Mental Health Care + Medicare Advantage

[Chazm]

With a MAPD PPO, the doctor has to agree to the terms and conditions as well.

that said, if you go out of network and the doctor doesn’t accept the terms of the plan, you can file the claim yourself.

 

[20th Maine]

With a MAPD PPO, the doctor has to agree to the terms and conditions as well.

that said, if you go out of network and the doctor doesn’t accept the terms of the plan, you can file the claim yourself.

In this market, nearly all MDs are employed by Hospitals, so MDs have to take whatever plans dictated by hospital

My MAPD carrier of choice--the HMO and PPO networks are--EVERY hospital in the metro.

Yeah if they wanna see Sister Makeeba Gatumbo the Voodoo priestess the MAPD wont cover it

Have had several clients that were traveling out of the US became ill and MAPD covered it--Supps dont

 

[rmhaire]

Unless it’s totally different in other areas of the U.S it’s just Med Sup agents thinking of anything they can to scare clients out of MA plans.

Trust me. It is totally different. I'm guessing that you're in a larger metro area. Run something in South Georgia.

As far as a 3500 ,ax OOP. It's double that and more down here.

it's a different world down here.

 

[20th Maine]

Trust me. It is totally different. I'm guessing that you're in a larger metro area. Run something in South Georgia.

As far as a 3500 ,ax OOP. It's double that and more down here.

it's a different world down here.

If it were just for MY benefit Med supps would be all I would sell. Zero service time. But I give clients the entire story and let them choose.

 

[Chazm]

If it were just for MY benefit Med supps would be all I would sell. Zero service time. But I give clients the entire story and let them choose.

Med supp clients are just as much service, if not more for me. They have part D that you have to include in service.

 

[sshafran]

They will be much better off paying 2500.00 for a Med Sup and then a crappy drug plan with a 505 deductible and lose all their dental, vision, OTC, gym, etc which easily takes them to paying well over the 3500.00 max OOP on an MA plan.
But at least their Dr doesn’t have to get prior auth for an MRI. Ha.

It is absolutely a fact that the PDP is inferior in many cases. I'd venture to say 65% of the time conservatively.

Sometimes the variance is so great it really makes selling the med supp difficult.

I now have a new sheet I developed (simple) that just puts estimates we know side-by-side.

The problem is you can't estimate medical out of pocket - so we discuss that via summary of benefits for the MA

Usually, though, many times the feedback is "wow it would take a lot of copays to add up to the savings all things considered."

$0 premium with $2k in dental (not tiered like 50% towards major - just a bucket), superior Rx coverage, $5 for PCP, max OOP $4,000-5,000; save $38 on the monthly gym fee... No $505 deductible...

 

[rmhaire]

Med supp clients are just as much service, if not more for me. They have part D that you have to include in service.

OM is much easier for me. I'm fortunate to be located in the deep south. Plenty of Bible toting conservatives down here. And they don't like the Feds messing with their health care.

Makes my job a little easier. I give them a choice. The majority choose OM.

And as far as us southerners go, the last time the Feds seriously pissed us off we went out and started a war.

 

[somarco]

With a MAPD PPO, the doctor has to agree to the terms and conditions as well.

that said, if you go out of network and the doctor doesn’t accept the terms of the plan, you can file the claim yourself.

When the PH files the claim direct does the carrier reimburse the PH or pay the provider?

 

[Packerland]

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Trust me. It is totally different. I'm guessing that you're in a larger metro area. Run something in South Georgia.

As far as a 3500 ,ax OOP. It's double that and more down here.

it's a different world down here.

Have ever considered an HI and or critical illness policy added to an MA to minimize MOP risk .. usually less than $45 per month

 

[rmhaire]

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Have ever considered an HI and or critical illness policy added to an MA to minimize MOP risk .. usually less than $45 per month

HI is almost automatic when I write MA. I give them all the choice.

CI not so much.