When a hospital or medical claim is submitted to Original Medicare, Medicare first determines whether the claim is approved or not and then assigns an “allowed amount.”
However, Medicare may not pay that allowed amount in full. Beneficiaries are responsible for the Part A deductible, Part A co-pays, the Part B deductible and Part B 20% co-share. Medicare pays its net share amount to the healthcare facility or provider and the individual is responsible for the remainder.
All or a portion of that remaining balance can be paid through the purchase of a secondary, or supplemental, insurance plan called Medicare Supplement – also called 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; that would be Plan F. And the lower the premium, the higher your share; that would be Plan N. Click and Enter Your 5-Digit New York Zip Code to Compare MediGap Plans F G and N in Your County
So What is a Medigap High Deductible Plan?
Instead of “that remaining balance being paid through the supplemental insurance plan” you would pay that portion not paid by Medicare up to a maximum amount of $2,800.
Once that $2,800 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 $2,800 in claims?
A: No – it’s more like maximum $2,800 in annual co-pays. Here is one example of how the plan pays claims. Beginning each January 1, Medicare Part B claims are subject to an initial deductible which the member is responsible for. After your satisfying the Part B deductible, Medicare Part B pays 80% of the claim and a standard F or G Plan would pay the remaining 20%. However with the High Deductible Plan, you would pay that 20% share until your total deductible and co-payments reach the limit, $2,800 in 2024.
Q: Which hospitals and doctors will accept my High F card?
Medigap High Deductible F and G 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 2024 yearly limit on out-of-pocket costs for all in-network medical services can be as high as $8,550, $12,500 if combined with non-network care. With a Medicare Supplement High Deductible plan, the maximum out-of-pocket costs is the $2,800 deductible.
- 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?
Calculate the the combined premium and annual out-of-pocket costs of a standard Medicare Supplement Plan F, G or N
- Assume a Standard Plan F monthly premium to average $300 monthly, that is $3,600 annually, with $0 copays
- With Standard Plans G and N, your monthly premium is lower however you are already responsible for the Part B deductible and, with Plan N, an office visit copay.
- Annual High Deductible premium (assume $70 monthly) equals $840 per year plus maximum $2,800 co-pays totals $3,640 worst case scenario. (Think $14,000 of Part B allowed claim amounts at 20% copays to reach that $2,800)
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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?
Click and Enter Your 5-Digit New York Zip Code to Compare MediGap Policies in Your Area Our agents are authorized to represent the Globe Life Insurance Company and Humana Medicare Supplement High Deductible Plans. Please call us at (518) 346-2115 or send any agent a quick note with your questions.
| 2024 | 2023 | |
| Part A deductible per period | $1,632 | $1,600 |
| + Part B deductible | $240 | $226 |
| + Part B co-share | 20% | 20% |
| = Maximum Out of Pocket | $2,800 | $2,700 |
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Open in new tab Source: https://www.cms.gov/files/document/cy-2024-medigap-high-deductible-options-fjg.pdf