Is High Deductible Plan F the Best
- Thread starter Stan21
- Start date
- 1,432
I stand corrected.
Apparently the MLR does apply to Medicare. I can't find a *.gov reference that mentions Medigap, but several *.com sites do. The page below makes reference to the MLR for Parts C and D:
https://www.cms.gov/Medicare/Medicare-Advantage/Plan-Payment/MedicalLossRatio.html
Apparently the MLR does apply to Medicare. I can't find a *.gov reference that mentions Medigap, but several *.com sites do. The page below makes reference to the MLR for Parts C and D:
https://www.cms.gov/Medicare/Medicare-Advantage/Plan-Payment/MedicalLossRatio.html
Seems a poor strategy to intentionally over pay hoping for a refund. There are likely stable lower cost carriers in your area. Carriers with similar insured blocks have similar claims. Intentionally over estimating claims would make them uncompetitive. You can't estimate claims if the carrier can't.
Look at current rate schedule to make sure carrier doesn't low ball early ages and lock in enrollees.
Look at current rate schedule to make sure carrier doesn't low ball early ages and lock in enrollees.
They had the best available rates here in rural NH. It is an issue-age policy. I was going to switch to plan-F figuring that I was not saving enough money to justify the extra risk. Then I got my first refund check. I assume the high-deductible plan attracts a healthier pool.
I realize that the refunds depend on the claim experience, but that's also true of future premium increases. I am very happy how this turned out.
I realize that the refunds depend on the claim experience, but that's also true of future premium increases. I am very happy how this turned out.
Perhaps I missed it, but the link provided by Alston discusses reporting requirements, the "85% rule" (which applies to fully insured group health plans, not individual plans), and this.
How many MA/PDP plans failed the MLR testing and had to issue a refund to CMS? How many were sanctioned or had their contracts terminated?
I suspect this is more govt bureaucracy and added expense that results in nothing.
As for the MLR refunds on Obamacare plans, the calculation applied to plans beginning in 2011 and the refund would be paid in 2012. Some carriers did have "excess margins" and issued rebates to policyholders on a pro-rata basis. Refunds were calculated based on premiums paid and had no direct relationship to plan deductibles, OOP, etc. I had clients who received rebates from a few of the carriers. Most of them got less than $50 but a few received several hundred dollars . . . enough to offset almost a months premium.
I don't believe any of my clients received rebates after 2012.
And I see nothing that says MLR extends to Medigap plans. Nor does MLR apply to cancer, hospital indemnity or accident plans. All of those, including Medigap, are secondary payers.
In the individual market any rebate accrues to the policyholder (except perhaps in the subsidized plans). From the link above it appears any excess goes back to CMS.
MLR rebates are much like life insurance par contracts. A carrier charges more than is needed to cover the risk and refunds any excess in the form of a non-taxable dividend.
Obamacare has not lowered the cost of health insurance except for low income people who, by DC definition, could not afford the new plans. The almost complete abandonment of the under 65 market by carriers certainly has done nothing to benefit the consumer.
As many agents as are represented on this site, covering almost every state in the union, makes it surprising that not a single one has ever had a policyholder client receive an MLR rebate on their Medicare supplement plan.
Pretty amazing, don't you think?
How many MA/PDP plans failed the MLR testing and had to issue a refund to CMS? How many were sanctioned or had their contracts terminated?
I suspect this is more govt bureaucracy and added expense that results in nothing.
As for the MLR refunds on Obamacare plans, the calculation applied to plans beginning in 2011 and the refund would be paid in 2012. Some carriers did have "excess margins" and issued rebates to policyholders on a pro-rata basis. Refunds were calculated based on premiums paid and had no direct relationship to plan deductibles, OOP, etc. I had clients who received rebates from a few of the carriers. Most of them got less than $50 but a few received several hundred dollars . . . enough to offset almost a months premium.
I don't believe any of my clients received rebates after 2012.
And I see nothing that says MLR extends to Medigap plans. Nor does MLR apply to cancer, hospital indemnity or accident plans. All of those, including Medigap, are secondary payers.
In the individual market any rebate accrues to the policyholder (except perhaps in the subsidized plans). From the link above it appears any excess goes back to CMS.
MLR rebates are much like life insurance par contracts. A carrier charges more than is needed to cover the risk and refunds any excess in the form of a non-taxable dividend.
Obamacare has not lowered the cost of health insurance except for low income people who, by DC definition, could not afford the new plans. The almost complete abandonment of the under 65 market by carriers certainly has done nothing to benefit the consumer.
As many agents as are represented on this site, covering almost every state in the union, makes it surprising that not a single one has ever had a policyholder client receive an MLR rebate on their Medicare supplement plan.
Pretty amazing, don't you think?
- 6,457
https://fas.org/sgp/crs/misc/R42735.pdf
First paragraph on page 5 of that document seems to indicate there is an MLR requirement for Medigap plans.
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It may go back to different legislation.
https://oig.hhs.gov/oei/reports/oei-09-93-00230.pdf
First appendix page in doct above--heading and 4th bullet.
I can't get this related to more current articles to be sure that it is still in effect.
First paragraph on page 5 of that document seems to indicate there is an MLR requirement for Medigap plans.
----------
It may go back to different legislation.
https://oig.hhs.gov/oei/reports/oei-09-93-00230.pdf
First appendix page in doct above--heading and 4th bullet.
I can't get this related to more current articles to be sure that it is still in effect.
- 6,457
