Medicare Plan F High-Deductible. Just how does that deductible work?

[Telly]

I'm confused. Doing some planning for later this year, I see tables that describe all the Medigap plans. "Plan F H-D" is always an asterisk on the regular Plan F column. The notes below usually say the about same thing - "Plan F also offers a high-deductible plan. If you choose this option, this means you must pay for Medicare-covered costs up to the deductible of $2240 in 2018 before your Medigap Plan pays anything".

I have also found a further short description that says what goes into the $2240 deductible you must meet before your Plan F H-D pays out anything, consists of costs like deductibles, co-insurance, and copayments.

But it seems that the original Medicare Part B deductible of $183 is covered, as is the Part A deductible. How is that possible, it seems to wrap back onto itself?

The Part B deductible is a once per year thing. I could understand that a Part A (hospitalization) FIRST hospital stay for a plan year deductible would not be covered (though they don't state that!), but following Part A deductibles could be covered, as that deductible is per-stay if out for 60 days (or something like that) within a plan year, so could have more than one Part A deductible to pay per plan year. But Part B deductible is only once per plan year.

Nowhere have I found a simple example of Plan F H-D in action! I thought I'd find something like "if Wilbur had a portion of his guts torn out, assuming $nnnnn costs, Wilbur on Plan F-H would pay xxx yyy and zzz". Have not found a breakdown example ANYWHERE!

Can someone please explain how this works? I understand the regular Plan F just fine, but not the H-D version with regards to its deductible!

 

[ivinsfan]

I'm in the same boast as the OP.

Since my DH had some major medical issues pop up when he was 64, I went to my insurance agent to select his Medicare plan and on her advice just blindly stuck him into BC Senior Gold. 0 out of pocket... he's had enough issues pop up that I don't question that choice. But when I get the quarterly or whatever EOB from SS, I still can't figure out how much money BC shelled out for his care. In other words, how much money we saved by having Senior Gold.

An added wrinkle is that he has VA coverage and Senior Gold offers no drug coverage. Its not an issue for him, but it will be for me when I go on Medicare later this year. Having to go through 2 layers of insurance is really confusing to me for some reason. I'm going to use the insurance broker that signed me up for ACA but feel I need to know more to make and informed choice.

 

[CRLLS]

DW and I both have F-HD. As I understand it, the Supplement (a.k.a. Medigap) plan does not affect anything directly related to Medicare Part A or Part B (or part D for that matter) . Supplements stand alone and as a result one must meet the Medicare deductibles before Medicare pays their first dollar. While in the pre-deduction period, all Medicare negotiated rates still apply to covered procedures/office visits.

The Supplement deductible of $2240 must be met before that policy pays out their 1st dollar. However the monies paid out for the Part A and Part B Medicare deductible, also apply to the supplement policies deductible. For example, on your 1st office visit of the year that Medicare says is allowed at $100, you pay that $100 to the doctors office. Medicare considers it to be part of your $183 annual deductible. In addition, that $100 is ALSO considered part of the $2240 deductible on the Supplement policy. IOW, you get double credit for that billing. The same process applies to Part A out of pocket covered payments. With respect to the Supplement, all out of pocket expense allowed by Medicare and paid by you, apply to the Supplement deductible.

That is how I understand it. I hope it is clear. We didn't meet the Supplement deductible last year (our 1st year in Medicare) so I can't say for sure. If I am wrong, someone will chime in.

 

[MichaelB]

Isn't the world of health insurance wonderful? (kidding ) We pay deductibles, copays, and coinsurance, and they aren't easy to understand. This Medicare pub explains some of it.

Medicare A covers hospitalization, and once the deductible is satisfied, you pay co-insurance.

Hospital Stay In 2018, you pay
■ $1,340 deductible per benefit period
■ $0 for the first 60 days of each benefit period
■ $335 per day for days 61–90 of each benefit period
■ $670 per “lifetime reserve day” after day 90 of each benefit period (up to a maximum of 60 days over your lifetime)

Skilled Nursing Facility Stay In 2018, you pay
■ $0 for the first 20 days of each benefit period
■ $167.50 per day for days 21–100 of each benefit period
■ All costs for each day after day 100 of the benefit period

Medicare B covers medical services (physicians, labs, etc) and you may be responsible for up to 20% of the approved amount for all those services.

Basically, a MediGap policy covers some or all of that co-insurance, and also may extend the coverage period for hospitalization.

 

[MBSC]

Nowhere have I found a simple example of Plan F H-D in action! I thought I'd find something like "if Wilbur had a portion of his guts torn out, assuming $nnnnn costs, Wilbur on Plan F-H would pay xxx yyy and zzz". Have not found a breakdown example ANYWHERE!

Can someone please explain how this works?

Medicare still pays first. Wilbur is responsible for the first $2240 in Medicare Part A/B cost sharing (Part A deductible, Part B deductible, and Part B coinsurance), then F-HD activates and picks up the remainder of the cost sharing.

Assuming he is admitted as an inpatient and has not received any Medicare covered services earlier in 2018, his Medicare cost share for this stay will consist of the $1340 Part A deductible, $183 Part B deductible, and 20% of the Medicare Part B covered approved amounts until all these total $2240.

Once he has paid $2240 in cost sharing, F-HD kicks in and picks up the remainder of his cost share. The inpatient facility fees (room and board, supplies, etc.) are billed to Part A. The inpatient professional services (surgeon, anesthesiologist, etc.) are billed to Part B.

Should he be admitted again later in the same year but after the 60 day Part A benefit period deductible has reset, F-HD will cover the new Part A benefit period deductible assuming he has met the $2240 cost share requirement.

 

[Telly]

DW and I both have F-HD. As I understand it, the Supplement (a.k.a. Medigap) plan does not affect anything directly related to Medicare Part A or Part B (or part D for that matter) . Supplements stand alone and as a result one must meet the Medicare deductibles before Medicare pays their first dollar. While in the pre-deduction period, all Medicare negotiated rates still apply to covered procedures/office visits.

The Supplement deductible of $2240 must be met before that policy pays out their 1st dollar. However the monies paid out for the Part A and Part B Medicare deductible, also apply to the supplement policies deductible. For example, on your 1st office visit of the year that Medicare says is allowed at $100, you pay that $100 to the doctors office. Medicare considers it to be part of your $183 annual deductible. In addition, that $100 is ALSO considered part of the $2240 deductible on the Supplement policy. IOW, you get double credit for that billing. The same process applies to Part A out of pocket covered payments. With respect to the Supplement, all out of pocket expense allowed by Medicare and paid by you, apply to the Supplement deductible.

That is how I understand it. I hope it is clear. We didn't meet the Supplement deductible last year (our 1st year in Medicare) so I can't say for sure. If I am wrong, someone will chime in.

Thanks!
That makes sense, and is what I would have expected. What bothered me is the including coverage of Part A & B deductibles in all of the charts I have seen. Even the single-sheet descriptions I found online of Plan F H-D!

 

[Telly]

Medicare still pays first. Wilbur is responsible for the first $2240 in Medicare Part A/B cost sharing (Part A deductible, Part B deductible, and Part B coinsurance), then F-HD activates and picks up the remainder of the cost sharing.

Assuming he is admitted as an inpatient and has not received any Medicare covered services earlier in 2018, his Medicare cost share for this stay will consist of the $1340 Part A deductible, $183 Part B deductible, and 20% of the Medicare Part B covered approved amounts until all these total $2240.

Once he has paid $2240 in cost sharing, F-HD kicks in and picks up the remainder of his cost share. The inpatient facility fees (room and board, supplies, etc.) are billed to Part A. The inpatient professional services (surgeon, anesthesiologist, etc.) are billed to Part B.

Should he be admitted again later in the same year but after the 60 day Part A benefit period deductible has reset, F-HD will cover the new Part A benefit period deductible assuming he has met the $2240 cost share requirement.

"Wilbur" and I both thank you for the great example!

For all of the time I have spent online trying to find the answer, never did I find an example. I wonder if they all are afraid of portraying anything that is Medigap, without just regurgitating what Medicare has already shown. As I mentioned in the post above, even the single-sheet descriptions showed that Part A & B deductibles were covered, which seems to show that it isn't just an issue of the classic Medicare chart that shows Medigap Plans on one axis, and the Benefits on the other.

To think that people with less mental facilities than me are going to figure this out as-written?

I have a recent book (available real cheap on Amazon) entitled "Get What's Yours for Medicare" by Philip Moeller. The book is very good, but as he says, Medicare is sooo complicated... I could not find the answer to my question in his book.

 

[NoMoreJob]

To think that people with less mental facilities than me are going to figure this out as-written?

This reply may not be relevant to the OP but could apply to others considering which plan to purchase.

The above quote illustrates the primary reason I ended up NOT going with F-high deductible, which I had concluded would likely be the best for me financially. I knew that as I age I will likely have more difficulty understanding complicated matters and to me there is nothing that is less easily understood than medical insurance and related billings. I decided that even if the additional premiums didn't end up paying for themselves financially in the long run, the reduction in complication and resulting frustration for me in my later years could be very valuable. I ended up purchasing Plan-G.

 

[REWahoo]

This reply may not be relevant to the OP but could apply to others considering which plan to purchase.

The above quote illustrates the primary reason I ended up NOT going with F-high deductible, which I had concluded would likely be the best for me financially. I knew that as I age I will likely have more difficulty understanding complicated matters and to me there is nothing that is less easily understood than medical insurance and related billings. I decided that even if the additional premiums didn't end up paying for themselves financially in the long run, the reduction in complication and resulting frustration for me in my later years could be very valuable. I ended up purchasing Plan-G.

While I understand your logic, all insurance and medical billing can be complex. I can't see my potential, perhaps almost inevitable mental decline a sufficient reason to pass up the opportunity to save what has amounted to more than $2k per year for DW and I. By the time I need help in figuring out my medical billing I'll probably need help with other aspects of bill paying as well, so I see no reason not to take advantage of the lower premiums from a HD plan.

 

[Dawg52]

While I understand your logic, all insurance and medical billing can be complex. I can't see my potential, perhaps almost inevitable mental decline a sufficient reason to pass up the opportunity to save what has amounted to more than $2k per year for DW and I. By the time I need help in figuring out my medical billing I'll probably need help with other aspects of bill paying as well, so I see no reason not to take advantage of the lower premiums from a HD plan.

I've had a $10k deductible for the last 10 years. A HD medicare supplement will seem like a 'gold' plan to me along with much lower premiums. About the only thing I'm looking forward to in turning 65 next year. Me being the born loser that I am, I will probably have major surgery a week before my birthday.

 

[ivinsfan]

This reply may not be relevant to the OP but could apply to others considering which plan to purchase.

The above quote illustrates the primary reason I ended up NOT going with F-high deductible, which I had concluded would likely be the best for me financially. I knew that as I age I will likely have more difficulty understanding complicated matters and to me there is nothing that is less easily understood than medical insurance and related billings. I decided that even if the additional premiums didn't end up paying for themselves financially in the long run, the reduction in complication and resulting frustration for me in my later years could be very valuable. I ended up purchasing Plan-G.

As I stated above I think I got oversold on my DH policy but I now realize this zero billing never paying a third party is definitely less stressful. Also coming off a major cardiac surgery my DH probably wouldn't have cleared underwriting for the Senior Gold policy. One thing that hasn't been mentioned is the lack of underwriting for the period you start Medicare. If you do develop a major illness with substantial out of pocket expenses every year you cannot upgrade without underwriting. This might vary in some states but is the rule here.

 

[ivinsfan]

While I understand your logic, all insurance and medical billing can be complex. I can't see my potential, perhaps almost inevitable mental decline a sufficient reason to pass up the opportunity to save what has amounted to more than $2k per year for DW and I. By the time I need help in figuring out my medical billing I'll probably need help with other aspects of bill paying as well, so I see no reason not to take advantage of the lower premiums from a HD plan.

Is this 1K per person or 2K per person...and is the saving solely on the policy or does it include the out of pocket you pay for medical care. Just a general answer is fine...I'm trying to wrap my head around this number before I go on Medicare...

 

[ivinsfan]

I've had a $10k deductible for the last 10 years. A HD medicare supplement will seem like a 'gold' plan to me along with much lower premiums. About the only thing I'm looking forward to in turning 65 next year. Me being the born loser that I am, I will probably have major surgery a week before my birthday.

Remember Medicare starts the first day of the month you turn 65

 

[ivinsfan]

Medicare still pays first. Wilbur is responsible for the first $2240 in Medicare Part A/B cost sharing (Part A deductible, Part B deductible, and Part B coinsurance), then F-HD activates and picks up the remainder of the cost sharing.

Assuming he is admitted as an inpatient and has not received any Medicare covered services earlier in 2018, his Medicare cost share for this stay will consist of the $1340 Part A deductible, $183 Part B deductible, and 20% of the Medicare Part B covered approved amounts until all these total $2240.

Once he has paid $2240 in cost sharing, F-HD kicks in and picks up the remainder of his cost share. The inpatient facility fees (room and board, supplies, etc.) are billed to Part A. The inpatient professional services (surgeon, anesthesiologist, etc.) are billed to Part B.

Should he be admitted again later in the same year but after the 60 day Part A benefit period deductible has reset, F-HD will cover the new Part A benefit period deductible assuming he has met the $2240 cost share requirement.

So under this plan in a high cost year including a hospital stay, Wilbur will never pay more then 2240...so the cost is Plan F high ded + 2240....BTW I think you could get a job writing the EOB for health insurance companies..or maybe Facebook terms of use...

 

[CRLLS]

Is this 1K per person or 2K per person...and is the saving solely on the policy or does it include the out of pocket you pay for medical care. Just a general answer is fine...I'm trying to wrap my head around this number before I go on Medicare...

Everything traditional "Medicare" is per individual. There are no family or spousal plans. For example, DW and myself, we pay 6 separate premiums per month! Part B, Part D and supplement, times 2. And that does not include optical or dental, which we self insure for.

 

[ivinsfan]

Everything traditional "Medicare" is per individual. There are no family or spousal plans. For example, DW and myself, we pay 6 separate premiums per month! Part B, Part D and supplement, times 2. And that does not include optical or dental, which we self insure for.

Of course I just wasn't clear about the total amount of savings..it's a benefit of Medicare that each person can get exactly what they need.

 

[Silver]

Both my DH and I have high-deductible plan F. I started it in 2016, and he started it in 2018. I pay $46 a month, adjusted down from $49 a month the first two years. (They just automatically adjusted it down and notified me.) DH pays $52 a month. We each see our PCP regularly, but not often, and our medical costs are fairly low. We pay the Medicare part B deductibles and 20% of any charges above that, but that's it so far.

For us, the high deductible plan F deductible is very reasonable as a "catastrophic" health insurance policy, and not all that catastrophic to be honest. Needing to pay all the part A, part B, and high deductible part F deductibles rarely would still be less than paying approximately $150 a month for another Medigap for the years we didn't need it.

I figure that if our health status changes and high deductible plan F isn't working, there is always open enrollment every year.

 

[ivinsfan]

Doesn't open enrollment depend on your state, it's my understanding if major medical issues arise you can be denied coverage on certain policies due to underwriting issues. I'm talking about switching plans not your original plan at the start of Medicare.

 

[REWahoo]

Is this 1K per person or 2K per person...and is the saving solely on the policy or does it include the out of pocket you pay for medical care. Just a general answer is fine...I'm trying to wrap my head around this number before I go on Medicare...

Here's my estimate of individual savings for DW and I since we enrolled in Medicare Supplement F-HD:

Average annual Plan F premium ~ $2,000
Average annual Plan F-HD premium ~ $700
Average annual premium savings = $1,300

We are both relatively healthy (thankfully) and what we have paid for medical care out of pocket has averaged less than $150 per person per year. So our savings for having plan F-HD has been approximately $1,150 ($1,300 - $150) annually for each of us.

 

[ivinsfan]

Here's my estimate of individual savings for DW and I since we enrolled in Medicare Supplement F-HD:

Average annual Plan F premium ~ $2,000
Average annual Plan F-HD premium ~ $700
Average annual premium savings = $1,300

We are both relatively healthy (thankfully) and what we have paid for medical care out of pocket has averaged less than $150 per person per year. So our savings for having plan F-HD has been approximately $1,150 ($1,300 - $150) annually for each of us.

Thanks for the info...

 

[Silver]

Doesn't open enrollment depend on your state, it's my understanding if major medical issues arise you can be denied coverage on certain policies due to underwriting issues. I'm talking about switching plans not your original plan at the start of Medicare.

It's my understanding that if you enrolled in original Medicare parts A and B when turning 65, and you applied for and obtained a medigap plan during that same open enrollment period, you avoid all future underwriting regardless of where you live.

 

[REWahoo]

It's my understanding that if you enrolled in original Medicare parts A and B when turning 65, and you applied for and obtained a medigap plan during that same open enrollment period, you avoid all future underwriting regardless of where you live.

Sadly, no.

After the Medigap Open Enrollment Period, insurers can refuse to sell you a Medigap policy, delay coverage, or charge you a higher premium because of an existing health condition.

However there are exceptions as this web page explains:

https://www.ehealthmedicare.com/medicare-supplement/changing-medigap-plans/

 

[ivinsfan]

It's my understanding that if you enrolled in original Medicare parts A and B when turning 65, and you applied for and obtained a medigap plan during that same open enrollment period, you avoid all future underwriting regardless of where you live.

To the best of my knowledge you get a pass on underwriting for your first sign-up only. If you decide to change companies or plans underwriting may come into play.

 

[Silver]

Ahhh.....good to know. Thank you both.

 

[Telly]

While we're talking about Medigap plans... The book on Medicare that I referenced above, mentions a change coming to Plan F (the regular Plan F, not the H-D version) in 2020.

The author states that a term in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), C and F plans sold to newly eligible Medicare beneficiaries will not cover the Part B deductible beginning in 2020. Those who already have it will be allowed to keep it and renew it each year. The author points out that this restriction may cause large numbers of Medicare newcomers to not buy these now-popular plans, so premiums may rise for remaining plan members.

From what I can find, the only difference between regular Plan F and Plan G, is that Plan G does not cover the Part B deductible and F does. Once Plan F for new enrollees doesn't cover Part B deductible, will Plan F for newbies disappear? Seems like it would, why have two plans, F & G, exactly the same then?