By Christian Regalado
I’ve been wanting to write this article for a while now because there isn’t a lot of discussion going on with retirees about the Medicare High Deductible G plan. With the rising costs and shrinking benefits offered with Medicare Advantage PPOs, this plan is worth exploring. More and more carriers are trying to push people into HMO plans because they cost insurers less, but I rarely recommend HMO plans in our area due to their limited network, need for referrals, and delays and risks that may come with prior authorization. This is why many locals choose a Supplement plan G or N if it fits their budget, or an Advantage PPO plan.
Many Medicare Advantage PPOs across the country have been consistently raising costs and trimming benefits due to recent changes enforced by CMS. Specialist copays are climbing. Dental, vision, and hearing allowances that once felt generous are now more limited. Some carriers in certain areas have been cancelling their PPOs altogether. So far, we still have decent options here, but the benefits are waning.
Our retiree population is smaller and more spread out than a city market, which means insurers have less leverage to build deep, competitive networks here. Advantage plans route members toward our one hospital in Miramar Beach, or facilities in Fort Walton Beach and Destin. But if you need a specialist who isn’t on staff locally, or you split time between 30A and a home up north, the PPO’s flexibility gets tested fast.
PPOs are sold on freedom. See more doctors, in or out of network, the brochures promise. Technically, that’s accurate, but many retirees discover the catch only when they need it most. Out-of-network care here often triggers higher coinsurance. Imaging, hospital admissions, and specialty referrals may require prior authorization before a procedure can even be scheduled. Specialist copays can run $50-$100 per visit, and add up quickly for anyone managing more than one condition.
High-Deductible Plan G is a lower premium Medicare Supplement, not an Advantage plan, and that distinction is exactly why it’s an option worth considering for those considering a lower cost plan. Most premium costs are well under $100 per month, but vary based on the carrier.
For 2026, the HD-G total deductible is $2,950. Think of that as your max out of pocket. There’s a $283 upfront deductible required before any coverage begins. Once that’s met, you pay 20% coinsurance (Medicare pays the other 80%) until you reach the full $2,950. After that, the plan pays 100% of covered Medicare Part A and Part B expenses, excluding premiums, for the rest of the year. Compare that to a PPO, where a difficult health year could mean a higher out-of-pocket maximum and fewer care options. With HD-G, you have a much lower worst-case number, but the main selling point is the extensive network with no referrals or prior authorizations.
The catch is that the HD-G plan only supplements Medicare parts A and B. This means you will still need to choose a stand-alone Prescription Drug Plan just like any other supplement plan. There are also no extra perks like silver-sneakers gym memberships, dental, hearing, or eyewear coverage. Depending on your situation, Medicare Advantage PPO or even an HMO may be your best choice. However, it is important to understand all of your options so that you can make the best decision. Call (850) 687-7606 or email me, Christian Regalado, at christian@30ahealthins.com anytime. I will be happy to be your trusted local contact for navigating this important decision.
