MAPD Vs Original Medicare

xrx1109

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Quick question. I would much rather sell a MED SUPP but its just not possible in all cases. My general question is if there is ever a time when it is advantageous to keep someone on original medicare instead of advising them to sign up for a MAPD plan?

Other then the fact we get paid by MAPD companies of course
 
Quick question. I would much rather sell a MED SUPP but its just not possible in all cases. My general question is if there is ever a time when it is advantageous to keep someone on original medicare instead of advising them to sign up for a MAPD plan?

Other then the fact we get paid by MAPD companies of course

A friend of my niece was considering an MAPD last AEP, although come to find out she is LIS so she wasn't limited to just AEP for chgs. Anyway, she has had a lot of medical procedures, a lot, and on Orig Med. The MA plan that she was considering had a higher Moop than the highest oop that she has incurred in orig med. So we analyzed specific med procedures and what it cost her on orig med, vs what her co-pay was going to be with the MA plan. Guess what, org med was cheaper even with no supp; 19 bucks to 25 bucks... and the co-pay she needed to pay up front where the 20% not paid by med she is billed for by the Dr and can work out a pymt arrangement.

So while she was swayed by the Silver Sneakers, et al, she came to her senses in time to eliminate that foolishness before it was too late. So in her case, and she is in a situation of high health care need, she was better off w/o the MAPD plan.

Additionally, when she was hospitalized, the hosp had some write down or forgiveness plan due to low income, and since she had no ins covg. Now, if she had ins covg with MAPD, does this somehow effect the subsidy or write down...? We don't know, but if it isn't broken don't fix it... she is getting along just fine now paying her Drs a few bucks per mo, and they keep seeing all the same.

So in her case, she is better off with Orig Med, was the joing conclusion.
 
Quick question. I would much rather sell a MED SUPP but its just not possible in all cases. My general question is if there is ever a time when it is advantageous to keep someone on original medicare instead of advising them to sign up for a MAPD plan?

Other then the fact we get paid by MAPD companies of course

I have 3 situations where MAPD is the way to go.
  1. In my city, there is a very large medical group that won't take original Medicare (they will even kick an existing patient out if they use original Medicare). There is one MAPD network they are part of. So if a client LOVES their doctor, and the doctor is in that group, I will still make sure they know the risks, but I will sell them an MAPD. Some patients are OK with finding another doctor, those will take Med Supp.
  2. If the client is on LIS (or should be), then an MAPD is appropriate.
  3. IF the client is generally healthy but so tight on their budget that they will either get nothing or an MAPD, I will sell the MAPD (at least it has an OOP max). I have one customer right now like that. She wasn't even planning to enroll in Part B for another year until her SS starts, but I showed her why she needs to find the extra $100/mo for Part B. Now an extra $100/mo for Med Supp & Part D is completely out of the question for the next year. I guarentee you if she is diagnosed with the big C, she will be better off with the MAPD than if she had only A & B.

Sometimes their retirement plan is a better deal for them. Otherwise, a Med Supp is required. I am not aware of a situation where the best option is to use Part A & B with nothing else.
 
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