MAPD Plans Vs. Med Supp

[Midlevel]

Jdeasy:

Just keep telling yourself that. The statement about a person being just as well off with just Medicare if they can't afford a Med Sup is absurd. Try telling that to the people that are paying 20% of Chemo or any of the other big charges with no OOP on Medicare. They will wish they had a Max oop of $3000, $4000, or whatever their particular MA plan has.

 

[jdeasy]

Jdeasy:

Just keep telling yourself that. The statement about a person being just as well off with just Medicare if they can't afford a Med Sup is absurd. Try telling that to the people that are paying 20% of Chemo or any of the other big charges with no OOP on Medicare. They will wish they had a Max oop of $3000, $4000, or whatever their particular MA plan has.

I don't have to tell myself anything. I am not brainwashed by the Human/UHC types of the world. Most of the PFFS plans here make the person that 20% anyway and it doesn't count toards the MOOP.

Also, very few, if any, that can't afford a med sup are paying those costs themselves anyway. They are on a medicaid or on a spend down.

If I run into someone that would truly be helped by an MA plan I refer then to someone to write it. I certainly do not use scare tactics as you are doing here to try and sell crap.

 

[tins]

I don't have to tell myself anything. I am not brainwashed by the Human/UHC types of the world. Most of the PFFS plans here make the person that 20% anyway and it doesn't count toards the MOOP.

Also, very few, if any, that can't afford a med sup are paying those costs themselves anyway. They are on a medicaid or on a spend down.

If I run into someone that would truly be helped by an MA plan I refer then to someone to write it. I certainly do not use scare tactics as you are doing here to try and sell crap.

Nobody likes dealing with MA plans and CMS. But, when the choice is between MA or Medicare alone, they are almost always better off with the MA. It's silly to think otherwise. Reduced costs for doctors, specialists, testings, hospitals, Out of Pocket Maximums, etc.
There are exceptions, but those are the exceptions.

 

[jdeasy]

Nobody likes dealing with MA plans and CMS. But, when the choice is between MA or Medicare alone, they are almost always better off with the MA. It's silly to think otherwise. Reduced costs for doctors, specialists, testings, hospitals, Out of Pocket Maximums, etc.
There are exceptions, but those are the exceptions.

You are certainly entitled to your opinion. Mine is different. But, you are also just wrong. How is a person off if their doctor doesnt take the PFFS plan and they have to change doctors?

How is the person better off if the medicare co pay is $12 and the co pay for for their MA plan is $20? How about if they don't have the MA plan co pay up front and the doctor that does take PFFS plans requires the co pay up front, but will bill for the medicare only patients?

Or, how about a hospital co-pay of $265/day for up to 18 days as one plan has here? How does that 10 day hospital stay stack up to what they would have paid with only medicare?

It still goes back to what I said earlier. The people that truly cannot afford a med sup are getting help and won't pay those bills anyway.

With plan N or even a hi-d F available there is no reason to have to deal with an MA plan. Especially PFFS and the restrictions. For the truly poor dual eligible plans are great. But since we don't have any of those here it's a moot point.

 

[DS4]

What is often forgotten is that Medicare Part B covers oral cancer meds,
Xeloda $840/mo
Alkeran $371/mo
Myleran $267/mo
Temodar $2670/mo
Hycamtin $750/mo
Trexall $556/mo
Oforta $1799/mo
Having to pay 20%??
My fav med supps are N & high deductible F now that the last MA left my county.

 

[SportsNut]

You are certainly entitled to your opinion. Mine is different. But, you are also just wrong. How is a person off if their doctor doesnt take the PFFS plan and they have to change doctors?

How is the person better off if the medicare co pay is $12 and the co pay for for their MA plan is $20? How about if they don't have the MA plan co pay up front and the doctor that does take PFFS plans requires the co pay up front, but will bill for the medicare only patients?

Or, how about a hospital co-pay of $265/day for up to 18 days as one plan has here? How does that 10 day hospital stay stack up to what they would have paid with only medicare?

It still goes back to what I said earlier. The people that truly cannot afford a med sup are getting help and won't pay those bills anyway.

With plan N or even a hi-d F available there is no reason to have to deal with an MA plan. Especially PFFS and the restrictions. For the truly poor dual eligible plans are great. But since we don't have any of those here it's a moot point.

Agree with most of the above here by jdeasy. An MAPD plan puts a ceiling in for them, but unless the client draws the very short straw with super expensive illness, they aren't better off with the MAPD... in most cases.

Did a comparison for a family friend of my sisters this season. Her gf's had her talked into a UHC-MAPD, wiht MOOP of $ 4300. She had a Part D plan and qual for extra help, so it was 9 bucks per mo, and her Rx is fairly reasonable with the 50% help. Her Dr visits for specialist, which she see 6 or more times per yr, were $ 18 under Part B, and going to be $ 35 under the MAPD. Part A Hosp, 1156 under orig m'care, and 1500 with MAPD; (of course capped at that where she could incur more than one Part A ded in a yr).

Bottom line was, she has had some fairly expensive years of healthcare in yrs past with no supp. After write down by the hosp and Dr's she sees, she was no where near 4300 moop. My question to anyone listening is, would the hosp or Dr's that are willing to write down a receivable by a poor patient with NO supp, (Medicare A&B only), and would they be as willing to do so with a higher amount owed after an ins co has reduced their potential payout that they rec'd from A or B only, since it is lower from M'care Part C...?

We came to the conclusion that she was better off with A&B only, with stand along Part D, than having MAPD with a Moop that was Poop.

The worst penalty or soft spot in the coverage of MAPD's is the in hosp coverage. For those that can close that gaping hole with a an indemnity product for in-hosp stays, the product becomes much more attractive, IMO.

And I agree 110% with the PFFS plans. I wouldn't wish that on my worst enemy. One only needs to have a large provider or hosp in an area refuse the PFFS plan offered, and that concept would be history... It do happen.

 

[Midlevel]

Jdeasy:

Definately using scare tactics by presenting both a Medicare Supplement + PDP and also a MAPD with a GTL Hospital plan. I think you are selling yourself short by not having options for Seniors other then an F or an N Plan. I can see you losing plenty of client's because an agent comes along and presents a MA and the client wonders why their current agent only showed them the one option. Happened alot for me (ran into client's with Med Sups that didn't know about Medicare Part C) this AEP, they love it when someone sits down and goes over A,B,C and D of Medicare and then presents several options for them to choose from.

To each his own, I'm not saying you are wrong but we all have different ways of doing things and don't accuse me of scare tactics because I present different options or because I think MA Plans might be better then just Original Medicare (especially for someone on early disability that can't buy a Med Sup). Almost everyone of them asked me which way they should go, I told them it's an individual decision and doesn't make me any difference either way they choose.

 

[billyg]

It is my opinion that a person that truly can't afford a med sup is just as well served by Medicare alone. The SNP's are great for the duals, but we don't have any of those here. Wellcare had a very good plan for the Medi/Medi even though it was PFFS. When that went away nothing took it's place.

JD, I don't know what the plans in your area look like, but most of the MAs here have an OOP max of between $3,500 and $6,700. This is worth something if the person has to undergo Chemo and/or Radiation therapy where the total Medicare adjusted costs can run over $100K. 20% of that is over $20K. Just the OOP max alone is better than Original Medicare.

I do think that we provide a service to our customers by educating them. However, in the end, it is my customer's decision, not mine as to which product will serve him best. On occasion I see someone who should be getting a Med Supp deciding on a MA. It just means I need to improve my educational presentation. But I would never recommend they stick with original medicare (and to date, I haven't had anyone make that choice).

 

[Newby]

JD, you are comparing the WORST MA plans for your example. Look at the Anthem plans and the Welborn plans.

I would definitely consider one of those myself when I reach Medicare. It would probably be the best health insurance plan I've ever had in my life. It would certainly be the least expensive.

We show all the options to each person and let them decide. Both systems are good. I just don't like the thought of being on GOVERNMENT healthcare which is what original Medicare is. I prefer that companies compete for my business. The only problem with that as I see it is an overload of government regulations and politicians screwing with everything.

 

[jdeasy]

JD, you are comparing the WORST MA plans for your example. Look at the Anthem plans and the Welborn plans.

I would definitely consider one of those myself when I reach Medicare. It would probably be the best health insurance plan I've ever had in my life. It would certainly be the least expensive.

We show all the options to each person and let them decide. Both systems are good. I just don't like the thought of being on GOVERNMENT healthcare which is what original Medicare is. I prefer that companies compete for my business. The only problem with that as I see it is an overload of government regulations and politicians screwing with everything.

The Anthem plan is terrible and they will pay outrageous amounts if they go out of network. It may be good for poor people, but if they are that poor they won't pay for their healthcare anyway.

The Welborn plan is the HMO. A person can buy a med sup for what it costs and not be tied to Welborn. I would agree that Anthem is a better option than Welborn. Still not better than just being on medicare alone.

I realize this is just my opinion, but it is an educated opinion. I was the top MA rep in this area for 3 different companies. I was certified by CMS to train agents to sell MA plans. I have seen the bills that people had to pay with MA plans. I have first hand knowledge about how difficult it is to deal a problem with the companies. I have had to deal with "customer service" people in another country that can't speak or understand english.

I do run into people sometimes that would be well served by an MA plan. Mostly that is people under age 65. I do refer those people to an MA specialist. I just got a card from him today thanking me for the referrals this year. I don't even know how many it was. I would guess less than 20.

I've had over 500 face to face meetings with prospects this year, so less than 20 times out of 500 I have seen a need to refer someone for MA plans. And most of those already had MA plans. They could just do better elsewhere.