Medicare Advantage Plans being dropped left and right

[Midlevel]

It's what a lot of these supplement-only guys don't understand. Some of these companies have INSANELY good networks, nowadays. My guess is, because these guys never write Advantage plans, they think it's still 2007, where 5 doctors and 4 hospitals fell in-network and the only thing available were HMO's.

My area.....Aetna. 100% of hospitals are in-network in the region. I look up 100 doctors, 95 are in-network, on average. It's to the point where I'm shocked when I see a doctor who isn't in-network, and my broker manager always says to reach out to him when it happens so that they can reach out and get them in-network.

If a doctor is out-of-network, guess what? Doesn't really matter. It's a PPO. Instead of paying $30 when they see them, they pay $40. Holy shit, the HORROR, I tell you! Not a.....(((GASP))) $10 difference!!!!

Most of the Med Sup only agents in my area are financial advisors or sell P&C too. All they ever offered was Mutual of Omaha G plan. Most of them are now sending their Medicare clients to me bc they are getting asked about all the stuff they see on TV etc. used to be they would just bash MA and people would listen. Those days are over since MA ads are everywhere and they talk to their friends who have MA and love it. My business has exploded these last 3 years bc people actually want to see all their options in an unbiased way and the Med Sup only’s just don’t want to deal with it anymore.

 

[AgentGeneral]

Yes. Our local local largest p&c sends me referrals now. We have been long time loyal customers of theirs with so much insurance though them. Gave them a bunch of my cards and that's where a good number of my referrals come from. They had one guy there that is about to retire and he has only done supps for years.


Many people jumping ship off Fs and Gs

Luckily we do have a no shortage of offerings and in network docs, esp for the main carriers.

I will say though with Aetna, yes all our hospitals take it, but some docs are not in network. I almost learned that the hard way. Luckily I was calling in advance and double checking 2022 going into 2023. I learned about the credentialing process docs go through and why they do what they do. Some of our local docs dropped Aetna, not for any other reason according to them other than there weren't enough patients on it to keep credentialing. I was told by one that this one in particular was a PITA for a few of the docs around here with large patient pools on the others.

Almost all our docs take Humana, BCBS, BCN, Priority and Hap, so I just stick with those. Keep it simple. And just check each year. I know UHC is large in many areas bt that ones off the table here too.

It isn't 2007, let alone 1999 anymore. Times are changing.

 

[Bevo]

You're all trying to bash Medicare Advantage as a business tactic and all you're doing is drawing insane scrutiny to our entire industry because you're sensationalizing things.

So it's just agents that bash Medicare Advantage drawing massive scrutiny to MAPDs? Nothing else going on lately you can think of?

 

[goillini52]

Only one I have seen was BCBS and that’s been that way for awhile. I think because they are BC they think they can get away with it and people will still buy. Not to say it couldn’t happen in 2025 when PDP’s change dramatically due to new rules. Something has to give with the drug plans.

Besides BCBS,,,,AARP, UHC, Humana, Molina and Wellcare have MAPD plans with full or partial deductibles.

 

[Midlevel]

Besides BCBS,,,,AARP, UHC, Humana, Molina and Wellcare have MAPD plans with full or partial deductibles.

Ok, must be the location. All of mine other then BCBS are 0.00 deductible on all tiers. The pdp part of MA's are always really good bc they don't want someone to not take the plan due to a prescription.

 

[sshafran]

My book is 100% OM + Medigap, yet I get a handful of calls from mostly new clients who are told by office staff "We don't take your plan".

Even though I tell them the doc does not need their Medigap card, they will still show it along with their Medicare card. Sometimes the office hands the Medigap card back because that plan isn't listed in our "system".

Last year a new client visited a providers office, owned by a large local hospital, and was told they had to pay a copay up front because the carrier isn't on their list. When the client called me I looked on the website and it clearly states they accept ALL MEDICARE SUPPLEMENT PLANS but does have a list of MA plans they don't accept.

The client goes back to the office and takes a printout from the website and was told they didn't know her card was for a supplement plan.

A few years back, similar problem. The Anthem contract with a local hospital was non-renewed and the business office sent a memo to all departments, free standing clinics and physician groups owned by the hospital, instructing them not to accept patients with Anthem MA plans.

A couple called in January frantically wanting me to change them to an Aetna MA plan because the office staff told them they had to change because they were no longer taking Anthem plans.

The memo clearly stated the hospital and subsidiaries would not accept patients with Anthem MA plans until further notice. There was no mention of Anthem supplement plans, only MA, yet they were refused. I called the office manager and was told the same thing . . . no Anthem plans would be accepted. I had to get someone from Anthem to contact the provider office manager and the hospital business office manager to get this straightened out.

This rarely happens, but still it is something I have to deal with from time to time.

And yet, there are agents here that state their MA clients have NEVER been refused by a provider office.

I find that difficult to accept.

A similar thing is going on here in NC with UHC and UNC (Ah, UNC... i.e. the University of North Carolina - and I can still hear the announcer at the Bulls game as the GOAT comes out of the tunnel: - from North. Carolina - Michael.... Jordan!)

Anyway, I have a heavy UHC book here in NC and UNC sent out letters to everyone and it hit the news that they "might not renew" with UHC (MAPDs) -- so the calls come in from the UHC Med Supps - same conversation as you had to have with your Anthem med supp. I only had one lady basically not believe me. Ok then, don't believe me.... I'm not wrong.

 

[kak6407]

A similar thing is going on here in NC with UHC and UNC (Ah, UNC... i.e. the University of North Carolina - and I can still hear the announcer at the Bulls game as the GOAT comes out of the tunnel: - from North. Carolina - Michael.... Jordan!)

Anyway, I have a heavy UHC book here in NC and UNC sent out letters to everyone and it hit the news that they "might not renew" with UHC (MAPDs) -- so the calls come in from the UHC Med Supps - same conversation as you had to have with your Anthem med supp. I only had one lady basically not believe me. Ok then, don't believe me.... I'm not wrong.

Yep same. So annoying. Also happening in SC with Prism Health I believe. You would think these hospitals could word the freaking letter better and state UHC Medicare Advantage or individual/employer based health plans. I need a templated email to send to the med sup clients that have called. My MAPD clients with UHC are all moving

 

[Chazm]

Yep same. So annoying. Also happening in SC with Prism Health I believe. You would think these hospitals could word the freaking letter better and state UHC Medicare Advantage or individual/employer based health plans. I need a templated email to send to the med sup clients that have called. My MAPD clients with UHC are all moving

They don’t want to word it better. It’s posturing to get them to come to better terms in their favor. The more they get people to call UHC to complain, the better.

 

[somarco]

They don’t want to word it better. It’s posturing to get them to come to better terms in their favor. The more they get people to call UHC to complain, the better.

BOTH sides posture in press releases, making it SEEM like the hospital may go bankrupt if they can't get the reimbursement increase they want . . . and at the other end of the table the carrier claims they are the ones aggrieved if they agree to pay more to providers.

The truth is, in most situations BOTH sides need the other to maintain patient and policyholder traffic flowing. Patients will usually not go to what is perceived as a lower quality provider for care, and policyholders are usually locked in to their MAPD plan until the next open enrollment.

Stalemate that usually get's resolved in a few days to weeks. Sometimes the disputes will drag on for day with each side pummeling the other in the press. And in some situations, the disagreement is permanent.

During the battle the downstream providers are generally hurt more due to significant loss of patient traffic. Hospitals can usually weather the storm better than front line physician practices with skinny profit margins.

 

[rmhaire]

Stalemate that usually get's resolved in a few days to weeks. Sometimes the disputes will drag on for day with each side pummeling the other in the press. And in some situations, the disagreement is permanent.

Sounds like Phoebe and UHC.