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calusa wrote: ↑

Wed Aug 22, 2018 7:24 am

in my case I knew there was a surgery that I had to decide on within a year that would have presented me with a definite minimum co-pay of at least $10,000.

Can you explain a little more?

I'm assuming you have Medicare Part B, and the discussion is about supplementing that coverage with a Medigap policy to cover what Medicare will not pay.

Are you saying that if you proceed with this surgery, you will face at least a $10,000 co-pay despite what Medicare Part B covers? And that your regular Plan F will cover all or most of that co-pay -- thus a high-deductible Medigap policy with a $2,200 deductible would make you pay the full $2,200 before it covered the rest of your $10,000 co-pay?

In my case, I don't know if the $2200 would be accurate, more, or less - regardless, the copay would be a mininmum if the estimate for the surgery cost was accurate (and it was). Consequently, I did not pay the deductible whatever the amount would have been nor did I pay the co-pay. Given what the difference in premium was between the full plan F and the high deductible plan F (less than $40/month $480/year) I considered plan F to be the better option. All medigap plans are consistent within type regardless of where you live or from whomever you buy it - the cost however, varies dependant on where you live (by ZIP code).

It is not possible to make an informed decision about Medicare supplements
without INFORMATION--especially access to the discounts Medicare demands from providers.

Given what the difference in premium was between the full plan F and the high deductible plan F (less than $40/month $480/year) I considered plan F to be the better option.

With a difference in the premiums of only $480/year, I would have reached the same conclusion!

I've only priced the difference in premiums with United American, one of only two companies that sell the high-deductible version of Plan F where I live. (The other company never responded to my inquiries.)

For 67-year-old males in southwest Florida, here are their annual premium rates for 2017:
-- Plan F (regular Plan F): $2633.00 per year
-- Plan F (high-deductible Plan F): $677.00 per year

While you're paying $480/year to save up to $2,200, I would have to pay $1,956 to save up to $2,200.

Pretty good deal for you; a terrible deal for me....

I'm curious as to whether this anomaly is because of the differences between our insurance companies, or related more to where we live (or age, or gender?).

(These United American rates are for their 'preferred' tier; rates for their 'standard' tier are higher, but proportionally the same.)

This is an interesting topic as I have to decide whether I want Kaiser or Medigap Supplement and if so which Medigap plan .

If your surgery is in hospital, does the $2200 include the $1360 Part A deductible?

In their promotional materials, United American clearly states that Medicare deductibles for both Parts A and Part B are included when determining if you've reached the $2200 annual deductible for out-of-pocket expenses.

Once someone has reached that threshold, their high-deductible Plan F begins paying the same benefits as a regular Plan F.

Until that threshold has been reached, the high-deductible Plan F pays nothing.

If signing up for the first time, you can use SHIIP to evaluate
the best Part B supplement at any time of the year.
After at, they help with Part D during open enrollment.
Changing part B supplements afterward may require underwriting.

greatunclebill wrote: ↑

Mon Aug 20, 2018 3:59 pm

you are mostly right except if tricare for life covers something and medicare doesn't, tricare for life becomes first payer and deductibles come into play. it's rare that it would happen that way. it's written in the plan because it could happen.

it also works the other way around. medicare covers things that tricare for life doesn't. in that scenario tricare for life doesn't cover the 20% and deductibles are back in play.

for the largest majority, both pay and i don't.

That is exactly how Medicare & my secondary BC/BS work.
If Medicare doesn't cover something, but BC/BS does, BC/BS pays 80% & I pay 20%
If Medicare covers something, but BC/BS does not, then I pay the Medicare 20%

In the instances where it has occurred, BC/BS paid 100% as "wellness" - so I didn't pay the 20% there