Once Original Medicare approves a claim, it will deduct from its approved amount that which you are responsible for and pay the difference directly to the provider.
That amount you are responsible for; the Part A deductible, the Part B deductible and Part B 20% co-share is often paid through the purchase of a secondary insurance plan or supplement coverage called Medicare Supplemental or Medigap.
These supplemental Medigap plans are offered in several lettered plan names. The most popular are Plans F (available only to individuals eligible for Medicare before 2020) G and N. Simply put, the higher premium plans cover more of your deductible and 20% share; think Plan F. And the lower the premium, the higher your share; that would be Plan N.
So What is the Medigap High Deductible Plan?
Many people are accustomed to paying 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.
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The Medigap High Deductible Alternative.
The High Deductible plan covers everything Standard plans F and G will, however the Medicare beneficiary pays a defined amount of co-pays out of pocket before the plan will pay ($2490 in 2022), that’s the “High Deductible.” Once that $2,490 out of pocket cost has been paid, the coverage is the same as the regular Standard Plan F or G, 100%
Q: Does that mean I have to pay the first $2,490 in claims?
A: No – it’s more like maximum $2,490 in annual co-pays. Here is a detailed example of how the plan pays claims. Beginning each January 1, Medicare Part B claims are subject to an initial deductible which the member pays, the amount is adjusted annually and is $233 for 2022. After that, claims still get billed to Medicare which approves the claim, however usually at a reduced amount. Medicare Part B pays 80% of the claim and a standard F or G Plan would pay the remaining 20%. With the High Plan, you would pay the 20% share until your total deductible and co-payments reach the limit, $2,490 in 2022. The 2023 deductible amount will be announced by the end of November, 2022
Q: Which hospitals and doctors will accept my High F card?
Medigap High Deductible F and H plans have the largest nationwide network of doctors and hospitals, because they have the same network as Original Medicare.
Q: How does a High Deductible compare to Medicare Advantage plan?
- For Medicare Advantage plans the 2022 yearly limit on out-of-pocket costs for all in-network medical services can be as high as $7,550, $11,300 if combined with non-network care. With Medicare Supplement High F plan, the maximum out-of-pocket costs for all medical services (no network) is the $2,490 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 Part D drug coverage; VA benefits meet that requirement.
- Medicare Advantage plans may include features like dental allowance, fitness membership, eyewear and hearing aid benefits not available with Original Medicare.
Q: Will a High Deductible Plan save me money?
A: It’s Possible.
Compared to a Standard F or G plan, you compare the combined premium and annual out-of-pocket costs.
- Assume a Standard Plan F or G monthly premium to average $250 monthly, that is $3,000 annually, with $0 copays
- Annual High Deductible premium (assumer $65 monthly below) equals $780 plus maximum $2,490 co-pays totals $3,270 worse case scenario. (Think $12,450 approved Part B claim amounts at 20% copays to reach $2,490)
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- Medicare Supplement plans require a separate Part D drug plan. We offer stand alone drug plans.
Q: Which Medicare High Deductible Plans are available in New York State?
Our agents are authorized to represent the Globe Life Insurance Company, Highmark BlueShield and Humana Medicare Supplement High Deductible Plans. Click and Enter Your 5-Digit New York Zip Code to Compare MediGap Policies in Your Area
Questions?
Please call me at (518) 346-2115 or send a quick note with your contact information and question.
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One reply on “What is a High Deductible Medigap Plan?”
Thanks for the details on the FAQs answers