I know that there are more than enough threads debating whether a med supp is better than an MA plan however I have never seen that compares a high deductible plan F VS a run of the mill advantage plan.
Heres my argument... A high deductible plan F with a $50 premium has a deductible of $1900 after which the beneficiary has no more deductibles, no more copayments,no more coinsurance and can go to any doctor or hospital in the country without a referal. While the beneficiary is within the deductible they are paying the 20% part b coinsurance, 135 deductible and part A deductibles. In arizona the average cost to see a doctor is about $100 so 100 x 20% equals an out of pocket of about $20 to see a doctor etc... If the part A deductible is 1068 for 60 days thats $17.8 dollars a day in the hospital(most MA plans are 200-$500 a day). The high deductible plan F would essentially give them a max out of pocket of $1900 which is much lower than most MA plans, and the out of pocket costs to see a doctor is very similar to most MA PPOs ($10-$20 copay) and 17.8 dollars per day in a hospital for 60 days a lot better than 2-$500 a day for most MA plans. So essentially I think that a $50 dollar premium high deductible plan F is better than just about any MA plan out there. Esepcially if the med supp company offers a free RX discount plan, vision, discounts, and hearig discounts.
It's better than an MA plan because it gives the person the freedom of seeing any Medicare provider. Your assessment of the hospital deductible though is incorrect. It's the FIRST $1,068, not spread out over 60 days.
Rick
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Yes I know but I can see how it may have sounded like I didn't. You pay 1068 whether your there for 1 day or 60 days. What I was trying to illustrate is that 1068 for 60 is a better rate by dividing out the 1068 over 60 days and that its a better rate than 200-500 a day on an advantage plan
I think the deductable for 2009 on a HD plan F is $2000. If the price is in fact $50 per month that's $600 per year reaching a total of $2600 if maxed out.
I have to hand it to you, I have never even given this a thought until now that is. You might just be on to something here!!
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Do MA plans include premiums in thier max out of pocket if there is a premium for the MA plan? I would guess that they do not include premiums... Maybe Im wrong.
Do MA plans include premiums in thier max out of pocket if there is a premium for the MA plan? I would guess that they do not include premiums... Maybe Im wrong.
NO. Premiums do not count towards the MOOP.
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Originally Posted by azmedsupagent
I know that there are more than enough threads debating whether a med supp is better than an MA plan however I have never seen that compares a high deductible plan F VS a run of the mill advantage plan.
Heres my argument... A high deductible plan F with a $50 premium has a deductible of $1900 after which the beneficiary has no more deductibles, no more copayments,no more coinsurance and can go to any doctor or hospital in the country without a referal. While the beneficiary is within the deductible they are paying the 20% part b coinsurance, 135 deductible and part A deductibles. In arizona the average cost to see a doctor is about $100 so 100 x 20% equals an out of pocket of about $20 to see a doctor etc... If the part A deductible is 1068 for 60 days thats $17.8 dollars a day in the hospital(most MA plans are 200-$500 a day). The high deductible plan F would essentially give them a max out of pocket of $1900 which is much lower than most MA plans, and the out of pocket costs to see a doctor is very similar to most MA PPOs ($10-$20 copay) and 17.8 dollars per day in a hospital for 60 days a lot better than 2-$500 a day for most MA plans. So essentially I think that a $50 dollar premium high deductible plan F is better than just about any MA plan out there. Esepcially if the med supp company offers a free RX discount plan, vision, discounts, and hearig discounts.
What are your thoughts?
Perhaps you did not see an earlier post where I indicated that to compare Med Sups to MA plans by cost analysis, one must add the MA Premium and the MOOP together to get a fair comparison. In the case of MAPDs, make sure you add the cost of the PDP to the Med Sup...
Bottom line though>>> Med Sup premium is a fixed cost. MA and MAPD plans are "pay as you go"... IOW, if you don't incur the expense, you don't incur the co-pay, so a healthier beneficiary will generally do better financially on a MA plan.
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Last edited by retread : 12-31-2008 at 11:30 PM.
Reason: Posts merged
HHHmmm indeed... Perhaps I did not see this earlier post you speak of. I understand what you are saying as far as a standard plan f VS a standard MA plan however I am not comparing a standard plan F. In this thread we are comparing a high deductible plan F with a $50 premium and it sounds like you are talking about MA Vs a standard plan F med supp. What are your thoughts on a high deductible F VS a typical MA?
Some HD F plans offer an enhanced rider for office visits ($5 co pay), vision and so on. In CA, Anthem has SmartChoice standard and both a plus and preferred option. SmartChoice is the HD F, Plus includes a LTCi rider, and Preferred has no LTCi rider but does cover office visits $5 co pay, vision and chiropractic outside of the deductible.
In my area, it runs very nice for Age 65:
SmartChoice $27 a month
SmartChoice Preferred $45 a month
SmartChoice Plus $66 a month
I don't really like the Plus or any of the AdvantageCare F riders for LTCi as they have 1 year elimination period then only one year of benefit. You can do better for your client with John Hancock.
So, the basic Smartchoice will run $324 a year for premium with a $1900 deductible (it's 1900 not 2000 for 2009).
Total out of pocket.........$2224 (premium + deductible)
Add in a PDP like that which comes with Freedom Blue $360
Total HD F with PDP would be $2524 give or take.
MAPD at zero premium (Freedom Blue) costs $0 premium with $4,000 OOPM. Includes PDP so no extra charge.
HD F with PDP................. $2524 out of pocket max
HD F w/rider with PDP........$2800 out of pocket max
MAPD..............................$4,000 out of pocket max
By the numbers, either HD F will provide the client with a less expensive coverage, depending on utilization.
With full utilization, HD F is a better choice. With low utilization, MAPD might be cheaper out of their pocket.
Also, I believe HD F can be used outside of CA. MAPD with Anthem (Freedom Blue) cannot be used across the state line (except emergencies I'm sure would be covered).
MAPD with Anthem (Freedom Blue) cannot be used across the state line.
Since the Freedom Blue will pay both in and out of network (medicare reimbursement limits), how do you figure it wouldn't pay in other states? Also, all MAPD plans cover at the very least emergency coverage anywhere in the US. I believe this might be one of the rare times you are incorrect.
Since the Freedom Blue will pay both in and out of network (medicare reimbursement limits), how do you figure it wouldn't pay in other states? Also, all MAPD plans cover at the very least emergency coverage anywhere in the US. I believe this might be one of the rare times you are incorrect.
Rick
I assume that emergencies would always be covered since there really is no control over when and where they occur or the closest facility available.
As to the other, I was specifically told by Anthem last year, do not try and use this plan outside CA. It is state-specific according to senior services. Unless that has changed this year, that is what I got direct from the horse's mouth on Freedom Blue.
I believe I asked it in relation to someone living in another state part time during the year. They told me no way on coverage outside of CA on Freedom Blue.
I just sent this question to the RSM, I will let you know the response as soon as I get it.
Being Friday at 5 PM, let's not count on getting an answer too quick.
I believe it has to do with the RPPO and LPPO designations for Anthem MA PPO plans. Freedom Blue is an RPPO, meaning regional PPO. I think that means the PPO only extends to the covered region (in this case CA only). Anthem also sells LPPO in other states which is LOCAL PPO, which restricts providers to a much smaller area than the RPPO (smaller service selection area within a state).
If a person just wants catastophic coverage, then sell HD F. If they would rather have a MAPD, let them have it.
You are there to educate the prospect about the options they have and help them decide which would be better for their circumstances, not what you believe they should have.
It has a lot to do with their finances also. With an MA, if they don't use it, they don't lose it.
I have found that most people want the small stuff covered also.
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"People who think they know it all really annoy those of us who do"
Being Friday at 5 PM, let's not count on getting an answer too quick.
I believe it has to do with the RPPO and LPPO designations for Anthem MA PPO plans. Freedom Blue is an RPPO, meaning regional PPO. I think that means the PPO only extends to the covered region (in this case CA only). Anthem also sells LPPO in other states which is LOCAL PPO, which restricts providers to a much smaller area than the RPPO (smaller service selection area within a state).
Let's see if you have guts to make a bet with me. I'll bet you not one, but two pints of Guinness that you're wrong and I'm right.
By the way, the brochure says you can see any doctor in or out of network. In addition, the RPPO/LPPO is only based upon the service area for eligibility to join, not who you can or cannot see.
I realize you're new to insurance so I'll be kind.
Let's see if you have guts to make a bet with me. I'll bet you not one, but two pints of Guinness that you're wrong and I'm right.
By the way, the brochure says you can see any doctor in or out of network. In addition, the RPPO/LPPO is only based upon the service area for eligibility to join, not who you can or cannot see.
I realize you're new to insurance so I'll be kind.
Rick
I am basing it on what Senior Sales Support told me. If it is, in fact, incorrect, then they gave bad information.
However, if in fact what they told me is incorrect, I will buy you two Guinnesses for proving the carrier wrong.
RABBI,
Yes, however part B would do a good job covering the small stuff while still within the deductible. I.E. A typicall doctor visit in AZ runs about $100 so a 20% coinsurance would be an out of pocket of $20. This is very comparable to an average MA. All the while if something catastrophic does happen the max out of pocket would be less than with an average MA... Correct...?
.... the RPPO/LPPO is only based upon the service area for eligibility to join, not who you can or cannot see.
Rick, it is amazing that there are some agents that don't know this. Not only are we required to cite the eligibility rules in our sleep, but anyone reading the "Please read and sign agreement" paragraph (which I do for them every sale) would have to understand that there is no network when it comes to an emergency or urgent care.
Did these guys just by coincidence miss the same question on their certification tests?
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I was getting ready to bash the slow learners again when I stopped to recognize that they don't have the advantage I have. I live a few blocks from the state line that splits a metropolitan area. PPOs around here range from some plans whose service areas cover both sides of the state line to some that are only one side of the state line or the other. Regardless of the "service area", any beneficiary enrolled in any PPO plan (all plans, not just BCBS or Coventry, etc.):
1) can go either side of the state line on self-referral if the provider is in the network directory and receive in-network coverage.
2) can go anywhere in the U.S. for self-referral routine care, but will be subject to out-of-network (OON) charges (20% co-insurance vs network co-pay).
3) will be covered anywhere in the U.S. in or out of network for urgent or emergency care for the plan co-pay for those services.
4) can go across the US border into Canada or Mexico if, at the time of the emergency the nearest hospital is across the border.
The big issue in selling plans in my area is the provider directory. Big plans like Coventry and Humana cover almost all hospitals in the area, and quite a few doctors are also in both of those plan networks, so the difference in the network is not significant. The smaller plans have a smaller number of providers, making OON more of a factor... But no MA member is restricted to a provider choice one side of the state line or the other regardless of his plan's service area as long as that provider is in his plan's provider directory (network).
The "service area" applies to enrollment eligibility, not provider access (per se).
(I suppose these slow learners don't know that ESRD is covered in MA plans if contracted AFTER ENROLLMENT either.)
I only do IFP and Group, not Medicare. Sorry, I have never taken a certification test nor have any interest in selling in the senior market. Just trying to learn something.
High Deductible Plan F VS MA Plan
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