Sunday, September 14, 2014

IBM OneExchange Medicare Supplement F High Deductible Experience

I'll start with a lament.  I still hugely miss IBM's retiree group plan for Medicare secondary insurance provided through Aetna Integration plan.  It offered such great coverage that went beyond what is provided by the government sanctioned Medicare supplemental plans and was so easy to use. It was a big, big take away.  End of lament.
I've written in early posts how I opted to stay with "Original Medicare" because I wanted maximum flexibility to be able to go to any doctor or clinic who would take Medicare anywhere in the country (  Another small reason I chose original Medicare is political.  Our federal government is using additional tax payer dollars to subsidize enrollees in Medicare Advantage plans versus enrollees in original Medicare.  Ergo, the government is subsidizing private insurance companies - another example of corporate welfare. The Affordable Care Act is trying to eliminate those extra payments but there is a slow phase out. 
Anyway, original Medicare is good insurance but medical copayments and deductible payments are limitless and can become exorbitant for catastrophic diseases.  Supplemental (aka medigap) insurance policies (offered by private insurance companies) provide insurance coverage for the copayments (known as coinsurance) and deductibles and thereby cap out of pocket costs. However, they offer no additional medical coverage (e.g., visits to an acupuncturist as was in Aetna Integration) and will only cover deductibles and copays for claims approved by original Medicare.
I decided my spouse and I would get  medigap F high deductible (F-HD) plans because the premiums are really low.  These plan do not provide any benefit at all until the client pays $2140 of copays and deductibles in a given year.  If those payments do exceed the $2140 the insurance then kicks in and  pays all deductibles and copays for the rest of the year. The counter resets every January.
This has been a complex medical year for my spouse. Even so, the total cost of copays and deductibles still hasn't even come close to $2140 so the medigap F-HD insurance has provided no benefit at all.  HOWEVER, the policy premiums are so low ($87/month - which is low for NY) that we are financially still way ahead by hundreds of dollars compared to buying a higher premium policy (e.g., medigap N) for a different kind of medigap that would have paid copays and deductibles immediately. We'll stay with F-HD plans for 2015.
As with any insurance coverage - car, house, boat ... the insurance premium paid goes up the more coverage you want.  Medicare Advantage plans sometimes obscure the fact that you are getting less (e.g., restricted doctor networks) for your premium payment - which might just be your part B premium.  Medigap plan premiums are high if you want copays and deductibles immediately covered.  During this fall enrollment time - I once again urge you to "do the math" and make sure your premium is worth the benefit you are receiving.
Updated 9/20/14:  I should have added to this post that you should check from time to time on your state's department of insurance website (in New York or call your state health insurance assistance agency  ( lists the phone number) to find out if there are new providers of  Medicare Supplemental plan offerings or if there have been premium changes for existing providers.  The state health insurance agency (aka SHIP) will also know the state rules for when or if you can switch to a different medigap plan.


  1. Hello, will you point me to your post on opting for the "original Medicare?' My husban's company is moving us to One Exchange so stumbling onto this site is most informative/instructive. Thank you.

    1. Thank you for your feedback. If you go to the right side of the blog all the posts for the blog (which goes back to 2009) are organized by date I posted an entry. The "why I like original Medicare" was written in September 2013. It is at