MediShare 65+ vs. Medigap Plan G
Both are powerful risk protection products that both provide very broad protections against high medical costs in retirement. Both have advantages and disadvantages. And both take very different approaches: Medigap Plan G represents the best of the traditional insurance strategy for Original Medicare beneficiaries, while MediShare 65+ is the best of the non-profit health sharing alternatives to insurance for Medicare beneficiaries.
This article will help you understand why Medicare by itself is insufficient to protect your financial security and access to health care in retirement, and explore the pros and cons of both Medigap Plan G and the MediShare 65+ health sharing.
So you can be confident that you’re choosing the best possible plan for your specific situation.
The Problem: Original Medicare By Itself Still Leaves Big Gaps in Coverage
Original Medicare (Parts A and B) still leave beneficiaries at risk of massive out-of-pocket costs in the event of a medical need.
These costs include the $1,600 deductible for hospital costs under Part A, and the 20% co-insurance under Medicare Part B, which covers physician’s fees, lab costs, durable medical equipment, and other provider fees. This 20% co-insurance amount is uncapped: Potential out-of-pocket costs are unlimited.
If you need a series of major surgeries, for example, that 20% could add up to six figures.
Medicare supplement (Medigap) insurance is designed to protect seniors from these potentially devastating out-of-pocket costs, and preserve their freedom of choice when it comes to seeking medical care.
Medigap Plan G is the best and most comprehensive of the standard Medigap policies available in 47 of the 50 states and the District of Columbia. It’s also the most popular among new Medicare enrollees.
And the most expensive.
But you get quite a lot for your money with Plan G: It covers all costs approved under Medicare Parts A or B, with the exception of the small Part B deductible, which is $216 as of 2023.
Everything else – including hospitalization charges under Part A, surgeon’s fees, anesthetists fees, co-pays for ER visits, durable medical equipment, lab fees, and up to three pints of blood are 100% covered, once you meet that $216 deductible for Part B services. Learn more at Medicare.org.
So Plan G provides an astounding amount of protection. But is it the most cost-effective way to meet this objective?
In some cases, it isn’t.
Plan G premiums can be very high – especially in high-cost areas. In some areas, Medigap Plan G can cost you over $500 per month, though the average nationwide is closer to a couple of hundred.
And depending on the Medigap company and plan you select, you could get taken by surprise by premium increases as you get older.
That’s why many people are considering a more affordable non-insurance plan, MediShare 65+, as a lower-cost alternative.
How Are Health Sharing Plans Like MediShare 65+ Different From Insurance Policies?
Unlike Medigap policies, MediShare 65+ is not an insurance product. It’s a health sharing plan, in which like-minded members agree to voluntarily share one anothers’ healthcare costs.
MediShare is one of the more established health sharing ministry organizations in operation, with more than 100,000 members across its various plans, though only a minority of these individuals are members of the Medicare-specific MediShare 65+ plan.
Because MediShare is not an insurance company, it doesn’t have to conform to laws that standardize Medigap insurance policies. It also has more freedom to define its membership, and to apply medical underwriting and negotiate pricing to reduce costs.
As a result, MediShare is able to provide very comparable protection against unexpected medical expenses in retirement – at just a fraction of the cost of a Medigap Plan G or N in most areas.
As of this writing in December 2022, MediShare 65+ members from age 65 through 74 pay a flat rate of $99 per month, no matter where they are in the country.
After age 75+ members pay $149 per month.
While monthly Plan G premiums vary widely, based on your age, sex, location, smoking status, and in some cases, your medical history, MediShare 65+ pricing very favorably in nearly all cities.
Especially when you factor in rate increases in many Medigap Plan G plans.
MediShare 65+: What’s Included?
Like Medigap Plan G, MediShare does require members to pick up a small portion of potential charge. Under Medigap Plan G, the most you would pay is the $216 Part B deductible (as of 2022).
With MediShare 65+, you would pick up the first $500 in medical costs normally covered under Original Medicare. That’s your Initial Member Responsibilty, or IMR, which in the health sharing world functions like a deductible.
However, both plans pick up 100% of Medicare Part A and B charges above that.
- Your Part A deductible
- Part B co-insurance amounts
- Co-pays on doctors’ visits, etc.
- Lab fees
Both MediShare 65+ and Medigap Plan G pick up excess charges. These are fees that your doctor may charge that are over and above the standard authorized Medicare reimbursement rate.
(Most other Medigap plans do not cover excess charges. You would have to pay them out-of-pocket.)
Inclusions Unique to MediShare 65+
While these procedures aren’t completely shareable under MediShare 65+, all members do receive access to substantial discount programs for things like LASIK surgery and other elective procedures generally not covered under Medicare.
These are not included under the standard Medigap Plan G, some carriers offer some limited additional programs to differentiate themselves from competitors.
This is why it’s important to look not just at premiums, but at the whole package.
- Members ages 65 to 74: $99/month
- Members age 75 and up: $150/month
ENROLL: MEDISHARE 65+
10-Year Price Lock-In on MediShare 65+
Members who join MediShare 65+ at age 65 are eligible for a 10-year price lock-in period. Your monthly contribution will not increase for 10 years after you sign up. This is a valuable benefit not available with Medicare supplement insurance carriers.
Both MediShare and Medigap Plan G share a number of exclusions. These are items neither plan normally covers. They include:
- Prescription drug costs. Most MediShare 65+ members and Medigap Plan G policyholders also purchase a separate, standalone Medicare Part D policy for their prescription drug needs.
- Costs for long-term custodial care. However, Original Medicare does cover limited nursing facility and rehab costs associated with a specific injury or hospital stay. If Medicare covers it, then both MediShare 65+ and Medigap Plan G will pick up the costs over and above the Part B deductible (for Medigap Plan G) or the initial unshared amount (for MediShare 65+).
Exclusions unique to MediShare 65+
As a condition of membership, MediShare members agree to adhere to generally healthy lifestyles, and not to drink to excess or abuse illegal drugs.
MediShare 65+ therefore does not share expenses arising from impaired driving charges when illegal drug use is involved. They also do not share costs associated with addictions treatment.
MediShare 65+ does not include charges to treat addiction to illegal drugs, nor share costs associated with overdosing on illegal drugs.
Medigap plans, in contrast, are required by law to cover these items, and any other injuries or illnesses associated with morally dubious behaviors and criminal activity.
As a result, millions of responsible, law-abiding Medigap policyholders are forced to subsidize these behaviors, and purchase coverage for these events even though they are not likely to need it.
If you already know you aren’t likely to need addictions treatment or drive under the influence, then health sharing may be the better bet for you.
When comparing Medigap plans, and when comparing Medigap to MediShare 65+, you should consider not only the Medigap Plan G monthly premium in the current year, but also take into account future premium increases.
Medigap plan pricing varies: Some plans quote a low initial premium, but will increase your premium every year as you get older.
Other plans will quote a higher premium, but it’s level for as long as you stay in the plan.
If you’re in good health, and expect to live a long time, the level premium may be a better deal.
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High Deductible Plan G
In some areas, you may be able to opt for a high-deductible version of Medigap Plan G.
With these plans, you take on more financial risk: You are responsible for the first $2,490 in hospitalization costs, as well as the first 216 in Medicare Part B costs (lab and physician’s charges, etc.)
In return, you pay a lower monthly premium.
The premium depends on your plan, location, and your age, sex, and tobacco use status.
A high-deductible Plan G may be a good match if you are in good health and you can absorb the occasional $2,490 deductible without it becoming a serious financial hardship.
However, you should compare your deductible and premium to what you would pay under MediShare 65+. In some areas – particularly areas with high costs of living and generally high healthcare costs, MediShare 65+ is actually still very competitive.
Want To See How Much You Can Save With Health Sharing?
It’s easy! Contact us today! Just click here, select your state, and choose an appointment day and time! One of our Personal Benefit Managers will get in touch for a free, no-obligation personal consultation!
Whether you’re a candidate for health sharing or sticking with the excellent Medicare Plan G is the right option for you, we’re able to get you in the best plan available in your state.
We represent MediShare 65+ as well as all the best Medigap insurance carriers in all 50 states, as well as the District of Columbia.
And we’re looking forward to working with you!
Here are some additional articles on Medicare programs: The Medicare Playbook 2023 Update is Here: The Only Medicare Handbook You’ll Ever Need | A Complete Guide to Medigap Plan G
Here are some additional pages related to this article: Medi-Share 65+: A Health Sharing Alternative for Medicare Beneficiaries | Complete Medicare Supplement Plan G Information
Misty Berryman is one of your Personal Benefits Managers at Medigap Advisors. She loves working for Medigap Advisors for many reasons, including being part of the solution to one of life’s most important healthcare challenges: choosing the right Medicare plan. Read more about Misty on her Bio page.