Physicians Mutual Innovative Plan G Medigap

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PorpoisefulLife
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Physicians Mutual Innovative Plan G Medigap

Post by PorpoisefulLife » Sun Jun 28, 2020 11:24 pm

I have been researching Medigap plans for DH and have been leaning towards high-deductible G after reading all the threads on here about HDG! We have been on an employer plan with a $4000 deductible each for many years and are used to paying out of pocket. Plus, we have well-funded HSA's. However, two things concerned me:

-the difficulty of upgrading to a lower-deductible plan if it should become necessary in the future
-if something should happen to me, the need for DH to deal with potentially a lot of individual bills and recordkeeping before reaching the $2340+ deductible per year. He has never had to take care of any insurance or financial stuff, since he didn't want to (I plan to require him to learn and pitch in, now that he's retired!).

So I was very surprised to see that Physician's Mutual offers an "Innovative Plan G" in my area, a concept which they apparently patented in 2013, and which I had not seen anyone mention on this forum (or anywhere else). I have heard of Innovative G plans which refer to extra vision or other coverage, but this is a HDG/G hybrid plan: the first three years are HDG and then the plan switches to regular G. Meanwhile, the lower premiums compared to G continue for the rest of life. Here are the respective Physician's Mutual monthly premiums for age 69 (includes a 10% household discount for living with a spouse):

HDG: $46.64, 67.74
Innovative G: $102.13, 124.61
Regular G: $128.29, 153.95

The first numbers are attained-age pricing, the second for issue-age pricing.

They also have F, HDF, and Innovative F, which he would be eligible for, but after reading all the threads about that group closing out, I'm not sure we want to go that way, although the HDF premiums are only 10 cents more than HDG.

Questions:

Is issue-age worth paying more up front to avoid increases due to age?

Is it reasonable to assume that the Innovative G rates might go up faster than HDG, but slower than G? Or does Physicians Mutual have the same increase across the board, like some companies do?

Does anyone have experience with this type of Innovative plan and/or can weigh in on Physician's Mutual rate increases, customer service, claims processing?

By the way, this plan was not listed on Medicare.gov. Physician's Mutual was not even listed as an HDG provider, just HDF. I had to go to their website.

whyamihere
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Re: Physicians Mutual Innovative Plan G Medigap

Post by whyamihere » Mon Jun 29, 2020 6:27 pm

PorpoisefulLife wrote:
Sun Jun 28, 2020 11:24 pm
I have been researching Medigap plans for DH and have been leaning towards high-deductible G after reading all the threads on here about HDG! We have been on an employer plan with a $4000 deductible each for many years and are used to paying out of pocket. Plus, we have well-funded HSA's. However, two things concerned me:

-the difficulty of upgrading to a lower-deductible plan if it should become necessary in the future
There are a number of companies that offer Medigap policies and the underwriting (and prices) vary from company to company.
The coverage is identical except for these "innovations" from Physician's. Pre-existing conditions are covered when you change from company to company if you're coverage level stays the same (assuming you're approved). The low deductible G plan is less administrative paperwork than the HD G plan and I don't want to do health claims administration during retirement.

-if something should happen to me, the need for DH to deal with potentially a lot of individual bills and recordkeeping before reaching the $2340+ deductible per year. He has never had to take care of any insurance or financial stuff, since he didn't want to (I plan to require him to learn and pitch in, now that he's retired!).

So I was very surprised to see that Physician's Mutual offers an "Innovative Plan G" in my area, a concept which they apparently patented in 2013, and which I had not seen anyone mention on this forum (or anywhere else). I have heard of Innovative G plans which refer to extra vision or other coverage, but this is a HDG/G hybrid plan: the first three years are HDG and then the plan switches to regular G. Meanwhile, the lower premiums compared to G continue for the rest of life. Here are the respective Physician's Mutual monthly premiums for age 69 (includes a 10% household discount for living with a spouse):
I'd get that in writing on insurance company letterhead, the switch from HD G to G. Last I heard the devil is in the details...
HDG: $46.64, 67.74
Innovative G: $102.13, 124.61
Regular G: $128.29, 153.95

The first numbers are attained-age pricing, the second for issue-age pricing.

They also have F, HDF, and Innovative F, which he would be eligible for, but after reading all the threads about that group closing out, I'm not sure we want to go that way, although the HDF premiums are only 10 cents more than HDG.
Regardless of the closing pool of applicants, the G plan tends to be less than the F in almost every zip code, on an annual premium basis, by more than the Part B deductible. I buy the G plan.
Questions:

Is issue-age worth paying more up front to avoid increases due to age?
Do you feel lucky? You have HSA balances, buy the less expensive and have the HSA offset costs (not directly per we but in an accounting sense).
Is it reasonable to assume that the Innovative G rates might go up faster than HDG, but slower than G? Or does Physicians Mutual have the same increase across the board, like some companies do?
Many independent agents represent multiple companies and can provide price history for various companies. Most people I've asked about this are able to shop around every few years and save a hundred bucks a year here and there (with no change in coverage).
Does anyone have experience with this type of Innovative plan and/or can weigh in on Physician's Mutual rate increases, customer service, claims processing?
Ask for more details on the true function of the "innovative" patent. If it's patented it is public. Get them to explain how it works using the public information. If you're comfortable with the inner workings maybe the plan works for you. I'm more comfortable sticking with standardized options where I can switch company to company with no sunk costs.

By the way, this plan was not listed on Medicare.gov. Physician's Mutual was not even listed as an HDG provider, just HDF. I had to go to their website.
Replied above in bold. You may want to check out the questionnaire that CMS/Medicare provides in the Choosing a Medical Policy guide. It's has some great information in bold and a list of things to ask your agent/company (including issue-age vs attained-age). I'd be concerned about pre-existing conditions not being covered if you change plans to a different plan letter, there's not necessarily the same protections in place. Some other posters know more details and hopefully they chime in now that you have a reply.
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Topic Author
PorpoisefulLife
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Re: Physicians Mutual Innovative Plan G Medigap

Post by PorpoisefulLife » Thu Jul 02, 2020 6:35 pm

HDG having more "administrative" requirements was exactly the second concern I mentioned, and why this Innovative plan made sense for the future.

There is no need to get anything in writing, because the Innovative plan does not "switch" you to a new plan; it has a rider the first 3 years (would actually be 2-1/2 for us since we'd be starting in July) which requires the $2340 deductible to be met each year before the plan pays out, then that rider drops away starting Jan 1 of the 4th year so that you have the full coverage of the G plan. This is described in writing on their website, and I'm sure in the plan documents as well. The lower premiums stay the same, however (other than the usual increases for age, inflation, etc. that other plans have).

Yes of course the G plan is less than the F; the point is that this Innovative plan has even lower premiums than the G plan (for life), even though it is the same as a G plan after the 3rd year.

Issue-age and vs. attained age has nothing to do with feeling lucky, and the HSA can't be used to offset premium costs since HSA's can't be used to pay for medigap premiums.

In the meantime, I have been sent a chart of premium increases in TN for plans F, G, HDF and Innovative F -- at least the 5-year, 10-year and 20-year average increases. No surprise that HDF went up a lot less than the others (even some decreases). The Innovative F plan had almost the same low increases as HDF. What was surprising was that the price increases for G were more than those for F. Of course, that is past history and who knows what will happen now that enrollment in F will be more limited. There is at least one report I've read that predicts F premiums will decrease and G will go up, because Most new enrollees in the F plan going forward will be underwritten and thus healthier, while G becomes the guaranteed issue plan for everyone, both healthy and unhealthy. (See CSG Actuarial 2019 Forecast)

I have read the patent. That does not answer my questions about Physician's Mutual customer service and claims processing.

There is no problem with preexisting conditions, since the Innovative plan does not switch you from one letter to another -- it is allways one plan, one premium.

In the meantime, from last week to this week, as of July 1, the rates for all the Physician's Mutual plans I was looking at have gone up by 4.5% across the board. If this is their inflation increase (obviously not the claims history increase, since then it would differ plan to plan), then it's pretty large. Add to that the increase for age if going with attained age, and the actual claims rate increases per plan, and it may be that PM increases premiums faster than other companies. On the other hand, this could just be indicative of what's going to happen with all companies in the era of Covid-19.

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FIREchief
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Re: Physicians Mutual Innovative Plan G Medigap

Post by FIREchief » Thu Jul 02, 2020 7:02 pm

PorpoisefulLife wrote:
Thu Jul 02, 2020 6:35 pm
There is at least one report I've read that predicts F premiums will decrease and G will go up, because Most new enrollees in the F plan going forward will be underwritten and thus healthier, while G becomes the guaranteed issue plan for everyone, both healthy and unhealthy. (See CSG Actuarial 2019 Forecast)
I was of the understanding that there will be no more new enrollees in Plan F. Did I misunderstand that?
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Eagle33
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Re: Physicians Mutual Innovative Plan G Medigap

Post by Eagle33 » Thu Jul 02, 2020 10:04 pm

FIREchief wrote:
Thu Jul 02, 2020 7:02 pm
PorpoisefulLife wrote:
Thu Jul 02, 2020 6:35 pm
There is at least one report I've read that predicts F premiums will decrease and G will go up, because Most new enrollees in the F plan going forward will be underwritten and thus healthier, while G becomes the guaranteed issue plan for everyone, both healthy and unhealthy. (See CSG Actuarial 2019 Forecast)
I was of the understanding that there will be no more new enrollees in Plan F. Did I misunderstand that?
Maybe folks born before 1955 are grandfathered in and can get medigap Plan F. Those of us born in 1955 and after are not eligible to get Plan F.
Rocket science is not “rocket science” to a rocket scientist, just as personal finance is not “rocket science” to a Boglehead.

whyamihere
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Re: Physicians Mutual Innovative Plan G Medigap

Post by whyamihere » Thu Jul 02, 2020 10:15 pm

Eagle33 wrote:
Thu Jul 02, 2020 10:04 pm
FIREchief wrote:
Thu Jul 02, 2020 7:02 pm
PorpoisefulLife wrote:
Thu Jul 02, 2020 6:35 pm
There is at least one report I've read that predicts F premiums will decrease and G will go up, because Most new enrollees in the F plan going forward will be underwritten and thus healthier, while G becomes the guaranteed issue plan for everyone, both healthy and unhealthy. (See CSG Actuarial 2019 Forecast)
I was of the understanding that there will be no more new enrollees in Plan F. Did I misunderstand that?
Maybe folks born before 1955 are grandfathered in and can get medigap Plan F. Those of us born in 1955 and after are not eligible to get Plan F.
New beneficiaries can't access the Plan F; existing beneficiaries who had an F can still buy an F but the applicant pool is potentially smaller due to newer enrollees not being to join the Plan F. There's a lot of unknowns and CSG, a private company that has a lot of info/understanding have written some opinions.
PorpoisefulLife wrote:
Thu Jul 02, 2020 6:35 pm
HDG having more "administrative" requirements was exactly the second concern I mentioned, and why this Innovative plan made sense for the future.

There is no need to get anything in writing, because the Innovative plan does not "switch" you to a new plan; it has a rider the first 3 years (would actually be 2-1/2 for us since we'd be starting in July) which requires the $2340 deductible to be met each year before the plan pays out, then that rider drops away starting Jan 1 of the 4th year so that you have the full coverage of the G plan. This is described in writing on their website, and I'm sure in the plan documents as well. The lower premiums stay the same, however (other than the usual increases for age, inflation, etc. that other plans have).
Per the patent, it can function differently according to the exact rider and plan benefits. I don't think recommending you get whatever your specific policy does in writing is offensive, they literally send you a policy in writing. I think anyone who has an insurance policy should know what it says on black and white rather than trust a sales person or the internet.
Yes of course the G plan is less than the F; the point is that this Innovative plan has even lower premiums than the G plan (for life), even though it is the same as a G plan after the 3rd year.
The innovative plan having lower lifetime costs for a retiree is not necessarily true and I don't think it's worth my time to have a straw man argument. You're misrepresenting my premise.
Issue-age and vs. attained age has nothing to do with feeling lucky, and the HSA can't be used to offset premium costs since HSA's can't be used to pay for medigap premiums.
We can't predict the future, you have to pick one or the other and ideally you pick right. I hope you're lucky but we won't know for years. Do you feel lucky? There's no time machine to go back and reverse the decision and in my post I literally said you can't directly offset the costs directly: for example you could just draw on the HSA and pay income taxes. Or you could use receipts from prior unreimbursed medical expenses without income taxes.

In the meantime, I have been sent a chart of premium increases in TN for plans F, G, HDF and Innovative F -- at least the 5-year, 10-year and 20-year average increases.
Cool, you got a report that I described in my post. Too bad there isn't enough history to compare plans as the innovative F's patent was approved only in 2013 -- there's only a small pool of policyholders that have successfully made it into the second leg of the innovations.
No surprise that HDF went up a lot less than the others (even some decreases). The Innovative F plan had almost the same low increases as HDF. What was surprising was that the price increases for G were more than those for F. Of course, that is past history and who knows what will happen now that enrollment in F will be more limited. There is at least one report I've read that predicts F premiums will decrease and G will go up, because Most new enrollees in the F plan going forward will be underwritten and thus healthier, while G becomes the guaranteed issue plan for everyone, both healthy and unhealthy. (See CSG Actuarial 2019 Forecast)

I have read the patent. That does not answer my questions about Physician's Mutual customer service and claims processing.
PM doesn't approve claims; that's done at the Medicare level. Medigap is secondary insurance. Customer service can vary significantly depending on the agent and home office staff. Last I checked PM is a captive agency, they disclose that the Innovative plan design allows for more marketing & commission expenses, and has a smaller agent distribution network than most other carriers on top of a more complex product. That doesn't seem like a great combo.

There is no problem with preexisting conditions, since the Innovative plan does not switch you from one letter to another -- it is allways one plan, one premium.
Sure, it's not a problem if you never switch. how committed to PM are _you_. If you bought the innovative Plan F/G and ever wanted to change you would be stuck with HD plans (not offered by all carriers) or change letters. Changing letters is a risk, therefore putting all your eggs in a Physicians Mutual plan is a risk. Sticking with non-innovative choices has less
risk in that regard and if you're healthy-ish I would rather jump from company to company with standardized plans keeping rates low than plan on one company's silver bullet. Most people I know switch companies but not plans.

Also the patent and news reports literally describes the function of a switch in coverage from HD to regular, and the riders that allow you to accelerate that decision to do it before the end of year 4. It can vary in actual application as states can approve or not approve offerings. Furthermore the reports I'm reading say it's four calendar years, not three. I'll admit I didn't go to their site as I'm not interested in switching my plan to them.


In the meantime, from last week to this week, as of July 1, the rates for all the Physician's Mutual plans I was looking at have gone up by 4.5% across the board. If this is their inflation increase (obviously not the claims history increase, since then it would differ plan to plan), then it's pretty large.
Why not call and ask the company? Beats arguing with strangers on the internet. With only two posts and the defense you're putting on for PM I'd think you work for them.
Add to that the increase for age if going with attained age, and the actual claims rate increases per plan, and it may be that PM increases premiums faster than other companies. On the other hand, this could just be indicative of what's going to happen with all companies in the era of Covid-19.
I don't have the PM plan, everything I read about it while buying a policy was a red flag to me. I could care less over the "potential" savings of a few thousand dollars over a lifetime as compared to the loss of flexibility. Bird in hand is definitely worth two in the bush.
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PorpoisefulLife
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Re: Physicians Mutual Innovative Plan G Medigap

Post by PorpoisefulLife » Fri Jul 03, 2020 4:30 pm

FIREchief wrote:
Thu Jul 02, 2020 7:02 pm

I was of the understanding that there will be no more new enrollees in Plan F. Did I misunderstand that?
No new enrollees who turn 65 after Jan 1, 2020. People who turned 65 before 2020 can still enroll, people who are already in a plan F can of course stay, and people in a different plan AND who turned 65 before 2020 can switch to F if the company allows and they pass underwriting. So my husband, who is currently 69, could enroll in F now or conceivably switch to F in the future from another plan (though with the high premiums, we probably wouldn't want to).

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Re: Physicians Mutual Innovative Plan G Medigap

Post by LadyGeek » Fri Jul 03, 2020 6:19 pm

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golf4ever
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Re: Physicians Mutual Innovative Plan G Medigap

Post by golf4ever » Wed Jul 15, 2020 12:40 pm

I am also looking at PM. Currently, they have the best price for Plan G here in Arizona. I'm turning 65 in late September. I wish to enroll in Plan G. Not innovative G as I don't think the annual total premium savings are worth possibly paying the $2350 deductible. To each their own.

How do I find out about PM's prior rate hikes in AZ? Related, how would I find about other insurance company's Medigap historical premium hikes? Yes, I realize that prior history is no guarantee for future increases.

I am asking about rate hikes, because unless you live in 1 or 7 states that forbid underwriting each enrollment period, we are likely stuck with our original insurance company choice. That said, I have had one Insurance rep say that I can leave Company A during the enrollment period, enroll in Advantage, and after 6 months I can change to Company B for Plan G WITHOUT UNDERWRITING - once. Is that scenario True or False?

Thank you!

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