What is the Medigap High F Plan?
This plan provides the same benefits as standard Plan F after a $2,300 (2019) deductible has been met.
The standard Plan F is a Medigap policy that pays the Medicare hospital and medical Parts A and B deductible and co-insurance – the dollars not paid by Original Medicare. Plan F is one of the most comprehensive supplemental plans, but the premium cost can be prohibitive for some people. The high deductible version of the plan, Medicare Plan F High Deductible, is more affordable for some.
Many people are accustomed to paying a some out of pocket costs for a hospital or doctor visit. Others would rather pay a higher monthly premium and have these costs covered in full. Standard plans F, G and N leave members with very little costs outside of their premiums, but the premiums tend to be higher than many budgets support.
The Medicare Plan F High Deductible Alternative.
The High F deductible plan covers everything Plan F does, but the member must pay a certain amount of co-pays out of pocket before the plan will pay. Once the out of pocket cost has been paid, the coverage is the same as the regular Plan F, 100%
Q: Does that mean I have to pay the first $2,300 in claims?
A: No – it’s more like maximum $2,300 in annual co-pays. The image below is a detailed example of how the plan pays claims. Beginning each January 1, Medicare Part B claims are subject to an initial $183 deductible which the member pays (See claims highlighted and labeled “1” in image below.) After that, claims still get billed to Medicare which approves the claim, usually at a reduced amount. In the example labeled “2” below, the doctor submitted a $220 claim and then accepted the Medicare approved amount of $76.65. Medicare paid its 80% ($57.72) and the 20% balance ($18.93) is your responsibility. A standard F Plan would pay that 20%. With the High Plan F, you would pay the 20% share, the $18.93, until your total deductible and co-payments reach $2,300. So in the $220.00 claim example below the member’s $18.93 payment counts toward the $2,300 deductible.
Q: Which hospitals and doctors will accept my High F card?
Medigap High-F plans have the largest nationwide network of doctors and hospitals, because they have the same network as Original Medicare. Compare that to a HMO Plan which may restrict you to receiving care only from participants in the HMO network, often local. (Listen to Dan’s interview with a former HMO member explaining how he couldn’t get approval to see an out of network oncologist.)
Q: How does a High F compare to Medicare Advantage plan?
- For 13 Medicare Advantage plans in New York Capital Region, the 2019 yearly limit on out-of-pocket costs for all in-network medical services average $6,027. With Medicare Supplement High F plan, the maximum out-of-pocket costs for all medical services (no network) is the $2,300 deductible.
- Medicare Advantage plans have restrictive (HMO) or preferred (PPO) network of doctors and hospitals. Medicare Supplement plans offer greater flexibility – the same network as Original Medicare.
- Most Medicare Advantage plans include Part D prescription drug plans. With Medicare Supplement, you will need to obtain separate creditable drug coverage; VA benefits meet that requirement.
- Medicare Advantage plans are Managed Care plans with a greater emphasis on coordinated, preventative and wellness care. With Medicare Supplement, you are in charge of your medical coordination.
- Medicare Advantage plans may include features like fitness membership, eyewear and hearing aid benefits not available with Original Medicare.
Q: Will a High F save me money? A: It’s Possible.
- Compared to a Standard F plan, you compare the combined premium and out-of-pocket costs.
- Annual Standard F premium (average $250 monthly below) equals $3,000 with $0 added.
- Annual High F premium (average $69 monthly below) equals $828 plus maximum $2,300 co-pays totals $3,128 worse case scenario. (Think $11,500 approved Part B claim amounts at 20% copays to reach $2,300)
- Compared to a Medicare Advantage PPO plan with Part D drug coverage, you compare premium and out-of-pocket costs.
- 13 Capital Region NY Medicare Advantage PPO plan premiums average $54 with average in network out-of-pocket costs limited to $6,027.
- Medicare Supplement plans require a separate Part D drug plan. Dan offers stand alone drug plans with NY state monthly premiums ranging from $17.10 to $77.70.
Q: Which Medicare High F Plans are available in New York State?
As of October 2018, three insurance companies offer a High Deductible Plan F. In Dan’s home zip code 12309, the four plans’ monthly premiums range from $58 (Globe Life Insurance) to $82.73. Yes, Dan is authorized to represent Globe Life Insurance Company, click here to download Globe Life application in PDF format. (Ref: New York State Department of Finance web site.)
Please call me at (518) 346-2115 or send a quick note with your contact information and question.
|Daniel G. Alcorn, a licensed and independent agent, represents licensed insurance companies in New York and other states. Dan may receive compensation for individual enrollments in Medicare Advantage, Medicare Supplemental Insurance , Medicare Prescription Drug or Long Term Care plans.|