Medigap Plan G high deductible

a60dan

Recycles dryer sheets
Joined
Dec 9, 2018
Messages
201
Just want to clarify my understanding.

Medicare has deductibles for Part A & B that I must pay before any Medicare plan G HD coverage kicks in.

After Medicare deductible is met, I must pay 20% coinsurance for part B

When the amount I’ve paid in total reaches $2800 (for 2024), my Plan G pays everything else as long as the provider participates in Medicare.

I’m leaning toward community rated plans (all pay same premium) or issue age plans (premiums not increased solely due to age) from a company with a good history of rate increases.

Part D prescription coverage is a separate topic.

Have I missed anything?
 
Did you check out Plan N? High deductible G is great when you’re healthy, but not so much if you develop a chronic problem or disease. Get sick late in the year and you can be hit with deductibles back to back. Plus the deductible increases each year.
 
Yes.

N: $431 /month

G: $404/month

G: HD $71/month community rated too
 
Yes.

N: $431 /month

G: $404/month

G: HD $71/month community rated too
Wow, that makes no sense since Plan G covers more. I’ve never heard of a Plan N being more expensive. I’d shop around. Our Plan N for both of us is only $244/month.
 
DH started with plan G around $108 just a few years ago. Your prices seem very high.
 
I’m guessing you don’t live in NY state?

I think it’s related to the fact that we are one of four states that prohibit underwriting on supplement plans. Even after initial enrollment, you can switch plans each year without medical questions……

Only 6 plans offered by Excellus. They clearly want to sell Medicare Advantage.

I checked my son’s zip code in Florida. They have 30 plans ��*♂️

I will continue my shopping in 2024 as I need to enroll in December.
 
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I’m guessing you don’t live in NY state?

I think it’s related to the fact that we are one of four states that prohibit underwriting on supplement plans. Even after initial enrollment, you can switch plans each year without medical questions……

Only 6 plans offered by Excellus. They clearly want to sell Medicare Advantage.

I checked my son’s zip code in Florida. They have 30 plans ��*♂️

I will continue my shopping in 2024 as I need to enroll in December.

G-HD looks like a bargain. Probably the other folks in the pool are young and healthy. You can switch to G before leaving NY if you ever move, right?
 
G-HD looks like a bargain. Probably the other folks in the pool are young and healthy. You can switch to G before leaving NY if you ever move, right?

I think that we can only switch at open enrollment, but yes I could switch prior to moving.

I’d be locking in those high premiums.

From what I’ve learned over the years, community rating with diverse age groups have historically had the best premiums.

Medicare is new to me, so I still have more to learn.
 
I think that we can only switch at open enrollment, but yes I could switch prior to moving.

I’d be locking in those high premiums.

From what I’ve learned over the years, community rating with diverse age groups have historically had the best premiums.

Medicare is new to me, so I still have more to learn.

Although it depends on the insurance company you may just be able to continue the same supplement with a new rate after switching states. Of course, if you move anywhere outside NY that would likely be much lower.
 
Wow, that makes no sense since Plan G covers more. I’ve never heard of a Plan N being more expensive. I’d shop around. Our Plan N for both of us is only $244/month.
Yesterday I met with a volunteer representing the NY State Health Insurance Assistance Program (SHIP).

I’m glad I’ve been educating myself because she went over all the supplemental and advantage plans.

Although she didn’t know why, she mentioned that the Excellus Plan G had increased significantly last year.

When she got to their “really good” new Advantage plan, and went over all the things they are “giving you” I said “ Now I know why they jacked up the Plan G premium 😊

The PPO Advantage plan is extremely tempting at $14/month, $1000 dental/vision on top of 2 cleanings, gym, etc.

She did counsel that our travel throughout the US would be better served by traditional Medicare.

My gut is still telling me to consider Plan G HD ($71/month Excellus) or Plan G at UHC AARP ($283/month).

The annual premium difference is~ $2550, close to the $2800 high deductible.

She also pointed out that she was glossing over the Advantage plans accepted by only one of the 2 hospital networks.

I’m intending to speak with a broker (recommended by former boss) at the end of the month.

REF
 
The good thing about NY is that if the fees go up with one plan you can just switch, right?
 
Yesterday I met with a volunteer representing the NY State Health Insurance Assistance Program (SHIP).

I’m glad I’ve been educating myself because she went over all the supplemental and advantage plans.

Although she didn’t know why, she mentioned that the Excellus Plan G had increased significantly last year.

When she got to their “really good” new Advantage plan, and went over all the things they are “giving you” I said “ Now I know why they jacked up the Plan G premium 😊

The PPO Advantage plan is extremely tempting at $14/month, $1000 dental/vision on top of 2 cleanings, gym, etc.

She did counsel that our travel throughout the US would be better served by traditional Medicare.

My gut is still telling me to consider Plan G HD ($71/month Excellus) or Plan G at UHC AARP ($283/month).

The annual premium difference is~ $2550, close to the $2800 high deductible.

She also pointed out that she was glossing over the Advantage plans accepted by only one of the 2 hospital networks.

I’m intending to speak with a broker (recommended by former boss) at the end of the month.

REF
Keep in mind the broker gets a much higher commission with Advantage plans. Make sure cancer drugs are fully covered after the deductible. Read all the fine print.
 
Unlike your employer group health plan where you must pay the deducible before the insurance pays. You have Medicare, once you pay the part B deducible (240.00) it pays 80%. The remaining 20% goes to your High G deducible. Example: you go to the doctor 10 times first 6 months of 2024, Medicare approved rate is 100.00 a visit. You get blood work and MRI for a total of 1240.00.
2240.00 Total bill. You pay first 240.00 and 20% of remaining bills of 440.00.
You go for lots of specialist visits totaling 2K you pay 20% 400.00 bucks,
3240.00 in bills and you pay 640.00 bucks. Stay out of the hospital, that goes your part A deducible.
I sold a lot of High G plans to engineers and accountants ( number crunchers).
 
Unlike your employer group health plan where you must pay the deducible before the insurance pays. You have Medicare, once you pay the part B deducible (240.00) it pays 80%. The remaining 20% goes to your High G deducible. Example: you go to the doctor 10 times first 6 months of 2024, Medicare approved rate is 100.00 a visit. You get blood work and MRI for a total of 1240.00.
2240.00 Total bill. You pay first 240.00 and 20% of remaining bills of 440.00.
You go for lots of specialist visits totaling 2K you pay 20% 400.00 bucks,
3240.00 in bills and you pay 640.00 bucks. Stay out of the hospital, that goes your part A deducible.
I sold a lot of High G plans to engineers and accountants ( number crunchers).
Electrical Engineer here 😀
 
Unlike your employer group health plan where you must pay the deducible before the insurance pays. You have Medicare, once you pay the part B deducible (240.00) it pays 80%. The remaining 20% goes to your High G deducible. Example: you go to the doctor 10 times first 6 months of 2024, Medicare approved rate is 100.00 a visit. You get blood work and MRI for a total of 1240.00.
2240.00 Total bill. You pay first 240.00 and 20% of remaining bills of 440.00.
You go for lots of specialist visits totaling 2K you pay 20% 400.00 bucks,
3240.00 in bills and you pay 640.00 bucks. Stay out of the hospital, that goes your part A deducible.
I sold a lot of High G plans to engineers and accountants ( number crunchers).
Can anyone clarify? I have always understood that if a person has Plan G-HD, they have to pay the entire (current) deductible of $2800 FIRST and the Part B deductible is part of this, and THEN Part B starts paying their 80% and Plan G-HD pays their 20%. For example, first medical bill (Medicare allowed amount) of the year is $2800, so have to pay $2800 out of pocket, then after that Part B will pay their 80% and Part G-HD 20% of subsequent amounts. Please correct my errors if any.
 
No. Medicare part B always pays 80% after a quite low annual deductible. It’s only the 20% copay covered by the Medigap plan that is high deductible.
Yes, I see my obvious error there. The $2800 deductible applies on the Plan G-HD part of it (I have Medicare A/B + FEHB but was interested in how the Plan G-HD actually worked).

So, Part A and B do their usual thing and one pays the Parts A and/or B deductibles as necessary for the situation. Plan G-HD does not pay anything until the Part A deductible and Part B deductible and 20% responsibility reaches their G-HD deductible of $2800 (my understanding is the Parts A&B deductibles count as part of the Plan G-HD $2800 deductible?).

This seems to make the Plan G-HD plan a very attractive option, since in my experience the 20% owed after Medicare pays its 80% on a "provider accepts assignment" claim is usually quite small.

The times where one might have to pay that $2800 deductible in full would seem to be when a hospital admits, or when it puts one in an "observation status" for a day or more (which falls under Part B), or other high cost tests or treatment. Still, $2800 out of pocket for the year seems relatively good. Still, I can also see why people choose Plan G or N so as to just not hassle it.

Please correct me if still in error.
 
Some of us choose Plan G so that we don’t have to track the higher deductible expenses as we age. Yes it saves money in the early healthy years but many states you can’t switch to a more comprehensive plan later.
 
Agree with ^^^^, except I chose N and am willing to pay the $20... if they charge me more that that I ask questions... my last visit was over $100... but I had not met my annual deduction...

IMO, do not try and save every penny today... look at the long run..
 
Some of us choose Plan G so that we don’t have to track the higher deductible expenses as we age. Yes it saves money in the early healthy years but many states you can’t switch to a more comprehensive plan later.
In my state HD F highest rate is about 130.00 vs the highest rate for regular F is 550.00 Big enough difference to cover the deducible in those late years when you are using $$$$. Every state and company is different but good to compare. Not many companies offering HD these days, smaller premium probably translates to less profit. Smaller premium means less commission for the sales people. If the insurance company does not like to offer it and my agent does not like to offer it, probably a good thing for me, :)
 
One of the best selling points of a standard plan G is you pay your $240 and any bills after that "ain't your problem, period." Anybody tries to bill you, you say "I thought you accepted Medicare assignment", they say "we do", then you say "well you better sharpen your pencil on those claims because I already paid my $240 and I have a plan G super payer". It's almost as good with plan N, but you need to pay the $20 for each doctor visit. That, as opposed to an HD plan, where you're paying all kinds of stuff, and who knows if they've got the claims complete. Anything they don't file right will be shown as your responsibility, even though it's because they didn't file it right.

I think most of us have seen the enormous difference in price between what they bill and what Medicare pays. So they "make a mistake" and leave off one service of a 10 service claim. So say the billed amount on that forgotten service is $150 and the Medicare amount is $20. But they "forget" to file it, so along with your 20% that you're paying on the other 9 (working on your Plan-G High Deductible), they toss-in the $150, and hope you don't notice.

Hospitals have a ton of money flowing through, but the margins are narrow. I'm not saying I know for a fact they do this on purpose, but I've seen a lot of these mistakes, and didn't get any mistakes where the patient got the benefit. It almost certainly depends on how shady the corporate hospital chain is... I'm sure some are better than others.
 
.....

I think most of us have seen the enormous difference in price between what they bill and what Medicare pays. So they "make a mistake" and leave off one service of a 10 service claim. So say the billed amount on that forgotten service is $150 and the Medicare amount is $20. But they "forget" to file it, so along with your 20% that you're paying on the other 9 (working on your Plan-G High Deductible), they toss-in the $150, and hope you don't notice.

......

I think the standard plans will have fewer issues to deal with. I really don't understand this failure to either submit claims or failure to submit them correctly. Maybe it's an error or maybe it's a scam. In your example if you paid the $150 I doubt that they would fix unit after getting paid :)
 
One thing your missing with an HD plan. You get to do all the bill paying yourself. So if something happens to your health,you need someone to take care of the billing. 2 1/2 years ago I racked up 190K bill,I have F HD, I paid all the hosp bills to my deductible I guess 2400 back then. But hosp billing is such a mess,they put me in collection for 30 bucks for a bill I never got. LOL Never the less at 67/month still a good deal,saved a lot over the past 11 years.
 
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I think the High deductible is a great deal, at 76, I've still never met my deductible. My monthly premium of $104 for my HD Plan F is a bargain for the coverage I now get, while having security of full coverage should my health care needs increase. The higher premium of plain plan G guarantees I'd pay more annually. Most of us can afford a onetime pay out of the deductible, but more commonly it's paid in smaller amounts over months.
 
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