$0 MAPD a Better Plan Than a Med Supp....

[FLM2]

I had a guy call me to tell me had to switch to UHC MAPD so he could get Silver Sneakers. I asked why he wanted an HMO instead of being able to go anywhere he wanted, especially since he travels so much. "The free gym membership". I told him I wouldn't do it, because his financial planner would kill me. So he told me he would get it on his own and hung up.

I called the FP and let him know what had transpired.

FP called the client and told him that if signed with an MAPD he was firing HIM.

Client called me to apologize for being short-sighted. Then I moved him to Cigna so he could get the $25/annual gym membership

You did exactly the right thing, that's a ridiculous reason for wanting MAPD but very typical of what happens when it's AEP and all of the TV commercials are blasting people with partial information rather than a balanced presentation.

 

[somarco]

Biased explanation, complete with scare tactics.

Do you currently have a doctor or doctors that you would like to keep?

Do you know if your doctor(s) accept MA plans and if so, which carriers/plans are accepted?

Looking at doctor visits, lab, etc., everything but Rx, how much do you currently spend on health care each year?

How many times do you go to the doctor during a year and do you routinely have lab work or other testing?

Do you have a problem with reviewing a list of doctors and hospitals that participate in an MA plan and changing providers if needed?

Do you travel outside of your home base on a regular basis?

Scare tactics. That is what sells.

I have stated before, I don't sell anything. What I do is explain the way things work and let them decide. I have no problem at all telling them they need to talk to another agent (about an MA plan) or suggesting they call a carrier direct (such as MOO, AARP/UHC, BX or Humana) if they feel those plans and carriers are a better fit.

People hate to be sold but they love to buy.

 

[agentjhc]

When MAPD is CIP PPO at $39 and Humana PPO at $80 both with a $6700 MOOP, a T65 female might like a $40-50 HDF ($2180) and $19.00 SS (if drugs T1 and T2). Plan N might look good as well. MAPD in counties in N GA near me are not the best in the world and Humana just dumped a $47 a month plan and left them with a $80 a month plan. I've had several calls about it. Healthy ones have choices unhealthy not as many.

 

[LostDollar]

It seems to me like my Dr. told me that CMS passes on the part B premium plus an additional amount to the Medicare Advantage companies. Is that true, and if so, doesn't selling a supplement help all on Medicare by keeping more money in that system?

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Well, some of the posts above prompted me to take a look-AARP medicare plan 1 hmo does better with my drugs than the PDP's. For example, SilverScript took Bystolic off it's formulary for 2017. Other lower cost 2017 PDP's seem to list it at Tier 4.
On the other hand, the HMO MAPD's seem to list it as tier 3. My overall drug cost seems to come up cheaper in the MAPD (HMO) than with a PDP.

I start to have a little sense of why some would choose the MAPD, I can't exactly pull it out into words, just sitting here feeling the terror of some situations that could happen.

 

[agentjhc]

It seems to me like my Dr. told me that CMS passes on the part B premium plus an additional amount to the Medicare Advantage companies. Is that true, and if so, doesn't selling a supplement help all on Medicare by keeping more money in that system?

----------

Well, some of the posts above prompted me to take a look-AARP medicare plan 1 hmo does better with my drugs than the PDP's. For example, SilverScript took Bystolic off it's formulary for 2017. Other lower cost 2017 PDP's seem to list it at Tier 4.
On the other hand, the HMO MAPD's seem to list it as tier 3. My overall drug cost seems to come up cheaper in the MAPD (HMO) than with a PDP.

I start to have a little sense of why some would choose the MAPD, I can't exactly pull it out into words, just sitting here feeling the terror of some situations that could happen.

In N Ga the $42 AARP PDP has Bystolic as a T3. Based on that Medicare . Gov shows it being lower cost annually than the SS and Hu/Wal for the reasons you stated. Assuming they are accurate.

 

[somarco]

https://www.blueskydrugs.com/Product/Bystolic

 

[agentjhc]

https://www.blueskydrugs.com/Product/Bystolic

Do you give this link to clients?

 

[somarco]

Absolutely! Except I will customize it for the med's they are taking.

I encourage all my clients who take expensive drugs, especially those that throw them into the donut hole, to work around their plan and minimize their OOP costs.

Blue Sky, Mark's Marine, GoodRx . . .

Why not use all the tools?

 

[Justin Bilyj]

Couldn't find Victoza on bluesky, pretty expensive drug! See any consistent savings in terms of margins from these sites?

 

[LostDollar]

Y'all are making me think hard here to get some thoughts formulated.

When I drove into Medicareland in August, one of my pieces of baggage was a little box of Bystolic, Clotrimazole/Betamethasone, Imipramine and Meloxicam. I had to start thinking about how the system required me to deal with those. And, essentially, in 2017 I get to start over with new formularies and an increase of approx $10 per month in the cheapest part D plan. I guess one of the things I need to consider is Canadian pharmacies and how one deals with getting prescriptions to them.

However, my post above had a different purpose. My little drug list is the only specific frame of reference I have to relate to the thread topic. Within PDP's I see Bystolic being off forumulary or a tier 4. The clotrimazole/betamethasone a tier 3. Imipramine and Meloxicam as tier 1 or 2. Imipramine often has an authorization restriction. Meloxicam sometimes has a quantity restriction.

Due to the vehemence of some of the discussion above, I wondered, what WOULD these look like in the MA world? What I think I saw is that Bystolic dropped to tier 3 on several plans. Ican't remember on the clotrimazole-it might have gone to tier 2. Authorization restrictions for Imipramine generally disappeared and sometimes there weren't any restrictions on Meloxicam either. The generalization of the result is that the $0 MAPD seems to provide a better drug result than the PDP supplement.

So if I was so on the edge financially that a serious medical issue would either drive me to death-because I could not afford the medical attention or to bankruptcy because I could not pay for the treatment I received, I think I could see one possibility why someone would consider taking the MA plan to get the drugs and just hope the medical attention needs did not happen. The HMO type restrictions could be less of a mental block at that financial level because that person might already be used to dealing with the restrictions of cheap to free clinics.