What is going on with Health Care Premiums?

[Katsmeow]

Some folks here are talking about ACA premiums, but I think the original 'What is going on' was related to the jump in Medicare premiums for some folks. Here's some info on the reason for the jump, why it only hit some folks, and a possible fix now in the works.

Nope. That isn't what this thread is about. This thread is about a jump in premium on a Medicare supplement policy.

 

[ziggy29]

Whoever said "what comes up must come down" obviously never considered US health care costs.

 

[donheff]

I didn't notice if anyone else noted that the budget deal will fix this year's Part B increase problem. Instead, all Part B participants will get smaller, gradual raises over several years to make up the difference.

 

[travelover]

Whoever said "what comes up must come down" obviously never considered US health care costs.

But then as Buffett says, trees don't grow to the sky. I believe in equilibrium, but sometimes it takes awhile.

 

[Car-Guy]

Whoever said "what comes up must come down" obviously never considered US health care costs.

Although they do try to balance out the ups and downs. While cost are going up, the things a policy covers tend to go down at the same time. Example my monthly premiums are going up next year but I'm finding a number of services that are either gone or more restrictive. You need to read the details of coverage to pick them out.

It appears to me that the drug coverage is the worse.

 

[kaneohe]

No, it only means if you initially enrolled in something other than 'G' (such as 'F' or Medicare Advantage and had high use there), the 'G' can deny your application request because it's subject to medical underwriting. But once accepted into 'G' or any other Medigap plan, it is guaranteed renewable regardless of health issues as long as premiums are paid on time.

If you live in a guaranteed issue state, such as NY or CT, you cannot be denied at any point.

So this distinction that you are trying make between F & G only applies to certain states?

 

[ziggy29]

Although they do try to balance out the ups and downs. While cost are going up, the things a policy covers tend to go down at the same time. Example my monthly premiums are going up next year but I'm finding a number of services that are either gone or more restrictive. You need to read the details of coverage to pick them out.

Well, it usually seems like a multiple whammy: premiums, deductibles and OOP maximums rise MUCH faster than inflation, let alone wage growth, and at the same time it seems like networks are becoming more restrictive and more and more folks are being forced into HMOs where insurance bureaucrats dictate your care far more than you and your doctor.

 

[jim584672]

Well, it usually seems like a multiple whammy: premiums, deductibles and OOP maximums rise MUCH faster than inflation, let alone wage growth, and at the same time it seems like networks are becoming more restrictive and more and more folks are being forced into HMOs where insurance bureaucrats dictate your care far more than you and your doctor.

That is a true general statement, but this thread relates to Medigap policies, which means no set network of doctors, only that they accept Medicare. The wide pricing differences for the exact same policy in the same location illustrates that these companies are setting prices based on what they can get and not on what the actual cost is. One must be careful in shopping for these plans.

 

[ziggy29]

That is a true general statement, but this thread relates to Medigap policies, which means no set network of doctors, only that they accept Medicare. The wide pricing differences for the exact same policy in the same location illustrates that these companies are setting prices based on what they can get and not on what the actual cost is. One must be careful in shopping for these plans.

Agreed -- that said, it seems like more and more providers are either not accepting Medicare, or at the very least not accepting new Medicare patients. So even for those in Medicare, especially those new to Medicare, it amounts to a "shrinking network".

 

[aaronc879]

I will do my best to keep this "non-political", but I wonder what will happen now since there appears to be an agreement between the Prez and Congress on the budget. A budget that includes yet more cuts to doctor reimbursements? I already can't believe how little the doctors are getting NOW from the insurance companies! I mentioned to my new primary care doc (who spent a FULL 45 minutes with me!) that she will get less money from the insurance company than what I pay to get an oil change...and that just isn't right.

I went to the doctor and spent less than 20 minutes with him. He got $137 for that time which is less than the $174 he wanted to charge. Even if he only sees 2 people an hour for 8 hours a day that's $2192 per day. I realize he and his partners have a lot of overhead but there's no way they are not profiting six-figures a year each. They are getting paid plenty for non-emergency physicians or surgeons.

 

[Dawg52]

I went to the doctor and spent less than 20 minutes with him. He got $137 for that time which is less than the $174 he wanted to charge. Even if he only sees 2 people an hour for 8 hours a day that's $2192 per day. I realize he and his partners have a lot of overhead but there's no way they are not profiting six-figures a year each. They are getting paid plenty for non-emergency physicians or surgeons.

I might spend 20 minutes or more in the examination room waiting on the doc, but I get less than 5 minutes with mine. Of course he's a Doc in a Box type of physician.

 

[MichaelB]

No, it only means if you initially enrolled in something other than 'G' (such as 'F' or Medicare Advantage and had high use there), the 'G' can deny your application request because it's subject to medical underwriting. But once accepted into 'G' or any other Medigap plan, it is guaranteed renewable regardless of health issues as long as premiums are paid on time.

+1
Here are some links to the Medicare page explaining guaranteed issue.
https://www.medicare.gov/supplement...edigap/guaranteed-issue-rights-scenarios.html
https://www.medicare.gov/find-a-plan/staticpages/learn/rights-and-protections.aspx

The pricing for these policies is really bizarre with wide variations from one insurer to another. Since Medicare supplement policy coverage is not a question of being in network or not (unlike Medicare Advantage plans) I do not understand why there is such a variation in policy pricing. I also do not understand why one would pick any offer other than the cheapest one? It's not obvious to me what the extra value is for additional premium paid.

A very good question, not easy to answer. These are still insurance policies, the issuers must process and pay claims. When an insurer fails to pay a claim the medical service provider often looks to the customer to make up the difference. I would looks for a low price, but also an insurer with higher satisfaction ratings.

 

[Rustic23]

Just me, but I don't think the 'high' salaries of doctors is responsible for the increase!

 

[ejman]

+1
Here are some links to the Medicare page explaining guaranteed issue.
https://www.medicare.gov/supplement...edigap/guaranteed-issue-rights-scenarios.html
https://www.medicare.gov/find-a-plan/staticpages/learn/rights-and-protections.aspx


A very good question, not easy to answer. These are still insurance policies, the issuers must process and pay claims. When an insurer fails to pay a claim the medical service provider often looks to the customer to make up the difference. I would looks for a low price, but also an insurer with higher satisfaction ratings.

Thank you for the links. I don't see the situation my wife is in i.e. voluntarily looking for a cheaper medigap plan with the same or lesser coverage during the open enrollment period. Now I wonder is that particular situation under a guaranteed coverage provision or does the Insurance company have the right of refusal during this particular period?

Is there a reliable source for satisfaction ratings for insurance companies in the medigap business?

 

[Gotadimple]

That is a true general statement, but this thread relates to Medigap policies, which means no set network of doctors, only that they accept Medicare. The wide pricing differences for the exact same policy in the same location illustrates that these companies are setting prices based on what they can get and not on what the actual cost is. One must be careful in shopping for these plans.

Medigap policies are controlled by state insurance commissioners in terms of price, and by CMS (the same friendly folks who bring you Medicare, Medicare Advantage, and the supplement plans) controls the content of each plan.

So all Plan F's contain the same coverage limits, coinsurance, etc. But they differ in price based on the pricing method used and the experience of the plan (claims paid out).

From Medicare.gov
The cost of Medigap policies can vary widely. There can be big differences in premiums that insurance companies charge for exactly the same coverage. . .
Each insurance company sets its own premiums. It is important to ask how an insurance company prices Medigap policies. How they set the price affects how much you pay now and in the future. Medigap policies can be priced or "rated" in three ways.
https://www.medicare.gov/find-a-plan/staticpages/learn/how-insurance-companies-price-policies.aspx

The above link describes the rating methods. You will need to ask the insurer what method they use to determine the rates.

- Rita

 

[kaneohe]

'F' is generally more expensive than 'G'+deductible because it's on the 'guaranteed issue' list after initial enrollment. This means 'F' has to accept high users of medical services. 'G' can pick and choose healthy members after initial enrollment.

Is there a 3rd party link that documents this ........ that F is on the guaranteed issue list and that G is not?

 

[Mulligan]

Just me, but I don't think the 'high' salaries of doctors is responsible for the increase!

Make that two... We all have known since birth that doctors get paid reasonably well. Yet we all didn't go to medical school and give up close to a decade of our lives to become one. Maybe they do deserve their pay. Physicians salaries consume under 10% of total healthcare dollars.


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[Car-Guy]

where insurance bureaucrats dictate your care far more than you and your doctor.

happening more and more often. Especially with the drug insurance companies.

 

[MBSC]

So this distinction that you are trying make between F & G only applies to certain states?

Everyone gets a one-time initial enrollment period, usually at age 65, when you can purchase any Medigap plan. After the initial enrollment is closed, federal regulations allow F to be guaranteed issue in certain limited circumstances. This usually creates a premium differential between F and G. NY & CT require all Medigap plans continue to be GI after initial enrollment so they may not see a premium differential.

Is there a 3rd party link that documents this ........ that F is on the guaranteed issue list and that G is not?

Reposting embedded link: 'guaranteed issue' list

You have a guaranteed issue right (which means an insurance company can’t refuse to sell you a Medigap policy) in these situations:

(List of situations - click one to expand and reveal the following)

You have the right to buy Medigap Plan A, B, C, F, K, or L that’s sold by any insurance company in your state.

 

[jim584672]

NY has no open enrollment for Medigap policies, they are open all year. It does prevent coverage of a pre-existing condition for 6 months. This can be lessened if there is no gap of coverage for more the 63 days.

 

[kaneohe]

Everyone gets a one-time initial enrollment period, usually at age 65, when you can purchase any Medigap plan. After the initial enrollment is closed, federal regulations allow F to be guaranteed issue in certain limited circumstances. This usually creates a premium differential between F and G. NY & CT require all Medigap plans continue to be GI after initial enrollment so they may not see a premium differential.

Reposting embedded link: 'guaranteed issue' list

SCG......thanks for clarifying the bolded above. Also thanks for your hint on clicking on one of the listed exceptions to bring up the magic words.
I had read some words regarding how in 2020 covering the deductible might be outlawed making plan F an orphan for new enrollees and increasing the premiums for older grandfathered enrollees. Fortunately CA has a birthday rule where you can migrate to lesser or equal plans for limited times around your birthday..........now to find out if we have a G plan where I live.

 

[mf15]

To the OP:
Check the policy,there should be a table of premium increases by year,
if the policy is age rated.

Seems to me medicare is a bargain. Of course I have no idea how much we have paid in since about 1966.
Wife spent a few hours in the ER back in July total bill about 5K.
My bill $176.00 and we have the plan F HD plan.



Old Mike