The Medicare Thread

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Originally Posted by fomofo

Medicare Advantage Plan (Part C):

You must keep paying your Part B premium to stay in your plan.

https://www.medicare.gov/basics/get-...-medicare-cost

(The Advantage plan may pay for all or part of the Part B premium.)

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Huh. Okay. So even though one is opting out of the benefits of Medicare A+B, they still (depending on the Advantage plan) need to pay the Part B monthly. So, Medicare Advantage is an even worse deal than it had seemed.

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Originally Posted by fomofo

I suspect there are lots of people of different income levels who have signed up for an Advantage plan without understanding exactly what they're getting (into, and perhaps giving up).

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Ah yes, marketing! Can't dispute that. What I said was that people who can swing the very modest monthly expense of Medicare + Medigap "shouldn't be considering Medicare Advantage's inferior coverage", not that they couldn't ignorantly be led to choosing inferior coverage anyway.

Cono has kindly shared a wealth of information, but it's interspersed in posts spread all throughout the thread. I've though about going back through those posts and pulling out the juicy bits to stuff into a reference doc, but ... I think about doing a lot of shit that I never get around to.

Short of that this is a good reference manual...

https://www.medicare.gov/medicare-and-you

You can download a PDF from that page.

I posted something in the Older Parents-WWYD? thread this morning I thought might be useful for folks wrestling with that kind of situation. Included therein was some general info about changes this year in the Medi-Cal (California Medicaid) program that could possibly be useful for someone in Cali trying to work out healthcare coverage.

FWIW...

Medi-Cal Asset Elimination FAQ

Medi-Cal (for People with Medicare)

Ways to Lower or Stop your Medi-Cal Share of Cost

In sum, this bill will create an annual open enrollment opportunity for Medicare beneficiaries to choose a Medigap policy during the same time frame as the Medicare Advantage Open Enrollment Period, which is January 1st to March 31st each year. This bill creates more parity with the rights of Medicare beneficiaries to move from one Medicare Advantage (MA) plan to another each year, or leave an MA plan by creating the same right to choose a Medigap plan. Medicare beneficiaries will be able to choose the most appropriate Medigap or MA coverage each year without being rejected for a health condition.

New Medigap Bill Would Create an Annual Enrollment opportunity with no health screenings

Bill Text: California Senate Bill 1236

Note that this would only apply to California.

This is a worthwhile listen. (And sadly yes to the above.)

Seniors choosing Medicare Advantage plans for the first time often don't realize they might get locked out of traditional Medicare for good. But changing this problem must be done state by state.

California tried to fix a major Medicare loophole for seniors

According to the piece the insurance companies lobbied the legislators and apparently killed the bill, although I do not see that reflected when I check the bill's current status in different places online, like this...

https://fastdemocracy.com/bill-searc...ls/CAB00032304

Medicare Advantage plans were designed to bankrupt Medicare by neocons. It was all part of the push to privatize Social Security and Medicare.


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Yep ^ And not to get all polyass but none of that is gonna exist if they get to institute project 2025. They will nuke it all.

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Originally Posted by MagnificentUnicorn

Medicare Advantage plans were designed to bankrupt Medicare by neocons. It was all part of the push to privatize Social Security and Medicare.


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Fact.

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Originally Posted by MagnificentUnicorn

Medicare Advantage plans were designed to bankrupt Medicare by neocons. It was all part of the push to privatize Social Security and Medicare.


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This is true, costs the medicare fund about 15% per beneficiary, per yr. more.

On a side note, the industry is worried. The inflation reduction act is capping out of pocket drug costs at $2000 per yr., so they will shift costs. Expect higher monthly premiums for part d plans, and med adv to get worse. They also instituted a plan to spread out drug deductables and costs, etc throughout the yr., but, a united health care rep I deal says they may not get paid back if the beneficiary drops the plan and there is a balance remaining.


Pay attention this fall.

Worth a read, and not just this section.

https://static.project2025.org/2025_...CHAPTER-14.pdf

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2025 Presidential Transition Project
1.
Make Medicare Advantage the default enrollment option.
2. Give beneficiaries direct control of how they spend Medicare dollars.
3. Remove burdensome policies that micromanage MA plans.
4. Replace the complex formula-based payment model with a competitive
bidding model.
5. Reconfigure the current risk adjustment model.
6. Remove restrictions on key benefits and services, including those related
to prescription drugs, hospice care, and medical savings account plans.26

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Check yoir NOC. I’m getting the 2025 apps and the advantage plans are cutting their extra benefits like otc benefits, dental etc. this was expected as part D out of pocket is now capped at 2500 for the yr.

My Aetna plan dropped the added 1200 you could use for a ski pass. And cut the dental in half.

Nothing terrible, but as I said before, never join an advantage plan for dental or dumb stuff, that comes and goes.and know if you do, your giving up your guaranteed right to a supplement if you had stayed on original medicare.

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Originally Posted by Cono Este

.....and know if you do, you're giving up your guaranteed right to a supplement if you had stayed on original medicare.

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For me, the one take away from the entire thread is this very point.

When you reach sign up age you are answering "choose how would you like to access, manage and pay for your healthcare for the rest of your life. With no easy way to change the decision*." Yet they never narrow it down to just these words.

*unless you live in a GI/Guaranteed Issue state.

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Originally Posted by Nobody Famous

For me, the one take away from the entire thread is this very point.

When you reach sign up age you are answering "choose how would you like to access, manage and pay for your healthcare for the rest of your life. With no easy way to change the decision*." Yet they never narrow it down to just these words.

*unless you live in a GI/Guaranteed Issue state.

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According https://www.medicare.gov/basics/get-...joining-a-plan you can switch during the open enrollement period every year, or am I not understanding this correctly? I never gave it much thought--when I retired from Kaiser i got enrolled in Senior Advantage for no premium (and they reimburse my Medicare premiums. Talk about the best benefits go to those who need them the least, but Kaiser tries to incentivize docs to retire--it's cheaper than paying them twice as much to work half as hard as young docs.) There is an alternate plan but I like Kaiser.

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Originally Posted by old goat

According https://www.medicare.gov/basics/get-...joining-a-plan you can switch during the open enrollement period every year, or am I not understanding this correctly? I never gave it much thought--when I retired from Kaiser i got enrolled in Senior Advantage for no premium (and they reimburse my Medicare premiums. Talk about the best benefits go to those who need them the least, but Kaiser tries to incentivize docs to retire--it's cheaper than paying them twice as much to work half as hard as young docs.) There is an alternate plan but I like Kaiser.

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That section you linked is referring to Medicare Advantage (MA) plans only, not Medigap (Supplement) plans which are totally different. MA Plans are intended to do annual signups as that section says. That's the Joe Nameth TV commercials around this time of year.

For Medigap (Supplement) plans it's different. And that's the basis of my rant and related to the point Cono Este made: The plan you pick at initial signup is the plan you should be prepared to stay with for the remainder of your life. My rant, and pet peeve, is it's never stated as such with these exact words and in such a short way***.

The entire system for Medigap (Supplement) plans is designed to prevent switching plans, ever, over one's lifetime. Footnote: Switching becomes slightly less complicated if you live seven of the states listed below, or in an 8th state, IL, and started with a specific insurer:

- CT, MA, ME, NY have year-round GI, but all premiums are higher because of this. For NY plans are higher by a factor of 200 to 300% vs. a neighboring non-GI state.
- CA, OR have birthday month GI rules.
- MO has an anniversary month GI rule.
- IL, if you signed up with Blue Cross Blue Shield of Illinois and Health Alliance, you get ongoing GI rights. Other Medigap (Supplement) carriers in IL do not offer this, ad IL does not mandate it. BCBS is being benevolent and probably has higher rates to make it work.

Reference for this state-by-state breakdown: https://www.kff.org/medicare/issue-b...across-states/

Another very helpful KFF writeup, for 2024 annual signups: https://www.kff.org/medicare/issue-brief/what-to-know-about-the-medicare-open-enrollment-period-and-medicare-coverage-options/

*** Edit to add: I already got through the Medicare initial signup. Yet it still pisses me off, wherever and whenever it comes up, that I had to spend hours and hours getting to understand this very point. Maybe I was just dump or numb to all the noise in medicare signups, but this point was one detail that never fully registered with me until I was well into the initial open enrollment period.

^^ great info. Thanks.


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I knew it was an issue if you chose an advantage plan and wanted to go back to the regular supplement, but are you saying this is an issue within supplements too? Going from supplement g to n for example? Just trying to clarify what part of switching plans you’re referring to. Maybe I missed that detail up thread but I’m confused

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Originally Posted by mcski

I knew it was an issue if you chose an advantage plan and wanted to go back to the regular supplement, but are you saying this is an issue within supplements too? Going from supplement g to n for example? Just trying to clarify what part of switching plans you’re referring to. Maybe I missed that detail up thread but I’m confused

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If you are not in any of one of these seven states, or IL with that specific plan listed, then yes it is an issue with all supplements.

It's also an issue if you want to jump from insurer #1's Plan N to insurer #2's Plan N, this means any plan F G K L M N.

All this is dictated by the main rule "... guaranteed issue (GI) protections for Medigap policies exist only during a one-time, six-month Medigap open enrollment period..." when you reach age 65.

Anything other than that -- you reach age 75 and say fuck it these plans are too expensive I'm gonna switch -- there is no GI. Yes, you can (try to) switch but the insurers you are switching into get to accept or deny on their own terms. People always quote this as 'you'll need to pass underwriting.' From what I've read there is no standard rule for underwriting and no guarantee it will be the same 10 years from now.

To me this all means the Medigap (Supplement) plan and the carrier you pick during the initial signup is the one you should plan to stay with for life.

Reading those two KFF links is where I had the ah-ha moment in this when I signed up.

Correct me if I’m wrong,but it sounds like you’re saying; you can go from Medicare Advantage plans back to Straight Medicare, but it’ll be difficult (impossible) to also get a supplement plan (aka Medigap) at that time.


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Originally Posted by jm2e

Correct me if I’m wrong,but it sounds like you’re saying; you can go from Medicare Advantage plans back to Straight Medicare, but it’ll be difficult (impossible) to also get a supplement plan (aka Medigap) at that time.


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Correct. You get six months to apply for a supplement without health questions, then After that, you have to be healthy to make the switch back. In most cases. If you are new to medicare , and in advantage less than a yr, you can switch without questions.

Just got a call, silverscripts, which is a great company and always had stable rates raised their $10 part d plan to,$40.


Just saw another plan that had 4000 in dental go to cleaning only.

This is what everyone is expecting. They capped total out of pocket drug costs at 2500, and now everything is changing to make up for it. Read your notices of change, look up your drugs on medicare.gov after October 15. You can change your own part d.

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Originally Posted by old goat

According https://www.medicare.gov/basics/get-...joining-a-plan you can switch during the open enrollement period every year, or am I not understanding this correctly? I never gave it much thought--when I retired from Kaiser i got enrolled in Senior Advantage for no premium (and they reimburse my Medicare premiums. Talk about the best benefits go to those who need them the least, but Kaiser tries to incentivize docs to retire--it's cheaper than paying them twice as much to work half as hard as young docs.) There is an alternate plan but I like Kaiser.

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You can switch advantage plans, and return to original medicare, but,you now have to answer health questions.

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Originally Posted by jm2e

Correct me if I’m wrong,but it sounds like you’re saying; you can go from Medicare Advantage plans back to Straight Medicare, but it’ll be difficult (impossible) to also get a supplement plan (aka Medigap) at that time.


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That is true, IMO.

But it is not what I am ranting about.

My rant, and my pet peeve, is this: When you do the initial enrollment nowhere do they (they, being the entire medicare industry) tell you, in as few words and as few sentences as this: If you choose to go with a Medigap (Supplement) you should plan for and be prepared to stay with the same Medigap (Supplement) Plan, F G K L M N, and same carrier, Aetna, UHC, MoH etc., for the rest of your life. You can try to change plans or carriers or both however there are roadblocks in attempting to do so. The roadblocks are not regulated or agreed to, the carriers decide what they are.

I see Cone Este posted you have to answer a questionnaire, i.e., underwriting.

My take on the use of an underwriting questionnaire is it is not mandated or regulated, it amounts to common practice among all the medigap insurers. At this point in time.

Can you count on an underwriting questionnaire still being common practice 5, 10 or 15 years from now? The carriers could change common practice, for example to require a complete physical. Or you could be in the situation of having been using a Medigap supplement for ten or 15 years, meaning you are age 75 or 80. Is it realistic to believe the carriers are going to welcome with open arms every 80 year old who comes along and decides he or she wants to switch plans to save on premiums? "Sure, come join our insurance pool we want as many 75 or 80 year olds as we can get."

Reference for this is on medicare.gov: Can I change my Medigap policy?

The one exception to all this is the seven states (eight if you include IL with a specific carrier) having the continuous GI rules, or the birthday month or anniversary month GI rules.

If my take on this is wrong feel free to go ahead and say why.

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Originally Posted by Cono Este

Just got a call, silverscripts, which is a great company and always had stable rates raised their $10 part d plan to,$40.


Just saw another plan that had 4000 in dental go to cleaning only.

This is what everyone is expecting. They capped total out of pocket drug costs at 2500, and now everything is changing to make up for it. Read your notices of change, look up your drugs on medicare.gov after October 15. You can change your own part d.

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Thanks, good head's up. I just got a Part D change notice today, haven't read through it. But I will.

I also got an email reminder, from the local broker I used, to schedule an annual review, I believe I'll do that also.

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Originally Posted by Nobody Famous

That is true, IMO.

But it is not what I am ranting about.

My rant, and my pet peeve, is this: When you do the initial enrollment nowhere do they (they, being the entire medicare industry) tell you, in as few words and as few sentences as this: If you choose to go with a Medigap (Supplement) you should plan for and be prepared to stay with the same Medigap (Supplement) Plan, F G K L M N, and same carrier, Aetna, UHC, MoH etc., for the rest of your life. You can try to change plans or carriers or both however there are roadblocks in attempting to do so. The roadblocks are not regulated or agreed to, the carriers decide what they are.

I see Cone Este posted you have to answer a questionnaire, i.e., underwriting.

My take on the use of an underwriting questionnaire is it is not mandated or regulated, it amounts to common practice among all the medigap insurers. At this point in time.

Can you count on an underwriting questionnaire still being common practice 5, 10 or 15 years from now? The carriers could change common practice, for example to require a complete physical. Or you could be in the situation of having been using a Medigap supplement for ten or 15 years, meaning you are age 75 or 80. Is it realistic to believe the carriers are going to welcome with open arms every 80 year old who comes along and decides he or she wants to switch plans to save on premiums? "Sure, come join our insurance pool we want as many 75 or 80 year olds as we can get."

Reference for this is on medicare.gov: Can I change my Medigap policy?

The one exception to all this is the seven states (eight if you include IL with a specific carrier) having the continuous GI rules, or the birthday month or anniversary month GI rules.

If my take on this is wrong feel free to go ahead and say why.

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We all signed our hippa privacy away at birth. They know meds we take.

There are many rules, mostly state specific. In Missouri, you can change once a yr. With no questions. It’s called the anniversary rule. Illinois does not have it and they are stuck with what they first buy if they are not healthy.

Everyone gets a shot at whatever they want in the beginning. If they hang up on me, their fault. The medicare and me book is pretty good, but in general, all these rules, enrollment windows are a fucking joke. Uselsss govt making up work for itself. Because of them, people have to have an agent to figure it all out.

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Originally Posted by Cono Este

The medicare and me book is pretty good, but in general, all these rules, enrollment windows are a fucking joke. Uselsss govt making up work for itself. Because of them, people have to have an agent to figure it all out.

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"Don't pee on my leg and tell me it's raining!" comes to mind.

Cono, in the many pages of this thread you have shared your intimate knowledge of the byzantine labyrinth that is our healthcare system, and for that we all owe you our thanks. And as an agent that confused people turn to for help in navigating the same to your credit you have also stressed over and over that traditional Medicare is the best option, and pointed out the potential downsides of Part C, aka Medicare Advantage, perhaps the biggest being potential loss of access to a Medicare Supplement (Medigap) policy.

While I'm sure there are many Gov't bureaucrats as well as minions working in the insurance industry that cherish their cozy little cube cog jobs it is the industry itself that fights tooth and nail to keep itself attached leech-like to all the points where funds flow in the system. The irony is most of those minions are going to be replaced by AI any day now, but the industry, (in actuality the relative few at the top of the corporate power structure), is going to continue to buy political influence and deny as much service and suck as much profit out of the system as it can for as long as it can.

Now if by "useless govt" you mean the politicians who have sold their souls to facilitate perpetuating the system as is, well, ok.

Again, thank you for your service. It's pretty fuckin sad that we need someone like you, but as long as we do I'm glad someone like you is around.

The aforementioned Medicare book...

https://www.medicare.gov/publication...re-and-you.pdf

Section 5 deals with Medicare Supplement Insurance (Medigap)

Question about Part D:
Can I freely change part D plans every year?
For example, I see a part D with monthly premiums of a couple bucks. Score? The same company also offers two more expensive plans. The "compare plans" option on medicare.gov says there's no difference besides the premium, though I believe that is a lie and each plan has a different list of covered drugs.

If I end up with some terribly expensive prescription, can I switch plans when October rolls around?

Yes, you can and should re-shop Part D every year during the 10/15 to 12/7 window, and you cannot be turned down by whatever you switch to.

Btw, if your Part D plan terminates, failing to re-shop can mean getting switched into a more expensive plan from that company, or left without D coverage if that vendor completely stopped participating in your area.

Edit: And of course the plans with different prices aren't the same; drug coverage of the cheaper one is going to approach the minimum that meets federal requirements. Different plans have different drugs in different cost baskets. But the cheapest plan is much better than not having a drug plan, and probably makes the most sense if you're relatively healthy and not regularly consuming prescription drugs.

When I retired they told me to sign up for Kaiser Senior Advantage if you want your health care covered. So glad I never had to figure any of this stuff out.

Glad you like your plan. What I have is near-universal coverage, nationwide, rest of my life, for a fraction of what I was paying before I turned 65 (and that was for a policy that was near useless when I spent much of the year in Utah). It's such a breath of fresh air to be locked in to actually excellent health coverage, and where there's zero possibility of getting jerked around or getting a bill in the mail where I can't even guess how many digits the amount will be.

And all I had to do was set aside my then-current audiobook for about a week of driving to get up to speed on how A/B/D/supps work, and the differences between the most popular supplement plans. Then I looked for a good broker to tell me, yes, that's a good plan, and to steer me to a company that's well established and less likely to give me painful premium surprises long-term. No biggie. And no more decisions to make on that; it auto-renews and is paid out of my SS.

As for Part D, if you're healthy, it's a no-brainer; set a reminder for Oct 15 and pick the plan that costs a few bucks instead of far more. Otherwise, go to a site like MedicareInsuranceDirect.com where you can cost out expensive drugs with the different plans that are available to you.

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Originally Posted by old goat

When I retired they told me to sign up for Kaiser Senior Advantage if you want your health care covered. So glad I never had to figure any of this stuff out.

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FYI

If you’re on a group retiree plan, you have not lost your guaranteed right to a supplement. you can try your retirement advantage plan first, and switch at any age if things change n

Update

I’ve change at least 50 plans the last three days. All called about increase in part d premiums etc. all but one was spending more. Today a guy with 10k in meds was switched for next yr and he’s capped at 4k between he and wife. So he’s happy, but most are calling up and pissed. Haven’t done too much advantage, but here the dental etc was all slashed. No more $1200 from Aetna either to spend on a pass.

Busiest I e ever been. .booked fernie for Dec 8-15th. But, will,go,where the snow is.

Thunder Snowing here even as I type.

RE: bobz, now I understand why all the old farts (me now one) scream, "keep your hands off my Medicare"

The other thing is, go ahead and just pick one if it's too confusing. Of the different supplement plans, the more popular 3 or 4 variants anyway, they all looked pretty acceptable. The beauty of Medicare Supplements is that they all cover the same thing, most or all (depending on plan) otherwise unpaid costs of Medicare covered care, and the supplement company has zero discretion or judgment as to what they do or don't pay for.

On Part D, I suppose you could just pick a mid-price one at random and it would probably be at least as good as whatever formulary an Advantage plan would saddle you with.

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Originally Posted by mcski

I knew it was an issue if you chose an advantage plan and wanted to go back to the regular supplement, but are you saying this is an issue within supplements too? Going from supplement g to n for example? Just trying to clarify what part of switching plans you’re referring to. Maybe I missed that detail up thread but I’m confused

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Depends on your state.

In Missouri we have the anniversary rule, also known as the birthday rule in other states. You can switch on your policy anniversary here without health questions.

Most states. You’re stuck with a pre existing condition.

If you want, I’ll look into your states rules.

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Originally Posted by bobz

The other thing is, go ahead and just pick one if it's too confusing. Of the different supplement plans, the more popular 3 or 4 variants anyway, they all looked pretty acceptable. The beauty of Medicare Supplements is that they all cover the same thing, most or all (depending on plan) otherwise unpaid costs of Medicare covered care, and the supplement company has zero discretion or judgment as to what they do or don't pay for.

On Part D, I suppose you could just pick a mid-price one at random and it would probably be at least as good as whatever formulary an Advantage plan would saddle you with.

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Go with g, or high deductible g. It’s 99% of what I sell.

For drugs, go to medicare.gov, enter zip, drugs, and pharmacy, and it will list them least expensive to expensive.

We have a 0 dollar WellCare plan next yr. I’m throwing everyone into it that it suits.

Never pay up for a part d plan, if you get a prescription for something not on formulary, you can get an exemption.

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Originally Posted by Cono Este

Depends on your state.

In Missouri we have the anniversary rule, also known as the birthday rule in other states. You can switch on your policy anniversary here without health questions.

Most states. You’re stuck with a pre existing condition.

If you want, I’ll look into your states rules.

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Here's a list I made of states with special rules.

I've been interested in compiling this since I did my initial eligibility signup and have since read so many open-ended comments (not necessarily on here) "yes, but if you live in state X then you get to ... blah blah blah".

Source for this: https://www.kff.org/medicare/issue-b...across-states/

CT, MA, NY	Continuous open enrollment, with guaranteed issue rights throughout the year. Any age 65 and up, any month.
ME	Requires insurers to issue Medigap Plan A (the least generous Medigap plan) during an annual one-month open enrollment period.
ME	Medigap policyholders can switch to a policy with equal or less generous benefits at any time during the year (not only during the annual open enrollment period) if there is less than a 90 day gap in coverage.
CA, OR	Allows beneficiaries to switch each year to a different Medigap plan with equal or lesser benefits within 30 days of their birthday.
MO	Allows policyholders to switch to an equivalent plan within 30 days before or after the annual anniversary date of their policy.
IL	Blue Cross Blue Shield of Illinois and Health Alliance provide ongoing guaranteed issue rights for all beneficiaries ages 65 or older.

I believe that CA and OR rule means 30 days before the birthdate not 30 days after. Not 100% certain on this.
I'm also not clear why the KFF write up sometimes refers to policyholders and sometimes beneficiaries. One can be a beneficiary but not (yet) a policyholder, so there's that point.

The last two yrs, I’ve slacked off, and I pretty much just replaced everyone with the anniversary rule. Insurance companies hate it.

Prettt sure I’m their biggest money loser. I think they put my shit on the back burner on purpose. I just wait them out.

In follow up to the table I posted above, here's an approach I've been reading about figured it's worth mentioning on here.

It's a way to leverage to the absolute maximum the (very generous) guaranteed issue rights offered by three states NY, CT, MA. It's best described by a use case:

Someone is coming up on age 65*, i.e., the time in life when they first sign up for medicare. They research medigap plans and learn the plans in their state cost 2 to 3 times (200% to 300%) more than the same plan in another adjacent state. So what costs $115 per month else where costs $265 per month in NYS (actual example). This shouldn't be a surprise because the medigap insurance companies in those three states have to accept anyone at any age into their plans and accordingly everybody pays a higher cost for this. The soon-to-be 65 year old decides to go with Medicare Advantage primarily because of the significantly lesser cost involved.

After several years on MA the now 70 year-old needs a medical treatment and his MA plan declines it. He appeals and it's still declined. He then uses the any-age, any-time-of-the-year GI rights and signs up for a Medigap plan. He knows there is a six month waiting period for preexisting conditions and he's OK with this. His new medigap plan pays for his treatment and the D Plan he already had covers the drug costs.

*Coming up on age 65 is not a requirement, you can do this at any age and anytime of the year if you live in any of these three states. IMO it's a smart way to leverage the GI rights in those states. Any why not the rights to do this are written into the state's laws, you're not taking advantage of a loophole or flying under the radar.

If you've sussed it all out correctly that would indeed seem to be the smart strategy, understanding that things can, and often do, change over time.

Curious, why is the northeast out in front on this?

Happy with Part G even though my fancy lifetime gym has a one year geezer waiting list now. I need the gym for the lady so not shopping elsewhere. Paying up.

Afa care it's great. Call any doc. No co-pay after medicare deductible. I have to have two derm procedures next month so my premium will be scratch for this year. My premium is $175/mo