Medicare Question - did you ever hit the limit?

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kd2008
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Medicare Question - did you ever hit the limit?

Post by kd2008 »

I am trying to understand/ gauge the deductible and out of pocket max limits being hit under various flavors of Medicare. This will help me understand what plan might work for my husband when he turns 65.

A. If you have Plan G, did you ever hit the part B deductible of $203? If so, at what age for the first time?

B. If you have Plan G HD, did you ever hit the plan deductible of $2370? If so, at what age for the first time?

C. If you have MAPD, did you ever hit the plan out of pocket max? If so, at what age for the first time?

D. If you have MSA Medicare Advantage plan, did you ever exhaust the money deposited in MSA? If so at what age?

E. Does anyone have Innovative G by Physicians Mutual? Did you ever hit the plan deductible of $2370 in the first three years? It changes to regular plan G after that.

F. Any other flavors of Medicare for which you hit the limit and when?

Thank you.
montanagirl
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Re: Medicare Question - did you ever hit the limit?

Post by montanagirl »

I usually hit the plan G deductible every year for one thing or another. I'm 72 and I think it wouldn't have happened as often on my 60s except for knee replacement at 69.

Without surgeries I wouldn't have gotten anywhere close to the HD deductible.
Shallowpockets
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Re: Medicare Question - did you ever hit the limit?

Post by Shallowpockets »

If the limit is within my bounds of paying it if I had to, all else is fine. You mention the $2370 for plan G HD. To me that is very acceptable. I could pay that easily if necessary. So I don’t parse it any further.
I would think that many, or most BHs would be able to fork up $2370 over the course of a year and probably if it occurred in one lump sum.
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kd2008
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Re: Medicare Question - did you ever hit the limit?

Post by kd2008 »

montanagirl wrote: Thu Aug 26, 2021 4:36 am I usually hit the plan G deductible every year for one thing or another. I'm 72 and I think it wouldn't have happened as often on my 60s except for knee replacement at 69.

Without surgeries I wouldn't have gotten anywhere close to the HD deductible.
Thank you for sharing this info.
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kd2008
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Re: Medicare Question - did you ever hit the limit?

Post by kd2008 »

Shallowpockets wrote: Thu Aug 26, 2021 7:13 am If the limit is within my bounds of paying it if I had to, all else is fine. You mention the $2370 for plan G HD. To me that is very acceptable. I could pay that easily if necessary. So I don’t parse it any further.
I would think that many, or most BHs would be able to fork up $2370 over the course of a year and probably if it occurred in one lump sum.
My question isn't about affordability.

It is about trying to understand using up of deductibles as one ages. When does it typically first happens, if it happens at all.
Nowizard
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Re: Medicare Question - did you ever hit the limit?

Post by Nowizard »

We have basic Medicare and Part D along with a supplement partially subsidized from a former employer. We have never hit the maximum for anything in the past 15 years. That fact is meaningless, however. The maximums are actuarily established, so the key is personal history and estimates of how it affects use of insurance.

Tim
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ResearchMed
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Re: Medicare Question - did you ever hit the limit?

Post by ResearchMed »

Nowizard wrote: Thu Aug 26, 2021 7:42 am We have basic Medicare and Part D along with a supplement partially subsidized from a former employer. We have never hit the maximum for anything in the past 15 years. That fact is meaningless, however. The maximums are actuarily established, so the key is personal history and estimates of how it affects use of insurance.

Tim
This ^

It's different for different people, and also often different for the *same* person year to year.
One year could be with minimal use of any medical care, and the next, some surgery and the co-pays and deductible disappear fast.
That might not happen again to that person (or one of a couple) for some time, or even never. Or maybe there are several more such years, including with expensive diagnostics.

We are older but not yet on Medicare, and DH prefers to keep working well beyond any "regular" retirement age.
But the issue of deductibles still comes up.
He rarely uses his up, but I almost always do.

And as soon as I hit that full deductible, or it becomes obvious it will, I start trying to get some extra meds, any pending labwork, etc., in case the next year is "under" the deductible. We have excellent coverage, so fortunately most of Rx cost is already covered.

But what others experience medically can vary so much - as it does per person year to year.
Some have chronic conditions such that deductibles might be hit most/all years, but that's not generalizable to others.
And age? My most expensive medical/surgical years were well before Medicare age.

Do you have a question that could more easily be answered so that it helps *you*?
Perhaps about which Medicare add-ons are most useful if someone has high medical costs, for example?
Or?

RM
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scifilover
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Re: Medicare Question - did you ever hit the limit?

Post by scifilover »

When younger, you have fewer issues, and thus fewer visits to see medicos. By the end of age 60's, many folks have more than an annual wellness dr. visit. My first annual extra was screening for skin cancer....then something funny on a visit to the optician for a new set of glasses meant seeing an ophthalmologist each year for cataract evaluation. With just these three things you meet the $203 deductible.....Other things can come up as well, but once you hit the $203 with G, ........Since hitting 65 we have only had F and more recently G. So we don't deal with maximums.
Shallowpockets
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Re: Medicare Question - did you ever hit the limit?

Post by Shallowpockets »

kd2008 wrote: Thu Aug 26, 2021 7:35 am
Shallowpockets wrote: Thu Aug 26, 2021 7:13 am If the limit is within my bounds of paying it if I had to, all else is fine. You mention the $2370 for plan G HD. To me that is very acceptable. I could pay that easily if necessary. So I don’t parse it any further.
I would think that many, or most BHs would be able to fork up $2370 over the course of a year and probably if it occurred in one lump sum.
My question isn't about affordability.

It is about trying to understand using up of deductibles as one ages. When does it typically first happens, if it happens at all.
Why are you worried about when you hit the limit? Depends entirely on a persons health and their utilization of medical care. One would think that the probability of using up that limit would increase year over year.
I don’t think there is a typical scenario, other than the surety of aging that is accompanied by increased use of medical care, even if only for preventative purposes.
I concur with an above post that once you reach the limit, you might want to maximize your medical care use for that year.
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kd2008
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Re: Medicare Question - did you ever hit the limit?

Post by kd2008 »

All good insights and perspectives.

A bit of background - While the deductibles are usually set by standardized plans, the premiums are set by medical loss ratio and state insurance approvals. There are myriad combinations of premiums, deductibles, coverages possible. Add in HSA funds that you may have saved or retirement benefit from a former employer. The combination that works in an actuarial sense for say "my husband" is not how the plan offerings were designed. One of the key information that state regulators do not ask and is probably not tracked/published is progression of uptake of deductible as a person ages in actuarial sense. On the consumer side we only see the increased pricing in certain instances for attained age in medigap offerings.

To me at least, it is fascinating to see seniors choosing, clustering around just a few plans - one is plan G, and other is one of the regional MAPD with a lot of ancillary benefits.

One has to wonder if the plan and the senior person are appropriately matched ever.
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midareff
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Re: Medicare Question - did you ever hit the limit?

Post by midareff »

I'm 74 on Plan F, fortunately. Without it I would hit whatever plan limits were in place easily through degenerative arthritis orthopedic surgeries, cancer treatments and a variety of other issues including treatment for wet macular degeneration. Still vertical, over top soil and see good walking 4 miles a day....and that is the purpose of medical treatments and insurance. Being to get what you need without cost concerns. I'd like to reach out and thank all you healthy folks for picking up part of the tab too.
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Re: Medicare Question - did you ever hit the limit?

Post by pshonore »

When I was on traditional Medicare (Plan G) , I hit the deductible every year. A single doctor's visit usually comes close to covering it. Now on Medicare Advantage, I have no deductible but a $10 copay for every visit.
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celia
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Re: Medicare Question - did you ever hit the limit?

Post by celia »

We hit the $203 deductible (which increases each year) with the first two visits each year. When you see several doctors, it can be annoying to figure out which service provider gets the deductible each year as Medicare assigns the deductible to the first claims they process each year rather than who you saw first that year. (Some doctors won’t submit bills early in the year until later since they don’t want to struggle getting deductibles from the patients. They let other service providers bill first.)

Since it’s easier to get through to the supplemental plan than to Medicare, we end up calling the supplemental plan each year to see who gets the deductible. (The Medicare Explanation of Benefits doesn’t come for a few months.)

One way to simplify is to have a known expensive test you need done in early January each year and not see anyone for a few months. Then you would pay the whole deductible to one provider.
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kd2008
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Re: Medicare Question - did you ever hit the limit?

Post by kd2008 »

pshonore wrote: Thu Aug 26, 2021 9:35 am When I was on traditional Medicare (Plan G) , I hit the deductible every year. A single doctor's visit usually comes close to covering it. Now on Medicare Advantage, I have no deductible but a $10 copay for every visit.
Thank you for sharing that valuable data point. I have lots of questions for you.

If I may ask, could you please share at what age did you shift to Medicare Advantage and why? Have you ever hit the out of pocket maximum with the advantage plan? Are your total costs(total of all premiums , copays, deductibles) less on Medicare Advantage plan? What kind of network coverage on the advantage plan made you feel ok about giving up National access on traditional Medicare?
Last edited by kd2008 on Thu Aug 26, 2021 9:50 am, edited 1 time in total.
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kd2008
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Re: Medicare Question - did you ever hit the limit?

Post by kd2008 »

celia wrote: Thu Aug 26, 2021 9:39 am We hit the $203 deductible (which increases each year) with the first two visits each year. When you see several doctors, it can be annoying to figure out which service provider gets the deductible each year as Medicare assigns the deductible to the first claims they process each year rather than who you saw first that year. (Some doctors won’t submit bills early in the year until later since they don’t want to struggle getting deductibles from the patients. They let other service providers bill first.)

Since it’s easier to get through to the supplemental plan than to Medicare, we end up calling the supplemental plan each year to see who gets the deductible. (The Medicare Explanation of Benefits doesn’t come for a few months.)

One way to simplify is to have a known expensive test you need done in early January each year and not see anyone for a few months. Then you would pay the whole deductible to one provider.
Thank you for the very valuable insight. I highly appreciate it.
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celia
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Re: Medicare Question - did you ever hit the limit?

Post by celia »

kd2008 wrote: Thu Aug 26, 2021 8:38 am To me at least, it is fascinating to see seniors choosing, clustering around just a few plans - one is plan G, and other is one of the regional MAPD with a lot of ancillary benefits.

One has to wonder if the plan and the senior person are appropriately matched ever.
It is not just about money. It is also about what insurances the providers accept. When we turned 65, we had to change two doctors for new ones since they didn’t ‘accept Medicare assignment’. OP, you and your spouse should call all your current providers first to confirm if they ‘accept Medicare assignment’ (the reasonable cost Medicare assigns to each service in your area). Also ask whenever you go to a new doctor for the first time after that.
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Re: Medicare Question - did you ever hit the limit?

Post by kd2008 »

celia wrote: Thu Aug 26, 2021 9:52 am It is not just about money. It is also about what insurances the providers accept. When we turned 65, we had to change two doctors for new ones since they didn’t ‘accept Medicare assignment’. OP, you and your spouse should call all your current providers first to confirm if they ‘accept Medicare assignment’ (the reasonable cost Medicare assigns to each service in your area). Also ask whenever you go to a new doctor for the first time after that.
Thank you for that valuable tip.
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Re: Medicare Question - did you ever hit the limit?

Post by celia »

kd2008 wrote: Thu Aug 26, 2021 9:48 am
pshonore wrote: Thu Aug 26, 2021 9:35 am When I was on traditional Medicare (Plan G) , I hit the deductible every year. A single doctor's visit usually comes close to covering it. Now on Medicare Advantage, I have no deductible but a $10 copay for every visit.
Thank you for sharing that valuable data point. I have lots of questions for you.

If I may ask, could you please share at what age did you shift to Medicare Advantage and why? Have you ever hit the out of pocket maximum with the advantage plan? Are your total costs(total of all premiums , copays, deductibles) less on Medicare Advantage plan? What kind of network coverage on the advantage plan made you feel ok about giving up National access on traditional Medicare?
The Supplemental plans (aka Medigap) are PPO plans where you can go to any doctor within the US who accepts Medicare assignment (I estimate 90% accept it). This is great if you travel. If you travel internationally, Plan G supplementals will cover a limited amount of foreign medical expenses that were urgently needed. (We’re thinking about writing a book about emergency rooms around the world. JK :) There’s a great urgent care site for visitors in St Mark’s Square in Venice, Italy.)

The Medicare Advantage plans are more like HMOs where you need to use a small group of doctors or get referrals. That doesn’t work if you need to see outside specialists who refer you to more-specialized specialists. We’ve found that some outside specialists won’t see you unless you have a Supplemental Plan since the HMO plan doesn’t pay them enough.

If you’re generally healthy or can’t afford a supplemental care plan, the Medicare Advantage plans can work for you. But you might have to wait longer for an appointment since there are lots of patients in the system. This is also location specific.
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Re: Medicare Question - did you ever hit the limit?

Post by DetroitRick »

Just started Medicare this February, so take this with a grain of salt. But...

Part B Deductible ($203), met this in March with one office visit (not including the annual no-deductible wellness exams or that initial welcome exam). Generally 1-2 office visits yearly would make me hit it every year.

I've got a supplement G policy. Also seriously considered both G-HD and N too. After lots of analysis, I concluded I would come out similar with any of the 3 over time. Within certain insurers, I found my preference stronger for particular choices among the 3, but in general terms not so much. For example, there weren't all that many G-HD offerings when I signed up last December. That will change, is changing. N vs. G spreads were all over the place among insurers here. Some under $10 in monthly premium, some over $30 difference, so the value proposition differed between insurers.

My reason for clustering my choice among the 3 medigaps simply lied with the size of the risk pools for each. A couple other alternatives were dismissed because the pools were too small for my taste (making future premium changes even harder to predict than normal).

My most likely scenario for hitting the G-HD deductible would be a short hospital visit ($1,484) followed by follow-up doctor visits, and some physical therapy. Naturally there are 100's of other scenarios, but that is the most likely one for me. I wouldn't expect Part B alone to add up to that much otherwise (but not impossible). Again, I'm comfortable that G, or G-HD or N would work out fine for me. The tough part is predicting medical needs as we age, but everyone thinks they can.

Medicare Advantage plans are generally fine too. Most of my friends (mid 60's to early 80's) have opted for them and none have hit their out-of-pocket maxes yet. Anything is possible of course. Networks in my area are very good and are likely to remain so for competitive reasons.

For Part D prescription coverage, I have the max $445 deductible and a fairly low ($23/mo) premium. I hit that deductible early in the year due to the cost of one single generic medication (some generics can be expensive) with a 90 day supply. Overall, I've found my total Part D expense to be slightly cheaper than recent prescription costs pre-Medicare (considering premium+deductible+copays/coinsurance). And cheaper than GoodRx. This was true for my meager list of medications, but obviously varies by what you do take or might take in the future. The devil here is clearly in the details - but it's a less critical decision since it can easily be changed every year during open enrollment.
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Re: Medicare Question - did you ever hit the limit?

Post by Winnie »

My spouse just started Medicare in February so not enough “use” experience. We have Physicians Mutual innovative G HD. Spouse has meet the $203 part b deductible and so far very little out of pocket. Spouse had non typical doctor usage in May which also included PT. We are still comfortable we made the right choice in coverage and company.
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kd2008
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Re: Medicare Question - did you ever hit the limit?

Post by kd2008 »

Winnie wrote: Thu Aug 26, 2021 1:15 pm My spouse just started Medicare in February so not enough “use” experience. We have Physicians Mutual innovative G HD. Spouse has meet the $203 part b deductible and so far very little out of pocket. Spouse had non typical doctor usage in May which also included PT. We are still comfortable we made the right choice in coverage and company.
Thank you for sharing your data point. Very helpful.
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kd2008
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Re: Medicare Question - did you ever hit the limit?

Post by kd2008 »

DetroitRick wrote: Thu Aug 26, 2021 12:57 pm Just started Medicare this February, so take this with a grain of salt. But...

Part B Deductible ($203), met this in March with one office visit (not including the annual no-deductible wellness exams or that initial welcome exam). Generally 1-2 office visits yearly would make me hit it every year.

I've got a supplement G policy. Also seriously considered both G-HD and N too. After lots of analysis, I concluded I would come out similar with any of the 3 over time. Within certain insurers, I found my preference stronger for particular choices among the 3, but in general terms not so much. For example, there weren't all that many G-HD offerings when I signed up last December. That will change, is changing. N vs. G spreads were all over the place among insurers here. Some under $10 in monthly premium, some over $30 difference, so the value proposition differed between insurers.

My reason for clustering my choice among the 3 medigaps simply lied with the size of the risk pools for each. A couple other alternatives were dismissed because the pools were too small for my taste (making future premium changes even harder to predict than normal).

My most likely scenario for hitting the G-HD deductible would be a short hospital visit ($1,484) followed by follow-up doctor visits, and some physical therapy. Naturally there are 100's of other scenarios, but that is the most likely one for me. I wouldn't expect Part B alone to add up to that much otherwise (but not impossible). Again, I'm comfortable that G, or G-HD or N would work out fine for me. The tough part is predicting medical needs as we age, but everyone thinks they can.

Medicare Advantage plans are generally fine too. Most of my friends (mid 60's to early 80's) have opted for them and none have hit their out-of-pocket maxes yet. Anything is possible of course. Networks in my area are very good and are likely to remain so for competitive reasons.

For Part D prescription coverage, I have the max $445 deductible and a fairly low ($23/mo) premium. I hit that deductible early in the year due to the cost of one single generic medication (some generics can be expensive) with a 90 day supply. Overall, I've found my total Part D expense to be slightly cheaper than recent prescription costs pre-Medicare (considering premium+deductible+copays/coinsurance). And cheaper than GoodRx. This was true for my meager list of medications, but obviously varies by what you do take or might take in the future. The devil here is clearly in the details - but it's a less critical decision since it can easily be changed every year during open enrollment.
Thank you for sharing your thought process. Helpful indeed.
Last edited by kd2008 on Thu Aug 26, 2021 11:05 pm, edited 1 time in total.
bradinsky
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Re: Medicare Question - did you ever hit the limit?

Post by bradinsky »

DW & I are both 68, retired & on Medicare. We both have supplemental G plans & also part D prescriptions. We hit our deductible early on each year because of bi-annual doctors visits. We owned & operated a manufacturing business for 40 years & I will say that our Medicare & supplemental insurance provide the best coverage we have ever had, at the absolute lowest price. For us, we both have a couple of medical issues & that makes the Advantage plans a poor choice. If you peruse Medicare.gov, there is a wealth of information about part C & D plans. When you get to the point you’re ready to sign up, it can almost be overwhelming, but in actuality it’s not. Also, some insurers with offer you a household discount it both husband & wife sign with them.
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Re: Medicare Question - did you ever hit the limit?

Post by Chuckles960 »

celia wrote: Thu Aug 26, 2021 9:39 am We hit the $203 deductible (which increases each year) with the first two visits each year. When you see several doctors, it can be annoying to figure out which service provider gets the deductible each year...
I don't have Medicare yet so this is confusing to me. Why do you need to figure out who "gets the deductible"? Won't the practice send you a bill if they were not reimbursed for the full amount?

Do you have to deal with Medicare and also the Plan G insurance company? Is it not the case that you flash your Plan G card at the doctor's office and they give you a relieved smile and it all gets taken care of?
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Re: Medicare Question - did you ever hit the limit?

Post by Chuckles960 »

midareff wrote: Thu Aug 26, 2021 8:49 amI'm 74 on Plan F, fortunately...
Except for the $203 deductible,Plan F and Plan G are identical. Yet, as has been noted previously here, Plan F costs way more than $203 extra per year compared to Plan G. (For the insurance companies I priced in my area, about $40/month more which is about $480/year more. So that would be about $275/year down the drain.)
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celia
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Re: Medicare Question - did you ever hit the limit?

Post by celia »

Chuckles960 wrote: Fri Aug 27, 2021 1:02 am
celia wrote: Thu Aug 26, 2021 9:39 am We hit the $203 deductible (which increases each year) with the first two visits each year. When you see several doctors, it can be annoying to figure out which service provider gets the deductible each year...
I don't have Medicare yet so this is confusing to me. Why do you need to figure out who "gets the deductible"? Won't the practice send you a bill if they were not reimbursed for the full amount?
1. Some doctors have incompetent billing offices or use an out-of-state billing service. When they use the wrong procedure code, the claim is denied because the service supposedly provided doesn't go with the diagnosis, so then they have to fix the claim and resubmit it. Sometimes it is a "correction" to an earlier claim, or a claim is submitted multiple times. Anytime they don't get the payment they think they should get, they will bill you. Then you get to figure out what went wrong and explain it to them. Eventually, you become friends with the patient ombudsman, if they have one. :) Some of them have magical powers that make bills disappear.

2. Some doctors offices will adjust the bill after they see the Medicare approved price and the amount they received from Medicare, then bill you for the remainder without waiting for the Supplemental Insurance to pay. Medicare already knows who your supplemental plan is with (since you chose it on their website), so they (usually) automatically forward the balance to the supplemental plan. If the bill is for 1/4 the amount Medicare paid, you can ignore these as they will fix themselves up. (Medicare pays 80%, Supplemental pays 20%. Supplemental is 1/4 of the Medicare payment.) The Supplemental Plans have no decisions to make as they are contracted to just pay the part that Medicare didn't. However, our Medicare EOBs arrive months after the Supplemental EOBs. So there is a lag time before you see the entire picture.

3. Occasionally your Explanation of Benefits describes services from a doctor you've never seen. These we report back as possible fraud, although they were more likely meant for someone whose Medicare number was a digit off from ours (ie, a typo).

I miss having Plan F where there was no deductible and no time spent on deductibles (although that didn't ensure timely payment if the billing service didn't know how to bill).
Do you have to deal with Medicare and also the Plan G insurance company? Is it not the case that you flash your Plan G card at the doctor's office and they give you a relieved smile and it all gets taken care of?
No problems at all during the appointment, although some want to see your cards every time you have an appointment, even if they just saw you recently.
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Re: Medicare Question - did you ever hit the limit?

Post by Chuckles960 »

celia wrote: Fri Aug 27, 2021 7:54 am
Chuckles960 wrote: Fri Aug 27, 2021 1:02 am I don't have Medicare yet so this is confusing to me. Why do you need to figure out who "gets the deductible"? Won't the practice send you a bill if they were not reimbursed for the full amount?
1. Some doctors have incompetent billing offices or use an out-of-state billing service...
Thanks for the details, this is good to know. Nothing is ever as simple as it could be.
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celia
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Re: Medicare Question - did you ever hit the limit?

Post by celia »

Chuckles960 wrote: Fri Aug 27, 2021 11:57 am Thanks for the details, this is good to know. Nothing is ever as simple as it could be.
Your view of what should happen probably happens for the majority of Bogleheads. But, as with any kind of insurance, you should understand your policy and speak up if your claims are not processed like you expect.

The drug plans are another source of complications, if you take several meds and they are in different tiers. The co-pay can be different every month. I once asked the pharmacist if there were many seniors who came in to pick up meds but if the price was more than it was previously and the patient didn’t have extra money with them, what would happen. She replied that it happens frequently and they go home to get more money or else don’t come back. :(

Another source of problems is the patient him/herself. I know someone who couldn’t decide if she should pay the Supplemental premiums monthly or once a year. Last December she mailed in both a check for the annual premium plus a form authorizing monthly withdrawals from her checking account. So each month she is confused when she gets a monthly bill reminding her how much will be withdrawn this month, but the amount is negative with the remaing pre-paid annual balance showing. The insurance company says they can’t turn off the billing statement as Medicare requires it be mailed for monthly reminders so I’m trying to get her insurance company to turn off the ‘monthly’ flag in their computer.

I’m fighting for other seniors who don’t have the cognitive ability to understand their insurance. Unfortunately, we’re expected to make important decisions that impact our health when we’re less likely to understand the implications.

The whole system gets more complicated each year.
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Re: Medicare Question - did you ever hit the limit?

Post by bradinsky »

celia wrote: Fri Aug 27, 2021 7:54 am
Chuckles960 wrote: Fri Aug 27, 2021 1:02 am
celia wrote: Thu Aug 26, 2021 9:39 am We hit the $203 deductible (which increases each year) with the first two visits each year. When you see several doctors, it can be annoying to figure out which service provider gets the deductible each year...
I don't have Medicare yet so this is confusing to me. Why do you need to figure out who "gets the deductible"? Won't the practice send you a bill if they were not reimbursed for the full amount?
1. Some doctors have incompetent billing offices or use an out-of-state billing service. When they use the wrong procedure code, the claim is denied because the service supposedly provided doesn't go with the diagnosis, so then they have to fix the claim and resubmit it. Sometimes it is a "correction" to an earlier claim, or a claim is submitted multiple times. Anytime they don't get the payment they think they should get, they will bill you. Then you get to figure out what went wrong and explain it to them. Eventually, you become friends with the patient ombudsman, if they have one. :) Some of them have magical powers that make bills disappear.

2. Some doctors offices will adjust the bill after they see the Medicare approved price and the amount they received from Medicare, then bill you for the remainder without waiting for the Supplemental Insurance to pay. Medicare already knows who your supplemental plan is with (since you chose it on their website), so they (usually) automatically forward the balance to the supplemental plan. If the bill is for 1/4 the amount Medicare paid, you can ignore these as they will fix themselves up. (Medicare pays 80%, Supplemental pays 20%. Supplemental is 1/4 of the Medicare payment.) The Supplemental Plans have no decisions to make as they are contracted to just pay the part that Medicare didn't. However, our Medicare EOBs arrive months after the Supplemental EOBs. So there is a lag time before you see the entire picture.

3. Occasionally your Explanation of Benefits describes services from a doctor you've never seen. These we report back as possible fraud, although they were more likely meant for someone whose Medicare number was a digit off from ours (ie, a typo).

I miss having Plan F where there was no deductible and no time spent on deductibles (although that didn't ensure timely payment if the billing service didn't know how to bill).
Celia, we were told by our insurer that because we were on Medicare & supplemental G plan prior to the F plan being discontinued, we could switch to the F plan during open enrollment. They said we were grandfathered in & it would be available. For us, the G plan plus the yearly deductible is considerably cheaper & we’re happy with what we have
Do you have to deal with Medicare and also the Plan G insurance company? Is it not the case that you flash your Plan G card at the doctor's office and they give you a relieved smile and it all gets taken care of?
No problems at all during the appointment, although some want to see your cards every time you have an appointment, even if they just saw you recently.
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David Jay
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Re: Medicare Question - did you ever hit the limit?

Post by David Jay »

celia wrote: Thu Aug 26, 2021 10:15 amThe Medicare Advantage plans are more like HMOs where you need to use a small group of doctors or get referrals. That doesn’t work if you need to see outside specialists who refer you to more-specialized specialists. We’ve found that some outside specialists won’t see you unless you have a Supplemental Plan since the HMO plan doesn’t pay them enough.
In our area there are also Medicare Advantage PPO plans.
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Chuckles960
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Re: Medicare Question - did you ever hit the limit?

Post by Chuckles960 »

celia wrote: Thu Aug 26, 2021 10:15 amThe Medicare Advantage plans are more like HMOs where you need to use a small group of doctors or get referrals. That doesn’t work if you need to see outside specialists who refer you to more-specialized specialists. We’ve found that some outside specialists won’t see you unless you have a Supplemental Plan since the HMO plan doesn’t pay them enough.
I am confused. HMO plans AFAIK require in-network providers. They would not normally pay the outside specialist anything at all.
David Jay wrote: Fri Aug 27, 2021 7:51 pmIn our area there are also Medicare Advantage PPO plans.
Yes, but going out of network is so much more expensive that they are nominally PPO plans but in effect HMO plans.

It may be that celia is talking about these so-called PPO plans, not HMO plans.
bradinsky
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Re: Medicare Question - did you ever hit the limit?

Post by bradinsky »

Chuckles960 wrote: Fri Aug 27, 2021 1:20 am
midareff wrote: Thu Aug 26, 2021 8:49 amI'm 74 on Plan F, fortunately...
Except for the $203 deductible,Plan F and Plan G are identical. Yet, as has been noted previously here, Plan F costs way more than $203 extra per year compared to Plan G. (For the insurance companies I priced in my area, about $40/month more which is about $480/year more. So that would be about $275/year down the drain.)
As of 12/31/2019, the F plan isn’t available to new enrollees. As you stated, the G plan with deductible is a better option anyway.
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celia
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Re: Medicare Question - did you ever hit the limit?

Post by celia »

Chuckles960 wrote: Fri Aug 27, 2021 8:13 pm It may be that celia is talking about these so-called PPO plans, not HMO plans.
Basically I like our Supplemental Plans as we see several specialists outside of our primary care group. After checking, I see that we have only one Medicare Advantage plan that is PPO, but I wouldn't trust it since if it goes away, we are then stuck with a Medicare Advantage HMO plan and can't return to a Supplemental Plan (without medical underwriting).
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kd2008
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Re: Medicare Question - did you ever hit the limit?

Post by kd2008 »

Thank you for a lot of helpful responses.

After considering our expected healthcare needs, amounts saved in HSAs, and optimizing other variables, I believe we are going to apply for plan G that will be an issued age policy with Old Surety (just $112/mo for plan G currently). They are an odd ball small player that ask probing health questions even though one can skip those during open enrollment period.

If we cannot work it out/ approved with Old Surety then try Physicians Mutual Innovative G.

If that doesn't work out, then attained age plan G HD with United American.

If we have to, then consider attained age plan G with AARP or BCBSOK.

If in the mean time something changes towards more attractive then Lasso Healthcare MA plan.

Or lastly if all specialists accept Community Care MAPD with $0 premium then consider that.

The specific company names are for our area.

Having an idea about how quickly the $203 deductible gets spent was very helpful and illuminating. Thank you once again.
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Re: Medicare Question - did you ever hit the limit?

Post by bltn »

celia wrote: Thu Aug 26, 2021 9:39 am We hit the $203 deductible (which increases each year) with the first two visits each year. When you see several doctors, it can be annoying to figure out which service provider gets the deductible each year as Medicare assigns the deductible to the first claims they process each year rather than who you saw first that year. (Some doctors won’t submit bills early in the year until later since they don’t want to struggle getting deductibles from the patients. They let other service providers bill first.)

Since it’s easier to get through to the supplemental plan than to Medicare, we end up calling the supplemental plan each year to see who gets the deductible. (The Medicare Explanation of Benefits doesn’t come for a few months.)

One way to simplify is to have a known expensive test you need done in early January each year and not see anyone for a few months. Then you would pay the whole deductible to one provider.
We go to our doctors as our annual visits come due. We let Medicare and the doctors offices keep up with the billing. And we pay our deductibles when the bills arrive. For our doctors, there is no difference in billing us or Medicare. The money comes reliably from either source.
We have a G supplement.
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Re: Medicare Question - did you ever hit the limit?

Post by doobiedoo »

For a different point of view, I have Medicare Advantage thru Kaiser [in southern CA]. Since we were in the Kaiser HMO [since 1980] before we qualified for Medicare, it was an easy choice. The Kaiser in-network services are extensive in my area. I have never had problems with referrals. We have also used Kaiser facilities while on travel in Hawaii and the SF Bay Area. Again no problems. However, I have never used medical services internationally. [We do not travel very much internationally.]

My wife did hit the max out-of-pocket expense when she was in cancer treatments. I just put it in the budget and expected to pay it every year. [We did.]

Medicare billing must be complicated. Since being in Medicare Advantage, the copays I pay at the time of service are invariably adjusted afterwards -- sometimes up, sometimes down. [This was not a problem in the regular Kaiser HMO. HMO copays were easy to understand.]
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celia
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Re: Medicare Question - did you ever hit the limit?

Post by celia »

kd2008 wrote: Sat Aug 28, 2021 1:17 pm . . . I believe we are going to apply for plan G that will be an issued age policy with Old Surety (just $112/mo for plan G currently). They are an odd ball small player . . .

If we cannot work it out. . .

If that doesn't work out, . . .

If we have to, then consider . . .

If in the mean time . . .

Or lastly . . .
Please check out the ability and procedure to change plans in your state. In many places, I don’t think you can change unless you find out you made a bad choice within the first 60 days or so or if the plan is no longer offered.

In California, there is the birthday rule that allows you to make a change only within 60(?) days of your birthday.
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kd2008
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Re: Medicare Question - did you ever hit the limit?

Post by kd2008 »

celia wrote: Sun Aug 29, 2021 5:36 pm
kd2008 wrote: Sat Aug 28, 2021 1:17 pm . . . I believe we are going to apply for plan G that will be an issued age policy with Old Surety (just $112/mo for plan G currently). They are an odd ball small player . . .

If we cannot work it out. . .

If that doesn't work out, . . .

If we have to, then consider . . .

If in the mean time . . .

Or lastly . . .
Please check out the ability and procedure to change plans in your state. In many places, I don’t think you can change unless you find out you made a bad choice within the first 60 days or so or if the plan is no longer offered.

In California, there is the birthday rule that allows you to make a change only within 60(?) days of your birthday.
Thank you for that tip. Yes, we have studied our state's rules regarding changing plans.
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Re: Medicare Question - did you ever hit the limit?

Post by bradinsky »

OP,
When your DH signs up for the supplemental insurance, he will not be required to undergo medical underwriting. All he will need to do is complete the necessary paperwork & select a carrier & plan. It’s very easy & straightforward. At some point in the future if he wishes to switch carriers, many will then require medical underwriting. If he has any significant medical issues, choose wisely at the onset, because switching in the future might be impossible, or extremely expensive. The exception to that would be if the carrier he was with stopped offering the supplemental insurance or went out of business. Then he would be able to choose a new carrier without medical underwriting, just like when he was first eligible.
For new enrollees, the process seems overwhelming but it’s just a bit more time consuming. DW & I both have the G plan & we feel that Medicare with the supplemental insurance is absolutely the best medical insurance we have ever had in our lives, and at a fraction of the cost of what we paid during our working careers. You can see a specialist without referral at anytime & your total out of pocket is the deductible, which goes up modestly each year. Once he satisfies that, he will not be required to pay anything more. If a medical provider tries to charge you anything additional, call Medicare. They do not tolerate that. Best of luck to you both. Stay healthy!!

Brad
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Re: Medicare Question - did you ever hit the limit?

Post by TexasPE »

montanagirl wrote: Thu Aug 26, 2021 4:36 am I usually hit the plan G deductible every year for one thing or another. I'm 72 and I think it wouldn't have happened as often on my 60s except for knee replacement at 69.

Without surgeries I wouldn't have gotten anywhere close to the HD deductible.
+1
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kd2008
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Re: Medicare Question - did you ever hit the limit?

Post by kd2008 »

bradinsky wrote: Sun Aug 29, 2021 8:09 pm OP,
When your DH signs up for the supplemental insurance, he will not be required to undergo medical underwriting. All he will need to do is complete the necessary paperwork & select a carrier & plan. It’s very easy & straightforward. At some point in the future if he wishes to switch carriers, many will then require medical underwriting. If he has any significant medical issues, choose wisely at the onset, because switching in the future might be impossible, or extremely expensive. The exception to that would be if the carrier he was with stopped offering the supplemental insurance or went out of business. Then he would be able to choose a new carrier without medical underwriting, just like when he was first eligible.
For new enrollees, the process seems overwhelming but it’s just a bit more time consuming. DW & I both have the G plan & we feel that Medicare with the supplemental insurance is absolutely the best medical insurance we have ever had in our lives, and at a fraction of the cost of what we paid during our working careers. You can see a specialist without referral at anytime & your total out of pocket is the deductible, which goes up modestly each year. Once he satisfies that, he will not be required to pay anything more. If a medical provider tries to charge you anything additional, call Medicare. They do not tolerate that. Best of luck to you both. Stay healthy!!

Brad
Thank you for your helpful insight.
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susa
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Re: Medicare Question - did you ever hit the limit?

Post by susa »

DetroitRick wrote: ....Part B Deductible ..
.. a supplement G policy... clustering my choice among the 3 medigaps ..
..Medicare Advantage plans are generally fine too. Most of my friends (mid 60's to early 80's) have opted for them
.....For Part D prescription coverage...
Our friends and family opted to keep it really easy and simpler than that.

How?

Having just Medicare A and B. No fear of excessive hospital or doctor bills. GoodRx coupons for any Rx.

Watch Dr David Belk videos on YT
Soon2BXProgrammer
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Re: Medicare Question - did you ever hit the limit?

Post by Soon2BXProgrammer »

susa wrote: Mon Aug 30, 2021 8:36 am
DetroitRick wrote: ....Part B Deductible ..
.. a supplement G policy... clustering my choice among the 3 medigaps ..
..Medicare Advantage plans are generally fine too. Most of my friends (mid 60's to early 80's) have opted for them
.....For Part D prescription coverage...
Our friends and family opted to keep it really easy and simpler than that.

How?

Having just Medicare A and B. No fear of excessive hospital or doctor bills. GoodRx coupons for any Rx.

Watch Dr David Belk videos on YT
WIthout some sort of supplement/advantage plan/etc, a person with just Medicare part A and B, has potentially unlimited medical (and drug) expenses.
Earned 43 (and counting) credit hours of financial planning related education from a regionally accredited university, but I am not your advisor.
bradinsky
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Re: Medicare Question - did you ever hit the limit?

Post by bradinsky »

susa wrote: Mon Aug 30, 2021 8:36 am
DetroitRick wrote: ....Part B Deductible ..
.. a supplement G policy... clustering my choice among the 3 medigaps ..
..Medicare Advantage plans are generally fine too. Most of my friends (mid 60's to early 80's) have opted for them
.....For Part D prescription coverage...
Our friends and family opted to keep it really easy and simpler than that.

How?

Having just Medicare A and B. No fear of excessive hospital or doctor bills. GoodRx coupons for any Rx.

Watch Dr David Belk videos on YT
If you’re retired, or soon to be & you’re looking for some really BAD advice, here it is!
bradinsky
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Re: Medicare Question - did you ever hit the limit?

Post by bradinsky »

Soon2BXProgrammer wrote: Mon Aug 30, 2021 8:51 am
susa wrote: Mon Aug 30, 2021 8:36 am
DetroitRick wrote: ....Part B Deductible ..
.. a supplement G policy... clustering my choice among the 3 medigaps ..
..Medicare Advantage plans are generally fine too. Most of my friends (mid 60's to early 80's) have opted for them
.....For Part D prescription coverage...
Our friends and family opted to keep it really easy and simpler than that.

How?

Having just Medicare A and B. No fear of excessive hospital or doctor bills. GoodRx coupons for any Rx.

Watch Dr David Belk videos on YT
WIthout some sort of supplement/advantage plan/etc, a person with just Medicare part A and B, has potentially unlimited medical (andr drug) expenses.
+1 Just this year, I encountered a few problems & doctors prescribed 2 drugs for me. One is $46 per month & the other is $38 per month. My costs for those using only GoodRx would be $486 & $491 respectively. Prior to the addition of the 2 new medications, I paid $7.80 per month for my part D premiums, with zero costs for 3 generic prescriptions. An earlier poster stated that they would use GoodRx for prescriptions. That works fairly well if generics are prescribed. Not all medications are available in generic.
Also, when it comes to paying medical bills, you definitely do not get the same discounts as insurance companies when paying bills. Healthcare without medical insurance is insanity, unless you’re on government assistance or welfare.
Soon2BXProgrammer
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Re: Medicare Question - did you ever hit the limit?

Post by Soon2BXProgrammer »

bradinsky wrote: Mon Aug 30, 2021 10:31 am
Soon2BXProgrammer wrote: Mon Aug 30, 2021 8:51 am
susa wrote: Mon Aug 30, 2021 8:36 am
DetroitRick wrote: ....Part B Deductible ..
.. a supplement G policy... clustering my choice among the 3 medigaps ..
..Medicare Advantage plans are generally fine too. Most of my friends (mid 60's to early 80's) have opted for them
.....For Part D prescription coverage...
Our friends and family opted to keep it really easy and simpler than that.

How?

Having just Medicare A and B. No fear of excessive hospital or doctor bills. GoodRx coupons for any Rx.

Watch Dr David Belk videos on YT
WIthout some sort of supplement/advantage plan/etc, a person with just Medicare part A and B, has potentially unlimited medical (andr drug) expenses.
+1 Just this year, I encountered a few problems & doctors prescribed 2 drugs for me. One is $46 per month & the other is $38 per month. My costs for those using only GoodRx would be $486 & $491 respectively. Prior to the addition of the 2 new medications, I paid $7.80 per month for my part D premiums, with zero costs for 3 generic prescriptions. An earlier poster stated that they would use GoodRx for prescriptions. That works fairly well if generics are prescribed. Not all medications are available in generic.
Also, when it comes to paying medical bills, you definitely do not get the same discounts as insurance companies when paying bills. Healthcare without medical insurance is insanity, unless you’re on government assistance or welfare.
(Adding on)
Just scale up those for costs for cancer treatment (an example) and the uncovered costs becomes a decision between destruction of wealth and death by not having insurance that caps the worse case scenario.
Earned 43 (and counting) credit hours of financial planning related education from a regionally accredited university, but I am not your advisor.
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Re: Medicare Question - did you ever hit the limit?

Post by Munir »

I have the AARP Medigap plan F. What are the pros and cons to changing to plan G? If this has been discussed previously, then I apologize and request a link to the previous discussion.
PS: I really appreciate Celia's comments.
Soon2BXProgrammer
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Re: Medicare Question - did you ever hit the limit?

Post by Soon2BXProgrammer »

Munir wrote: Mon Aug 30, 2021 12:27 pm I have the AARP Medigap plan F. What are the pros and cons to changing to plan G? If this has been discussed previously, then I apologize and request a link to the previous discussion.
PS: I really appreciate Celia's comments.
Plan g is almost identical to plan f except having to pay the part b deductible. Also there are restrictions on people becoming medicare eligible after a certain date on picking plan f. Over the long run plan f participants will get older and sicker and the risk pool will become statistically more expensive.

Not that you need to do something now, but eventually you might want to... and you need to determine how your state let's insurers price policies... (attained age, age joining the plan, or community rated) as this might influence what you do and when you do it
Earned 43 (and counting) credit hours of financial planning related education from a regionally accredited university, but I am not your advisor.
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Munir
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Re: Medicare Question - did you ever hit the limit?

Post by Munir »

I understand that the monthly premiums of plan G are lower than that of Plan F but the annual deductible is covered under plan F but not by plan G. Speaking strictly in $ terms, which is less expensive as total cost?
Soon2BXProgrammer
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Re: Medicare Question - did you ever hit the limit?

Post by Soon2BXProgrammer »

Munir wrote: Mon Aug 30, 2021 12:51 pm I understand that the monthly premiums of plan G are lower than that of Plan F but the annual deductible is covered under plan F but not by plan G. Speaking strictly in $ terms, which is less expensive as total cost?
Plan and state/zip code dependent and probably will change over time.
Earned 43 (and counting) credit hours of financial planning related education from a regionally accredited university, but I am not your advisor.
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