Med Advantage Question (newby)

[somarco]

This person has a GROUP (self funded) MA plan. Open enrollment going on now. This is not a traditional MA plan.

 

[TwoCents]

Anyone correct me if I'm wrong. When a beneficiary chooses a Medicare Advantage plan they come off original Medicare. The beneficiary can change back to Original Medicare with no underwriting during the free look period, and if after 60 days of effective date, they must wait until nearest open enrollment period to change with no health underwriting. They are allowed back on original Medicare with a January 1st effective date and can apply for a supplement. In this case the woman has to do this during the upcoming open enrollment. I have helped individuals twice doing this. Had to deal with an the legal department with Humana once because and underwriting supervisor said it could not be done. Some pretty young agent around my neck of the woods talked the husband into an MA while full well knowing his wife had Alzheimers.

I don't even know where to begin on how to correct these statements. Go back to Original Medicare with no underwriting? What the hell does underwriting have to do with OM? Free look period applies to Med Supp, not Medicare Advantage. Start over. Try again. Sheesh.

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MA companies will make sure you understand that an enrollee in fact does NOT come off original Medicare. They are still a part of the system but the med advantage company pays the doctors rather than Medicare.

You have ONE year to leave a med advantage plan and return to original Medicare without part c, during any time during that first 12 months in a part c plan.

I would qualify your statement by saying only those who enrolled into an MA during their Age 65 ICEP qualify to be able to leave the MA during the first 12 months in order to return to Original Medicare.

 

[FRJ]

BlueMedicare Regional PPO is the best option for nationwide network.

CMS Infraction!

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You need to go to medicare.gov and do a plan search for this prospect's home residence...you'll get all your premium answers there for MA plans. Also sounds like you are not certified to sell MA plans so you're in way over your head. On the plus side, this lady sounds like a prime med sup prospect.

The questions have already been answered for you.
Aetna, humana and UHC have ppo's at $0 premium. Florida blue ppo is $41 I believe.

 

[Tim Resnick]

As someone who spends a few months a year in California and lives in Florida (and have a bunch of CA clients all over the state) I can tell you that the approach is 100% WRONG.

None of the MAPD PPO plans have comparable networks in California, where virtually everything is an HMO and regional rather than statewide

The Florida Blue Regional PPO MAPD is awful and is a terrible choice for anyone let alone someone who travels.

Your client is paying $600 a month, she needs a Medicare Supplement and Part D plan. If she wants a lower premium, an HDF or Plan K would be OK or just get a Plan F plus drug plan and her premium is 50% lower than her current situation.

You've been a newbie for over a year, maybe it's time to actually learn something.

Thanks FLM

No kidding, So the local Humana Regional MA PPO plan would be insufficient for someone traveling from Fla.? Thanks for the info. Humana advertises that this plan would cover those in CA., but maybe they are exaggerating?---I don't know.

PS. She's not my client. As i said originally, she's my neighbor. I should also preface all this by saying i am licensed but don't hold myself out as an agent. I'm full-time college student but don't advertise myself as an agent. This conversation just came up and I thought it would be good info to share with the agents).

Thanks again!

 

[FLM2]

Thanks FLM

No kidding, So the local Humana Regional MA PPO plan would be insufficient for someone traveling from Fla.? Thanks for the info. Humana advertises that this plan would cover those in CA., but maybe they are exaggerating?---I don't know.

PS. She's not my client. As i said originally, she's my neighbor. I should also preface all this by saying i am licensed but don't hold myself out as an agent. I'm full-time college student but don't advertise myself as an agent. This conversation just came up and I thought it would be good info to share with the agents).

Thanks again!

The provider would have to be in network for a similar plan out of state for the PPO to cover it as In Network-I have FL clients who summer in Minnesota and it works fine but Humana does not offer PPO plans in California so it's highly doubtful that someone would find a doctor willing to take the plan in a non-emergency situation.

I've never seen a Humana advertisement supporting your claim, here is the exact wording from the ANOC for their MAPD Choice PPO:
Section 2.2
Getting care using our plan's optional visitor/traveler benefit
You may get care when you are outside the service area. You may need to pay higher cost-sharing for routine care from non-network providers, but you won't pay extra in a medical emergency or if your care is urgently needed. If you have questions about your medical costs when you travel, please call Customer Care.

You have access to providers in the Humana Choice network in all of our service areas. If you need urgently needed care or non-emergency care while traveling outside the plan's service area, call Customer Care. We'll tell you whether you're in one of our other Humana Choice service areas and help you find an in-network provider. You may see any provider you choose, but your out-of-pocket costs may be higher if you see an out-of-network provider.
If you are in another Humana Choice service area and are using your U.S. Travel Benefit, you can be outside your service area for up to 12 months.

California is very regional, there may be some areas where the PPO could work and many where it won't, it still doesn't change the fact that she needs a Med Supp

 

[keith48]

I don't even know where to begin on how to correct these statements. Go back to Original Medicare with no underwriting? What the hell does underwriting have to do with OM? Free look period applies to Med Supp, not Medicare Advantage. Start over. Try again. Sheesh.

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I would qualify your statement by saying only those who enrolled into an MA during their Age 65 ICEP qualify to be able to leave the MA during the first 12 months in order to return to Original Medicare.

Not true. You can return to original Medicare during AEP (Oct 15- Dec 7) with an effective date of Jan 1 of the next year, or during the Disenrollment Period which runs from January 1 through Feb 14 each year.

If you are referring to returning to a Medigap plan with no underwriting, then your statement is only half true. That is one of TWO ways that you can move to original Medicare with a Medigap plan with no underwriting.

The second option is if you dropped a Medigap plan to go to Medicare Advantage and want to return to your Medigap plan with original Medicare. you can do that within the first 12 months of leaving the Medigap plan. Both of these options are referred to as your Trial Right.

If your previous plan is still available with the same company, you can return to that plan with no underwriting. If it is not, you will be allowed to choose a Medigap Plan A, B, C, F, K, or L that is sold by any insurance company in your state with no underwriting. You cannot choose a Plan D, G, M, or N under this option. I just published an article on my website this week talking about the Medicare Advantage Trial Right options, so it is still fresh in my mind. Hope this helps.