Jack's Blog on Medicare Plan Choices

A Medicare Advantage Plan medical deductible is an amount you must pay out-of-pocket for covered health care services before your insurance plan starts to pay. At the end of my blog, I will go over why people do it but first, here is a explanation of what the deductible is:

1. Definition: It’s a set amount you pay for covered medical services each year before your plan begins to pay its share.  It may be scary high like $500 or more.

2. How it works:

   – You pay 100% of costs until you reach the deductible amount

   – After meeting the deductible, you typically pay copayments or coinsurance

   – The plan then covers the rest of the costs for covered services

3. Variability: Deductibles will vary between plans. Some plans have no deductible, while others may have separate deductibles for medical services and prescription drugs.

4. Yearly reset: The deductible usually resets each year on January 1.

I understand this might sound intimidating, but keep in mind that certain services are likely excluded from the deductible. While I say ‘likely,’ rest assured that the specific plan you’re reviewing will clearly outline these details in the explanation of benefits. Below is a typical list of services that are usually excluded. ‘Excluded’ means you won’t need to meet the deductible beforehand. For instance, you wouldn’t need to pay the full deductible before visiting your Primary Care Physician (PCP) at the regular copayment rate.

In-Network only: Ambulance Services

• Chemotherapy Drugs and Administration
• Diabetic Monitoring Supplies
• Diagnostic Colonoscopy
• Diagnostic Mammography
• Lab Services
• Medicare Part B Covered Drugs
• Primary Care Physician’s office visits
• Specialist’s office visits

Both In-Network and Out-of-Network:

• Emergency Room Services
• Medicare Covered Preventive Services
  • IE: Immunizations such as Flu & Pneumonia

Services not covered by Original Medicare

• Urgently Needed Services at Urgent Care Centers

Have I enrolled customers into these plans? Yes. I have customers enrolled in plans with medical deductibles that meet their needs. However, these individuals are generally healthy and don’t anticipate requiring hospitalizations, surgeries, or costly tests like MRIs or CT scans. Of course, it’s impossible to predict when these services might become necessary. As with any insurance-related matter, there is risk involved. The key question is: would you prefer the insurance carrier to bear the risk, or are you willing to assume more of that risk yourself?

The reason some individuals are willing to take on more risk is that the insurance carrier may offer a Part B Giveback of up to $100 or even more, per month. Essentially, they might return a portion of what you’re paying for Medicare Part B.

When I present my customers with the option of a Medical Deductible Plan, I always provide a customized side-by-side comparison with two other plans. This allows them to clearly see how each plan impacts their medical coverage, prescription medications, and additional benefits beyond Medicare.

Here is my disclaimer.  I gather most of my information from Medicare.gov and CMS.gov and to the best of my knowledge, it is accurate.  Please use this information as a guideline.

Before choosing an Advantage or Supplement plan, ensure you have a thorough understanding of Medicare itself. When it’s time to explore your options, don’t fall for a sales pitch from a single company or an agent representing only one provider.

At “More Plans More Choices,” I can provide you with side-by-side comparisons from various insurance carriers. More carriers plus more plans equals more choices.

Call me toll free at (888) 883-6074