MAPD Plans Vs. Med Supp
- Thread starter jmarkk1
- Start date
Aside from Chazm's mention, what seems to be getting lost in this discussion is the one-size-does-NOT-fit-all nature of MAPDs.
Med supps are easy. They're standardized so a Plan F is a Plan F. The only variation is the price.
MAPDs are the opposite; virtually every MAPD is different. With Medicare Advantage, the company is free to design a plan where everything (copays, network, MOOP, etc.) can be different with the only limitation that the plan must be "actuarially equivalent" to Medicare alone. Actuarially equivalent doesn't mean the hospital copay, for example, can't be higher than the Medicare Part A deductible--and all too often it is.
MAPDs in some states are significantly different--better or worse--than other states. They also can vary a lot from county to county. Florida might be an example of a state with good MAPD plans (large number of low and $0 premium MAPD choices and very high med supp rates). According to JD, Kentucky might be an example of a state with not so good MAPD plans.
In my home state of Michigan, there is a huge variation from county to county. Overall, I consider the state to be weak for MAPDs but there is a three county area with multiple $0 premium and low premium plans, some with good copays and MOOP. And pretty much all the non-$0 plans that are available in those counties have lower premiums than the rest of the state--if they are even available at all outside the region.
Hospital copays across all plans range from $1575 ($225/day x 7 days) to $375 ($75/day x 5 days).
So you can't make a sweeping statement that an MAPD is better or worse for everyone everywhere, even though it may be true in their particular state and county.
Med supps are easy. They're standardized so a Plan F is a Plan F. The only variation is the price.
MAPDs are the opposite; virtually every MAPD is different. With Medicare Advantage, the company is free to design a plan where everything (copays, network, MOOP, etc.) can be different with the only limitation that the plan must be "actuarially equivalent" to Medicare alone. Actuarially equivalent doesn't mean the hospital copay, for example, can't be higher than the Medicare Part A deductible--and all too often it is.
MAPDs in some states are significantly different--better or worse--than other states. They also can vary a lot from county to county. Florida might be an example of a state with good MAPD plans (large number of low and $0 premium MAPD choices and very high med supp rates). According to JD, Kentucky might be an example of a state with not so good MAPD plans.
In my home state of Michigan, there is a huge variation from county to county. Overall, I consider the state to be weak for MAPDs but there is a three county area with multiple $0 premium and low premium plans, some with good copays and MOOP. And pretty much all the non-$0 plans that are available in those counties have lower premiums than the rest of the state--if they are even available at all outside the region.
Hospital copays across all plans range from $1575 ($225/day x 7 days) to $375 ($75/day x 5 days).
So you can't make a sweeping statement that an MAPD is better or worse for everyone everywhere, even though it may be true in their particular state and county.
- 1,070
The future has Medicare being privatized, (trillion dollars a year lost to fraud and waste) and the MA is already in place and just needs tweaking. Sooner than that we'll see the F plan disappear and the N type plan, with dr. copay will be the model to cut down on unnecessary dr visits.
I explain the differences between a sup and MA. If they can comfortably afford the sup, that's what they get. I get plenty of MA business from 75 + yr olds who can't afford the sup premium anymore. If they take the MA to begin with and save the premium a sup would cost in a special account, they will have the money if crisis hits. If it never happens, they kept the money instead of giving it to the ins. co. MA plans are about shared risk. Buying an F plan is transferring all the risk which is expensive, sort of like having a zero deductible on your car and house. The fact is the sups are draining Medicare because of overuse by the insured, running to the dr constantly and by abuse by the providers since the insured doesn't pay anything, the dr keeps them coming back too often and performing unnecessary tests. I'll take a MAPD PPO and share the risk and save my monthly premiums for a better retirement. If my MOOP is $5k, I would be paying that every 18-24 months in sup & D premiums. There is an outside chance we will take HDF - maybe but only because we will be full time travelling in a motor home. Not sure yet.
The main point is to explain the upsides and downsides to both products and let the prospect decide. Works well for me.
I explain the differences between a sup and MA. If they can comfortably afford the sup, that's what they get. I get plenty of MA business from 75 + yr olds who can't afford the sup premium anymore. If they take the MA to begin with and save the premium a sup would cost in a special account, they will have the money if crisis hits. If it never happens, they kept the money instead of giving it to the ins. co. MA plans are about shared risk. Buying an F plan is transferring all the risk which is expensive, sort of like having a zero deductible on your car and house. The fact is the sups are draining Medicare because of overuse by the insured, running to the dr constantly and by abuse by the providers since the insured doesn't pay anything, the dr keeps them coming back too often and performing unnecessary tests. I'll take a MAPD PPO and share the risk and save my monthly premiums for a better retirement. If my MOOP is $5k, I would be paying that every 18-24 months in sup & D premiums. There is an outside chance we will take HDF - maybe but only because we will be full time travelling in a motor home. Not sure yet.
The main point is to explain the upsides and downsides to both products and let the prospect decide. Works well for me.
Last edited:
Frank,
I did understand what you were saying people think they are never going to get sick or get cancer, etc. I guess I also took it as saying MA Plans are like dropping your insurance completely and I just don't think they are that bad.
Sorry I misunderstood your intent.
I did understand what you were saying people think they are never going to get sick or get cancer, etc. I guess I also took it as saying MA Plans are like dropping your insurance completely and I just don't think they are that bad.
Sorry I misunderstood your intent.
- 16,906
Do ANY of us under age 65 agents have health insurance that is as good as a decent MAPD?
I know I don't.
So saying they are no good doesn't sound too smart to me.
They are frustrating for the agents selling them. But I would take one in a heartbeat if I could get one.
I know I don't.
So saying they are no good doesn't sound too smart to me.
They are frustrating for the agents selling them. But I would take one in a heartbeat if I could get one.
- 687
- 15,319
Some of the same agents that advocate HSA plans as being a good value have decided that MA plans are not a good value.
I don't quite understand why saving $2K a year on IFP by using an HSA is good but the same savings on an MA compared to a supp is bad.
This AEP I sold 60% MA and 40% supps. Different plans for different people. That's called being an insurance agent.
Rick
I don't quite understand why saving $2K a year on IFP by using an HSA is good but the same savings on an MA compared to a supp is bad.
This AEP I sold 60% MA and 40% supps. Different plans for different people. That's called being an insurance agent.
Rick
- 11,280
- 397
Under 65 I am not on a fixed income. If I end up with a 12K OOP medical bill (which is my current OOP max) I have the means to pay it off (if not right away, over time). For many people on a fixed income, not so. If you work extensively with this demographic, you know. You have to be very careful when you do not have the means to just go get another job to make some extra money.
I have not said that MAs don't have their place. They do. They are certainly better than just using original Medicare (which was advocated by someone else earlier) because of the OOP max. Even a relatively high OOP max ($6,500) is better than not having one. This is why I will sell it if the Med Supp doesn't fit.
It's not that they're "no good", just that Med Supp is frequently better.
