MA sales question

[midwestbroker]

If you live in a metro, MA's usually are not the new kids on the block. They have been around for over 15 years. Humana has had some sort of Medicare MA plan in Kansas City since 1991.

In the Balance Budget Act of 1997, Clinton made Medicare + Choice ,the first standardization of MA plans. In 2003 with the Medicare Modernization Act, they made Medicare + Choice Part C of Medicare and formed Part D.

If we look at the history of the plans and try to project that to the future, then I would see in a worst case scenario that PFFS plans would become less available. However the metro markets with local HMO and PPO plans would remain as nothing has happened. They were around prior to the over funding of the plans, so they have established that they can survive at a lower capitation rate.

 

[Winter_123]

And let's face it.... if you are striving to serve your clients, you should have a MedSup in your bag that is very close to the annual cost of an MA plan.

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Good info. Let me give a ultra-simplified example so I can get at my question a little more specifically.

Suppose company XYZ offers a zero premium MA with a moop of 3200 so the cost of the ma premium and the cost of the med sup premium would not even be close because there is no premium. Suppose further that plan F med supp is 2600 a year for some of the major carriers in the state (just accept that, some are more, some are less, I know). Suppose client could potentially afford a med supp if it were a major advantage to him over an ma so it is not just a question of affordability, but he does not want to throw dollars at it just because he has them when it might not make sense economically.

So the client sees that with original medicare he has exposure and that a med supp would fix that. With an MA he would have exposure up to 3200 (in this example). On the other hand, he is saving the amount of the med supp premium in "good years" or most of it anyway. He has no known heavy duty health issues and figures that the savings in med supp can be applied to the moop if and when and that as long as he can cover the moop that a med supp doesnt get him any more care than with an MA if he is satisfied with his network, if that applies.

Again, this is a client who could potentially afford an MA but his thought process does not take him there. Where is he going wrong? I am trying to better understand the position many take here that an MA makes sense only if the client cannot afford a med supp. Obviously they would get hammered by the moop if they had not saved that amount up but a med supp has cash flow challenges as well.

Where is the client going wrong here? I don't know. I am asking.

Winter

 

[retread]

You are looking at the situation simply in terms of dollars. You missed the whole point of my earlier post. SECURITY is the issue. Who knows what will happen a year from now? Will the client have a sudden heart attacK? get cancer? will he then be able to medically qualify for a Med Sup? Then there is the political landscape to consider... what will the MA offerings be? Yes, HMOs and PPOs are more stable than PFFSs. But if Congress puts the axe to all MA subsidies, how much will these plans raise their premiums? They are not NON-PROFIT organizations! Premiums WILL go up under adverse funding levels. And, as plans pull out, the remaining will have less competition. In a word, a lot can happen in the not to distant future.

Personally, I look at all options, and consider them all for the present, if you view them as calendar year choices. Let the client decide for him/herself what his risk level is for the future, and what he wants to do to assuage his anxiety level. Financial planners conduct a risk tolerance survey for clients wishing to invest in securities...how much to put in stocks vs bonds, etc. I think about insurance in a similar fashion. There are a lot of insurance policies to cover almost every conceivable circumstance, but at what point are you driving your client into the poor-house? I make suggestions, but they make the choice.

Congress is driven by voting polls. They are not a very patient group on the whole. I think that MA plan expenses will go down each successive year, and the program will be seen successful, if given enough time. Let's just hope Congress will give it the time it needs to prove itself. If we can only get past next years elections......? IOW, the position I state above may change in the next 15 months, and, if future market risks decrease, I will have to adjust my advice to my prospects.

 

[Winter_123]

You are looking at the situation simply in terms of dollars. You missed the whole point of my earlier post. SECURITY is the issue..

No, I didn't miss it. I am simply looking for an answer to the question I asked rather than what you chose to answer. You raise questions about the long term stability of MA's and those are valid factors. And indeed I do look at dollars and what level of coverage the dollars may provide. Most clients do as well. Thus, I laid out a scenario and asked where the client would come up short dollar and coverage wise if he went with an MA. If there is an experienced person here who is able to reply to the question I raised, with the assumption that MA's will continue to be around, it would be helpful. All editorial side comments are helpful too but I am still looking for a reply to the core question I raised.

Thanks for any help.

Winter

 

[retread]

Math is math. What you seem to be asking is what the crystal ball is saying, hence the comments. Let's put it this way: I had a client earlier this year that wanted/needed nuclear medical testing. Would the MA plan cover his expenses? Med Sup would, but the MA plan(s) charged extra. Just how many of these issues can we go into here? No one knows the future, hence the risk factor. You cannot accurately predict future costs due to the unpredictable nature of things. Some clients want complete coverage, others elect minimal, yet others moderate in between, trying to hedge their bets. Some know what they might expect (but don't want to disclose it to you), others don't have a clue.

I don't know what to say, other than if I were you, I would discuss with this client what his risk tolerance is, and try to forecast a scenario that could put a dollar value on it, then do the math again.

 

[Winter_123]

Math is math. What you seem to be asking is what the crystal ball is saying, hence the comments. Let's put it this way: I had a client earlier this year that wanted/needed nuclear medical testing. Would the MA plan cover his expenses? Med Sup would, but the MA plan(s) charged extra. Just how many of these issues can we go into here? No one knows the future, hence the risk factor. You cannot accurately predict future costs due to the unpredictable nature of things. Some clients want complete coverage, others elect minimal, yet others moderate in between, trying to hedge their bets. Some know what they might expect (but don't want to disclose it to you), others don't have a clue.

I don't know what to say, other than if I were you, I would discuss with this client what his risk tolerance is, and try to forecast a scenario that could put a dollar value on it, then do the math again.

Indeed to the risk analysis. However, my question was a hypothetical to see what the general consderations and watch-outs might be. Obviously a clients specific circumstances, wishes, and risk tolerance come into play.

Thanks for your help.

Winter

 

[retread]

I think I am tapped out on this reply... there are others that can offer you more, I think. But in closing let me just say that the highest cost in senior health tends to be in the drug arena. In your first post, you mentioned MA plans, and I assumed you also were also considering MA-PDs in the mix. This is a big assumption! Be careful when you are calculating the cost of the Med Sup to include a PDP (I am sure you are) but just so no one else thinks I have ignored this subject, let me be specific. I have Med Sups whose premiums match MA and/or MA-PD plans sans PDP. However, even when adding the additional cost of a PDP, a Med Sup can provide better coverage at minimal increase over an MA-PD.

Sure, you can save a few bucks with an MA-PD, as long as everything else goes well. However, a long stay in the hospital will make the Med Sup look better, and more than one long stay even better yet. What you need to admit is that the average hospital stay for a Medicare beneficiary is 3.5 days. However, it is the nature of "averages" that give rise to the concept of risk management. Some people like to expect the best, but plan for the worst. In my opinion, if someone can afford it, go with the Med Sup. Same logic I apply with LTC, there are less costly alternatives in LTC, but you always sacrifice some risk against the premium.

Thanks for the opportunity to discuss this with you.

 

[Cenla Agent]

One stay in the hospital by itself in almost every case will still be cheaper with an MA than a Supp since the worst MA I've seen is maybe $900. (Maybe it's different in other markets). Now if it's 3, 4 or more admissions during a calendar year, of course that's going to be different.

Other than a year with multiple hospital admissions, the biggest exposure with MA is outpatient costs, especially where it's something repetitive like chemo, radiation, etc. and they have to pay maybe 20% or $50 per visit for something that's being done for several weeks or months. Also, some plans have a max OOP and some do not.

 

[Insuranceman]

I have written over 300 MA plan, about 98% on the first visit.

 

[midwestbroker]

It all boils down to this:

What does the client have now and what are they wanting to do.

If they have a supp...

Can they afford it?
Can they afford the risk of not having it?

If they have a MA or MAPD plan...

Do they want to change to an improved plan?
Do they want to go back to a supplement (provided underwriting and cost are not an issue)?