Fact Check on the limit of liability with HD-G with a serious illness like cancer

[jo85336578]

I have been under the impression that a person insured by a HD-G plan is only liable for the monthly premiums on the HD-G as well as the HD-G annual deductible ($2,950 in 2026), no matter what - even if you get socked with a million-dollar hospital bill in one year. Am I correct?

The reason I am asking is a statement I read at a respected broker's site, and forgive me for this "copy and paste:"

Massive Out-of-Pocket Risk:  If you were to develop a severe, chronic, or critical illness (such as cancer requiring expensive treatments or infusions), you will blow through the High-Deductible G (HD-G) deductible very early in the year. Once you meet it, you then pay 20% coinsurance on all subsequent Medicare-approved services, which can equal thousands of dollars.

In other words, isn't the statement about "Massive out-of-pocket risk" above incorrect?

Edit to illustrate the rational decision on which to buy (G vs. HD-G): 

And if your maximum annual outlay ("MOOP") for an HD-G plan is  the sum of your HD-G premiums plus your annual HD-G annual deductible is less than the G premiums plus the annual Part B deductible, the rational decision would be to choose Medigap HD-G. (And if you believe as I do that G premiums are likely to increase more than the HD-G annual deductible, it's even more of slam dunk to choose the HD-G plan over the G plan, at any age, regardless of health or number of times you might need medical services.  (I would caution anyone without an amount equal to twice your  annual HD-G annual deductible sitting in the bank to pay irregularly-scheduled co-pays to find a way to  have such funds available before signing up for HD-G. The HD-G plan requires financial discipline.) Agree?

[GailL1]

@jo85336578 

SO WHAT if you blow thru the deductible early in the year - then that’s it for the year.

I would love to see this - can you give me a link or a name and I can look it up.

[jo85336578]

I found it while googling and now I cannot find it. 

Thank you for your reply and thoughts. 

In my case, I really am planning to switch from G to HD-G at the  (Clearly, I don't want to move from the pot to the fire.) So I especially appreciate your feedback. The scales are clearly in favor of the HD-G.

[GailL1 · Accepted solution]

@jo85336578 

You are right and they (whomever they are) are wrong.  Everybody pays premiums for their plan of what ever type they pick.  For a HD - G Medigap plan, you pay the high deductible of whatever is set that year (2026 - $ 2950) and then that is all you will pay as long as you get services that Medicare covers.

The deductible is made up of whatever you pay out of pocket - so it will count 

(1) Your Part B deductible (2026 - $ 283),

(2) any of the cost that Medicare does not pay - that includes the 20% or other amounts since Medicare does not always use the 80 % of Medicare approved charges on everything - there are other payment formulas that they use - but you still only have to pay the part that Medicare does not pay up to the High deductible

.

Your Medigap insurer keeps up with this - cause claims processing works just like it does with a regular Plan G once you have reached that High Deductible payment limit for the year.  

If you are having a lot of claims going in, it might take a while to even out but once everything is in and processed, the final amount should be reconciled.

Medicare.gov - Compare Medigap Plan Benefits 

Note:  the link says:

Plans F and G also offer a high‑deductible plan in some states.  You must pay for Medicare‑covered costs (coinsurance, copayments, and deductibles) up to the deductible amount of $2,950 in 2026 before your policy pays anything.

“Before your policy pays anything”  Medicare always pays their part no matter who the other payer maybe - you or your plan depending on where you are in meeting the high deductible.

Maybe they are talking about years and year of paying the High Deductible?  

WHO is saying what you posted?  Cause they are very wrong.

EDITED TO ADD:  I do remember on reddit once someone mentioning an agent that had it all confused thinking that Medicare didn’t pay anything until the beneficiary with a HD plan had met their high deductible .  That ‘s not right.  Medicare always pays their part.  Then Medicare using the Medicare cross-over which most Medigap insurers use, sends the claim onto your Medigap insurer they process it and your MSN shows what is paid and what is not and that is your part until it reaches your high deductible. Then the Medigap plan starts paying exactly like a regular Plan G.  Claims are categorized by services date so that’s how they cut it off at the end of the year - service date.  At the beginning of the year, you could have some of both being processed - old year and new year - got it?

I think I posted the other day about the historic High Deductible amounts going back to 2015 - it changes every year based on the cost of living index - the same one that is used for our COLA increases.