deductible which is $233 this year. Then Original Medicare kicks in, Original Medicare pays their part, for example 80% of part B approved amounts and you pay 20% up to, $2490 for the whole year which includes the $233 part B deductible you already met. After that your “high deductible” G plan pays all of your benefits listed. Wow! Most major medical group insurance I get to review daily does not even come close to that.
Number 3. Yup, there is one more. Like the other plans it is not available in all states and it is not offered by all carriers. The INNOVATIVE G plan. The average premium for the innovative is about $100-$110 somewhere between the other 2. The way this plan works is, you pay your monthly premium. You go to the doctor. You are responsible for the Medicare part B deductible which is $233 this year. Then Original Medicare kicks in. Original Medicare pays their part, for example 80% of part B approved amounts and you are responsible for the remaining 20% up to $2490 for the whole year which includes the $233 part B deductible you already met. For the innovative G plan, you only have that “high” out of pocket exposure your first 2 full years. After your second policy anniversary, January 1, 2025 if you purchased it this year, your plan becomes the standard G plan which means from then until Heaven, you will only ever be responsible for the Part B deductible of $233. After 2 full years of exposure to picking up pieces of your cost, the plan takes over.
Isn’t Medicare wonderful? We call your enrollment process a treasure hunt. We have access to some of the most brilliant customizable solutions and public information to make great recommendations. Now you even know that you don’t have to just take “the cheapest one” or believe that a G is a G is a G.
You are now empowered and know that you have THREE different Plan G structures. 1. The standard G plan, 2. The “high deductible” G Plan, and number 3. The innovative G plan.
I know it’s a lot of information, but the more you know about your rights and options, the more likely you are to choose the exact coverage that you want. You have this window, in my field they call it a “golden ticket” because you can choose whatever coverage you want that is available to you without being denied based on health past, present or potential future. You have more options and rights than you’ve ever had for health coverage.
If you need help with your coverage or have questions about your specific state, Text or call me personally. My name is Ellie Saul, CEO and Mama Bear of Mamabear resources LLC my number is 341-226- MAMA that’s 341-226-6262. You worked your whole life for this. Protect your retirement.