F plans provide the maximum coverage offered by a medigap. See the comparison chart at the end of this post for all the types of medigap plans that are available. A reminder - no matter who is selling a medigap plan - the elements are always the same. So, buy the cheapest medigap plan in the letter category you are considering. There is no advantage to buying a higher premium policy.
OK - so I like F plans because they cover everything. Why the deductible version? After all, the deductible portion of the F+ plan is currently $2110. This deductible is set by Medicare and not by the insurance companies. It goes up a bit every year but nothing drastic. Last year it went up by $10. Even so, $2110 seems like a lot of money but when you do the math it really isn't.
At first, I did a bunch of calculations to decide whether or not to use a high deductible F plan. I looked at my coinsurance payments in 2012 and in 2013 and a lot of "what ifs" as to when would F be better than F+.
In my opinion that is not at all necessary. Here is my current analysis;
- Take the F+ deductible and divide it by 12. In 2013 (2110/12) is 175.83. For the sake of simplicity I'll use 176.
- Add $176 to the F+ policy monthly premium. In New York the monthly premium is about $80/month so the effective F+ premium is $256/month.
- Compare the adjusted F+ premium (e.g., $256/month) to the montly premium for an F plan with no deductible. In New York it is about $323/month.
- If the adjusted F+ premium is lower than the F premium then the F plan without a deductible is more expensive - always buy the F+ plan. So, in my NY example, no matter my health - I will pay less in deductible and premiums to have an F+ plan ($256 vs. $323) than to have an F plan.
- If the adjusted F+ premium is the same as or higher than the F premium then buy the F plan if you are not healthy.
- If the adjusted F+ premium is the same as the the F premium and you are healthy buy the F+ plan because you might get lucky and not pay out the whole deductible.
- If the adjusted F+ plan is higher than the F premium and you are healthy then decide if you want to gamble you will stay healthy. If you get sick - especially early in the year - it may end up costing you more to be on an F+ plan.
I pulled the following chart off the www.medicare.gov website:
| Medigap Benefits | Medigap Plans | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| A | B | C | D | F* | G | K | L | M | N | |
| Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
| Part B coinsurance or copayment | Yes | Yes | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes*** |
| Blood (first 3 pints) | Yes | Yes | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes |
| Part A hospice care coinsurance or copayment | Yes | Yes | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes |
| Skilled nursing facility care coinsurance | No | No | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes |
| Part A deductible | No | Yes | Yes | Yes | Yes | Yes | 50% | 75% | 50% | Yes |
| Part B deductible | No | No | Yes | No | Yes | No | No | No | No | No |
| Part B excess charges | No | No | No | No | Yes | Yes | No | No | No | No |
| Foreign travel exchange (up to plan limits) | No | No | Yes | Yes | Yes | Yes | No | No | Yes | Yes |
| Out-of-pocket limit** | N/A | N/A | N/A | N/A | N/A | N/A | $4,800 | $2,400 | N/A | N/A |
** After you meet your out-of-pocket yearly limit and your yearly Part B deductible, the Medigap plan pays 100% of covered services for the rest of the calendar year.
*** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don't result in inpatient admission.
If you live in Massachusetts, Wisconsin or Minnesota check medigap offerings are different. Check with the state SHIP (www.shiptalk.org will give you the phone number) to find out what they offer.
Most charts of Medigap plans show only plan F among the rest of the alphabet, and indicate that there is a High deductible version of plan F that has a deductible of $2110 for 2013. Usually there is a note at the bottom of the chart that explains how plan F high deductible (you refer to it as F+) differs from Plan F. Depending on the chart the notation will either read like this:
ReplyDelete1. "You must pay for Medicare-covered costs up to the deductible amount ($2,110 in 2013)
before this Medicare Supplement policy pays anything."
Or this;
2. "High Deductible Plan - This plan provides the same benefits as Plan F after one has paid a calendar year deductible of $2,110 for 2013. Out of pocket expenses for this deductible are expenses that would ordinarily be paid by the plan. These expenses include the Medicare A and B expenses that would ordinarily be paid by the plan. These expenses include the Medicare A and B deductibles, but not the foreign travel emergency deductibles."
My friend and I differ on whether we, the purchaser of a F high deductible plan, have to pay the Part A and/or Part B deductible out-of-pocket or whether the plan pays these. I say we have to pay it out-of-pocket and that it'll be applied to the total deductible of $2110 for 2013. My friend contends, that no, the plan pays the medicare Part A and/or B deductibles and leaves us with the $2110 deductible to to be satisfied before the plan pays any additional medicare expenses.
Who is right?
YOU are right. The F high deductible plan pays nothing at all until your out of pocket costs total $2110 (for 2013). After that it pays for everything EXCEPT a $250 deductible if you get sick during foreign travel. Reminder - if you have $$ left in your HRA account you can submit those copay bills for reimbursement. In a post I did today I provided a link to a brochure on www.medicare.gov that is excellent and describes medigaps in detail.
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