MAPD Plans Vs. Med Supp

[jmarkk1]

I still have much to learn in regards to the senior market. One thing I've noticed is seniors seems to "think" MAPD plans are the way to go because the premium dollars are so low....even $0 including PDP coverage. They have a difficulty paying for a premium that they "may never use." (quoting a senior i recently met)
I've noticed that this perception is almost always focused on doctor's visits only. The only time they use their insurance is to go to the doctor. So a copay is more manageable in their minds along w/ a $0 premium plan, compared to paying $120/month for a plan F.
I understand that some individuals will want to go with a $0 premium plan regardless of the $4800 of risk, but I can't imagine any senior going down this route if they truly understood what would happen to them if they used their insurance for more than a doctor's visit.
Am I right?

 

[healther]

I still have much to learn in regards to the senior market. One thing I've noticed is seniors seems to "think" MAPD plans are the way to go because the premium dollars are so low....even $0 including PDP coverage. They have a difficulty paying for a premium that they "may never use." (quoting a senior i recently met)
I've noticed that this perception is almost always focused on doctor's visits only. The only time they use their insurance is to go to the doctor. So a copay is more manageable in their minds along w/ a $0 premium plan, compared to paying $120/month for a plan F.
I understand that some individuals will want to go with a $0 premium plan regardless of the $4800 of risk, but I can't imagine any senior going down this route if they truly understood what would happen to them if they used their insurance for more than a doctor's visit.
Am I right?

It really depends on the situation. If you are using the $120/month for a plan F you also have to factor in the Part D $40/month in order to be a fair comparison to a $0 premium MAPD. If a senior is comfortable paying that money out every month, then a supplement + PDP is the way to go IMO. But if they aren't and they have a viable MAPD option that at least provides a MOOP, what is wrong with that? Most health insurance policies in the real world don't provide first $ coverage. My personal policy has a higher MOOP than most of the MAPD's I represent, paired with a pretty nasty deductible which none of my MAPD's have.

 

[JGold814]

It really depends on the situation. If you are using the $120/month for a plan F you also have to factor in the Part D $40/month in order to be a fair comparison to a $0 premium MAPD. If a senior is comfortable paying that money out every month, then a supplement + PDP is the way to go IMO. But if they aren't and they have a viable MAPD option that at least provides a MOOP, what is wrong with that? Most health insurance policies in the real world don't provide first $ coverage. My personal policy has a higher MOOP than most of the MAPD's I represent, paired with a pretty nasty deductible which none of my MAPD's have.

I think what jmarkk1 is getting at is that people don't think that they will ever encounter a time when they would have to write a nearly $5k check. So they view it as there's no need to spend the additional cost for the plan F+ pdp.

They don't look at it as protecting themselves against something catastrophic.

But as with any insurance....you get what you pay for.

 

[SportsNut]

Seems as though there are two type of M'care Beneficiaries who select an MAPD.

1. The situation where the Supp prem would take food off of the table, litterally. Not that the MAPD wouldn't, of course, but they decide to take that chance.

2. Those that believe that they are invincible and those larger oop claims will not happen to them. Frankly this works successfully for a lot of folks.

In that case, you give them what they want, an MAPD. All you can do here is educate them, or attempt to do so, and they take the risk from there. I make certain that I document what their exposure is with MAPD compared to a supp, and that they acknowledge that they have further financial exposure with MAPD... to eliminate the selctive amnesia at a later time. As long as you cover this in sufficient detail with them, and they still select the higher risk product, then you have done your job.

 

[jmarkk1]

You guys are seeing where I'm coming from exactly. It's not that the MA plans don't have a place, but mostly because of me starting this biz w/ an outfit that promotes MA plans, I feel like I've really lost sight of the other side of the coin because I really wasn't be taught to sell med supps....and frankly speaking....not getting paid enough to sell them. ($125/med sup regardless of plan)

Now that I've seen the "light" I've switched my conversations with seniors, and I still hear the same thing from many of them. They are mostly concerned with Part B costs and really don't care that they could have large Part A costs on top of everything.

I understand that Med Supps can get expensive, but at the end of the day MA plans are potentially more expensive....and they have the option every year to join these plans if needed. But they don't always have the option of joining a med sup plan because of insurability issues.

 

[DS4]

I had 41 insureds with Anthem Freedom Blue RPPO. This plan is non renewing 1.01.12.
This plan had zero premium and included Part D.
I'm almost done rewriting everyone to a med supp & stand alone Part D.
Almost every one of these insureds forgot about the max out of pocket of $3350.

 

[billyg]

You guys are seeing where I'm coming from exactly. It's not that the MA plans don't have a place, but mostly because of me starting this biz w/ an outfit that promotes MA plans, I feel like I've really lost sight of the other side of the coin because I really wasn't be taught to sell med supps....and frankly speaking....not getting paid enough to sell them. ($125/med sup regardless of plan)

Now that I've seen the "light" I've switched my conversations with seniors, and I still hear the same thing from many of them. They are mostly concerned with Part B costs and really don't care that they could have large Part A costs on top of everything.

I understand that Med Supps can get expensive, but at the end of the day MA plans are potentially more expensive....and they have the option every year to join these plans if needed. But they don't always have the option of joining a med sup plan because of insurability issues.

Part of the issue may be demographic, but much of it is the presentation.

The demographic aspect is if you are meeting with someone who simply can not afford $100-$150/mo for a premium, then MA will almost always be the way to go.

But for folks who can afford it, it boils down to presentation. If they are T65, ask them what they are paying now for insurance. Then point out their deductible and OOP max. Show them that the MA plans frequently have OOP expenses similar to original Medicare, except for the Max OOP annual limit. Paint the picture for them that 1 in 2 men get cancer at some point in their life. "Have you had cancer yet?" What about Cataract (sp?) surgery. How much will that cost? If you have a heart attack or trip and fall what will it cost (ambulance, hospital stay, surgery, CT/MRI, SNF, Rehab, etc.)

As I have been following this approach, about 20% still select MA, but primarily because they are already upside down on their budget (even here I find interest in a cheap Cancer policy). About 80% select Med Supp + PDP. Of those, the "healthier" applicants are choosing Plan N while the "unhealthier" applicants are choosing Plans F & G.

 

[JGold814]

Almost every one of these insureds forgot about the max out of pocket of $3350.

There's a surprise...how many times does an agent hear that one?
- - - - - - - - - - - - - - - - - -

...Of those, the "healthier" applicants are choosing Plan N while the "unhealthier" applicants are choosing Plans F & G.

A lot of that's also gotta do with the zip code they're in. I've seen some areas where the difference in cost is only like $10-$20 a month to get the plan F over the others so a lot of people just end up going with the plan F and have the extra coverage in case it's needed. If it's $40 or $50 a month different, then they go with the N if they're in decent health.

 

[Midlevel]

The best plan is whatever the client feels comfortable with. Our job is not to tell them this product or that product is the way they should go. It's not like a MAPD is the perfect product for a 70 year old female non-smoker with a few minor health problems. It's an individual decision. I've got people with alot of money on MA plans and I've got people that are pretty close to Medicaid or at least living paycheck to paycheck.

You lay out all their options for a Medicare Supplement and a PDP alongside a MAPD with a GTL (or any other hospital indemnity plan) and let them make their own decision. Some people hate the idea of copays while others hate the idea of paying a monthly premium for a Med Sup + PDP. Once they see you truely are not trying to push one product over the other you gain their trust because they can clearly see you are not trying to just push a product on them to make a sell.

This is just my opinion and it works well for me.

 

[jdeasy]

The best plan is whatever the client feels comfortable with. Our job is not to tell them this product or that product is the way they should go. It's not like a MAPD is the perfect product for a 70 year old female non-smoker with a few minor health problems. It's an individual decision. I've got people with alot of money on MA plans and I've got people that are pretty close to Medicaid or at least living paycheck to paycheck.

You lay out all their options for a Medicare Supplement and a PDP alongside a MAPD with a GTL (or any other hospital indemnity plan) and let them make their own decision. Some people hate the idea of copays while others hate the idea of paying a monthly premium for a Med Sup + PDP. Once they see you truely are not trying to push one product over the other you gain their trust because they can clearly see you are not trying to just push a product on them to make a sell.

This is just my opinion and it works well for me.

If were just going to buy what they want then agents are not needed and they just place their orders direct with the company of their choosing.

I used to big on MA plans. I had almost 1000 on the books. More than half were duals. I haven't written an MA plan in almost 3 years now. Same for PDP's. I do help my clients with Medicare.gov to get into a PDP or I refer them to someone that will.

It is my opinion that a person that truly can't afford a med sup is just as well served by Medicare alone. The SNP's are great for the duals, but we don't have any of those here. Wellcare had a very good plan for the Medi/Medi even though it was PFFS. When that went away nothing took it's place.

One does not have to write MA/MAPD's to be succesful in the senior market. As Frank says all the time, he "didn't become an independent agent to be CMS' butt boy". Neither did I.

Of course my opinion of MA plan is also clouded by the fact that we only had PFFS here. Still pretty much that's the case. Humana does have a PPO now, but I would not represent Humana for any amount of money. There is one HMO here and it's terrible. A person can get a med sup for the price of it.

I do run into the occasional person that can't afford a med sup and contrary to my advice they want an MA plan. I refer then to a friend that still writes that crap.

There has not been one day since I stopped writing MA plans that I wished I still had them. I've never done the AHIP, but I do have to take those stupid certification tests to keep my renewals with some companies. That's enough refresher every year to remind me how sickening it is to sell those plans.