Medigap plan F hi-ded ?

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Hexdump
Posts: 1615
Joined: Fri Oct 10, 2008 7:28 am
Location: Houston, Texas

Medigap plan F hi-ded ?

Post by Hexdump » Mon Feb 01, 2016 9:33 am

I have plan G now and have just gotten 2 rate increases within 6 months.
I am consideing going to plan F hi deductable but I am unclear what the charges would be that I would have to pay.
From my last medigap notice, these are the numbers shown.
Submitted expenses : 191.03
Eligible expenses : 106.80
Medicare payments : 83.73
Remaining expenses : 106.80
% paid 20
Total benefit amount : 21.36

I also read that the deductable for 2016 was approx $2,100 so which of those number above would apply against the deductable. I don't know yet what the premium would be and will find out more later today.
My 1st guess would be the 106.80.

Thanks,

Spirit Rider
Posts: 8902
Joined: Fri Mar 02, 2007 2:39 pm

Re: Medigap plan F hi-ded ?

Post by Spirit Rider » Mon Feb 01, 2016 11:17 am

For Medicare, the relevant number is the eligible expenses. Medicare Part B pays 80% and you are responsible for the remaining 20%. It is this 20% that gets applied to whatever deductible you have.

The Medicare payments are not 80% of the eligible expenses. The break down after the deductible has been met should normally be:
  • Submitted expenses : 191.03
  • Eligible expenses : 106.80
  • Medicare payments : 85.44
  • Remaining expenses : 106.80
  • Total benefit amount : 21.36
Does this statement indicate part of the deductible was being met?

The only difference between Plan G and Plan F is the amount of the deductible. The Plan G deductible is equal to the Part B deductible, 2016 = $166. The Plan F deductible is 2016 = $2180.

Which plan will be better for you depends on what your medical costs are for the year and what your cost share is. Don't just look at the premium. There is no guarantee that Plan F will be less expensive for you. The Plan F cost could be the yearly Plan F premium + $2180. The plan G cost will most likely be the yearly Plan G premium + $166;

Also, depending on your state, you are likely required to undergo medical underwriting to switch plans. Although some carriers may not require it, especially going to a plan with less coverage. However, unless you are in one of the few good states, you are not going to be able to go back to plan G without medical underwriting.
Last edited by Spirit Rider on Mon Feb 01, 2016 11:33 am, edited 1 time in total.

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Toons
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Location: Hills of Tennessee

Re: Medigap plan F hi-ded ?

Post by Toons » Mon Feb 01, 2016 11:31 am

Spirit Rider wrote:For Medicare, the relevant number is the eligible expenses. Medicare Part B pays 80% and you are responsible for the remaining 20%. It is this 20% that gets applied to whatever deductible you have.

Your numbers seem to indicate that maybe part of your deductible was applied for this statement. The Medicare payments are not 80% of the eligible expenses. The break down after the deductible has been met should normally be:
  • Submitted expenses : 191.03
  • Eligible expenses : 106.80
  • Medicare payments : 85.44
  • Remaining expenses : 106.80
  • Total benefit amount : 21.36
The only thing I can think is that part of your deductible was applied to this statement.

The only difference between Plan G and Plan F is the amount of the deductible. The Plan G deductible is equal to the Part B deductible, 2016 = $166. The Plan F deductible is 2016 = $2180.

Which plan will be better for you depends on what your medical costs are for the year and what your cost share is. Don't just look at the premium. There is no guarantee that Plan F will be less expensive for you. The Plan F cost could be the yearly Plan F premium + $2180. The plan G cost will most likely be the yearly Plan G premium + $166;

Also, depending on your state, you are likely required to undergo medical underwriting to switch plans. Although some carriers may not require it, especially going to a plan with less coverage. However, unless you are in one of the few good states, you are not going to be able to go back to plan G without medical underwriting.
+1
Excellent Explanation :happy
"One does not accumulate but eliminate. It is not daily increase but daily decrease. The height of cultivation always runs to simplicity" –Bruce Lee

mur44
Posts: 668
Joined: Tue Feb 27, 2007 9:30 am

Re: Medigap plan F hi-ded ?

Post by mur44 » Mon Feb 01, 2016 1:41 pm

If your health is good, you can save money by
switching down to Medigap 'F' High Deductible
plan. Look for the cheapest insurance company
premium as the benefit is identical.

Also, look into Medigap Plan 'N'. It is also
popular along with Plans 'C', 'F' and High
Deductible 'F'.

Your SHIP (State Health Insurance Assistance
Program) counselor can provide unbiased and
free counseling and free Medigap charts:

https://www.shiptacenter.org/


Disclosure: I am a Certified Volunteer Medicare Counselor from NJ

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