High Deductible Medicare Plan G and Plan F

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vested1
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High Deductible Medicare Plan G and Plan F

Post by vested1 »

I've searched online and on this forum and can't find the answer to my question, so please indulge me.

My wife and I have AARP UHC Medicare Plan N, and I was considering changing to an HD Plan F or G. The website for the intermediary company that we have to go through to qualify for our HRA's (Health Reimbursement Accounts) from our former employers is vague on the differences, and the rep there couldn't answer the question. We paid around $100 each for plan N in 2020, and the HD plans G and F have premiums of under $50.

From what I understand, with either HD plan you have to meet a plan deductible of $2,340 before they pay for anything. The only difference I can see for coverage is that the HD plans pay the Part B premium and the excess part B charges, which in our case is only the copay for an office visit. We are already reimbursed by our HRA for those items, but our prescription costs wipe out the funds in the HRA's by the end of August, even though we get $11,200 reimbursed every year, which is why I'm trying to reduce all healthcare expenses.

So as far as I can tell, the only advantage to the HD plans for us is the lower premium, which is wiped out by the $2,340 deductible. It would seem that having one of those HD plans is only worthwhile if you incur a lot of Part B medical expense, which we don't.

The regular, non HD Plans F and G don't have that $2,340 deductible, but are about $125 a month for my wife and about $135 for me. Am I misinterpreting this, and does anyone have either HD plan and would be willing to tell me the advantages and disadvantages of having one?

The website for the intermediary says we are eligible for both HD and non HD F and G plans, which contradicts the other thing I read about those plans being restricted beginning in 2020.
kaneohe
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Re: High Deductible Medicare Plan G and Plan F

Post by kaneohe »

vested1 wrote: Thu Oct 15, 2020 11:28 am ..........................................

......................... The only difference I can see for coverage is that the HD plans pay the Part B premium and the excess part B charges, which in our case is only the copay for an office visit. ................................

So as far as I can tell, the only advantage to the HD plans for us is the lower premium, which is wiped out by the $2,340 deductible. It would seem that having one of those HD plans is only worthwhile if you incur a lot of Part B medical expense, which we don't.

............................................
re: the bolded
Do the HD plans really pay the pt B premium?
Seems like the HD plans are only worthwhile if you incur very little pt B medical expenses.
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vested1
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Re: High Deductible Medicare Plan G and Plan F

Post by vested1 »

kaneohe wrote: Thu Oct 15, 2020 12:35 pm
vested1 wrote: Thu Oct 15, 2020 11:28 am ..........................................

......................... The only difference I can see for coverage is that the HD plans pay the Part B premium and the excess part B charges, which in our case is only the copay for an office visit. ................................

So as far as I can tell, the only advantage to the HD plans for us is the lower premium, which is wiped out by the $2,340 deductible. It would seem that having one of those HD plans is only worthwhile if you incur a lot of Part B medical expense, which we don't.

............................................
re: the bolded
Do the HD plans really pay the pt B premium?
Seems like the HD plans are only worthwhile if you incur very little pt B medical expenses.
No, I wrote that incorrectly with my eyes crossed from spending hours on this today. HD plans don't cover Part B premiums but do cover extra Part B charges, including copays. This adds little value.

My main question was about the $2,340 HD deductible. I don't think this would cover prescription copays either, which is the majority of our copay cost, so I don't think the HD F or G plans or the non HD F or G plans are appropriate for our situation. Our HRA's already reimburse our Part B and Plan N premiums but fall short of fully reimbursing prescription copays and part B extra costs. They should in 2021 as an existing program which we finally qualify for will eliminate about $5,800 in prescription copays for us on a single medication.
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Abe
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Re: High Deductible Medicare Plan G and Plan F

Post by Abe »

My wife and I have Plan F high Deductible. The premium is about $48 each per month. We have never reached the $2,340 deductible in a year, but the main reason we have the HD plan is to cover an extremely high hospital bill. Of course medicare pays 80%, so we just pay the 20% out of pocket. If we had say a $200k or more hospital bill, we would be limited to the deductible amount ($2,340) out of pocket.
ETA: We have a separate drug plan with Humana. The premium on it is $13.20 per month.
Last edited by Abe on Thu Oct 15, 2020 3:40 pm, edited 1 time in total.
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kaneohe
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Re: High Deductible Medicare Plan G and Plan F

Post by kaneohe »

vested1 wrote: Thu Oct 15, 2020 2:04 pm ...............................................

My main question was about the $2,340 HD deductible. I don't think this would cover prescription copays either, which is the majority of our copay cost, so I don't think the HD F or G plans or the non HD F or G plans are appropriate for our situation. Our HRA's already reimburse our Part B and Plan N premiums but fall short of fully reimbursing prescription copays and part B extra costs. They should in 2021 as an existing program which we finally qualify for will eliminate about $5,800 in prescription copays for us on a single medication.
Medigap plans like F & G do not cover Rx drugs. You need a part D plan for that but if you have something at work that is better.............. if you are not familiar w/ GoodRx.com you might want to investigate. They offer discounts on Rx drugs for no cost. Your price depends on the pharmacy you go to.

The Medigap plans like F & G are for catastrophic coverage where you get a serious disease w/ costs of 100K or more. You may not have anything like that now but there are no guarantees in life.
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GerryL
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Re: High Deductible Medicare Plan G and Plan F

Post by GerryL »

I have had an F-HD plan for my first 6 years on Medicare. Just switched to G-HD, which is a switch you are allowed to do in Oregon within 30 after your birthday. I chose the high deductible path because I do not regularly use a lot of heathcare services. I often don't even get up to the Medicare deductible, and have not yet gotten anywhere near the high deductible. But I have been saving, on average, $150 a month on my premium, and I know what the top out-of-pocket costs will be in the event of a bad year. And my budget can handle that.

Regarding Medicare deductible, in the F-HD plan it is counted as part of the high-deductible limit. In the G-HD plan it is not.
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vested1
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Re: High Deductible Medicare Plan G and Plan F

Post by vested1 »

Thank you all for your replies.
kaneohe wrote: Thu Oct 15, 2020 3:17 pm
vested1 wrote: Thu Oct 15, 2020 2:04 pm ...............................................

My main question was about the $2,340 HD deductible. I don't think this would cover prescription copays either, which is the majority of our copay cost, so I don't think the HD F or G plans or the non HD F or G plans are appropriate for our situation. Our HRA's already reimburse our Part B and Plan N premiums but fall short of fully reimbursing prescription copays and part B extra costs. They should in 2021 as an existing program which we finally qualify for will eliminate about $5,800 in prescription copays for us on a single medication.
Medigap plans like F & G do not cover Rx drugs. You need a part D plan for that but if you have something at work that is better.............. if you are not familiar w/ GoodRx.com you might want to investigate. They offer discounts on Rx drugs for no cost. Your price depends on the pharmacy you go to.[/b]

The Medigap plans like F & G are for catastrophic coverage where you get a serious disease w/ costs of 100K or more. You may not have anything like that now but there are no guarantees in life.


We do have Part D with two different providers, Wellcare for me and Humana for my wife due to different coverage levels for each of us. Prescription copays are currently over 7k a year, but we will reduce that by about 5.8k in 2021 by being approved for a program that pays for the most expensive drug entirely. The cost for the tier 4 drug from GoodRX is higher than what we pay with Part D.

We need to separate our Part D and Medigap plans from each other, rather than going with a Medicare Advantage plan or by having it all managed by one of our two former employer intermediaries in order to get both HRA's from our separate former employers. My wife's former employer provides 7k in reimbursement (Medigap for both of us) and my former employer provides 4.2k in reimbursement (Part D for both of us). Both HRA's will pay for any expense for either of us. Still we run out of that reimbursement amount for the last 4 months of the year. We will end up with over 15k in premiums and copays in 2020, excluding the costs for possible surgery, specialists, dental, vision, and chiropractic if needed.

The copay in January and February is huge for the single tier 4 drug that my wife takes, but gets to catastrophic level by March. Copay for that drug in January was over $1,900 and over $900 in February, with the remainder of the year at $297 a month. My meds cost about $12 every 90 days. If I also needed an expensive drug we would be in trouble because Medicare treats every person as an individual, not a family member with family caps on OOP expenses.

We are extremely lucky to have the HRA's which don't count as income because they are simply reimbursement. We get no 1099's or other tax forms from either former employer for the reimbursed $11,200 yearly amount. This has the added benefit of allowing us to avoid withdrawals from the portfolios, which in turn keeps our taxable income under the amount needed to qualify for the tier 4 drug program which pays for it starting in 2021.

That drug has been on the market for over 21 years, and the manufacturer has been successful in blocking a generic version through lobbying. Between our copays and what Medicare Part D pays, the drug costs over $72,000 a year. Without it my wife would be in a wheelchair. The drug price went up 9.5% in 2020, also increasing our copays by that amount.


I'll have to look into this further. My sister has had 3 bouts with cancer, including surgery, and hospital stays while on Medicare with Medigap and Part D and has paid almost nothing. I would also imagine, like any other policy, there are exclusions that end up to be "gotcha's" regardless of which plan you go with. I had to stay in the hospital last year for 4 days due to an unseen medical emergency that nearly took my life. I received no bill for that event while on Medicare, other than a $50 copay for the emergency room.
kaneohe
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Re: High Deductible Medicare Plan G and Plan F

Post by kaneohe »

vested1 wrote: Fri Oct 16, 2020 5:21 am

............................

The Medigap plans like F & G are for catastrophic coverage where you get a serious disease w/ costs of 100K or more. You may not have anything like that now but there are no guarantees in life.
.......................................

We are extremely lucky to have the HRA's which don't count as income because they are simply reimbursement. We get no 1099's or other tax forms from either former employer for the reimbursed $11,200 yearly amount. This has the added benefit of allowing us to avoid withdrawals from the portfolios, which in turn keeps our taxable income under the amount needed to qualify for the tier 4 drug program which pays for it starting in 2021.

.


I'll have to look into this further. My sister has had 3 bouts with cancer, including surgery, and hospital stays while on Medicare with Medigap and Part D and has paid almost nothing. I would also imagine, like any other policy, there are exclusions that end up to be "gotcha's" regardless of which plan you go with. I had to stay in the hospital last year for 4 days due to an unseen medical emergency that nearly took my life. I received no bill for that event while on Medicare, other than a $50 copay for the emergency room.
[/quote]

clever use of color! yes, I'm somewhat familiar w/ HRAs since I have one (much smaller than yours). They are nice.

You can google for what Medicare does not cover..........mostly it seems dental/vision and LTC which the supplement wouldn't cover either since Medicare doesn't...........not aware of much else. Plan G is nice because you don't have
to worry about the details of what happens (except the deductible) since everything else is covered by either Medicare or the supplement.

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Eagle33
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Re: High Deductible Medicare Plan G and Plan F

Post by Eagle33 »

Medicare.gov site explains How to compare Medigap policies
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