Switching from Medicare Advantage to original Medicare plus Medigap and PDP.

[goillini52]

Tell me if I'm wrong, but it seems to me that even HDF or HDG is much better than any Medicare Advantage plan. I mean, how many MA plans have a $2870 MOOP?

One thing about MA, You don't have a $2,870 deductible before you can begin using it like you do with HD.

I'm not a fan of MA, but feel you need to look at that aspect when comparing to HD.

 

[Garya505]

One thing about MA, You don't have a $2,870 deductible before you can begin using it like you do with HD.

I'm not a fan of MA, but feel you need to look at that aspect when comparing to HD.

The $2870 HDG deductible is on the 20% that A/B don't pay, so it works like a MOOP.
How do the MA deductible and MOOP work? I really have no idea.

 

[goillini52]

The $2870 HDG deductible is on the 20% that A/B don't pay, so it works like a MOOP.
How do the MA deductible and MOOP work? I really have no idea.

Good point.

I've never sold a HD, and never will.

Most MA's don't have a deductible. They have copays. Once your copays reach the MOOP, you have "100%" coverage the rest of the year (unless they deny claims).

 

[LostDollar]

That's one consideration that's difficult to put a value on. I wouldn't want to burden my wife with something like that if I were to get really sick, or when I die.

@kgmom219 has made posts in the past saying she has discussions with clients about who is going to handle payment paperwork when clients want HD or Plan N.

Her business is growing so I don't know if she still does that.

I can tell you that no one else in my family would have an interest in carefully monitoring Part B provider bills in a year of big usage, they would just pay provider bills which could risk overpayment of bills in relation to the deductible amount.

 

[Garya505]

@kgmom219 has made posts in the past saying she has discussions with clients about who is going to handle payment paperwork when clients want HD or Plan N.

Her business is growing so I don't know if she still does that.

I can tell you that no one else in my family would have an interest in carefully monitoring Part B provider bills in a year of big usage, they would just pay provider bills which could risk overpayment of bills in relation to the deductible amount.

That's what my wife would do if I was incapacitated or dead. There's no way she's going to want to learn how HDG works or understand an EOB. She would just pay it.

 

[rousemark]

Real life experience with HDG:
I had about $35,000 of bills submitted to medicare. After they did their voodoo magic repricing, my share was under $600. (Which is the average for HDG's with Physician's Mutual.)

I think it would take a lot to max out the HD of $2800.

To be fair, you need to add the premium to that.

 

[somarco]

I have HDF.

So far I have only satisfied the B deductible maybe 3x in the last 10 years.

My OOP (above the deductible)

2024 - $356
2023 - $221
2022 - $190

Gross claims were considerably more but when you factor repricing + 80% paid by Medicare the amount owed by the patients can be very low until you have large claims.

One thing about MA, You don't have a $2,870 deductible before you can begin using it like you do with HD.

I have HDF and use mine all the time. Even though I have never had a claim reimbursed I still get the benefit of Medicare repricing.

 

[somarco]

I think it would take a lot to max out the HD of $2800.

If all OP claims, about $30k before you get into the 100% reimbursement. Maybe more, maybe less.

 

[rousemark]

One thing about MA, You don't have a $2,870 deductible before you can begin using it like you do with HD.

I'm not a fan of MA, but feel you need to look at that aspect when comparing to HD.

You do not have $2870 out of pocket before any benefits are paid. Medicare is paying their share.

 

[Garya505]

You do not have $2870 out of pocket before any benefits are paid. Medicare is paying their share.

Correct. And a lot of people get that wrong. Probably one reason for the low sales. Another reason is probably the low commissions. I mean, what agent in their right mind wants to spend more time explaining something that gets them maybe 1/3 or 1/4 the commission as Plan G?