Raise your hand if you are worried about your out-of-pocket health care costs. We thought so. As we discussed in previous articles, health care costs continue to rise, even much quicker than the ordinary cost of living. As of this writing, the average health insurance increase for 2018 plans is between 8% and 10%.
Additionally, many carriers have dropped out of the Affordable Care Act (i.e. Obamacare) exchanges. Do you have affordable health insurance options in your area? Probably not.
To remain solvent with the ACA, these carriers need to raise costs extensively. Premiums aren’t just increasing. Copays, coinsurance, and deductibles are increasing as well.
How will you manage these costs? One way is to use a type of supplemental insurance which will offset these costs. In this article, we review GTL Advantage Plus. GTL Advantage Plus is a hospital indemnity plan which pays you a cash benefit for covered services. The benefit of the hospital indemnity plan is that you can use the money for whatever you want.
Who Is GTL?
Guaranteed Trust Life Insurance Company (GTL) is an 80+ year-old, family-run company. It offers life insurance as well as many other types of supplemental insurance. It is a mutual company, which means its policyholders own the company. Its products are available in 49 states.
The company prides itself on paying claims for its policyholders. Between 2014 and 2016, the company paid more than $80 million in claims.
The company invests conservatively and doesn’t have any debt ($0) on its balance sheet.
Arguably GTL’s most popular insurance product is its GTL Advantage Plus. Next we discuss the Advantage Plus in more detail.
What is GTL Advantage Plus?
GTL Advantage Plus is a hospital indemnity plan. You might be wondering what an indemnity plan is? An indemnity plan is an insurance plan which pays a cash benefit per a set schedule. For example, if you go to the doctor, an indemnity plan might pay you $50 back. It doesn’t matter what the doctor charges you. You receive the $50 to use for whatever you want.
Indemnity plans usually do not work in coordination with your other insurance. In other words, it does not matter to the hospital indemnity plan what your underlying health insurance pays. That’s the prime benefit of a hospital indemnity plan. An example will make this clear.
Easy Example How A Hospital Indemnity Plan Works
For example, let’s say you go to the doctor. You present your primary health insurance information.
Your provider charges you $64.25. You then send in the claim information to your indemnity plan. Per the plan, you receive $50 back. Your out-of-pocket cost for the doctor visit is $14.25. However, you can do whatever you want with the $50. Although it is outside the scope of this article, indemnity plans can help with negotiating your out-of-pocket costs as we describe in another article.
There are many types of indemnity plans. Some indemnity plans focus on accidental injuries and the associated costs. Others are more general and pay for a myriad of things. Then there are those that cover hospital costs. The Advantage Plus plan is a hospital indemnity plan which covers an array of inpatient (i.e. hospital) and outpatient (i.e. doctor) services.
The GTL Advantage Plus plan is usually used in concert with Medicare (although it can work with traditional under-65 health insurance). Since Medicare and most Medicare plans leave beneficiaries with potentially, significant out-of-pocket costs, this plan can help offset those costs.
The Specifics Of The GTL Advantage Plus Plan
As we mentioned, the GTL Advantage Plus is a hospital indemnity plan. This means if you go to the hospital and have any other covered situation, you will receive a cash benefit to offset your out-of-pocket costs. The Advantage Plus plan covers:
- hospital confinement
- ambulance trips
- dental and vision
- short duration hospital stay / observation care
- outpatient surgery
- skilled nursing facility
The minimum application age for GTL Advantage Plus is 40 years old and the maximum is 85, depending on state law.
A person can apply during the guarantee issue timeframe between ages 64.5 and 65.5. That means people with significant health conditions such as diabetes, COPD, etc can obtain this plan.
It is important to stress that they can obtain this plan during the guarantee issue timeframe between ages 64.5 and 65.5. If they apply outside this timeframe, they will go through underwriting.
You have 4 choices for the hospital confinement. You can select a 3 day, 6, 10, or 21 day hospital confinement. Additionally, you can choose up to a $600 per day benefit. The hospital confinement covers you if you have a stay in the hospital. Let’s say your Medicare Advantage plan’s hospital copay is $300 per day and you spend 4 days in the hospital. Your OOP is $1,200. If you selected a plan with a $300 benefit, you would receive $1,200 back from GTL. If you selected a plan with a $600 per day benefit, you would receive $1,800 back and pocket the $600.
The hospital confinement comes with an accident benefit and a mental health benefit. These benefits are in addition to the hospital confinement.
A major advantage of the Advantage Plus plan is that it covers Medicare observation status (observation care). You may not realize that observation care is considered outpatient for Medicare. This can be a financial detriment. Why?
Essentially, this means you will pay a higher out-of-pocket amount than if your stay was inpatient. We wrote a whole article on observation status. The main takeaway: you don’t have to worry as the Advantage Plus plan will pay 100% of the daily hospital benefit you select.
Additionally, ss long as you do not have another hospital stay within a 60 day period from your hospital release date, your hospital confinement days restore back.
Example To Make This Clear
For example, you select a 10-day plan. You are in the hospital for 5 days and released. You don’t go back into the hospital until the 61st day of the window. Your benefit restores back to 10 days. If you go back into the hospital within the 60 days, you can use up any remaining eligible days. In this example, you have another 5 days remaining. After 5 days, the GTL Advantage Plus plan won’t pay a benefit until you are out of the hospital for 60 days.
Other Benefits Included In GTL Advantage Plus
All GTL Advantage Plus plans come with the following, additional benefits:
*hospitalization due to mental illness – pays up to $175/day in the hospital. Honestly, many hospital indemnity carriers do not touch mental illness (i.e. anxiety, depression, etc.). The daily benefit is in lieu of, not in addition to, the regular hospital confinement benefit
*ER benefit – of up to $150 if you are admitted to the hospital upon an ER visit.
Riders Available On The GTL Advantage Plus
The GTL Advantage Plus plan comes with many riders. Where you live determines the available riders. Be sure to check your state. These riders come at an additional cost.
ambulance – will pay a benefit to and from the hospital. Hospital admittance is not a requirement usually.
lump sum hospital rider – will pay a lump sum on admittance to the hospital in addition to your hospital confinement
skilled nursing facility – will pay a benefit upon admittance to a skilled nursing facility (provided you were an inpatient in a hospital for 3 days). Some states will allow first day benefit. Other states allow a benefit upon the 21st day in a skilled nursing facility
outpatient surgery – must have an outpatient surgery, will pay a lump sum. For example, a hip replacement is outpatient surgery.
cancer rider – will pay a benefit upon incidence of cancer
short stay hospital – 12 to 24 hours in a hospital, Advantage Plus will pay a benefit
dental and vision rider – will pay you a benefit for out-of-pocket costs for dental and vision costs. Will pay you 80% of actual charges. A $100 deductible exists for non-preventative procedures. Preventative procedures like cleanings or eye exams have no deductible. You can receive a cash benefit by going to any dentist or optometrist you choose
Underwriting / Application
Simplified issue application. There are no MIB checks or phone interview. It is simple yes/no questions. How easy is that? Way easy!
As we mentioned, people ages 64.5 to 65.5 are eligible for guaranteed issue. It does not matter what kind of health conditions they have. This is huge.
If you don’t apply within the guaranteed issue timeframe (ages 64.5 to 65.5), there is a 6-month pre-existing condition limitation. Anything seen by a doctor during the prior 6 months of the start date of the policy is not covered for the following 6 months. Again, this limitation does not apply for guarantee issue applicants! If you have moderate to severe health conditions, you want to apply during the guarantee issue window.
E-application is available. A short verification phone call is made for identity purposes. It is to prevent identity theft and fraud.
You call customer service. They will mail or email forms to fill out. If you sign the HIPAA form, GTL will obtain an itemized hospital bill on your behalf. Once the required documents are received, claims are paid within a week.
What Are The Drawbacks Of The GTL Advantage Plus?
Every insurance has drawbacks. One drawback of every insurance is the concept of a “sunk” cost. You spend your money for probably no future benefit. The same is true here. However, this is insurance! And, that is the purpose of insurance! Let’s get that out of the way now. You, traditionally, do not make money on insurance.
If you are thinking that GTL Advantage Plus plan isn’t worth it or if you don’t need it, can you can pay $1,500 tomorrow if you have a hospitalization? Probably not since most Americans can’t come up with a $500 for an emergency.
Your best bet is to insure this risk. Are premiums expensive? Likely not.
What would you rather pay? The hospital bill or a small premium that covers it?
Having worked with many hospital indemnity plans, I can see there are some small drawbacks. For instance, it would be nice if they offer an outpatient doctor visit and imaging benefit. I think many people would derive more value from the plan.
However, GTL Advantage Plus covers a lot of the gaps in your health insurance or Medicare. Moreover, it does so in a very affordable way.
Now You Know About GTL Advantage Plus
The GTL Advantage Plus plan can help you save money on your out-of-pocket health care expenses. Although we did not discuss premiums, they are very reasonable. Depending on your age, riders, and coverage amount, you could obtain a plan for less than $400 annually.
Nest steps? Contact us for a quote, or use the form below.
Remember, this works in concert with both traditional health insurance as well as Medicare. With increases in medical costs, this plan can help offset your out-of-pocket costs. We are conscientious of a budget as well as protecting your family. We will work with you to determine which plan is right for you.