Medicare Supplements Vs. Medicare Advantage

Jessica Durphy · 10-17-2009, 02:38 AM

You know, I'm kinda new to this whole thing! But I've found a passion for the Senior Market, and in my very RURAL area, there are no other agents selling Medicare Supps or MA's. I just need to know, WHAT IS BETTER??? Some say, MA are stupid and a waste of time and money! But they tend to cover things that Med Supps won't! I deal with a company called New Era, their part C plan doesn't have any coverage for Vision, Dental, or Prescriptions~ MA plans do! New Era is the only company that I work with thus far for the Supplements.... On the other hand, with MA, I am appointed with Highmark, and am in the process of getting appointed with Mutual of Omaha and AARP.

I think the Seniors like that the MA plans have the prescription drug built into the plan, they like the fact that they can get at least 1 cleaning (dental exam) a year, and hearing aid coverage, vision coverage...

I think both have their pros and cons, but can someone give me a little insight on why you think the one is better than the other?

My goal is to make money, yet do what is in the best interest of the Senior!

GreenSky · 10-17-2009, 02:59 AM

The best thing you can do is contract with www.ritterim.com. They offer most major carriers and will be happy to help you. Both of you are in PA.

Rick

HarryRenard · 10-17-2009, 03:55 AM

You also might want to do a search for the information you seek, I promise there is enough to keep you busy for days. And some of them are quite informative. Also I second the ritter suggestion his site will have a lot of helpful reading and when your ready you can give them a call to get started.
As for your question which is better, there really is not a perfect answer, 9 out of 10 times its gonna be completely situational.
Either way Good luck to you.

jdeasy · 10-17-2009, 03:55 AM

Originally Posted by Jessica Durphy

You know, I'm kinda new to this whole thing! But I've found a passion for the Senior Market, and in my very RURAL area, there are no other agents selling Medicare Supps or MA's. I just need to know, WHAT IS BETTER??? Some say, MA are stupid and a waste of time and money! But they tend to cover things that Med Supps won't! I deal with a company called New Era, their part C plan doesn't have any coverage for Vision, Dental, or Prescriptions~ MA plans do! New Era is the only company that I work with thus far for the Supplements.... On the other hand, with MA, I am appointed with Highmark, and am in the process of getting appointed with Mutual of Omaha and AARP.

I think the Seniors like that the MA plans have the prescription drug built into the plan, they like the fact that they can get at least 1 cleaning (dental exam) a year, and hearing aid coverage, vision coverage...

I think both have their pros and cons, but can someone give me a little insight on why you think the one is better than the other?

My goal is to make money, yet do what is in the best interest of the Senior!

You need a lot of training on med sups and MA/MAPD/PDP and on the differences.

You should get with an FMO that offers a lot of the training you need. Right now you have just enough information really make some huge mistakes.

Tom Highway · 10-17-2009, 04:14 AM

You may get a ton of answers on this, but from a sheer maintenance standpoint (you maintaining the member) I am seeing more and more that Medicare Advantage is a huge pain in the ass. I've done/am in the process of doing both MAPD and Med Supps, too.

Let me give you just one recent example.

Not too long ago, I enrolled this lady who is a dual eligible into a MAPD plan. Before you all go off on me for that, duals are my bread and butter, and I know how to put them in the right plan, and it is indeed a good plan for tem. Anyway, I had to make sure ALL her docs were in the plan's network, which was no easy task since she has several docs and a chiropractor.

Things roll along, and I have gotten several calls from this lady, pleased with the plan, and upset about some doctor issues that I reviewed over and over and over and over with her in the first place.

Thursday, I got 14 calls from her in about a 5 minute time span, and I'm not lying about that. She would call, hang up, call again, again, again. I was on an appt, so I didn't pick up, but when she FINALLY left a message, she said "hey, I need you to pick up, this is an EMERGENCY. I'm at my doctor's office, and they are not contracted with the plan". This just pissed me off, because of the multiple calls, and because of the flippant use of the word "emergency". No, lady, a head injury, chest pains, broken neck, THAT is an emergency. You sitting in a doctor's appt who you KNOW is not contracted in your medicare advantage network and trying to go see him anyway is NOT an emergency.

And this is just one issue among so many that can go wrong when a person has any minor problem with prescriptions, network docs, bills, denial of service, etc. And a person like this will not hesitate to try and throw me (you) under the bus, which is why I have to spend so much time documenting and covering my butt.

Med Supps, on the other hand - no "network", no bills/prior authorizations, or other such nonsense.

And add to that all the restrictions of who you can call, getting permission to call, scope of appt, recording conversations, etc.

So yeah, med supps are much more agent friendly, and, I dare say, easier and probably more cost effective for the seniors. There are people who MAPD is right for, but, overall, med supps are the way to go.

Dowejonez · 10-17-2009, 07:10 AM

The vision, dental and hearing benefits usually are not a viable point to consider when helping your client find the right product.

It's always best to make sure your client is aware of how much exposure they have and what kinds of claims will hit their OOP max. Make it a decision in their best interest....always. Sometimes you just have to leave it alone and walk away.

Chazm · 10-17-2009, 04:39 PM

To answer your question, neither is better than the other....IMHO.

Example. What if you meet a client who lives by herself and $600/month SS? Is the med supp better for her? Be prepared because chances are you will get a charge back if you sell her that.

Vision and Dental is just fluff. Not even real benefits

Be prepared to have a scope of appointment with you and just have the client sign it if you bring up MA at all, technically thats not even the correct way to do it but oh well.

Jessica Durphy · 10-17-2009, 04:54 PM

Originally Posted by jdeasy

You need a lot of training on med sups and MA/MAPD/PDP and on the differences.

You should get with an FMO that offers a lot of the training you need. Right now you have just enough information really make some huge mistakes.

I'm learning! I love doing this and working with seniors! I'll admit, I'm not the PRO like some of you are, but I intend to be someday. I don't mind doing "homework"...
- - - - - - - - - - - - - - - - - -

Originally Posted by Tom Highway

You may get a ton of answers on this, but from a sheer maintenance standpoint (you maintaining the member) I am seeing more and more that Medicare Advantage is a huge pain in the ass. I've done/am in the process of doing both MAPD and Med Supps, too.

Let me give you just one recent example.

Not too long ago, I enrolled this lady who is a dual eligible into a MAPD plan. Before you all go off on me for that, duals are my bread and butter, and I know how to put them in the right plan, and it is indeed a good plan for tem. Anyway, I had to make sure ALL her docs were in the plan's network, which was no easy task since she has several docs and a chiropractor.

Things roll along, and I have gotten several calls from this lady, pleased with the plan, and upset about some doctor issues that I reviewed over and over and over and over with her in the first place.

Thursday, I got 14 calls from her in about a 5 minute time span, and I'm not lying about that. She would call, hang up, call again, again, again. I was on an appt, so I didn't pick up, but when she FINALLY left a message, she said "hey, I need you to pick up, this is an EMERGENCY. I'm at my doctor's office, and they are not contracted with the plan". This just pissed me off, because of the multiple calls, and because of the flippant use of the word "emergency". No, lady, a head injury, chest pains, broken neck, THAT is an emergency. You sitting in a doctor's appt who you KNOW is not contracted in your medicare advantage network and trying to go see him anyway is NOT an emergency.

And this is just one issue among so many that can go wrong when a person has any minor problem with prescriptions, network docs, bills, denial of service, etc. And a person like this will not hesitate to try and throw me (you) under the bus, which is why I have to spend so much time documenting and covering my butt.

Med Supps, on the other hand - no "network", no bills/prior authorizations, or other such nonsense.

And add to that all the restrictions of who you can call, getting permission to call, scope of appt, recording conversations, etc.

So yeah, med supps are much more agent friendly, and, I dare say, easier and probably more cost effective for the seniors. There are people who MAPD is right for, but, overall, med supps are the way to go.

I wouldn't go off on you for that!! I have sold about 12 MAPD plans, and so far, EVERYONE is truly happy with them. I've heard NO complaints.

My reasoning for asking is that, as I mentioned, in my area (so far) New Era offers the best price for Med Supps... but for these folks to buy a PDP on top of that, it costs them sometimes double what a MAPD plan is! That's what they look at... ALWAYS before I ever go to an appointment, I try to get as much information from a senior as I can, just by talking to them... I see what their needs are, I can get a feel of what's the most important to them, and then I try to go by that! If they are very concerned about how much is a copay, deductible, what's it going to cost for an ER visit, what if i have to take an ambulance, etc.... I just try to get them into something that will be best for their situation and pocket book...

I have a gentleman that in November he's going to change from his PFFS to New Era, because he gets his prescriptions from the VA or Walmart ($4.00)... so for him to get a Supp is SOOO much better, no copay,no deductible, no more money out of his pocket other than his monthly premium. (to him I hung the moon, he's referred so many folks to me.) I love the idea of a supp... but I just hate that the other portions folks ask me about I have to tell them, no this plan doesn't cover that! BUT with your permissions and signature, I can tell you about this other idea that I may have and it could possibly work for you....

jdeasy · 10-17-2009, 06:07 PM

Originally Posted by Jessica Durphy

I'm learning! I love doing this and working with seniors! I'll admit, I'm not the PRO like some of you are, but I intend to be someday. I don't mind doing "homework"...
- - - - - - - - - - - - - - - - - -

I wouldn't go off on you for that!! I have sold about 12 MAPD plans, and so far, EVERYONE is truly happy with them. I've heard NO complaints.

My reasoning for asking is that, as I mentioned, in my area (so far) New Era offers the best price for Med Supps... but for these folks to buy a PDP on top of that, it costs them sometimes double what a MAPD plan is! That's what they look at... ALWAYS before I ever go to an appointment, I try to get as much information from a senior as I can, just by talking to them... I see what their needs are, I can get a feel of what's the most important to them, and then I try to go by that! If they are very concerned about how much is a copay, deductible, what's it going to cost for an ER visit, what if i have to take an ambulance, etc.... I just try to get them into something that will be best for their situation and pocket book...

I have a gentleman that in November he's going to change from his PFFS to New Era, because he gets his prescriptions from the VA or Walmart ($4.00)... so for him to get a Supp is SOOO much better, no copay,no deductible, no more money out of his pocket other than his monthly premium. (to him I hung the moon, he's referred so many folks to me.) I love the idea of a supp... but I just hate that the other portions folks ask me about I have to tell them, no this plan doesn't cover that! BUT with your permissions and signature, I can tell you about this other idea that I may have and it could possibly work for you....

The majority of my my MA business has been duals and I've done over 800 MA plans. I can't imagine an instance where it would be in the dual eligible person's interest to ever enroll them in an MAPD. The time I could think it would be is for an SNP. Since we don't have any of those here in my area, there is never a reason to enroll a dual into an MAPD. You do a dis-service to an LIS person to enroll them into a $0 premium MAPD. They are going to get their PDP plan paid for if they are 100% LIS and they would get more benefits from a stand alone MA for their medical needs.

Of course, I am not a believer in MAPD for anyone. Of my over 800 MA plans, less than 10 are MAPD. A person will always have more choices if they are kept separate. What if they like the PDP part of the MAPD, but, not the rest? They will give up both to go somewhere else. What if they like the medical, but the MAPD formulary is not as inclusive as another PDP? They will give up the MAPD to get the more inclusive PDP.

What about now when Wellcare and Coventry are pulling out of the PFFS, but not the PDP. The people on MAPD plans with those two will have to make two changes. Many of my Wellcare and Coventry clients are now taking advantage of the right to get a med sup. The fact that I never put them in MAPD plans is now making it a much easier switch for me and for the clients.

The only time I could see it as a good thing to enroll someone into an MAPD would be when the person needed a PDP and couldn't afford one and there was a $0 or very low cost MAPD available for them. Even though I have sold many MA plans, I've always told my clients that there is nothing better than a med sup if they can handle the premiums. As for the exapmple that someone else gave about a person making only $600 per month. That person would be a QMB plus and on full medicaid. They would not need a med sup, an MA or a PDP. They may need help with chosing their PDP and you could jump thru many hoops for that $25 or you could let Medicare help them with the choice. They could benefit from an SNP if available.

Chazm · 10-17-2009, 06:37 PM

^you are right I would write them evercare for low income but I was just trying to give an example.....or I could say someone making $1k month and every cent is currently paying the bills. It wouldn't be smart to put them in a monthly plan when my MAPD is free

jdeasy · 10-17-2009, 06:47 PM

Originally Posted by Chazm

^you are right I would write them evercare for low income but I was just trying to give an example.....or I could say someone making $1k month and every cent is currently paying the bills. It wouldn't be smart to put them in a monthly plan when my MAPD is free

If they are making only $1000 per month, they would be SLMB or QI-1 and qualify for help on their PDP. It would be a dis-service to put those people into an MAPD. That's the stuff Humana would do.

Jessica Durphy · 10-17-2009, 07:30 PM

I'm sorry, some of what you are saying is a bit over my head... I'm not out to "schister" anyone. That's not who I am or what I'm about! What I have been selling is Highmark PPO or PFFS (HMO is not available through Highmark in my area)... New ERA Medicare Supp Plan C... as I have said, so far, I've had no issues or complaints! I personally haven't dealt with anyone YET that qualify for LIS.

A few short months is all I've gotten under my belt, I ask guidence... not a bang on the head before I even get good and started!

Tom Highway · 10-17-2009, 07:48 PM

Of course, the duals I've written have been in a SNP for duals, which I still consider MAPD. I don't know about state by state, but in Alabama, it's illegal to enroll someone who is on medicaid into a med supp. I do my due dilligence even more than I may need to because I'm not going to leave my neck out there for somebody to go after.

There are a lot of good responses here, and I think that there's no right or wrong answer to your question. I think that jdeasy definitely knows what he's talking about, because I've talked to him before about all this.

Your question, overall, is sort of like asking "which is better - term life or whole life?". There are so many different situations that it just depends.

You're definitely doing the right thing, Jessica, by preparing and positioning yourself as an expert to do right by your prospects. Each carrier should have some specific training which will give you a lot of answers. United Healhcare actually has some really good, really professional training on medicare in general, med supps, and MA. I don't know if they get into a lot of the LIS levels and SNPs and medicaid, at least not in the module I did, but it'll be somewhere. LIC levels/levels of subsidy can be confusing as heck until you have that "aha" moment, but you've GOT to know that stuff, unless you really want to mess somebody up.

Keep on going though, you have a great attitude and are on the right track!!

Jessica Durphy · 10-17-2009, 08:03 PM

Thank you! I have lots of plans, I've contacted all of our Senior Centers in about 5 or 6 different towns around here, each of them has agreed to letting me come in and sharing "free" information! I've attended several different Senior Bazaars/Expo's, and have gotten tons of folks that want me to call them and get a hold of them come AEP... I'm excited about the prospects! Because I know pretty soon, it'll all come together for me and I'll get that moment like you were describing that "aha" moment!!!

Tom Highway · 10-17-2009, 08:38 PM

Originally Posted by Jessica Durphy

Thank you! I have lots of plans, I've contacted all of our Senior Centers in about 5 or 6 different towns around here, each of them has agreed to letting me come in and sharing "free" information! I've attended several different Senior Bazaars/Expo's, and have gotten tons of folks that want me to call them and get a hold of them come AEP... I'm excited about the prospects! Because I know pretty soon, it'll all come together for me and I'll get that moment like you were describing that "aha" moment!!!

I know that you're probably already doing this, but just make sure that you're following the CMS guidelines if this if for medicare advantage.

If you're talking about plan specifics, you have to register that on the CMS calendar as a sales event, and there may be secret shoppers there. There are some specific things that you need to say at the beginning of the presentation, and if anyone walks in late, say it again. Make sure that you have a CMS approved scope of appointment form if you can enroll people at the event, or a CMS approved permission to contact form.

If it's an educational event, you're VERY limited in what you can do, and a secret shopper can still be there.

If you have food there, be sure that it's only from the "approved" food lists on CMS' website.
If you're doing it at a senior center around a meal time, be VERY careful in not being there when food is present.

You see why people say medicare advantage is such a pain??

arnguy · 10-17-2009, 08:42 PM

In rural areas you probably would be doing better to offer a Med Supp because the providers in an MA may be scarce. I am not familiar with the Highmark network. In the metropolitan area of Philadelphia, MAs were a slam dunk, but with the new enrollment period coming up both Independence Blue Cross and Aetna are pulling in their horns. Both are eliminating their Dual Medicare/Medicaid Advantage Plans, eliminating the zero premium MA plans, and increasing the premiums on their other MA plans. Bravo is moving in to pick up the slack; however, their provider network is limited. CIGNA is moving in, also, but they do not offer a zero premium plan.

Of course, selling MAs sounds tedious with all the restrictions imposed by CMS which is why I am not active in the senior market. Until now, it has been difficult to sell Med Supps here with the competion from the MAs. The climate is changing...rapidly in this area.

Good luck. BTW the suggestion by Rick to contact Ritter is an excellent one.

Jessica Durphy · 10-17-2009, 09:05 PM

Yea, I do my best to follow the rules and regulations of CMS, I finished up my trainings for the CMS about 3 weeks ago, for 2010. My plans are to discuss the differences in a PPO, HMO, and PFFS plan! NOT differences in what's covered and the prices of things (if they start asking more detailed quesitons, I can go ahead and have everyone fill out SOA forms).... I'll have to double check that before actually doing it! In the past, at the bazaars/expo's... I've taken a plate full of homemade cookies, which are OK!

I saw the suggestion from Rick, and I tried to thank him, but for some reason I couldn't submit 2 posts at the same time ... ??? I don't know! But I deal with www.nimbroker.com (National Insurance Markets, Inc. That is who my boss, Dan Williams has dealt with for years. But Monday am, I will make mention of Ritter and get his take on it.

Tom Highway · 10-17-2009, 09:38 PM

Originally Posted by Jessica Durphy

Yea, I do my best to follow the rules and regulations of CMS, I finished up my trainings for the CMS about 3 weeks ago, for 2010. My plans are to discuss the differences in a PPO, HMO, and PFFS plan! NOT differences in what's covered and the prices of things (if they start asking more detailed quesitons, I can go ahead and have everyone fill out SOA forms).... I'll have to double check that before actually doing it! In the past, at the bazaars/expo's... I've taken a plate full of homemade cookies, which are OK!

I saw the suggestion from Rick, and I tried to thank him, but for some reason I couldn't submit 2 posts at the same time ... ??? I don't know! But I deal with www.nimbroker.com (National Insurance Markets, Inc. That is who my boss, Dan Williams has dealt with for years. But Monday am, I will make mention of Ritter and get his take on it.

Do make sure you double check that. From the way you're putting it (talking about the difference in HMO/PFFS/PPO with no plan specific information is an educational event. As I understand it, you CANNOT get a scope of appt at an educational event.

11/14/2008 New MIPPA guidelines summarized
Sales/marketing at educational events
Agents may not conduct sales activities at educational events. This prohibition includes distributing marketing materials and the distribution or collection of enrollment applications. An event is educational if it is advertised as such. If the event is not advertised as educational Plans may conduct sales activities.

Plans and agents may:

Distribute educational materials (Materials must be free of Plan-specific information and any bias towards one plan type over another.)
Display a banner with the Plan name and/or logo
Distribute promotional items, including those with Plan name, logo and toll-free customer service number and/or Web site (Promotional items must be free of benefit information.)
Distribute a business card if the beneficiary requests information on how to contact the agent (The business card must be free of plan marketing or benefit information.)

Plans and agents may NOT:

Discuss Plan-specific premiums and/or benefits
Distribute or display BRCs, Scope of Appointment forms, or sign-up sheets
Set up personal sales appointments or get permission for an outbound call to the beneficiary
Attach business cards or Plan/agent contact information to educational materials

Personally, I would NEVER do an educational event. What's the point? You can do it as a sales event and put it on the CMS calendar, and talk plan specifics and get scopes. You just have to make sure there are some things you say about networks, forumlaries, etc, and address questions somehow (a good way to do that is to say "I know that there may be some questions, but each of you will have a unique situation. Questions may be handled better in a more private setting, and you can fill out a permission to contact form that will let me give you all the time you need to ask specific questions).

arnguy · 10-17-2009, 09:39 PM

FYI Ritter is located in Harrisburg, PA. Craig Ritter is the principal.

Cenla Agent · 10-17-2009, 10:34 PM

The only way I can see an educational event being beneficial is with a captive sales force that is simply trying to build their company's brand. For the independent agent, I can't see it being worthwhile, especially if much cost is involved in putting on the event.

If possible it may be useful to do events like these at senior centers and other places where the management may be receptive to educational events but not receptive toward sales meetings. This is an activity that may be a good idea for some MA agents to do during lock-in. Since telemarketing is now prohibited for MA/PDP, I would think that some companies are using the educational events as a way to simply get in front of people they otherwise might not be able to reach except through direct mail or TV ads.

Tom Highway is correct. My understanding is that you cannot get SoA or permission to call at an educational event. If you give them your card the prospect has to call you.

My understanding is that unless the event is advertised as an educational event, it can be a marketing event, even if your primary purpose for the meeting is to educate. The catch phrase is that you can educate at a marketing event but you cannot market at an educational event.

If there is still some confusion, then it's best to review the CMS and carrier requirements again. There will be increased CMS efforts with secret or mystery shoppers this year (including at home appts.) and at least some carriers will have their own secret shoppers out there as well.