What are the differences between regular “Plan F” and “High Deductible Plan F”?



What are the differences between regular “Plan F” and “High
Deductible Plan F”?

High Deductible Plan F has a deductible of $2,110.00 for calendar year 2013. Benefits from the High Deductible Supplement Plan F will not begin until your out-of-pocket expenses total $2110.00.

With Plan F, there is no out-of-pocket expense for this annual deductible.

These two plans pay the same benefits after you have paid your deductible. There are additional factors to consider in determining which policy is better for your own situation.

What about Medicare Part A? Isn’t there a deductible for that, also?

Under Medicare Part A for 2013, the deductible for hospitalization is $1184.00: If you are hospitalized, Medicare pays all but $1184.00 for your first 60 days in the hospital. If you have High Deductible Plan F, you are going to have to pay that deductible. If you have regular Plan F, you do not.

Is there yet another deductible for Medicare Part B?

Under Medicare Part B, there is a calendar year deductible of $147.00. When you go to see your doctor you will pay for the doctor visits out of your pocket until you have met the $147.00 deductible. After the Part B $147.00 deductible has been met, Medicare will pay 80% of the doctor visits and you will be responsible for the co-insurance of 20%. In dollars and sense terms this means: If the doctor charges Medicare $90.00 for the visit, Medicare will pay $72.00 and you will pay $18.00.

Here’s an example: You are at your doctor a third time this year. The doctor has charged $90.00 for each of the visits.
The first visit would cost you $90.00 out of pocket.
The second visit would cost you 63.60 out of pocket.
The third visit would cost you $ 18.00 out of pocket.

How did we arrive at these numbers? Well the first visit you had not yet met the deductible so you had to pay for the visit in full.

For the second visit only $57.00 of the deductible was remaining so you paid that $57.00. Of the remaining $33.00 ($90-$57=$33), Medicare will pay their 80% leaving you with the responsibility of paying your co-insurance, 20% of the $33, which is $6.60, for a total of $63.60 ($57+6.60) for 80% of the doctor’s $90.00 charge, leaving you with only your 20% co-insurance of $18.00 for you to pay out of pocket for visit 3.

High Deductible Plan F will cost me more in deductibles. When is it a good option?

If you are paying deductible and co-insurance how does this benefit you? Lower premiums.

As I write this in March of 2013 I have a major carrier quoting Plan F for a 67 year old female at $140.86 per month. This same carrier offers high deductible F at $51.48. This is a premium savings of $89.38 per month. If you are comfortable with assuming the deductible risk, approximately every 2 years you will have saved the deductible in lower premium.

For an evaluation of your current policies, and to help determine which plan is better for your personal needs, call me, Tom Ostdiek, at 630-834-0125