Medigap High Deductible Plan F

[Antigone]

Can someone please let me know if this is correct?

Medigap High Deductible Plan F has an annual deductible of $2,000. Doctor's office visits are covered under Medicare Part B, so with this plan, let's say Mr. Jones goes to doc in January, visit is $168 (or whatever Part B deductible will be for 2012).

He pays that amount in full and in doing that, he satisfies the Part B deductible, which would mean any additional doctor's office visits (or anything under Part B) would be at a 20% co-insurance.

 

[somarco]

Mr. Jones goes to doc in January, visit is $168 (or whatever Part B deductible will be for 2012).

He pays that amount in full and in doing that, he satisfies the Part B deductible, which would mean any additional doctor's office visits (or anything under Part B) would be at a 20% co-insurance.

Yes.

Hi F pays nothing until policyholder has $2,000 OOP.

 

[Antigone]

Yes.

Hi F pays nothing until policyholder has $2,000 OOP.

Well, you're saying both yes and no, and this is what I'm trying to clarify.

When the Part B deductible has been met, why would someone still be paying full-price for Part B services? With only original Medicare, when Part B deductible is met, rest of Part B services for that year, is at 20% coinsurance.

Medicare & You booklet says:

Plan F also offers a high-deductible plan. If you choose this option,
this means you must pay for Medicare-covered costs (coinsurance,
copayments, deductibles) up to the deductible amount of $2,000 in 2011
before your policy pays anything.​

Since they include deductibles, copayments and coinsurance in the amount that goes towards the $2,000,
to me that says once the Part B deductible (or Part A, but B is easier met than A) is met, services are at coinsurance. I hear a lot of people selling it this way, and it make sense to me, and then I hear others who say the first $2,000 of expenses is paid.

One must be right and the other wrong. I don't want to misrepresent the benefits.

 

[Todd King]

Once the dedutible is met, the client will pay the 20% up to $2000. Medicare still pays their 80% regardless. It's the Med Supp that isn't going to pay anything until the client puts out $2000 OOP.

 

[Antigone]

Once the dedutible is met, the client will pay the 20% up to $2000. Medicare still pays their 80% regardless. It's the Med Supp that isn't going to pay anything until the client puts out $2000 OOP.

Thanks, I think I have it now. Can I take it one step further?

Mr. Jones is in the hospital with high ded plan F. He will be responsible for Part A deductible $1,132 and the Part B deductible of $168, for a total of $1,300. Any additional Part B services are at 20% coinsurance, and if he meets $2,000 OOP for the year, he has no more OOP. And since he's met Part A deductible, there is no copay or coinsurance for that hospital stay or another hospital stay in the same benefit period. Correct?

Does anyone know what Part A and Part B deductibles will be for 2012? They are not in Medicare & You handbook.

 

[somarco]

you're saying both yes and no,

Yes, and no . . .

Hi F is just like F except with a $2,000 front end Medigap deductible.

Once the insured satisfies the Hi F deductible there should be no additional OOP.

The gap deductible can be met with hospital admission, doc visits or other A & B Medicare deductibles and coinsurance.

The confusion comes with the addition of a gap deductible. F = Hi F + $2000 front end deductible.

 

[Antigone]

Yes, and no . . .

Hi F is just like F except with a $2,000 front end Medigap deductible.

Once the insured satisfies the Hi F deductible there should be no additional OOP.

The gap deductible can be met with hospital admission, doc visits or other A & B Medicare deductibles and coinsurance.

The confusion comes with the addition of a gap deductible. F = Hi F + $2000 front end deductible.

Many thanks! I was confusing Medicare paying when Part B ded is met as the plan, which, of course, it's not. Duh! Sometimes I can't see the forest for the trees with this stuff. I've always done Medicare Advantage and this is my first year with Medigap, and I forget to think about original Medicare.

I know some agents refuse to sell it saying policy holder pays first $2,000, end of discussion. I think it's a good option for those who have the funds if needed but don't want to throw them out the window every month with Plan F.

I do want to present it correctly! Thanks for clearing up my confusion.

 

[GreenSky]

I do want to present it correctly! Thanks for clearing up my confusion.

The "problem" with this plan is I can't live on 13-21% commission on a $35 monthly premium. It's worse than trying to make a living selling individual dental.

It's great that you want to understand the plan. It's not so great that you expect to present it properly or otherwise.

Unless of course you are independently wealthy or using this to find money to cross sell other coverage.

Rick

 

[somarco]

No disagreement Rick.

I have a few Hi F's on the books and it is mostly people who are accustomed to high deductible HSA's. A few are also those who cannot afford anything else and want to limit exposure.

Wrote a husband & wife this week on Hi F which means a 5% discount on premium + another 2% for monthly bank draft. Final premium will be $85 at 12% = $10/month.

What makes it even worse is this is with Blue that can't seem to get my commission right on the other business I write with them.

 

[SportsNut]

A few are also those who cannot afford anything else and want to limit exposure.

Wrote a husband & wife this week on Hi F which means a 5% discount on premium + another 2% for monthly bank draft. Final premium will be $85 at 12% = $10/month.

So why wouldn't someone that is in the "can't afford anything else" category, be better off with a MAPD plan at 0 prem out of pocket...?

Gimme sum of dat ed-u-ka-shun on the subject. This isn't my main area of interest but trying to pick this up on the fly.

Also, another question that I would like to pose here: Do any of you who are in the med supp or MA business ever enroll clients into Low Income Subsidy with SSA...? (those folks making 150% or less of the Fed Poverty Level, or less than $ 1362.00 per month in income, and having less than $ 12,640 in liquid assets, not counting home and auto values, etc.). Or do you just not deal with those poor folks...?