"G" as I have become a little older (64 years young) is my favorite letter of the alphabet, well other than my 17 year old son a junior in high school maybe getting an "A" once in a while. That would be nice too. A high deductible G plan would be awesome for so many who want that plan, but would like to pay less in premiums. They could use that savings for the drug, dental, vision plans etc. That would help a lot with the affordability and peace of mind also. I still love the low deductible "G" plan the most though. Well except for that birthday present, you know the one where they say congratulations it's your birthday, you get a premium hike, you get a premium hike, you get a premium hike.and you and you and you.
Exactly. If you are okay with the High Deductible, you will be okay with HD G. We see a lot of people who start on HD G and forget about the High Deductible once health issues arise and want to switch. So, as long as someone is comfortable with that deductible not only now, but in the future, they will be happy with it.
The Part B deductible is part of the $2700 in 2023 :) Think of the $2,700 as a max out of pocket and it includes deductibles, copays, coinsurance, etc. Does not include premiums. Great question!
1 - If you are enrolled in a HDG plan in Florida and have used $1900 of the $2700 deductible and move to another state and enroll in another HDG does your $2700 deductible start from $0 or does the previous $1900 get factored in? 2 - If you are enrolled in a HDG plan in Florida and move to a state that does not offer a HDG plan is there an exemption to choose a new plan possibly G without underwriting involved?
1st question - your deductible will carry over with you to the new plan for that calendar year. 2nd question - it depends on the state and insurance company, meaning some will have you switch to their plan and costs if they have a presence in the new state if you move. You keep the same plan, but now pay Colorado rates as an example rather than Florida rates. Some insurance companies don't care. You got your HD G in Florida, you move somewhere else and just keep your same HD G. Supplement plans don't have a network, so from a provider/facility perspective, it is the same regardless of where you live. This would make sense if there isn't a HD G in the state to which you are moving. Moving out of a coverage area qualifies as a special election period event, so you could switch to a different Supplement without medical underwriting if you so choose. So... several different scenarios 🙂 Does that help?
@@Theretirementnerds Thanks for the reply but want to clarify and verify question 2. 1- When traveling to any state in the USA it does not matter where the HDG derives from it is usable nationwide wherever medicare is accepted. Correct? 2 - When not traveling from state to state but actually relocating to another state ("moving out of a coverage area") "is the special election period event" accepted nationwide or does that depend on each state? Will some states require underwriting to switch plans or do all states follow the same rules where no underwriting is required to switch plans during a special election period?
Hello, In community pricing states I assume HD-G (and G) premiums would not rise as fast over the years as non-community pricing states. Would rise only for insurers’ annual cost related increases and not for increasing age based premium increases. Does that sound right? Besides HD-G benefits of lower premiums, not being tied to a network of health care providers (effectively access to ~99% of healthcare providers) under Medigap, and not being subject to the 15% excess charge under HD-G (and G), I have heard of the following two things:
1: Medigap plans have “trial rights” provision. I can start with plans HD-G and D and then if I have doubts on my HD-G (or my health facts change(?)), I can switch to Medicare Advantage during an annual enrollment period (AEP). Then I can switch back to HD-G without an underwriting before the next AEP if I do not like the Advantage plan once I am in it. This switch back and forth can be done once. So this is a way to start with HD-G (or G) and leave some options open. I believe this one time “trial right" applies to all / most Medigap plans. Let me know any comments on this. 2: I have heard that at least one HD-G provider would allow me to switch from HD-G to G w/in the first two years of HD-G w/out underwriting. So that would also leave another option fully open. Do you know which provider(s) allow that? Thanks much.
Yes and no. In many states, there are community rated plans AND non-community rated plans, so the state won't really determine the rate increases as much. In general (not always), community-rated plans start a little higher anyway. Premium increases will mostly be determined by how costly the pool of individuals on that plan will be. If company A has 100 people in their HD Plan G pool, and 3 people get really sick and have super high costs... That company and their rates will increase substantially. If company B has 100,000 people in their HD Plan G pool and 300 people get sick, their rates won't go up as much because of the risk being spread out across a larger pool. So, community rating vs non-community rating doesn't matter as much as that insurance company's pool. I think your comment suggests this, but the community rating premiums will reflect any risk adjustments necessary to try and keep premiums in higher than expenditures out.
I'm curious why someone would choose this plan? 2800/12 = it's like $233 a month + the monthly premium. Am. I right? If you visit a doctor only once a year for any condition or health problem, you have to pay $2800 upfront?
Hi there. For healthy people, it can be a good setup. You have the Part B deductible ($240 this year). After that, when you visit the doctor, you pay 20% of the cost of the Medicare allowed amount. Let's pretend you have a procedure that is $1,000. Medicare covers $800, you would pay $200. That $200 goes to the HD G deductible.
@@Theretirementnerds👋 Won't it be more affordable if someone chooses a plan G or N? At the end of a year beneficiaries will pay less than HD G? Thanks!!
If i have a supplement HDG and i am taken to the hospital and admitted, am i expected to pay the $1500 out of pocket immediately or does Medicare PART A pay 80% of the admission charge leaving me with the remainder to be billed and to pay until i meet the $2700 threshold?
Your HDG starts after Medicare takes care of its portion. Part A isn't the 80/20 coverage, that would be Part B, so for any Part B charges, remember that there is a Part B deductible ($226 in 2023) that you would pay first. Then, Part B will cover 80%. Then, you are responsible for the other 20% until you meet your HD G deductible. Does that help?
The deductible does change. Over time, it has increased. Both for High Deductible G and regular G. Regular G is just the Part B deductible, which historically has gone up. There are years (about one in ten) where the Part B deductible goes down a little. This happened for 2023.
Ca you later change from a high deductible G to a regular G in a way that avoids the pitfalls of an advantage plan? - you know if you get sick or need to start using it a lot.
This will depend on the state you are in. In most states, you would need to go through medical underwriting to switch up from a HD G to a regular G. If you are trying to switch because something has happened, probably not super likely to get approved for that switch.
@@Theretirementnerds What about in California? I'm not quite clear on the "equal or lesser value plan", is HD G to regular G equal, greater, or lesser value.
@@jazzzman1000 High Deductible G is a lesser coverage plan. Lower premiums. Much more cost-sharing with that deductible vs Regular G. So you would go through underwriting if you are on a HD G and wanted to move up to regular G. For most (anyone eligible for Medicare in 2020 or later) G is the highest coverage plan. Hope that helps!
@@Theretirementnerds Both plans have the same "coverage", no? I'm still a bit clear on the definition of the word "lesser value", so it comes down to the cost sharing? The max out of pocket for a HDG is $2700 + the premium which is potentially almost double the regular G premium in my area. Is that what makes regular G more "valuable"? It this actually written somewhere on the official Medicare site? Thank you!
I am going on 64 yrs and leaning towards the G HD I am going to move and buy a house in the near future (so I don't have a zip code to check availability of this plan) and I would hate to buy a house where I can't get this coverage. Does the availability of this plan pertain to location of hospitals of city size? Or is it random? Thank you for your time.
Varies by state. If you know what state you'll be living in, we can take a look. Feel free to email me at erik@90daysfromretirement.com with your state and we can see.
Do you pay your Plan B deductible or does that roll into the $2700? Also if you have a High Deductible plan F would that plan B deductible be covered initially? Thanks.
It's a nuanced answer that comes down to billing. The short answer is that the Part B Deductible rolls into that $2,700 amount for HD G. HD Plan F covers the Part B deductible. People can only get HD Plan F if they were eligible for Medicare before January 1, 2020, so Plan F (HD or regular) is not available to everyone. Thank you for watching!
Thank you. I’m 71 and just starting medicare and HD Plan F is available for me at basically the same price as HD plan G. Always wondered what the difference was. Sounds like F is the way to go.
@Lloyd Ericson in your case, it sounds solid! I'd still sit down with an agent who knows your area and discuss with him or her. Won't cost you anything. You can even tell them you'd like a HD F and they can help with which insurance companies are easiest to work with.
@@Theretirementnerds Just to make sure that I understand, the maximum out of pocket in 2023 for medical expenses under either a HD F or a HD G would be $2700 (i.e., not $2926 for the HD G). Correct? I am 74 years old and currently have a $0 Premium Medicare Advantage Plan with a MOOP of $5500. I am considering switching to a Supplemental Plan so that I don't have to worry about networks and pre-authorizations. I live in New York State which is Community Rated and I understand that I can switch to a Supplemental Plan without medical underwriting.. Currently, the premium in my area for Plan G is approximately $260/month and for HD G is approximately $60/month. If I decide to switch to a Supplemental Plan, it appears that in my case, HD G makes better financial sense than Plan G given the big difference in premiums between the two plans. Any comments? Thanks and thanks for your very informative videos.
@Clark Price thank you for watching. If you send me an email to erik@90daysfromretirement.com I can connect you with our partner in NY that is more familiar with the NY plans and enrollment period details.
The billing by providers and facilities to the insurance company and the payout by the insurance company to those providers and facilities doing the billing may not be done in an orderly timeframe to track the $2700 deductible. Example is a patient has fullfilled the $2700 deductible by March 1st including a $1450 bill for services on March 1st. However that $1450 billed by provider to the insurance company for March 1st services is not paid by the insurance company to the provider until August 2nd due to delays caused by corrections to billing errors. Is that $1450 not factored into the $2700 deductible until August 2nd because it was not processed and paid quickly? If that is the case where the $1450 is not factored into the $2700 deductible then does the patient that had already paid out of pocket for their $2700 deductible by March 1st now has an extra $1450 to pay out of pocket until the insurance company pays out that $1450 to the provider? Is this correct or does medicare use the non-processed and not paid amount of $1450 billed on March 1st and factor that into the deductible on March 1st or is August 2nd the actual day that the deductible of $2700 has been met because that is when the payment of $1450 was made to the provider/facility?
The patient should always wait to pay their deductible until they receive their Medicare Summary Notice (MSN). This is the Medicare-equivalent to an EOB. It'll have all of the billed charges, adjustments, and the patient responsibility in the form of the deductible in this case. Medicare should have that $1450 in the example you have squared away and will send you the Medicare Summary Notice that will have that $1450 applied to your deductible. Maybe I'm not understanding the question correctly, but deductible payments go to your providers/facilities and timing of such is based on Medicare timing, not the insurance company when talking about Supplements. We have some clients who go in and immediately pay their office deductible before receiving the Medicare Summary Notice and that payment can be incorrectly allocated. Always wait for the Medicare Summary Notice before making payments, and then when you do receive that notice, make the payments :)
@@Theretirementnerds Asking these questions to financially plan out any additional amounts needed in excess of the $2700 deductible in a HDG. If providers/labs/facilities can not sync with the Medical Summary Notices may be a better option to go with a standard plan G and pay the extra premiums over a monthly time frame rather than get slammed with extra bills that can only get reimbursed later by the providers/labs/facilities after they sync. The overall advantage of a HDG is lower payments and possible lower annual costs if the $2700 deductible is not reached after syncing . Paying the office deductible before receiving the Medicare Summary Notice is sometimes non avoidable when the individual/client is bounced around between specialists, lab work and tests all within a few days of service of each. Are the medical summary notices available online and do the providers, labs, facilities have access to a Medical Summary Notice database so they can sync?
@@thiagosantiro2327 this is the huge problem with HDG, you have to become a CPA to keep up with all of these inaccurate bills and then collect the overpayments from the providers, it can be a night mare. Providers don't code properly and sometimes don't bill for weeks.
@@kathylawrence6855 I am not personally. But I have partners who are. I can make the introduction if you'd like. If you would like me to, send me an email at erik@90daysfromretirement.com and I'll connect you to them. Thank you!
"G" as I have become a little older (64 years young) is my favorite letter of the alphabet, well other than my 17 year old son a junior in high school maybe getting an "A" once in a while. That would be nice too. A high deductible G plan would be awesome for so many who want that plan, but would like to pay less in premiums. They could use that savings for the drug, dental, vision plans etc. That would help a lot with the affordability and peace of mind also. I still love the low deductible "G" plan the most though. Well except for that birthday present, you know the one where they say congratulations it's your birthday, you get a premium hike, you get a premium hike, you get a premium hike.and you and you and you.
Exactly. If you are okay with the High Deductible, you will be okay with HD G. We see a lot of people who start on HD G and forget about the High Deductible once health issues arise and want to switch. So, as long as someone is comfortable with that deductible not only now, but in the future, they will be happy with it.
Is the $226 Part B deductible credited toward the $2700, or is it in addition to it? Some say yes, some say no!
The Part B deductible is part of the $2700 in 2023 :)
Think of the $2,700 as a max out of pocket and it includes deductibles, copays, coinsurance, etc.
Does not include premiums.
Great question!
You failed to mention that the deductible goes up with inflation. $2700 today, was $2300 just a while ago.
1 - If you are enrolled in a HDG plan in Florida and have used $1900 of the $2700 deductible and move to another state and enroll in another HDG does your $2700 deductible start from $0 or does the previous $1900 get factored in? 2 - If you are enrolled in a HDG plan in Florida and move to a state that does not offer a HDG plan is there an exemption to choose a new plan possibly G without underwriting involved?
1st question - your deductible will carry over with you to the new plan for that calendar year.
2nd question - it depends on the state and insurance company, meaning some will have you switch to their plan and costs if they have a presence in the new state if you move. You keep the same plan, but now pay Colorado rates as an example rather than Florida rates.
Some insurance companies don't care. You got your HD G in Florida, you move somewhere else and just keep your same HD G. Supplement plans don't have a network, so from a provider/facility perspective, it is the same regardless of where you live. This would make sense if there isn't a HD G in the state to which you are moving.
Moving out of a coverage area qualifies as a special election period event, so you could switch to a different Supplement without medical underwriting if you so choose.
So... several different scenarios 🙂
Does that help?
@@Theretirementnerds Thanks for the reply but want to clarify and verify question 2.
1- When traveling to any state in the USA it does not matter where the HDG derives from it is usable nationwide wherever medicare is accepted. Correct?
2 - When not traveling from state to state but actually relocating to another state ("moving out of a coverage area") "is the special election period event" accepted nationwide or does that depend on each state? Will some states require underwriting to switch plans or do all states follow the same rules where no underwriting is required to switch plans during a special election period?
Hello,
In community pricing states I assume HD-G (and G) premiums would not rise as fast over the years as non-community pricing states. Would rise only for insurers’ annual cost related increases and not for increasing age based premium increases. Does that sound right?
Besides HD-G benefits of lower premiums, not being tied to a network of health care providers (effectively access to ~99% of healthcare providers) under Medigap, and not being subject to the 15% excess charge under HD-G (and G), I have heard of the following two things:
1: Medigap plans have “trial rights” provision.
I can start with plans HD-G and D and then if I have doubts on my HD-G (or my health facts change(?)), I can switch to Medicare Advantage during an annual enrollment period (AEP).
Then I can switch back to HD-G without an underwriting before the next AEP if I do not like the Advantage plan once I am in it. This switch back and forth can be done once.
So this is a way to start with HD-G (or G) and leave some options open. I believe this one time “trial right" applies to all / most Medigap plans.
Let me know any comments on this.
2: I have heard that at least one HD-G provider would allow me to switch from HD-G to G w/in the first two years of HD-G w/out underwriting.
So that would also leave another option fully open.
Do you know which provider(s) allow that?
Thanks much.
Yes and no. In many states, there are community rated plans AND non-community rated plans, so the state won't really determine the rate increases as much.
In general (not always), community-rated plans start a little higher anyway.
Premium increases will mostly be determined by how costly the pool of individuals on that plan will be.
If company A has 100 people in their HD Plan G pool, and 3 people get really sick and have super high costs... That company and their rates will increase substantially.
If company B has 100,000 people in their HD Plan G pool and 300 people get sick, their rates won't go up as much because of the risk being spread out across a larger pool.
So, community rating vs non-community rating doesn't matter as much as that insurance company's pool. I think your comment suggests this, but the community rating premiums will reflect any risk adjustments necessary to try and keep premiums in higher than expenditures out.
Outstanding content! Thanks for your time creating it!
Thank you David!
I tell ya listening to all this is enough to make you sick.
I'm curious why someone would choose this plan? 2800/12 = it's like $233 a month + the monthly premium. Am. I right?
If you visit a doctor only once a year for any condition or health problem, you have to pay $2800 upfront?
Hi there. For healthy people, it can be a good setup.
You have the Part B deductible ($240 this year). After that, when you visit the doctor, you pay 20% of the cost of the Medicare allowed amount.
Let's pretend you have a procedure that is $1,000. Medicare covers $800, you would pay $200. That $200 goes to the HD G deductible.
@@Theretirementnerds👋 Won't it be more affordable if someone chooses a plan G or N? At the end of a year beneficiaries will pay less than HD G?
Thanks!!
thank you
If i have a supplement HDG and i am taken to the hospital and admitted, am i expected to pay the $1500 out of pocket immediately or does Medicare PART A pay 80% of the admission charge leaving me with the remainder to be billed and to pay until i meet the $2700 threshold?
Your HDG starts after Medicare takes care of its portion.
Part A isn't the 80/20 coverage, that would be Part B, so for any Part B charges, remember that there is a Part B deductible ($226 in 2023) that you would pay first. Then, Part B will cover 80%. Then, you are responsible for the other 20% until you meet your HD G deductible.
Does that help?
Will the deductible also rise over time like the premium will? Or is that always going to be the $2700?
The deductible does change. Over time, it has increased. Both for High Deductible G and regular G.
Regular G is just the Part B deductible, which historically has gone up. There are years (about one in ten) where the Part B deductible goes down a little. This happened for 2023.
Ca you later change from a high deductible G to a regular G in a way that avoids the pitfalls of an advantage plan? - you know if you get sick or need to start using it a lot.
This will depend on the state you are in. In most states, you would need to go through medical underwriting to switch up from a HD G to a regular G.
If you are trying to switch because something has happened, probably not super likely to get approved for that switch.
@@Theretirementnerds What about in California? I'm not quite clear on the "equal or lesser value plan", is HD G to regular G equal, greater, or lesser value.
@@jazzzman1000 High Deductible G is a lesser coverage plan. Lower premiums. Much more cost-sharing with that deductible vs Regular G.
So you would go through underwriting if you are on a HD G and wanted to move up to regular G.
For most (anyone eligible for Medicare in 2020 or later) G is the highest coverage plan.
Hope that helps!
@@Theretirementnerds Both plans have the same "coverage", no? I'm still a bit clear on the definition of the word "lesser value", so it comes down to the cost sharing? The max out of pocket for a HDG is $2700 + the premium which is potentially almost double the regular G premium in my area. Is that what makes regular G more "valuable"? It this actually written somewhere on the official Medicare site? Thank you!
I am going on 64 yrs and leaning towards the G HD
I am going to move and buy a house in the near future (so I don't have a zip code to check availability of this plan) and I would hate to buy a house where I can't get this coverage. Does the availability of this plan pertain to location of hospitals of city size? Or is it random?
Thank you for your time.
Varies by state. If you know what state you'll be living in, we can take a look.
Feel free to email me at erik@90daysfromretirement.com with your state and we can see.
Another great video. Thanks
Thank you Walter!
Do you pay your Plan B deductible or does that roll into the $2700? Also if you have a High Deductible plan F would that plan B deductible be covered initially? Thanks.
It's a nuanced answer that comes down to billing. The short answer is that the Part B Deductible rolls into that $2,700 amount for HD G.
HD Plan F covers the Part B deductible.
People can only get HD Plan F if they were eligible for Medicare before January 1, 2020, so Plan F (HD or regular) is not available to everyone.
Thank you for watching!
Thank you. I’m 71 and just starting medicare and HD Plan F is available for me at basically the same price as HD plan G. Always wondered what the difference was. Sounds like F is the way to go.
@Lloyd Ericson in your case, it sounds solid! I'd still sit down with an agent who knows your area and discuss with him or her. Won't cost you anything. You can even tell them you'd like a HD F and they can help with which insurance companies are easiest to work with.
@@Theretirementnerds Just to make sure that I understand, the maximum out of pocket in 2023 for medical expenses under either a HD F or a HD G would be $2700 (i.e., not $2926 for the HD G). Correct? I am 74 years old and currently have a $0 Premium Medicare Advantage Plan with a MOOP of $5500. I am considering switching to a Supplemental Plan so that I don't have to worry about networks and pre-authorizations. I live in New York State which is Community Rated and I understand that I can switch to a Supplemental Plan without medical underwriting.. Currently, the premium in my area for Plan G is approximately $260/month and for HD G is approximately $60/month. If I decide to switch to a Supplemental Plan, it appears that in my case, HD G makes better financial sense than Plan G given the big difference in premiums between the two plans. Any comments? Thanks and thanks for your very informative videos.
@Clark Price thank you for watching. If you send me an email to erik@90daysfromretirement.com I can connect you with our partner in NY that is more familiar with the NY plans and enrollment period details.
The billing by providers and facilities to the insurance company and the payout by the insurance company to those providers and facilities doing the billing may not be done in an orderly timeframe to track the $2700 deductible. Example is a patient has fullfilled the $2700 deductible by March 1st including a $1450 bill for services on March 1st. However that $1450 billed by provider to the insurance company for March 1st services is not paid by the insurance company to the provider until August 2nd due to delays caused by corrections to billing errors. Is that $1450 not factored into the $2700 deductible until August 2nd because it was not processed and paid quickly? If that is the case where the $1450 is not factored into the $2700 deductible then does the patient that had already paid out of pocket for their $2700 deductible by March 1st now has an extra $1450 to pay out of pocket until the insurance company pays out that $1450 to the provider? Is this correct or does medicare use the non-processed and not paid amount of $1450 billed on March 1st and factor that into the deductible on March 1st or is August 2nd the actual day that the deductible of $2700 has been met because that is when the payment of $1450 was made to the provider/facility?
The patient should always wait to pay their deductible until they receive their Medicare Summary Notice (MSN). This is the Medicare-equivalent to an EOB. It'll have all of the billed charges, adjustments, and the patient responsibility in the form of the deductible in this case.
Medicare should have that $1450 in the example you have squared away and will send you the Medicare Summary Notice that will have that $1450 applied to your deductible.
Maybe I'm not understanding the question correctly, but deductible payments go to your providers/facilities and timing of such is based on Medicare timing, not the insurance company when talking about Supplements.
We have some clients who go in and immediately pay their office deductible before receiving the Medicare Summary Notice and that payment can be incorrectly allocated. Always wait for the Medicare Summary Notice before making payments, and then when you do receive that notice, make the payments :)
@@Theretirementnerds Asking these questions to financially plan out any additional amounts needed in excess of the $2700 deductible in a HDG. If providers/labs/facilities can not sync with the Medical Summary Notices may be a better option to go with a standard plan G and pay the extra premiums over a monthly time frame rather than get slammed with extra bills that can only get reimbursed later by the providers/labs/facilities after they sync. The overall advantage of a HDG is lower payments and possible lower annual costs if the $2700 deductible is not reached after syncing . Paying the office deductible before receiving the Medicare Summary Notice is sometimes non avoidable when the individual/client is bounced around between specialists, lab work and tests all within a few days of service of each. Are the medical summary notices available online and do the providers, labs, facilities have access to a Medical Summary Notice database so they can sync?
@@thiagosantiro2327 this is the huge problem with HDG, you have to become a CPA to keep up with all of these inaccurate bills and then collect the overpayments from the providers, it can be a night mare. Providers don't code properly and sometimes don't bill for weeks.
👍💯💕
Thanks for the content as always. Looks like you did not shave today. 😢
Thank you so much!
Correct, I did not shave that day :) Not a fan of razors.
@@Theretirementnerds Me either. It is a dreaded grooming hassle.
Great video!
Thank you Kathy!
Are you licensed in SC?
@@kathylawrence6855 I am not personally. But I have partners who are. I can make the introduction if you'd like.
If you would like me to, send me an email at erik@90daysfromretirement.com and I'll connect you to them.
Thank you!