Downgrading From PruExtra Premier

[DW]

I'm looking to downgrade my Pruextra Premier due to the rather high premiums that I'm paying.

It also has features that I don't really need.

The only good thing is that it covers 100% but that comes at a cost.

I'm currently looking at the Pruextra Premier Lite.

Anyone here downgraded their Pruextra plan before?

 

[BBCWatcher]

I'm looking to downgrade my Pruextra Premier due to the rather high premiums that I'm paying.
It also has features that I don't really need.
The only good thing is that it covers 100% but that comes at a cost.

It doesn’t. All Integrated Shield plan and rider combinations are required to have at least some co-insurance.

I'm currently looking at the Pruextra Premier Lite.

Yes, the lowest cost rider for Prudential’s PRUShield Premier is PRUExtra Premier Lite CoPay. If that’s still too expensive then your next lower cost option is to switch the base plan to PRUShield Plus. Just be aware that if you switch to PRUExtra Premier Lite CoPay first you probably cannot switch to PRUShield Plus with PRUExtra Plus CoPay. It’ll have to be PRUShield Plus with PRUExtra Plus Lite CoPay to avoid a preexisting condition reset.

 

[tangent314]

Yes I've downgraded from the full PRUExtra Premier to PRUExtra Premier Lite CoPay.

Can't say much about whether it's good or bad, I mean, obviously if you remain healthy then downgrading is good but if you end up needing a really big claim then downgrading is bad.

My only advice is to look at how much you will end up paying if something happens to you. $3000 max out of pocket per year for any treatment in excess of $28500 (assuming you go with a panel doctor) isn't going to crush me financially

 

[IcYFl4mEz]

If you are on 100% non copay now, i remember downgrading also no need to copay. Ask them for their non copay plan

 

[BBCWatcher]

Can't say much about whether it's good or bad, I mean, obviously if you remain healthy then downgrading is good but if you end up needing a really big claim then downgrading is bad.

It depends on when that first claim is, and it doesn't have to be big. (In fact, big claims are well insured no matter what rider you have.) You pay less in premiums every year but more co-insurance when there's a claim. And then you get whacked with claims-based pricing if you choose to stay on the more expensive rider, so for many people it's a "once and done" affair.

If you are on 100% non copay now, i remember downgrading also no need to copay. Ask them for their non copay plan

NOBODY offers a zero co-insurance Integrated Shield plan/rider. All of them must have at least minimum co-insurance. That's at least a 5% co-pay capped no lower than $3,000 per year. This MOH regulation came into effect in 2021.

 

[petromax]

NOBODY offers a zero co-insurance Integrated Shield plan/rider. All of them must have at least minimum co-insurance. That's at least a 5% co-pay capped no lower than $3,000 per year. This MOH regulation came into effect in 2021.

If your policy is old one and you never terminate/missed payment, there are still plans with no co-pay

 

[BBCWatcher]

If your policy is old one and you never terminate/missed payment, there are still plans with no co-pay

Ah, OK, you're referring to riders purchased prior to March 8, 2018. It depends on the carrier, but I'm not aware of any that haven't modified the terms of those riders. Many have involuntarily rolled those rider policyholders to new riders with co-insurance. Prudential handled their "zero dollar" riders a different way: it added claims-based pricing (and to some of their current riders). So you can file a claim on your "zero dollar" Prudential rider, but then your rider premiums are increased if you stay on the rider — another form of co-insurance. And those heritage/legacy riders are quite pricey already.

 

[IcYFl4mEz]

If your policy is old one and you never terminate/missed payment, there are still plans with no co-pay

Ah, OK, you're referring to riders purchased prior to March 8, 2018. It depends on the carrier, but I'm not aware of any that haven't modified the terms of those riders. Many have involuntarily rolled those rider policyholders to new riders with co-insurance. Prudential handled their "zero dollar" riders a different way: it added claims-based pricing (and to some of their current riders). So you can file a claim on your "zero dollar" Prudential rider, but then your rider premiums are increased if you stay on the rider — another form of co-insurance. And those heritage/legacy riders are quite pricey already.

Yes, Pru bought long ago, still remain no copay.
However, some agent will tell you that if you downgrade your plan, will become copay, which is not true.
need to ask them for the old plan for you to downgrade.

 

[s0tong]

Yes, Pru bought long ago, still remain no copay.
However, some agent will tell you that if you downgrade your plan, will become copay, which is not true.
need to ask them for the old plan for you to downgrade.

Thanks for this. All along I thought downgrade = copay kicks in

 

[bluerail]

Yes, Pru bought long ago, still remain no copay.
However, some agent will tell you that if you downgrade your plan, will become copay, which is not true.
need to ask them for the old plan for you to downgrade.

You mean you downgrade from Private no copay to Public no copay?

 

[BBCWatcher]

Yeah, I think that’s the only way with Prudential to maintain the “no copay” rider, to downgrade the base plan. But I’m putting “no copay” in quotation marks because there are copays of a sort: your rider premium is jacked up when you make a claim. That’s the claims-based pricing. And that’s after paying a higher premium for the “no copay” rider.

I guess it might make sense to cling to the “no copay” rider if you expect to make a small or medium claim soon. (Big claims will hit the $3,000 annual cap regardless.) Otherwise it’s tough to justify.

 

[DW]

Yes I've downgraded from the full PRUExtra Premier to PRUExtra Premier Lite CoPay.

Can't say much about whether it's good or bad, I mean, obviously if you remain healthy then downgrading is good but if you end up needing a really big claim then downgrading is bad.

My only advice is to look at how much you will end up paying if something happens to you. $3000 max out of pocket per year for any treatment in excess of $28500 (assuming you go with a panel doctor) isn't going to crush me financially

The premier lite copay is quite attractive as its not claim based pricing.

What do you mean by in excess of $28500?

Do you feel that the pru panel provides a good danger of doctors to choose from?

 

[tangent314]

The premier lite copay is quite attractive as its not claim based pricing.

What do you mean by in excess of $28500?

Do you feel that the pru panel provides a good danger of doctors to choose from?

With PRUExtra Premier Lite CoPay If your hospital bill is $28500, you are covered
50% of the first $3500 (you pay $1750)
95% of the remaining $25000 (you pay $1250)

Total you pay $3000. If the bill is higher than $28500, you will still pay $3000, as long as you see a panel doctor.

With the non-lite plans you only pay $1425 for a bill of $28500. You only need to pay the $3000 cap for a bill of $60000 or higher.

$3000 isn't going to hurt me too badly, I'm fine paying that amount for a smaller actual bill, so the lite plan makes sense. The important thing is I'm protected from having to pay a huge bill for some super expensive operation.

 

[BBCWatcher]

Usually the $3,000 capped co-insurance is MediSave payable, and it's often claimable under employer-provided coverage (if you have some). And you have more cash on hand because you didn't have to pay the higher rider premiums. And you're not subject to claims-based rider pricing.

We should also point out that the $1,750 deductible is the maximum deductible. If you obtain care from a public hospital in B1 ward or lower then the $1,750 initial deductible could be lower — as low as $750 (C ward, short stay subsidized ward).

 

[IcYFl4mEz]

With PRUExtra Premier Lite CoPay If your hospital bill is $28500, you are covered
50% of the first $3500 (you pay $1750)
95% of the remaining $25000 (you pay $1250)

Total you pay $3000. If the bill is higher than $28500, you will still pay $3000, as long as you see a panel doctor.

With the non-lite plans you only pay $1425 for a bill of $28500. You only need to pay the $3000 cap for a bill of $60000 or higher.

$3000 isn't going to hurt me too badly, I'm fine paying that amount for a smaller actual bill, so the lite plan makes sense. The important thing is I'm protected from having to pay a huge bill for some super expensive operation.

Why will you choose to downgrade to Lite Copay , instead of Pruextra Plus(with no copay) ?

 

[BBCWatcher]

Why will you choose to downgrade to Lite Copay , instead of Pruextra Plus(with no copay) ?

Simple answer: some people want to try insuring in a way that more fully pays for private hospital care, i.e. avoids PRUShield Plus's 65% proration factor applied to private hospitals. And if that's what you value and what you want to pay for, OK, that's what the insurance market can provide.