Medigap Plan F Hi-deductible
Medigap Plan F Hi-Deductible – What You Need To Know
The discussion below is about Medigap plans F and G Hi-Deducible.
These plans operate the same way with one exception. Medigap Plan G Hi-Deductible requires the plan holder to pay the annual Part B deductible. More on this below.
Medigap Plan F Hi-Deductible is available for people eligible for Medicare before 1/1/2020. If your Medicare eligibility started January 1, 2020/later you are eligible for Plan G Hi-deductible.
Either of these Medigap plans will protect your retirement savings from runaway Medicare covered health care expenses. This is done by placing a ‘cap’ on your share of your costs annually. This ‘cap’ is called your plan’s deductible. This is similar to a Medicare Advantage plans ‘Out of pocket limit’.
CMS sets the amount of the deductible and it can change annually. Check this year’s deductible here.
How do the hi-deducible Medigap plans compare to Medicare Advantage (MA) plans
We like how these plans compare to Medicare Part C (MA plans). The advantages include the features reviewed below.
- No networks to fuss with as all doctors (and other providers) that accept Medicare insurance are available to you.
- You do not have an insurance company reviewing your doctor’s approach to solving your health issue.
- MA plans attach a ‘prior authorization’ requirement on some medical procedures. This can mean a delay in getting the care you need. Read the article found here.
- for an update on the movement to eliminate this practice.
- When you are on Original Medicare, prior authorizations for health care are not present. They may be present for some Part B medications.
Are the rules of Original Medicare easier to understand than those of a Medicare Advantage plan?
Maybe. Medicare Part A and B rules are available on the Medicare.gov website. This same set of rules remain in place no matter where you live in the US.
Rules for MA plans are documented in a 200-300 page booklet called the evidence of coverage (EOC). This EOC is unique to each plan. They can be found on each insurance company(s) website.
The EOC can and often does change annually. Why? Because the details of MA plans can change annually. What can change? Just about everything. This includes:
- The doctors and hospitals available to plan members.
- Your share out out of pocket.
- Prescription medications covered by the plan.
- Which services require prior authorizations.
Remember, availability of Medicare Advantage plans are available in specific Counties within each State. Insurance companies decide on where they offer their plans. If you move, you may have to change plans. This means starting over by familiarizing your self with the plans available in the area where you move.
Idaho Residents that live in a County without MA plan(s) should consider a Medigap plan. They are a good alternative to MA and other higher premium Medigap plans too.
Understand the math behind this plan
Be aware the Federal government pays most of your Part A and B costs. This is true whether you stay with Original Medicare or enroll in a Medicare Advantage plan. You are responsible for the left over cost(s). These come in the form of deductibles, copays and co-insurance.
Read this to learn your share of the left over costs when you use Part A and B services. You can find this same information in the documents for each MA plan. These are titled the ‘Summary of Benefits’ and ‘Evidence of Coverage’.
Your hi-deductible Medigap plan pays the rest of your Part A and B left over costs when your share has hit the plan’s deductible.
The monthly premiums for these plans
These plans have a monthly premium just like all Medigap and many Medicare Advantage plans. Check out the monthly premiums for the plans offered in Idaho here.
Isn’t the deductible for these 2 plans similar to the maximum out of pocket limit (MOOP) of Medicare Advantage plans?
Yes. We feel these 2 Medigap plans should have been called ‘Medigap plans with an annual out of pocket limit’. This would better frame the comparison (in costs) to Medicare Advantage plans.
The ‘deductible’ amount for these Medigap plans is at least 50% less than the MOOP for most Idaho HMO & PPO plans. This difference can be more If a person enrolls in a Idaho PPO plan.
What else do I need to know about a comparison between Medicare Advantage plans to these Medigap plans?
A good start would be to read the article published by Kiplinger. This is available here.
This article points out a key issue people have when they are diagnosed with health issues requiring hospitalization. The point is MA plans can have defined networks. This means all of the experienced providers qualified to treat you may not be available. Think about this. Why would a person want to be restricted from their choice of doctors and hospitals?
Medicare Advantage plans with defined networks (like HMO plans) have this feature. PPO plans can charge plan members noticeably more when they use non-network providers. How much more is documented in the plan’s Summary of Benefits and their EOC. When people stay with Original Medicare, any provider that accepts Medicare insurance is available.
Medigap Plan F Hi-Deductible or a Medicare Advantage plan
Medigap Plan F (or G) Hi-Deductible should be considered by all people on Medicare.
We think these plans are suitable for people that can effectively budget for the copays, deductibles, and coinsurance. This is the same process people with most Medicare Advantage plan members have to do too. Again, the ‘deductible’ amount for these 2 plans is considerably lower than the MOOP in most Idaho MA plans.
Having the flexibility to use any provider that accepts Medicare is a feature we can’t emphasize enough. You do not need permission from your primary care physician to see a specialist either. You can travel anywhere in the US and your plan is accepted.
When Can I enroll in Medigap Plan F Hi-Deductible?
You can find more information about this on pages 14 – 16 of the Choosing a Medigap Policy. Then read pages 21- 24.
Existing Plan Members can change plans annually during their birthday window
Why would a policy holder do this? Because you can save money.
You will not have to go through an underwriting interview to change companies and get the same plan. The Idaho law regulating when you can change plans without underwriting was implemented on 3/1/2022.
We recommend Idaho residents with a Medigap plan check this annually. Just put a note on your to do list for your birthday. The savings by changing companies and get the same plan can be meaningful.
Annual Medigap Plan F Hi-Deductible Rate changes
Monthly premiums for the Medigap Hi-Deductible plans can change annually. Budget 6-9%% range.
Idaho residents interested in Medigap Plan
We are available to help guide you through this process. Call us on (208-867-0296).
We are here to help.
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