MA or MS? Age 63....

GoPokes

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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.
 
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.
 
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.
 
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.
 
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.
 
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.
 
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.
 
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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