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2018 is my first full year with a Medicare advantage plan ( for 2017, the month of December I was on original Medicare only).
For 2018 I have Security Health MSA plan. I am happy with the plan, but I am not happy with the 2019 change to less money being deposited and having a higher deductible. I too am concerned about the yearly changes in the deposit and the deductible in future years with a MSA plan.
I am considering for 2019 to go with a high deductible plan f supplement.
Yes, the $2000/$2500 deposits were decent - $1,500/$1620 not so much - although Medicare reimbursement rates are so low those amounts do go pretty far. I broke a small ankle bone this year - two doctor visits, two x-rays, total Medicare allowed charges $165. I also use the MSA for dentist and chiro. It's too bad you weren't able to participate earlier when deposits were higher and could have built up the account. Yes, $780 reduction in the deposit is significant as is the higher deductible.
The issue for me in WI, is the high-deductible F is priced too high imo, given the plan may never pay a dime for years if your health holds. In my case, at 76 y/o, premium is over $1k a year. A lot to pay for no benefit. So, since I never doctor, I'm probably sticking with the Security MSA for this year although, because its deductible is lower, I have toyed with the idea of going back to NetworkHealth. I may make that switch next year depending on who is offering what. NetworkHealth was my first MSA - had laser eye surgery done under that plan which took $1,500 of the $2,000 deposit for that year.
Another option, depending on your location, is the NetworkHealth PPO Advantage for low or very small premium, with a decent network in the Milwaukee area. NetworkHealth is Wisconsin-based and partially owned by Froedtert Hospital/Medical College. If I ever enroll in a traditional Advantage plan, it would most likely be NetworkHealth.
[quote=Ariadne22;53488859]Yes, the $2000/$2500 deposits were decent - $1,500/$1620 not so much - although Medicare reimbursement rates are so low those amounts do go pretty far. I broke a small ankle bone this year - two doctor visits, two x-rays, total Medicare allowed charges $165. I also use the MSA for dentist and chiro. QUOTE]
I agree Medicare reimbursement rates are low and the amounts do go far. In July 2018, I had lab work done, a doctor visit and was administered a pneumococcal vaccine. My costs were about $397. Not bad in my line of thinking. I paid the bill out of my pocket to maintain my $2400 and to carry over to 2019. My plan was to bill a big nest egg. To stay with MSA and to keep saving 100% of the deposit. I felt I could always pay a yearly bill of about $500 out of my pocket. After all, it’s a zero premuim plan.
Then September came. I did something dumb! I ended up in the emergency room via car transport. IV’s in both arms, x-rays, pain relief, CAT scans and MRI, 47 hours in the hospital over the course of three days. I am currently at about $3500 to my $5000 deductible with about $500 more in anticipate payments this year for various doctor office visits and x-rays, for a total of $4000 for the year. So yes, the Medicare reimbursement rates are low and do go far.
I will be completely heathy about the first of the year and anticipate my 2019 medical cost out of pocket to consist of lab work, office visit and pneumococcal vaccine (about $400). I am completely pleased with my current Security Health MSA plan on how they service my claims. The money nest saving idea no longer matters to me, I took a risk and I cost myself by needing medical coverage I did not plan on.
I am still a risk taker, so plan F High Deductible looks pleasing to me. I like the idea of the government setting deductibles rather than insurance companies. I also like the idea of paying an issued age premium rather than attained age. The MSA plan, well the insurance company can change some of its coverage, deposits and deductible at will from year to year. So who knows what one gets. With plan F HD, every thing is set in stone coverage wise by the government.
Plan D coverage: currently have Senior Care RX ($30 a year) and plan to continue. I take no meds.
I am looking at a Medicare Supplement Insurance. I am looking at a Physicains Mutual P237 w/rider B398 Rider Innovative Plan. My attained age premium is $104.23 monthly. The issue age premium is $121.69 monthly. The deductible is $2240 I believe for 2019. With the Innovative Plan, I must meet an annual plan deductible each year before the plan pays anything. This deductible goes away January 1 following my third policy anniversary. Preventive care benefits are payable with no deductible requirement.
The beauty of this plan above is after the January 1 following the third policy anniversary, the plan is exactly a Plan F policy. If I signed up for the Plan F now, the monthly attained age premium would be $195.59 and the issued age premium would be $228.35.
Might you have any thoughts on the Physicians Mutual plan above?
I will be completely heathy about the first of the year and anticipate my 2019 medical cost out of pocket to consist of lab work, office visit and pneumococcal vaccine (about $400). I am completely pleased with my current Security Health MSA plan on how they service my claims. The money nest saving idea no longer matters to me, I took a risk and I cost myself by needing medical coverage I did not plan on.
I am still a risk taker, so plan F High Deductible looks pleasing to me. I am looking at a Medicare Supplement Insurance. I am looking at a Physicains Mutual P237 w/rider B398 Rider Innovative Plan. My attained age premium is $104.23 monthly. The issue age premium is $121.69 monthly. The deductible is $2240 I believe for 2019. With the Innovative Plan, I must meet an annual plan deductible each year before the plan pays anything. This deductible goes away January 1 following my third policy anniversary. Preventive care benefits are payable with no deductible requirement.
The beauty of this plan above is after the January 1 following the third policy anniversary, the plan is exactly a Plan F policy. If I signed up for the Plan F now, the monthly attained age premium would be $195.59 and the issued age premium would be $228.35.
Might you have any thoughts on the Physicians Mutual plan above?
FYI - 2019 hd-F deductible is $2,300.
If I understand the foregoing correctly, the PM plan is a high-deductible F for three years, with guaranteed issue rights to a full Medigap F after three years.
So, you would be paying annually first year and for two add'l years thereafter for the hd-F - keep in mind there may be premium increases and the hd-F deductible increases about $60/year - at least :
Physicians Mutual:
$1,250.78 - Premium ($104.23x12) .....500.00 - Add'l expected medical expenses $1,750.78 - Annual Cost for the hd-F . 1,800.00 - Add'l Exposure til $2,300 deductible is met $3,550.00 - Worst case exposure
I suggest you compare this to the community-rated AARP UHC Medigap Basic Plan with copays ($20 per dr. visit, $50ER), to which you would add riders for hospital deductible/foreign and home health care, as follows - based on 1951 birth date:
AARP UHC:
$1,304.04 - Premium ($108.67 x 12)
.....289.80 - Premium Part A Hosp. Deduct/Foreign Travel (or $144.90 for 50% cost sharing rider)
.......29.40 - Premium home health care rider (well worth the $$ imo)
.....185.00 - Part B deductible .....160.00 - Estimated Dr. copays - eight visits $1,968.24 - Total Costs/Worst case exposure
plus, plan will pay $120 toward non-Medicare covered preventive care.
There is a $217/year difference between your expected costs for both plans, but you have an additional $1,800 exposure with the PM plan because of the $2,300 deductible.
In short, instead of buying a high-priced hd-F Medigap in WI, I would choose the AARP Basic Plan and add the two riders listed above. Many posters here are insured w/AARP UHC and are very happy. You can price UHC, here:
You would also need to become a member of AARP for the first year. The membership fee is $15, I believe, which will be part of your application process.
You probably know Plan F will no longer be sold to those newly eligible for Medicare in 2020 - i.e., age 65. Which means the risk pool for all insurers will be closed and gradually, over time, the insurers will be insuring older and sicker people, which means higher percentage premium increases for you because of medical costs for the closed risk pool.
Otoh, because it is community-rated, UHC caps premium increases due to age at age 77, whereas PM full Medigap F plan continues age-based premium increases (whether attained-age or issue-age) to age 85.
Re Physicians Mutual, I had a high-deductible F with them for about two years. I eventually dropped it because I never doctor and moved to the MSA. The PM unlimited diagnostic/preventive feature is attractive. I never used it, however.
Imo, PM, like Wisconsin Physicians Service (WPS), is on the higher end of the price range because the plans are only available through its commission-paid agents. Good company, no knocks there, but I believe UHC is far more cost-effective over time. Knowing age-based premium increases stop at age 77 is an important feature, especially if you expect to live a long time.
Last edited by Ariadne22; 10-29-2018 at 04:52 PM..
If I understand the foregoing correctly, the PM plan is a high-deductible F for three years, with guaranteed issue rights to a full Medigap F after three years.
Yes, the PM plan becomes a full comprehensive plan F after 3 years, meaning no deductible to meet after three years.
In my case, I would go with the Issue Age plan at $121.69 a month.
Yes, the PM plan becomes a full comprehensive plan F after 3 years, meaning no deductible to meet after three years.
In my case, I would go with the Issue Age plan at $121.69 a month.
Well, the AARP Basic Plan becomes an even better buy, because the $217 differential mentioned above is now moot.
For virtually the same dollars, the AARP UHC Basic Plan with copays is a full Medigap - not a plan with so much additional exposure. Had you had that plan this year with your bad event, your costs would have been $1,968 - not the hd-F premium + the additional $2,300.
You may have yet come out ahead with the MSA, because your $4,000 in expenses were partially offset by the $2,400 deposit, so your cost was $1,600 - less than either AARP UHC or the hd-F. The hd-F would have been the most expensive.
In short, I would not buy an HD-F for $108 when I could get a full Medigap for the same price - no matter what that agent tells you - and I think I know who you are dealing with. He may be trying to scare you with AARP's two price increases (age until you reach age 77, and medical cost increase) - neither of which are significant and still result in the end with a better policy with less exposure.
In short, imo you're way overpaying if you choose PM - and especially if you go with the higher priced issue-age.
AARP is community-rated. That is the best pricing structure over the long-term and only AARP offers this in non-guaranteed issue states.
Are you still considering PM - if so, why? I don't see the value there, at all.
Last edited by Ariadne22; 11-03-2018 at 01:16 PM..
Further to this, as an illustration of how community-rating works, I did a comparison on the UHC link provided above for the UHC Basic Plan in WI for a 78 y/o and an 88 y/o - the premiums were identical:
AARP UHC - 78 y/o or 88 y/o - identical premiums:
$170.77 Premium
...37.95 - Premium Part A Hosp. Deduct/Foreign Travel (or $19.25 for 50% cost sharing) .....3.85 - Premium home health care rider (well worth the $$ imo)
$212.57 - Total Premium All Riders
Now, Physicians Mutual has quoted you a full Medigap premium at age 68 or 69 for an issue-age policy of $228.35, higher than the above. Further, you have no idea what that premium would be in ten years when you reach 78. Is there a guarantee the premium will, in fact, even be $228.35 in three years or is that subject to annual increases for regional medical costs which most insurers impose?
Again, the only difference between the F and Basic w/copays is $185 Part B deductible, $20 copays per Dr. visit, $50ER. Nothing earthshaking.
Important:
Quote:
Physicians Mutual, in its 2018 filing with the Office of the Insurance Commissioner in the State of Wisconsin, Milwaukee County, quotes for an 85 y/o with an issue-age policy an annual premium of $5,637/$469.75 monthly.
Compare that to UHC policy for an 88 y/o with an annual cost of $2,550.84/$212.57 monthly. Sure, you pay the Part B deductible and small doctor copays, but you'd need a lot of doctor and ER visits to make up the annual difference of $3,086/$257.18 month - and if Part B deductible increases, so will the premium. Rates quoted are for this year's $183 deductible.
There is no way you should be buying an issue-age policy from Physicians Mutual now or ever unless there is some fantastical feature I don't know about.
Last edited by Ariadne22; 11-03-2018 at 08:31 PM..
Now, Physicians Mutual has quoted you a full Medigap premium at age 68 or 69 for an issue-age policy of $228.35, higher than the above. Further, you have no idea what that premium would be in ten years when you reach 78. Is there a guarantee the premium will, in fact, even be $228.35 in three years or is that subject to annual increases for regional medical costs which most insurers impose?
The same question applies to the UHC $212 rate. That is the rate a 78 y/o pays today, not what joey52 will pay after 10 years of inflation is applied to the UHC plan and he reaches 78.
Quote:
Originally Posted by Ariadne22
There is no way you should be buying an issue-age policy from Physicians Mutual now or ever unless there is some fantastical feature I don't know about.
There is. You are not understanding issue-age policies. The $469 rate for an 85 y/o is for new enrollees only. It is for a person who did not lock-in the issue-age rate when they were young. When a person does not lock-in the issue-age when they are young, then it acts like an attained-age plan until they finally do enroll. IOW, it is subjected to annual age increases until they enroll at age 85.
When a person enrolls in an issue-age plan while still young (68), they lock-in that rate as far as age increases are concerned. Once a young person has locked-in the issue-age premium, the plan is subject only to inflation increases just like a community-rated plan.
Quote:
An Issue Age rated Medigap policy means that you buy your policy based on your age at the time of application. Someone who is 70 will pay a higher premium when they purchase than their neighbor who is 65. However, once the policy is issued, it will never go up specifically based on your age.
UHC plans use a modified community-rated pricing structure. Before age 77, they act like an attained-age plan with lower initial premiums and age increases. This gives UHC an advantage before age 77 compared to a locked-in issue-age plan.
A WI Medigap that acts like Plan N ($20 copays) will have lower premiums than a Medigap that acts like Plan F.
Last edited by SCGamecock; 11-04-2018 at 06:43 AM..
I need to state my age and location better. I should have done this from the start. I know how location in a state can change premium amounts. Sorry about that
I was born the last week in December 1952. I am presently age 65. My zip code is 54901.
The PM numbers are accurate as I have the pricing sheet from a friend who turned 65 this year. I am not working with a PM agent. I am the kind of guy who likes to understand how things work before I would contact an agent.
It is my understanding the premium issued age $121.69 P237 w/ B398 Rider (also called the “Innovative Plan”) does not change (other than inflation).
There is. You are not understanding issue-age policies. The $469 rate for an 85 y/o is for new enrollees only. It is for a person who did not lock-in the issue-age rate when they were young. When a person does not lock-in the issue-age when they are young, then it acts like an attained-age plan until they finally do enroll. IOW, it is subjected to annual age increases until they enroll at age 85.
lol.....thank you, once again, for reminding me of what I once knew but had 'disremembered.' I think advanced age is catching up with me. Makes complete sense.
Quote:
Originally Posted by SCGamecock
When a person enrolls in an issue-age plan while still young (68), they lock-in that rate as far as age increases are concerned. Once a young person has locked-in the issue-age premium, the plan is subject only to inflation increases just like a community-rated plan.
My understanding of issue-age is that premiums will increase based on the claims for that particular risk pool - in OP's case - age 66 in 2019 - in Area 2 (zipcode 54901) in WI.
Therefore, wouldn't that mean no new enrollees into that risk pool and as the pool grows older and sicker, the premiums would be raised to compensate for the claims in that pool? Whereas the UHC community-rated risk pool continues to enroll new, younger (presumably) healthier beneficiaries which mitigates the higher costs of the aging enrollees - especially after age 77.
Otoh, we had a poster on this board who died at age 70 last year (lung cancer). She lived in Florida where UHC sells only issue-age policies. She cited her 96 y/o father (in 2015) paying $265 in FL for UHC Plan F issue-age when he switched from a different Medigap. $265 is great rate for a 96 y/o imo, so issue-age certainly had something to do with that low premium.
Quote:
Originally Posted by Robyn55
My father switched from a very ancient non-standardized Medigap policy to a plan F policy last year - when he was 96. And is currently paying about $20 more than he was paying in the past - about $265/month. I think we're all getting our money's worth out of our Medigap policies. Robyn
So, how impactful is the issue-age risk pool on premiums?
Quote:
Originally Posted by SCGamecock
UHC plans use a modified community-rated pricing structure. Before age 77, they act like an attained-age plan with lower initial premiums and age increases. This gives UHC an advantage before age 77 compared to a locked-in issue-age plan.
Do issue-age policies then become more attractive after age 77 - IF enrollee locked in the premium at age 65?
Quote:
Originally Posted by joeyj52
I need to state my age and location better. I should have done this from the start. I know how location in a state can change premium amounts. Sorry about that
I was born the last week in December 1952. I am presently age 65. My zip code is 54901.
It is my understanding the premium issued age $121.69 P237 w/ B398 Rider (also called the “Innovative Plan”) does not change (other than inflation).
Well, initially I thought the foregoing was too good to be true to continue forever and that after three years the rider would expire.
You are in Area 2 in WI. Filing with the OIC gives these rates for the Comprehensive Plan and Discount Rider:
The Deductible Discount Rider applies a $2,240 calendar year deductible to the Comprehensive Policy benefits for the first four calendar years of the policy. The high deductible amount is adjusted annually by the Secretary of the United States Department of Health and Human Services. Beginning with the fifth calendar year, Comprehensive Policy benefits are payable in full with no deductible.
I then dug out my old brochure from PM and it does say:
Quote:
The Innovative Deductible Discount Rider
Lowers your premium costs for life [emphasis added]
--up to 28% lower than our Comprehensive plan.
So, it would appear this is a forever discount which, at your age, sounded pretty good to me. However, I then realized the Comprehensive Policy will be subject to increases because of inflation, while it would appear the discount applied would not change.
Which means assuming 5% inflation in premium, in ten years, the 65 y/o Comprehensive Plan premium of $2,740 would become $4,463, less the $1,460 discount (assuming no COLA), for a net cost for that plan at age 75 of $3,003, or $250.40/mo. At age 85, the numbers become worrisome - premium $7,270, less $1,460, net premium $5,810, or $484/mo. Of course, 5% medical cost inflation figure may be too high over that length of time. If you do talk to an agent, ask him if the discount adjusts for inflation, as well.
Perhaps SCGamecock can shed further light on this.
Last edited by Ariadne22; 11-05-2018 at 12:47 AM..
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