Explaining Hospital Indemnity Plans

Ever wonder what Hospital Indemnity Plans cover?
Mackenzie explains in the latest podcast episode.

Watch the video version here. 

https://youtu.be/RP1HJQa2Fhk

https://www.premiermedicaresolutions.com/

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Transcript

SPEAKER_00 0:10

We're gonna be talking about uh GTL Guaranteed Trust Life and their hospital indemnity product. So we're talking about GTL Guaranteed Trust Life, their Advantage Plus Elite. Um, it's really, really a great product. So you can add this. It's it's typically for people who are on a Medicare Advantage plan. So what is hospital indemnity insurance? So it's something that you add on attached to your Advantage plan. You pick the amounts based on what your out-of-pocket costs are could be with your Medicare Advantage plan. So as we saw in the video, here's the example, Beth. So she has uh her her inpatient copay is$300 a day for six days. So after six hours, this will kick in, but after six days, her copay would be eighteen hundred dollars. So we would look at, all right, well, your hospital co-pays$300 a day, we it would reimburse you for six days. So it does pay you directly cash, which is nice, it doesn't send it directly to the hospital. And also, what's nice about these is that after 60 days of not being in the hospital, the policy resets, and so you can use that again. You can use that hospital again. So they have not this company has not raised their rates in in over 10 years. They don't increase as you age, uh, which makes it really nice, makes it really affordable. Um, so if you're looking at you know potentially looking at a Medicare supplement plan, with Medicare supplement plans, those premiums will increase every year. That's that's a that's a guarantee. With GTL, with their hospital indemnity, there's it's guarantee issue, meaning you don't have to answer all those underwriting questions between eight the ages of 64 and a half up to 75. There are some additional questions if you want to add on other products as we'll as we'll see here. It included, it will give you money back if you go to the ER, which is which is nice. So, how you would choose to go about this is you choose your base benefit. Okay, do you want um so the base of it is is of course the hospital and the indemnity portion. You can add on a skilled nursing writer, an ambulance benefit rider, outpatient therapy. So the outpatient therapy would uh reimburse you for physical therapy. It even does up to 10 days of chiropractic or five days of chiropractic. You can do a cancer lump sum benefit rider. Um, also you do the guaranteed purchase for the option rider, which gives you the wellness rider. The wellness rider would reimburse you$100 for you know your wellness exam, your physical each year. You can also add it for outpatient surgical rider, critical accident, lump sum hospital, and then a dental envision benefit rider. So for the ambulance rider, your options you can choose from$50 up to$400. It can be used up to four times a year, lifetime max of 12 trips. It also does cover air ambulance, and you don't have to have any sort of uh hospital confinement required in order to use this. So you can also add a cancer lump sum benefit rider. With this, it does add a little bit of expense to it, but your coverage options are$2,500,$5,000,$7,500,$10,000,$15,000, or$20,000. So on average, it would be about$29.79,$2,975 a month. It does have specific benefits other than just giving you that lump sum. So cancer, cancer in situ. So this would get pay you 25% of the lump sum upon your diagnosis. For skin cancer, you would get a$500 benefit for basal cell or squamous cell, skin's carcinoma. This is payable three times over the life of the policy. I highly recommend adding the reoccurrence benefit writer. This is really, really cool. So if you have a$10,000 lump sum cancer writer with a reoccurrence, you're diagnosed with cancer, you submit a claim to GTL, you get a check for$10,000 after treatment. If you're in remission, um, even if you're in remission over five years, then the writer would be 100% restorable. So if you're diagnosed with cancer, go on remission, and then one year it comes back, or if it's an entirely new cancer, GTL will pay 10% of your lump sum benefit. Two to three years would be 25%, four years would be 50%, and any anything five years plus, it would pay that lump sum a hundred percent. You can also add it for skilled nursing. And I will I will tell you, let me go back to the the the cancer, the lump sum. You know, I've been doing this for going on nine years, and in my time, I've had five or six people that have hit their maximum out of pockets. It was all a few years ago. Five of the six people ended up passing away right after. The the the sixth person, she hit her maximum out of pocket because she had uh for radiation. So that's where this would come in handy. Now she is still alive, she's still with us and thriving. Um, but this is one of the ways that people hit their max out of pocket. Now it's important to remember that only 4% of people nationwide hit their max every year, you know, and the United States is a large country, and so the max out of pockets will vary from area to area. So some may be lower, some may be higher. So keep all that in mind. The other way that people hit their maximum out of pocket is with a skill is through skilled nursing. So typically, and I will say typically, um, the first 20 days are covered at zero cost. There may be, you know, this is I'm speaking to plans here in the Austin area. There are plans that have a little bit of a copay per day for the first 20 days, but typically the first 20 days are are at no cost to you. So with their skilled nursing benefit writer, you can choose an option for days 1 through 20, or you can choose an option for days 21 through 100. I recommend looking at the 21 through 100. You can choose up from 100 to$300 per day. Now it does have some requirements. The skilled nursing or SNF stay, it has to be for the same condition, and the stay has to begin within 30 days of your hospitalization, which has to be a minimum of three days. The observation time does not count. Um, and then this benefit also does restore after 60 days if there's no confinement in the hospital or skilled nursing facility. So if we're looking at days 21 through 100, a good average is about$225 a day. Um, and again, I'm speaking to the plans in the Austin area. The people that have hit, that have have um hit their maximum of pockets, they've had multiple, multiple, multiple full hospitalizations days. And then they're they're in days past day 20 with their still nursing. Now, for each of those days, if the benefit, if if your cost is$225, you're paying that$225 per day for those. Um, so that's and typically the people that are in there you know long term, it's people that may have a condition like ALS or they're they're pretty sick and they're not getting better at the rate that you know somebody their age who is healthy would be getting better. So this is add a little bit of protection and makes you feel a little bit better about having to be in there. You're not having to worry about, hey, I'm gonna be out of pocket all this money. You can also add on an outpatient therapy benefit writer. So you it pays up to$50. You can choose either for 15 days or 30 days. Now, if you let's say you have a physical therapy and a speech therapy appointment on the same day. If you have it on the same day, it will pay the$50. If you have it on two separate days, it'll pay you$50 for each visit. What's really nice is I mentioned earlier, that you can also get reimbursed for chiropractic, up to$50 for five days a calendar year. So adding that on, uh that's also a way that people hit their max out of pockets, is is um with physical therapy. A lot of the time you're having to go two, three times a week, and that adds up, especially if your co-pays 40-50 bucks. So this will help out with that. You can also do a critical accident uh benefit rider. With this, after an emergency room visit, this rider pays you a lump sum for these following types of accidents. So accidental death, if you have the$5,000 plan, it'll pay$5,000. If the$10,000 plan, it'll it'll reimburse you$10,000 or your family. Hip or skull fracture,$1250 on the$5,000 or$2,500 on the$10,000 plan. If you dislocate your hip, it's$1,000 on the five on the$5,000 plan,$2,000 on the$10,000. Um knee dislocation or knee ligament tear, it'll give you$500 on the$5,000 plan or$1,000 on the$10,000 plan. If you just fracture a fracture of bone or other$250 on the$5,000 plan and$500 on the$10,000 plan. Now this does have a 30-day waiting period before it can kick in. That means if you get the policy in the first 30 days, you break your break your break your hip. That amount would not be payable. So try to put keep yourself in bubble wrap until that 30 days is passed. You can also add on an outpatient surgical benefit writer. This would be if you have a day surgery. So thinking in an ambulatory or uh in an outpatient uh portion of an inpatient hospital. You can choose between 250, 500, 750, or$1,000 lump sum. You can use it twice a year. Um, but it's it can't be used for MRIs or x-rays or other non-surgical procedures. So that is something that you can also add. Now, when we add the guaranteed purchase option benefit writer, this will allow you to go back in and increase your hospital amount. So let's say if it's uh$300, you can increase it by 10% of the original value. So you could increase it up to$330, up to five times before you turn 85. Your increase in benefits will be based on issue H rates, um, no pre-existing uh condition limitation, and there's no additional underwriting. With this, you also get the wellness writer that pays you$100 for a physical examination performed by a healthcare. So it could be doctor, nurse, practitioner, or physician's assistant. Now, this also does have a 30-day waiting period, but it doesn't add that much, and at the very it doesn't add that much to to add the guaranteed purchase option benefit writer, and I have a little bit of a breakdown in um prices at the very end. So what's gonna be the best option for you? At the minimum, you could look at um the hospitalization. So choose what your daily rate is, how you want to be reimbursed. You can also get the ambulance benefit rider. The ambulance benefit rider is very low cost to add. Um better, you get the hospital indemnity option, you choose the outpate the apologies, ambulance benefit rider, and then also the outpatient therapy benefit rider. The best, it's uh it's kind of fully loaded. So you get the hospital indemnity portion, you choose the ambulance 7,500 lump sum cancer benefit rider. Remember, they do go up to 10,000 uh to 20,000. And then you can look at the outpatient therapy benefit writer. You can also customize it, you don't have to choose all of those things. That's what's really cool about this product is that you choose what's gonna be um good for you and your budget and what your health needs are. So this is a little breakdown. So let's say this is based on uh somebody who's turning 65 in March of 2026. So let's say your hospital co-pays$300 and you have to pay that for five days. So the GTL benefit, you would choose, all right, I'm gonna be reimbursed$300 for five days. Now the cool thing about it is if you if you're in the hospital for two days, you submit a claim, it'll pay you$600. Now, you still have three days, three days that you can use within that 60-day period if you are readmitted. And that does reset after 60 days. So that would put you around$22.08 a month. Something else that GTL does automatically, they give you an emergency uh ER copay benefit included. So let's say your emergency copay is$130, GTL reimburses you$150, and it doesn't add anything to your premium. Ambulance, let's say it's$300. So you choose for, all right, I want to be reimbursed$300, that costs you two dollars and 14 cents a month. So it does not add that much, and it helps you with you know with your$300 bill. Now, when we're looking at radiation chemotherapy max out of pocket, this is this is the max out of pocket of of your plan. So let's just say it's$7,000 in network. GTL, remember, you can do uh$2,500,$5,000,$7,8500, or$10,000. I went with a$10,000 here with 100% recurrence. That means that if you're cancer free for after five years, it'll pay you 100% back. If it's after one year, um, it'll be uh 10%, two to three years, it's 25%, at four years is 50%. That makes your premium, adds$33.78 to that. Now I highly recommend looking at the skilled nursing facility. So let's say your copay is$218 for the last 80 days. So this would kick it if you're in a skilled nursing facility from days 21 plus. So GTL, we would embrace you$220 for 80 days. That would add$14.23 to your monthly premium. Annual wellness physical, typically with advantage plans, they're covered at 100%. Um, GTL will automatically just give you this$100. Um, that's what that guaranteed purchase option writer, which allows you to increase your hospital confinement daily rate by 10% over five times up until um your age 85. So that adds$7.64, and you can get$100 back for going to get your physical, which you don't have to pay anything out of pocket for. For the outpatient therapy copay, let's say your copay is$45. The highest plan with GTL is you get reimbursed$50 for 30 days throughout the year. That also does include five days of chiropractic. That would add$6.99 a month. So this last bit, the dental vision average monthly cost, let's just say it's$50. You can add a GTL benefit for$400. That adds$26.80 a month to your premium. I don't necessarily think that that's something that you would have to add. Um, you know, choosing between dental and vision versus skilled nursing or um this cancer lump sum, I would probably choose the cancer lump sum or the skilled nursing facility if you have to choose from one. Automatically, there's a dollar sixty-eight uh cent a month policy fee. So if you had all of these items, that would make your premium$115.34 a month. All right, that does help protect your maximum out of pocket. This is a way that you can get more peace of mind without having to add on you know a Medicare supplement policy, which the rates will increase each year. Like I said, GTL has not increased their premiums in over 10 years, uh, and they're a really great company. So once you enroll, you'll get a welcome packet in the mail. It'll go through you know what your benefits are, it'll have a welcome, um, welcome letter and show you how to go online and access your policy. So let's talk a little bit about who GTL is. So they have an A, AM Best Rating. So an AM best rating rates a uh a company's financial solvency. It goes all the way to AAA. Um, so GTL, third generation family-run mutual insurance company, they've been offering insurance since 1936 and they have great customer service. They make it really easy to submit a claim and everything. So if you have any questions, please reach out to me. I know that was fast. Um, and if you are curious as to how does it look for me and my specific policy, call me, text me, send me an email. I'm here, I'm here for you. Thanks for listening to another episode of the Medicare Matters podcast with McKenzie. Please make sure to subscribe wherever you get your podcast so you don't miss an episode. Please also leave a review as that helps me reach more people that can benefit from this podcast content. If you have questions or topics that you want me to cover for a future episode, please email them to McKenzie at Premier Medicare Solutions.com.