Comparison PLAN F, G and N

[neville clynes]

Please see Eli Noam's detailed discussion in his "MEDIGAP"plans analysis " conversation above.

 Note PLAN F does not seem ever a good idea over PLAN G as the only difference is coverage of 164 dollar PLAN B deductible at a much higher premium cost. So this is only a comparison between PLAN N and G. 

 PLAN N  is  cheaper but has the following deficiencies compared to G.

The first which is often mentioned is the "excess medicare charges". This only comes into play if your doctor is not  "participating " in Medicare. This sounds like he/she may not be part of Medicare. Actually that is not the case. The doctors who are not part of Medicare at all have  "opted out " . Those doctors can charge whatever they want and a patient cannot be reimbursed by Medicare.  Doctors in Medicare either "participate"  or are "non particpaters". See for a more detailed discussion:

https://www.kff.org/medicare/issue-brief/how-many-physicians-have-opted-out-of-the-medicare-program/

In any case , 1 percent of doctors have "opted out" . They are irrelevant to this discussion. About 3 percent of Medicare doctors are "non participaters" . You would know if your doctors is one of these because you would pay them directly (at your visit ) and receive some reimbursement from Medicare in a check to your home.  Again , this is very unusual.  If you have never received a Part B medicare check to your home, you have only "particpating" doctors . 

"Excess charges" only come into play if you have one of these rare "non participating" doctors. However, in any case they are only able to charge an excess of 5% over the usual Medicare charge in NY (15 % in NJ). In NY , office visits alone can be charged 15 % over. It would take many , many visits to make up for the excess premium of Plans G over N.

However a more significant difference is that PLAN N allows for 20  dollar copays. In this case MEDIGAP PLAN N wpays for 20 percent co-insurance but yo would be responsible for 20.00 copay for every visit. If you are expecting more than 3 doctor visits a month, this may start to make sense to pay the extra premium (for AARP/UHC plans, not Humana) for PLAN G  over PLAN N. Less than approx 36 visits a year , likely better off with PLAN N.  You can calculate the cross over yourself comparing the premium differences of the company you choose.