Why arent high deductible medigap plans more popular?

[LostDollar]

You're right, the Part B deductible is included as part of the HDG deductible. Including the B ded in the calculation actually raises the breakeven point by the amount of the B ded.

Using approximate premiums as an example.

G: $150/mo premium so annual OOP is 12*150+240=2040

HDG: someone paying $50/mo will have OOP of $2040 when annual covered expenses are $6240 (premium $600, $240 Part B ded, 20% of $6000 in expenses after B ded)

In this scenario, HDG max out of pocket would be $3400 (premium + HDG ded). This OOP would be reached when total covered Medicare expenses come to around $13,000.

For anyone wanting to find the breakeven point in their state, the formula is (G monthly premium - HDG monthly premium) * 60 + B deductible

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Caveats:

Caveat for those reading this reply

I am not an insurance agent.

I have had an HDF plan for several years.

I have had at least one year when (somewhat to the detriment of my personal health) I did not use it at all.

I have had one year where I did max out the deductible (and I think my liability would also have maxed out at the current deductible of $2,800.)

I have had a few years where I had payment liabilities that were less than 50% of that year's HD maximum.

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Comment(s):

One thing that concerns me about carrying HD F or G is becoming trapped in a particular plan in case of a health event.

If you have an adverse health event that prevents you from changing Medigap plans and you are carrying an HD F or G, you are then locked into a more expensive F or G plan (HD premium + HD current year deductible) than you might otherwise have had.

It seems to me that this consideration might be a drag factor on an increasing market share of HDG which @Yagents posits above.

 

[Ron Van D]

I have a HDG.

I was just looking back through my 2022 claims. I had a colonoscopy (polyps removed), PSA issues which resulted in doctor visits, an MRI, and a prostate biopsy.

The total billed to Medicare was 32483.09

My responsibility totaled $440.32.

 

[Yagents]

I'd rather be "stuck" on an HDG plan vs MAPD or G. Move on LD

 

[gregj]

unpopular opinion(?): some version of HD Supplement benefit design will, maybe relatively soon, find its way on to the MAPD menu - not MSA, but "high comprehensive deductible with a swirl of Rx, dental, vision, other stuff", along with 'simplified' (looser) networks.

 

[LostDollar]

I'd rather be "stuck" on an HDG plan vs MAPD or G. Move on LD

Some may not care to assume that risk. They need the opportunity to understand details of what they are signing up for before they sign.

 

[ValeRosso]

I have a HDG.

I was just looking back through my 2022 claims. I had a colonoscopy (polyps removed), PSA issues which resulted in doctor visits, an MRI, and a prostate biopsy.

The total billed to Medicare was 32483.09

My responsibility totaled $440.32.

How?

 

[LostDollar]

How?

Processing by CMS MAC contractor:

A) Reduction of Provider Part B charges from "Billed Amount" to "Medicare Allowed Amount".

(Beneficiary can also examine their Medicare EOB (MSN) to see whether or not the claim was automatically crosswalked to the Medigap provider.)

B) Medicare payment of their share of the allowed amount.

C) Final amount(s) due from Medicare Beneficiary = Their (Beneficiary's) share of the amount(s) allowed by Medicare plus any provider charges disallowed by Medicare.

A LostDollar bill payment step--I can not tell you if other Medicare Beneficiaries also do this.

When you have the HD J,F, or G plan, DO NOT PAY any provider bills UNTIL YOU SEE the claim has been processed by the HD plan carrier and you have received the proper reduction in your current year High Deductible Obligation. Also check the provider invoice to you to see the provider has not added late charges to your Medicare approved obligation to the provider.

 

[renee15]

I pay $115/month for plan G
add the $240 ded or $20/month
and
$165 medicare part B premium monthly
so about $300 per month before we add the
PDP
seniors don't want to add yet another deductible-I've had ZERO clients ask for a high deductible plan in the 19 years I have sold medicare plans

 

[renee15]

UHC paid out about 20K last year on my husband's bills-cancer is expensive

 

[Chazm]

I pay $115/month for plan G
add the $240 ded or $20/month
and
$165 medicare part B premium monthly
so about $300 per month before we add the
PDP
seniors don't want to add yet another deductible-I've had ZERO clients ask for a high deductible plan in the 19 years I have sold medicare plans

If I were Medicare eligible, I would have Plan G for the sole fact that when I gave my seminar presentations, I would tell them it's the plan that I have. And I'd rather pay more up front to not have any surprise costs, or denials.

People always ask what my parents have and it's embarrassing to tell them, but they wanted an HMO.