Med Advantage Question (newby)

[Chazm]

The OON charges for the UHC Regional PPO could be through the roof, not a good plan for someone who spends lots of time in CA during the year.

I agree. Which is why I mentioned the other ppo's as well. I wasn't saying they should choose UHC. Just laying out options.

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Hey Thank you Guys,

She has Medicare part A and B. But like i said, her premium is over $600 mth, and doesn't have Part D either.

I understand that MA is actually Part C and was hoping that going with a Private MA plan might save her $ (but I'm not sure---like i said, i'm a Newby so please forgive my ignorance).

Anyway, does any have an idea on how much her premium might be for a Med Adv Plan?

• She's 70 yrs old, in good health, and we live in S.fla.?
• Are there dis-advantages to having a Med. Advantage Plan?

Thanks again...!

The questions have already been answered for you.
Aetna, humana and UHC have ppo's at $0 premium. Florida blue ppo is $41 I believe.

Disadvantages to part c? Co-pays, coinsurance. She could lose her doctor if they decide to not take the plan one day.

To be honest you really need to have an agent that can give her the help she needs. I would pass it off to someone else before you give her bad info.

You keep on pushing part c but if I were you I would mention that she is currently spending $600, for half the amount she can have 100% coverage, no network of doctors and travel all over the US. How does that sound ma'am?

 

[Tim Resnick]

BlueMedicare Regional PPO is the best option for nationwide network.

Thanks Money,...that's a BCross plan. I'm not sure, but i think that BCross is captive so i will have to call an BCross agent.

Prospective client moved from Tallahassee to rural Georgia. She is on the state plan with BX as the carrier/administrator.

Very rich plan. Low deductible, low OOP (in network). She has A & B.

Also has non-alcoholic cirrhosis diagnosed a few months ago via liver scan.

No network providers in her area. Had to drive 70 miles to get scan and paid $150 for a scan that would have been "free" in Florida.

She and husband have been trying to decide if she wants to stay on the MA plan or switch to Medigap. Husband turns 65 in September.

They have been researching options since June. Called me last week. Referral from an agent in their town I know that does not handle Medicare.

During the initial phone conversation they mentioned the OON "problem" and the $150 scan. Asking for details, they said it was a liver scan and gave me the diagnosis.

We have a problem.

She turned 65, enrolled in A & B in March.

They waited until 7 months later to call and with her diagnosis she won't pass underwriting.

She will keep her MA plan.

Took app for husband.

Thanks Somarco,...so if she would have signed up for a Medigap plan within 6mths, there would have been No underwriting and she would have been covered?

The questions have already been answered for you.
Aetna, humana and UHC have ppo's at $0 premium. Florida blue ppo is $41 I believe.

Disadvantages to part c? Co-pays, coinsurance. She could lose her doctor if they decide to not take the plan one day.

To be honest you really need to have an agent that can give her the help she needs. I would pass it off to someone else before you give her bad info.

Thanks Chaz,...

1. you mentioned Florida Blue (are you signed up with them?) If so, are you familiar with the BlueMedicare Regional PPO?

(oh i will refer her to someone who's an expert, just trying to learn and i do appreciate your input)

You keep on pushing part c but if I were you I would mention that she is currently spending $600, for half the amount she can have 100% coverage, no network of doctors and travel all over the US. How does that sound ma'am?

2. You are saying a Medicare Supplement would be better if she travels and cuts her cost in half (aprx)? (I think Money mentioned that BlueMedicare Regional PPO has a national network...in that case perhaps this plan might work best)

***AGAIN, just reading and learning and appreciate ALL you guys and input.


THANK YOU !

 

[Chazm]

Thanks Money,...that's a BCross plan. I'm not sure, but i think that BCross is captive so i will have to call an BCross agent.



Thanks Somarco,...so if she would have signed up for a Medigap plan within 6mths, there would have been No underwriting and she would have been covered?



Thanks Chaz,...

1. you mentioned Florida Blue (are you signed up with them?) If so, are you familiar with the BlueMedicare Regional PPO?

(oh i will refer her to someone who's an expert, just trying to learn and i do appreciate your input)



2. You are saying a Medicare Supplement would be better if she travels and cuts her cost in half (aprx)? (I think Money mentioned that BlueMedicare Regional PPO has a national network...in that case perhaps this plan might work best)

***AGAIN, just reading and learning and appreciate ALL you guys and input.


THANK YOU !

I have never recommended anyone to choose the Florida blue ppo. If you're going to have a premium you might as well get a med supp.
Aetna and humana have a network outside of Florida just like Florida blue does.
Florida blue has a premium on that plan in hopes that people choose their hmo instead. I heard it straight from their meetings.

 

[LostDollar]

Hey Thank you Guys,

She has Medicare part A and B. But like i said, her premium is over $600 mth, and doesn't have Part D either.

I understand that MA is actually Part C and was hoping that going with a Private MA plan might save her $ (but I'm not sure---like i said, i'm a Newby so please forgive my ignorance).

Anyway, does anyone have an idea on how much her premium might be for a Med Adv Plan?

• She's 70 yrs old, in good health, and we live in S.fla.?
• Are there dis-advantages to having a Med. Advantage Plan?

Thanks again...!

(I am not an agent.)

I see there have been several responses since I started hunting up these threads.

Selling MA and MAPD (and also PDP because it requires same kinds of Govt supervision and certification) are controversial.

Here is a (one of many) thread that will give you some sense of negatives:
http://www.insurance-forums.net/for...e-plan-part-d-my-worst-decision-t85103-5.html

Here is a thread that will give you some sense of the positives:
http://www.insurance-forums.net/for...ertified-vs-not-getting-certified-t89030.html

At the end of the day, you will have to make your own choices for yourself.

One other point that has been emphasized multiple times in threads I have read over the last 6 months is that FL is different than the rest of the US in terms the Medicare marketplace and MAPD plan features (at least for folks that use the plans IN Florida).

In my state, the SHIP office does not recommend the MAPD plans if you can afford something else, because of the large oop amounts.

 

[steveadlman]

Why not switch her to a Medicare Supplement where she can see any doctor or hospital of her choice that accepts Medicare patients. She would be fully covered when she travels anywhere in the United States.

 

[LostDollar]

Re medigap:

CMS has lots of information on their site.

Here is a medigap page:

https://www.medicare.gov/supplement...gap/when-can-i-buy-medigap.html#collapse-2227

 

[Matthew King]

So here's my take. If she can qualify for a Medicare Supplement. Because she's traveling it would be best to get a Medigap because she will have no network and will still save money. (so go with the advice that a ton of people have already said).

 

[FLM2]

Thanks Money,...that's a BCross plan. I'm not sure, but i think that BCross is captive so i will have to call an BCross agent.



Thanks Somarco,...so if she would have signed up for a Medigap plan within 6mths, there would have been No underwriting and she would have been covered?



Thanks Chaz,...

1. you mentioned Florida Blue (are you signed up with them?) If so, are you familiar with the BlueMedicare Regional PPO?

(oh i will refer her to someone who's an expert, just trying to learn and i do appreciate your input)



2. You are saying a Medicare Supplement would be better if she travels and cuts her cost in half (aprx)? (I think Money mentioned that BlueMedicare Regional PPO has a national network...in that case perhaps this plan might work best)

***AGAIN, just reading and learning and appreciate ALL you guys and input.


THANK YOU !

As someone who spends a few months a year in California and lives in Florida (and have a bunch of CA clients all over the state) I can tell you that the approach is 100% WRONG.

None of the MAPD PPO plans have comparable networks in California, where virtually everything is an HMO and regional rather than statewide

The Florida Blue Regional PPO MAPD is awful and is a terrible choice for anyone let alone someone who travels.

Your client is paying $600 a month, she needs a Medicare Supplement and Part D plan. If she wants a lower premium, an HDF or Plan K would be OK or just get a Plan F plus drug plan and her premium is 50% lower than her current situation.

You've been a newbie for over a year, maybe it's time to actually learn something.

 

[Higru]

Prospective client moved from Tallahassee to rural Georgia. She is on the state plan with BX as the carrier/administrator.

Very rich plan. Low deductible, low OOP (in network). She has A & B.

Also has non-alcoholic cirrhosis diagnosed a few months ago via liver scan.

No network providers in her area. Had to drive 70 miles to get scan and paid $150 for a scan that would have been "free" in Florida.

She and husband have been trying to decide if she wants to stay on the MA plan or switch to Medigap. Husband turns 65 in September.

They have been researching options since June. Called me last week. Referral from an agent in their town I know that does not handle Medicare.

During the initial phone conversation they mentioned the OON "problem" and the $150 scan. Asking for details, they said it was a liver scan and gave me the diagnosis.

We have a problem.

She turned 65, enrolled in A & B in March.

They waited until 7 months later to call and with her diagnosis she won't pass underwriting.

She will keep her MA plan.

Took app for husband.

Anyone correct me if I'm wrong. When a beneficiary chooses a Medicare Advantage plan they come off original Medicare. The beneficiary can change back to Original Medicare with no underwriting during the free look period, and if after 60 days of effective date, they must wait until nearest open enrollment period to change with no health underwriting. They are allowed back on original Medicare with a January 1st effective date and can apply for a supplement. In this case the woman has to do this during the upcoming open enrollment. I have helped individuals twice doing this. Had to deal with an the legal department with Humana once because and underwriting supervisor said it could not be done. Some pretty young agent around my neck of the woods talked the husband into an MA while full well knowing his wife had Alzheimers.

 

[Chazm]

Anyone correct me if I'm wrong. When a beneficiary chooses a Medicare Advantage plan they come off original Medicare. The beneficiary can change back to Original Medicare with no underwriting during the free look period, and if after 60 days of effective date, they must wait until nearest open enrollment period to change with no health underwriting. They are allowed back on original Medicare with a January 1st effective date and can apply for a supplement. In this case the woman has to do this during the upcoming open enrollment. I have helped individuals twice doing this. Had to deal with an the legal department with Humana once because and underwriting supervisor said it could not be done. Some pretty young agent around my neck of the woods talked the husband into an MA while full well knowing his wife had Alzheimers.

MA companies will make sure you understand that an enrollee in fact does NOT come off original Medicare. They are still a part of the system but the med advantage company pays the doctors rather than Medicare.

You have ONE year to leave a med advantage plan and return to original Medicare without part c, during any time during that first 12 months in a part c plan.