Medicare Advantage

[midwestbroker]

I agree Frank.

Humana tried expanding into Lafayette county last year for 2007 (for those not in Missouri, it is the next county east of the metro). I did a lot of marketing with Dr's offices, seminars at local restaurants, pharmacies, etc and it yielded me 1 app. I was running into group plans and Golden Rule's plan G. Mind you this was the HMO they were marketing, but I had the PFFS as well.

I would take the app for the orig carrier that you had them under. As long as that was their first MA plan, they should be able to get their supp back guar issue.

 

[Crabcake Johnny]

I'm about to start selling MA on the side soon and unless I'm being naive I'm running a doctor/hospital search for every prospect to make sure their current doctors/hospitals take the plan and the network is wide enough locally so nothing becomes an issue. I'm hearing and reading more and more about people buying MA plans only to find their doctors don't take it or the surrounding network is extremely thin. Running a search before the appointments would seem to work.

 

[Slick]

I'm about to start selling MA on the side soon and unless I'm being naive I'm running a doctor/hospital search for every prospect to make sure their current doctors/hospitals take the plan and the network is wide enough locally so nothing becomes an issue. I'm hearing and reading more and more about people buying MA plans only to find their doctors don't take it or the surrounding network is extremely thin. Running a search before the appointments would seem to work.

With PFFS MA's, you can't really have a list. PFFS is accepted on a case by case basis. Now that being said, obviously providers will have a general policy and a history with a PFFS, but they have no contract and absolutely nothing stating they will take the PFFS in the future.
Some carriers will offer a list of "participating providers". This list is BS and when you actually get a answer as to what the list represents, they will say it is simply a list of providers the carrier has done business with the in the past (not necessarily PFFS business).
Moving forward, I know of no reason that a educated provider would chose not to accept the PFFS save for the beneficiaries' inability to pay their co-payment, however collecting co-payments is done everday by providers, most are simply spoiled by Medsups.

 

[Crabcake Johnny]

This is a HMO MA.

 

[midwestbroker]

That is the great thing about selling an HMO or PPO product. You have a network right there at your fingertips.

I will say that working with the Medicaid market, you can tell them they are not limited to only Medicaid doctors. That is a big +. I have met very few Medicaid benes who love their doctor.

With a PFFS plan, if there is a HMO or PPO (regional or local) plan close by under the same carrier, most of the time they will take the PFFS plan. At least that is what I have found.

 

[Crabcake Johnny]

I'm actually pretty excited about the MA opportunity. The research I've done on the Bravo plans has shown that it's a better move for Medicaid patients. Again, the only downfall would be in their doctors or other caregivers weren't in the HMO, however Elder Care is telling me their network is immense in Baltimore - less dense as you hit the burbs but I'll be doing Baltimore.

They're telling me it's an 80% closing ratio - I'm figuring 40%. 2 appt's a day is 10 a week which is 4 closed and 6 apps X $300 give me $1,800 to put into health insurance marketing - which is the entire reason I'm doing this. Not like I want to run around Balt. city meeting Medicaid patients for a living.

 

[J.R.]

I'm actually pretty excited about the MA opportunity. The research I've done on the Bravo plans has shown that it's a better move for Medicaid patients. Again, the only downfall would be in their doctors or other caregivers weren't in the HMO, however Elder Care is telling me their network is immense in Baltimore - less dense as you hit the burbs but I'll be doing Baltimore.

They're telling me it's an 80% closing ratio - I'm figuring 40%. 2 appt's a day is 10 a week which is 4 closed and 6 apps X $300 give me $1,800 to put into health insurance marketing - which is the entire reason I'm doing this. Not like I want to run around Balt. city meeting Medicaid patients for a living.

HaHa, I had a great idea talking to the lady about this opportunity. I conveyed that this a great opportunity to shoot an "Insurance Agent 101" video.

Fade in: Two agents walk into B-more, coffee in hand and cell phones at the ready. After each appt. one yells to the other "You still alive?" A resounding yes is heard through the projects. ONWARD !!!!

 

[arnguy]

Millions of Seniors to Be Pushed Out of Medicare Advantage

- America's Health Insurance Plans
July 27, 2007

Nearly three million seniors would lose their Medicare Advantage coverage under legislation proposed in the House of Representatives, according to the non-partisan Congressional Budget Office (CBO).
In testimony before the Ways and Means Committee this evening, CBO director Peter Orszag said that under the CHAMP Act, Medicare Advantage enrollment would fall from approximately 8.2 million currently to 5.5 million in 2012, a reduction of 33 percent from current enrollment levels.
Karen Ignagni, President and CEO of America's Health Insurance Plans (AHIP) said that the CBO estimates confirmed that millions of seniors would no longer have access to the enhanced benefits, coordinated care, preventive services, disease management programs and out-of-pocket protection that Medicare Advantage plans provide.
"This legislation would be devastating to millions of seniors who count on Medicare Advantage for their health security," said Ignagni.
Ignagni added that most of the 5.5 million remaining Medicare Advantage beneficiaries would be faced with significant benefit cutbacks and higher out- of-pocket costs if Congress moves forward with the plan to drastically cut payments to Medicare Advantage plans.

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Interesting.


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[senior-advisor-indiana]

So basically the goverment has to lose their a** in order to keep these plans attactive.

 

[midwestbroker]

It seems that every news story fails to mention that Part C plans are 10 years old. They have been around prior to the government over funding them, and they worked then. Sure, the rural markets may suffer, but the metros will go on as they have been.

The difference is a HMO 4 - 5 years ago was $50 a month, and now you can get them for $0. That is still a lot less then a supp that may run over $100+ more per month.

I am waiting to see what happens with AARP starting to offer MA plans next year. They may want to pull away from over funding, but they will not want the government to stand in the way of them gaining new members.