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Reply to MA or MS? Age 63....     
Old 09-12-2017, 01:09 PM   #1
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MA or MS? Age 63.... MA or MS? Age 63....
I know this we've debated this with age 65+ but since this is a bit different so I wanted to run this by you guys and get your opinions.

Referral just called me Friday. Her husband is 63, A&B effective date 10/01/17 (next month).

Zip 73624, Washita County.

One MAPD, PPO, $177/month.

Or plan A $240 and up, plus a PDP $28.

Prescription copays are about the same either way (about $30/mo total)

Since we never talk about Plan A vs a higher priced MAPD. I wanted to see what everyone else would say.
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Old 09-12-2017, 01:41 PM   #2
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Todd King on MA or MS? Age 63....
 
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MA or MS? Age 63.... Re: MA or MS? Age 63....
I think I would push the MAPD over a Plan A any day.
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Old 09-12-2017, 01:44 PM   #3
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MA or MS? Age 63.... Re: MA or MS? Age 63....
My advice would be based on the reason for disability and their risk tolerance (whether or not hospitalizations and/or a lot Part B expenses may be likely in the next 2 years) as well as how good the MAPD is (co-pays, MOOP, etc). I wouldn't recommend based on premium alone.

If this person has 4 specialist visits a month, the co-pays alone will probably negate the possible savings of going with an MAPD. Not to mention having a network. if they are pretty healthy (I have plenty of those who are "disabled"), I don't know that the benefits of the A are worth the extra $1200 a year if their health is good and their risk tolerance is high.

When T65 happens, would put them on supp though.
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  Reply With Quote to MA or MS? Age 63....
Old 09-12-2017, 02:22 PM   #4
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kgmom219 on MA or MS? Age 63....
 
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MA or MS? Age 63.... Re: MA or MS? Age 63....
Network. Network. Network.

Will the disability cause Part B claims greater than the premium (and copay) differential?

If the network is decent and they only see a doc a few times a year, MAPD til 65, then Plan G.

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  Reply With Quote to MA or MS? Age 63....
Old 09-12-2017, 03:23 PM   #5
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MA or MS? Age 63.... Re: MA or MS? Age 63....
Originally Posted by GoPokes View Post
I know this we've debated this with age 65+ but since this is a bit different so I wanted to run this by you guys and get your opinions.

Referral just called me Friday. Her husband is 63, A&B effective date 10/01/17 (next month).

Zip 73624, Washita County.

One MAPD, PPO, $177/month.

Or plan A $240 and up, plus a PDP $28.

Prescription copays are about the same either way (about $30/mo total)

Since we never talk about Plan A vs a higher priced MAPD. I wanted to see what everyone else would say.
I'm guessing there is a low MAPD penetration rate in that county if there's only one plan and it's $177 per month.
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  Reply With Quote to MA or MS? Age 63....
Old 09-12-2017, 04:00 PM   #6
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MA or MS? Age 63.... Re: MA or MS? Age 63....
I looked up the plan, it is a Humana Regional PPO so the network should at least be decent and it can be used outside of the plan service area as well.

The premium is $177 but the Part D plan is about $35 so the medical premium is $141.

The two big holes in a Plan A are the hospital deductible and Skilled Nursing copay, if there was risk that both would be used on an annual basis the MAPD plan would possibly make sense but I would present both and leave the decision to the client.
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Old 09-12-2017, 06:08 PM   #7
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DS4 on MA or MS? Age 63....
 
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MA or MS? Age 63.... Re: MA or MS? Age 63....
Originally Posted by GoPokes View Post
I know this we've debated this with age 65+ but since this is a bit different so I wanted to run this by you guys and get your opinions.

Referral just called me Friday. Her husband is 63, A&B effective date 10/01/17 (next month).

Zip 73624, Washita County.

One MAPD, PPO, $177/month.

Or plan A $240 and up, plus a PDP $28.

Prescription copays are about the same either way (about $30/mo total)

Since we never talk about Plan A vs a higher priced MAPD. I wanted to see what everyone else would say.
RPPO has Out of Pocket Spending Limit: $10,000 In and Out-of-network
$6,700 In-network
Going with Medicare, and, Plan A, your annual out of pocket costs would probably be less than $6700 or $10,000.

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D. Dayton Sayer IV
Dayton Sayer Insurance Agency, Inc.
Sayerins.com

"The most valuable commodity I know of is information" Gordon Gekko
  Reply With Quote to MA or MS? Age 63....
Old 09-13-2017, 09:24 AM   #8
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MA or MS? Age 63.... Re: MA or MS? Age 63....
Is there a PFFS in the area?
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Old 09-13-2017, 09:54 AM   #9
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MA or MS? Age 63.... Re: MA or MS? Age 63....
Originally Posted by Labesky View Post
Is there a PFFS in the area?
Two posters already said there is ONE plan, and only ONE plan available in the area.

Besides, even if there was a PFFS plan available, that is the absolute worst choice anyone can make for MAPD-rather than give you the reasons why that is the case you need to do your own research and learn something.
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Old 09-13-2017, 10:09 AM   #10
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MA or MS? Age 63.... Re: MA or MS? Age 63....
Originally Posted by FLM2 View Post
Two posters already said there is ONE plan, and only ONE plan available in the area.

Besides, even if there was a PFFS plan available, that is the absolute worst choice anyone can make for MAPD-rather than give you the reasons why that is the case you need to do your own research and learn something.
I believe there are also two MA only plans. A Humana PFFS plan ($66 monthly premium) and a Humana PPO plan ($0 monthly premium). Not that changes anything in this scenario.
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