Evercare MAPD Plan for duel eligibles

jereri · 05-13-2007, 11:14 PM

i am getting appointed to sell this product. has anyone had any success or challenges selling this plan they would be willing to share?

retread · 05-15-2007, 05:47 PM

(Pardon me, but it is "dual", as in two, not "duel" as in a fight, isn't it?)

jereri · 05-15-2007, 09:34 PM

you are probably correct but then again im no super genius when it comes to spelling. have you sold the Evercare product?

retread · 05-16-2007, 06:20 PM

No, but I have a couple of enrollment kits. I just haven't had the opportunity to study the product and find a market it would be suitable for. That's one of the reasons I am lurking here. Would also be interested in any comments.

wilkin · 05-16-2007, 09:10 PM

I've sold a couple dozen MA plans but none like Evercare. I think it could be a good area to specialize in with lots of potential for referrals from low income housing managers, senior centers, etc. What is the commission for Evercare?
-Bill

policy doctor · 05-16-2007, 09:32 PM

I am looking over these products now and unless I'm missing something here, I don't see where they're so great.

The OOP is higher than other carriers, and the co-pays to the client is initially higher also which means that tab will run up quick to their MAX for the year. So for those clients who cannot afford a Med Supp, they will have a large bill to pay if they have hospital /surgical needs.

I also don't understand the need for such a variety of plans. Here in metro Atlanta we have 5 immediate counties, then the surrounding counties for a total of 13. I think I counted 7 different plans for these areas....do I have time for all this?

I also noticed that their SNP program is a network program. So if they don't visit the drs/hosp in that directory, they (client) will pay 30% of that hosp cost, but it doesn't say how much for the dr. I think I will order that evidence of coverage on these plans. Even though every medical plan has exclusions and limitations, it is good to be familiar beforehand and not get surprised.

jereri · 05-16-2007, 11:21 PM

my understanding is that Evercare has a product designed specifically for medicaid/medicare clients. like traditional medicaid there are no copays for the client but they are given additional benefits medicare/medicaid doesnt provide, for example, transportation, dental benefits, eyeglasses, hearing aids, a nurse care manager etc... seems like a no lose situation for the medicaid client but perhaps i am missing something

jereri · 05-16-2007, 11:23 PM

by the way, the FMO i have signed up with is paying $400 per application

GreenSky · 05-16-2007, 11:29 PM

The drawback is that you take a Medi-Medi client and place he or she into managed care. If the doctor would prefer to be capitated inside the HMO, then fine. But to move an individual from a fee-for-service plan into an HMO may significantly reduce the choice of provider.

It is true that the copays, etc. are reduced to zero, but perhaps the doctor prefers fee for service.

While I have enrolled plenty of people into MA HMO plans (used to work for Secure Horizons), my personal opinion of these types of plans is that they are only for people with no other alternative.

That being said, if you can get their provider to agree that the HMO is a better alternative AND can get referrals, you're gold! But without the participation of the doctor, I think you're restricting you clients' ability to receive medical care.

Rick

retread · 05-17-2007, 11:53 AM

Quote:

Originally Posted by jereri

my understanding is that Evercare has a product designed specifically for medicaid/medicare clients. like traditional medicaid there are no copays for the client but they are given additional benefits medicare/medicaid doesnt provide, for example, transportation, dental benefits, eyeglasses, hearing aids, a nurse care manager etc... seems like a no lose situation for the medicaid client but perhaps i am missing something

Very good point! I know I run into many rural folk that have need of a managed care plan.

It is always necessary to make sure they won't lose their primary care doctor, but often these doctors are in short supply in rural areas, and will accept coverage. You just need to be careful. A quick call to the doctor can possibly resolve that issue.

There are other clients that have no doctor at all! For these people, this plan could be a God-send. As always, no plan is perfect, and not all plans are good for all people.

g1bass · 05-17-2007, 03:12 PM

I have sold both Chronic Illness and Dual products and think they arent too bad,this being predicated on the extensiveness of the network in your area. Also remember this, when dealing with the elderly poor, you are looking at a group that is not so great at changing doctors or locating network doctors. " I want to see Dr Billsalot cos I been seein him for 20yrs, I don't want to change." There is a LOT of service work maintaining these customers, a LOT! Typically if a pharmacy declines a drug or their copays are not reflecting LIS or if the PBM and Insurance company have a disconnect you end up having to sort it for them.

policy doctor · 05-17-2007, 07:30 PM

That's What I wanted to hear! The am't of service work involved. Fine if the ins company does this; but what agent can afford to field a bunch of calls during the business day!

jereri · 05-18-2007, 12:37 AM

who has time to field all these service calls during the business day. i will be too busy selling zero premium final expense insurance from the mystery company with the mystery investor with the mysterious insurable interest...

g1bass · 05-18-2007, 09:18 AM

When I say a lot, I mean a LOT! I receive on an average 10 calls from duals every week, requesting service and for the most part it can't be handled from my office, it requires a special trip. Some of these people simply can't do for themselves, some are simply lonely, some are just too lazy and refuse to help themselves. I like the products and feel they do benefit people and Evercare even helps provide transportation to doctors appointments and a nurse co-ordinator, but many of these people are way beyond needy, and I'm a soft touch.

Googly Moogly · 09-20-2007, 11:10 PM

I have been enrolled about 20 people this month on Evercare. It has the largest network of doctors in my area and really is my fall back plan. I usually try to put them on another plan which has a larger formulary and a few extra benefits but, the network is not as large. So far the Evercare plan for me is very easy to sell.

Googly Moogly · 09-20-2007, 11:13 PM

Another plan that is nice is the Evercare MP plan which is for clients with a long term illness such as Hypertension, Diabetes, COPD, etc. Check it out. It can be used year round and for anybody....not just Medi/Medi. They are allowed a one time special enrollement for this plan due to their condition. It has a 700 Max OOP. Great plan for sick people.

Winter · 09-21-2007, 09:27 AM

Quote:

Originally Posted by Googly Moogly

I have been enrolled about 20 people this month on Evercare. It has the largest network of doctors in my area and really is my fall back plan. I usually try to put them on another plan which has a larger formulary and a few extra benefits but, the network is not as large. So far the Evercare plan for me is very easy to sell.

Whats the commission on that type of sale?

Winter

Googly Moogly · 09-21-2007, 11:11 AM