Mapd Replaces Medicare?

[insurance5511]

Had client call me today needed to get some diagnostic testing, the doctors office tell her she's "replaced" her original medicare with this new humana ppo mapd...now she cant get her xrays and lab-work for free which I know she can't with an mapd but why would the dr tell her she lost her original Medicare?

thanx

 

[Newby]

Re: Mapd Replcaes Medicare?

If you told her it doesn't replace her original Medicare you pretty much committed a CMS violation. MedSup's pay in addition to Medicare. Medicare advantage plans pay instead of Medicare or replace Medicare.
How else could you explain it and be truthful and compliant?

 

[LostDollar]

Re: Mapd Replcaes Medicare?

Had client call me today needed to get some diagnostic testing, the doctors office tell her she's "replaced" her original medicare with this new humana ppo mapd...now she cant get her xrays and lab-work for free...wtf???

Is this what the doctors do, I told her no way it replaces it..what would you do here to make her happy?

thanx

https://www.medicare.gov/sign-up-ch...-plans/how-medicare-advantage-plans-work.html

Read the first paragraph.

 

[WCMason]

Re: Mapd Replcaes Medicare?

Had client call me today needed to get some diagnostic testing, the doctors office tell her she's "replaced" her original medicare with this new humana ppo mapd...now she cant get her xrays and lab-work for free...wtf???

Is this what the doctors do, I told her no way it replaces it..what would you do here to make her happy?

thanx

Your client is confusing a Medigap that does pay for all of her labs and x-rays (depending on the plan) with an MA plan that has copays. How did she get the idea that the plan you sold her would get her labs and x-rays for free? No PPO MA plan has ever included that.

From the doctor's perspective the MA plan does replace Medicare, at least as the place claims are filed. But your client should already know that. Did your client forget what you told her about how Medigap plans differ from MA plans, or did you forget to tell her?

 

[GreenSky]

Re: Mapd Replcaes Medicare?

MA plans do replace the Medicare benefit with private insurance primarily paid for by Medicare. The beneficiary is subject to the copays and coinsurance from the MA plan.

So from everyone's standpoint as far as benefits MA plans do replace Medicare. To tell anyone something else would be dishonest and a CMS violation.

I can't wait for someone to quote chapter and verse from CMS. Perhaps someone who simply trolls here can do it.

Rick

 

[insurance5511]

Re: Mapd Replcaes Medicare?

I remember reading that mapd plan administer thier Medicare but they never lose original Medicare. I explained what a med supp is compared to mapd and she couldn't afford it. so when someone gets an mapd plan it replaces thier original Medicare or does it administer it??

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If you told her it doesn't replace her original Medicare you pretty much committed a CMS violation. MedSup's pay in addition to Medicare. Medicare advantage plans pay instead of Medicare or replace Medicare.
How else could you explain it and be truthful and compliant?

Sorry didn't explain correct... the dr to her if she had original Medicare she would have to pay for it.

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Your client is confusing a Medigap that does pay for all of her labs and x-rays (depending on the plan) with an MA plan that has copays. How did she get the idea that the plan you sold her would get her labs and x-rays for free? No PPO MA plan has ever included that.

From the doctor's perspective the MA plan does replace Medicare, at least as the place claims are filed. But your client should already know that. Did your client forget what you told her about how Medigap plans differ from MA plans, or did you forget to tell her?

No I explained just original post wasn't done correct. The dr said since her mapd replaced her original Medicare it wouldn't be covered...but if she had only Medicare would she have 20% oop instead of just a small co pay with an mapd? The

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Your client is confusing a Medigap that does pay for all of her labs and x-rays (depending on the plan) with an MA plan that has copays. How did she get the idea that the plan you sold her would get her labs and x-rays for free? No PPO MA plan has ever included that.

From the doctor's perspective the MA plan does replace Medicare, at least as the place claims are filed. But your client should already know that. Did your client forget what you told her about how Medigap plans differ from MA plans, or did you forget to tell her?

No I explained just original post wasn't done correct. The dr said since her mapd replaced her original Medicare it wouldn't be covered...but if she had only Medicare would she have 20% oop instead of just a small co pay with an mapd? The

 

[somarco]

Re: Mapd Replcaes Medicare?

They have to maintain Medicare A & B (pay the premium). But . . . their benefits are managed by an insurance carrier that determines the benefits, copay's, deductibles, etc.

In a way the MA does replace Medicare but it does not eliminate the need to pay the B premium.

Sounds like you need a refresher course in MA and Medicare.

 

[insurance5511]

Re: Mapd Replcaes Medicare?

https://www.medicare.gov/sign-up-ch...-plans/how-medicare-advantage-plans-work.html

Read the first paragraph.

Thanx you, will copy and save

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If you told her it doesn't replace her original Medicare you pretty much committed a CMS violation. MedSup's pay in addition to Medicare. Medicare advantage plans pay instead of Medicare or replace Medicare.
How else could you explain it and be truthful and compliant?

I explained both differences, just posted wrong sorry. As an experienced agent what exactly do you tell clients?

 

[LostDollar]

Re: Mapd Replcaes Medicare?

Caveat, Not an agent.
When you start talking about the 20%, you are looking at a medigap policy for that coverage.

Here are some brief comments about that, they include a link to a more lengthy cms publication about Medigap policies.

https://www.cms.gov/Medicare/Health-Plans/Medigap/index.html

 

[insurance5511]

Re: Mapd Replcaes Medicare?

They have to maintain Medicare A & B (pay the premium). But . . . their benefits are managed by an insurance carrier that determines the benefits, copay's, deductibles, etc.

In a way the MA does replace Medicare but it does not eliminate the need to pay the B premium.

Sounds like you need a refresher course in MA and Medicare.

Doesn't this mean mapd manages thier original Medicare? They don't lose it??

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https://www.medicare.gov/sign-up-ch...-plans/how-medicare-advantage-plans-work.html

Read the first paragraph.

Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. You'll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan and not Original Medicare.


"You still have original Medicare". Sorry been at this about a year and this why I try to stick to med supps but sometimes you have clients who can't afford them. Very confusing