Medicare Advantage
- Thread starter TheSalesWolf
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- 1,908
The reason everyone is so confused is because of lack of training, on the part of the FMO's and the Insurance Companies.
Here is how I state the options, for those who are on Medicare:
Medicare Supplement plans fill in the "gaps" left by Medicare Parts A and B. For a monthly fee to the insurance company every month, you can tell all your friends that, thanks to Medicare Supplements, you didn't have to pay a dime while you were in the hospital, or when you saw your doctor.
With Medicare Advantage Plans, there is no need to pay a monthly fee, up front. You simply pay as you go. There are "predictable" costs for each doctor visit, each medical procedure, each trip to the dentist, chiropractor, and medication filled.
With both plans, you are still in Medicare, it's just a matter of who is administering the health coverage to you.
What I do, ladies and gentlemen, is find out who their doctors are (including their specialists),and what medications they take. I start from there. Then, I find out if having dental, vision, and hearing is important. If not, I would begin talking about Medicare Supplements. If it is, then I would begin the discussion about Medicare Advantage Plans.
For every horror story I hear about Medicare Advantage Plans, I hear one about Med Supps. They are both valid options.
Getting trained and certified was the best experience I've had. I was totally confident when I went out on an appointment. Because I didn't work leads or telemarketing leads, I was able to approach it my own way, and gather information up front (such as current physicians, medications, etc.).
Almost every MA/MS sale has led to a referral. I'm really glad most agents don't want to spend the time to sell it. It leaves more business for me.
Medicare is like Long Term care. Don't dabble in it. Refer it to someone who knows it inside and out.
Here is how I state the options, for those who are on Medicare:
Medicare Supplement plans fill in the "gaps" left by Medicare Parts A and B. For a monthly fee to the insurance company every month, you can tell all your friends that, thanks to Medicare Supplements, you didn't have to pay a dime while you were in the hospital, or when you saw your doctor.
With Medicare Advantage Plans, there is no need to pay a monthly fee, up front. You simply pay as you go. There are "predictable" costs for each doctor visit, each medical procedure, each trip to the dentist, chiropractor, and medication filled.
With both plans, you are still in Medicare, it's just a matter of who is administering the health coverage to you.
What I do, ladies and gentlemen, is find out who their doctors are (including their specialists),and what medications they take. I start from there. Then, I find out if having dental, vision, and hearing is important. If not, I would begin talking about Medicare Supplements. If it is, then I would begin the discussion about Medicare Advantage Plans.
For every horror story I hear about Medicare Advantage Plans, I hear one about Med Supps. They are both valid options.
Getting trained and certified was the best experience I've had. I was totally confident when I went out on an appointment. Because I didn't work leads or telemarketing leads, I was able to approach it my own way, and gather information up front (such as current physicians, medications, etc.).
Almost every MA/MS sale has led to a referral. I'm really glad most agents don't want to spend the time to sell it. It leaves more business for me.
Medicare is like Long Term care. Don't dabble in it. Refer it to someone who knows it inside and out.
- 14,809
The "MA bashing" stories we read in the news are obviously more pronounced since in general the articles are written by liberal journalists who want free government healthcare for everyone. Any move the country makes to farm anything out to private companies is going to be met with disdain. Look at all the horror stories written after Part D was implemented.
For every "horror story" you read about MA there's 10 horror stories about Medicaid and Medicare in general.
For every "horror story" you read about MA there's 10 horror stories about Medicaid and Medicare in general.
- 2,370
Bob, that is true lack of training is a big part of it. MA plans pay in larger sums to the agent and the IMO, while supps pay, but it is over a longer period of time.
So, newer agents hear, you can make $300 to enroll them in this MA or $15 per month to enroll them in this supp, you know what they are going to focus on.
John has a great opportunity since supps are not an option for Medicaid beneficiaries.
So, newer agents hear, you can make $300 to enroll them in this MA or $15 per month to enroll them in this supp, you know what they are going to focus on.
John has a great opportunity since supps are not an option for Medicaid beneficiaries.
- 14,809
True. I seem to have a unique opportunity since Bravo by Elder Health offers great HMO plans and a huge network in the Baltimore metro area - much less dense as you get into the burbs but I don't think there's a shortage of Medicaid patients in Baltimore.
This is also money in the side for me - not needed money. No one's signing crap until I check out their doctors and any other caregivers to make sure they're in network. I'm extremely senior-minded since my parents are in their mid-70's.
Also, has anyone mentioned that one of the side benefits of MA plans is the stigma being lifted regarding being on Medicaid? Although technically there's no difference they can now tell their friend, family and neighbors that they are on "Aetna" or "Elder Care" and not Medicaid.
Baltimore went away from "Food Stamps" to an Independence card thereby lifting the stigma and embarrassment associated with paying for food with vouchers.
This is also money in the side for me - not needed money. No one's signing crap until I check out their doctors and any other caregivers to make sure they're in network. I'm extremely senior-minded since my parents are in their mid-70's.
Also, has anyone mentioned that one of the side benefits of MA plans is the stigma being lifted regarding being on Medicaid? Although technically there's no difference they can now tell their friend, family and neighbors that they are on "Aetna" or "Elder Care" and not Medicaid.
Baltimore went away from "Food Stamps" to an Independence card thereby lifting the stigma and embarrassment associated with paying for food with vouchers.
- 2,370
That is one of the selling points that another agent I know uses.
Would you rather be in the doctors office saying you have Medicaid or you have Aetna?
Would you rather be in the doctors office saying you have Medicaid or you have Aetna?
- 1,704
The true test of any health plan is in the claim experience.
These MA plans are just being rolled out to the masses....like in 2007 season.
Clients who don't have doctor/hosp bills love saving premium money. They perceive MA's as having protection in case of medical need, and that is a security blanket for them.
Until there is heavy claim pressure from several specialists, tests, hospital and Skilled nursing home....we don't know how these advantage plans will perform...esp the PFFS.
And that's the true test. remember, with Advantage you shifted the liability to the client. That's why he pays and pays.
l
These MA plans are just being rolled out to the masses....like in 2007 season.
Clients who don't have doctor/hosp bills love saving premium money. They perceive MA's as having protection in case of medical need, and that is a security blanket for them.
Until there is heavy claim pressure from several specialists, tests, hospital and Skilled nursing home....we don't know how these advantage plans will perform...esp the PFFS.
And that's the true test. remember, with Advantage you shifted the liability to the client. That's why he pays and pays.
l
- 14,809
In the case of dual eligibility and MA taking the place of Medicaid it would interesting to hear how any insurance company would justify not paying a claim to the state.
You also have to remember that it's the insurance lobby greasing the palms of all those politicians who got them to pass legislation that farms it out to seniors. If the insurance companies "screw" seniors by dicking around with claims they're shooting themselves in the foot. Congress will just put MA plans out of business. There will be zero tolerance for insurance companies issuing MA plans not paying claims.
You also have to remember that it's the insurance lobby greasing the palms of all those politicians who got them to pass legislation that farms it out to seniors. If the insurance companies "screw" seniors by dicking around with claims they're shooting themselves in the foot. Congress will just put MA plans out of business. There will be zero tolerance for insurance companies issuing MA plans not paying claims.
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- 7,066
I'm not sure I understand what you mean by "heavy claim pressure". How is the claim pressure going to be any different than it already is with those who are on Medicare? If anything I would think it would be less with PFFS plans.
Doctors accepting patients who have a PFFS plan know exactly how much they are going to get paid for their services. (More than they get from an HMO.) They also know they are going to get paid the same as they do for people who are on Medicare. It's not about how much they get paid, it's how fast they get paid.
With other Advantage plans, not PFFS, the HMO for example has a lot of control over what the doctor does and doesn't do in treating his/her patients. (I've been told that doctors get a bonus at the end of the year from the HMO for those patients they don't treat.) Those same restrictions are not placed on doctors who accept patients on a PFFS plan, it is just as though the patient is still on Medicare.
People who are on Medicare and have a supplement do not pay a penny to go to the doctor, hospital, tests, etc. With a PFFS play there are copays. The copays, no matter how small, are going to discourage a lot of seniors from making going to the doctor a hobby. Yes, I have clients who I really believe that their hobby is going to the doctor to get the latest pill they see on TV.
I have always felt that Medicare should have a $10.00 copay, or more, when a person goes to the doctor. I believe that alone would greatly reduce claims and the depletion of Medicare's budget. If seniors had to pay to go to the doctor a lot of them would think twice before making an appointment.
And no, I don't think that a supplement policy should pick up the copay when they go to the doctor. The person on Medicare needs to pay that copay themselves.
In my opinion one of the "good" things about the PFFS plans is that there is a copay when they go to the doctor.
- 7,066
I hear tons of "horror stories" about HMO's for seniors, a lot of "horror stories" about those with a PFFS plan, but I don't recall any from people who are on Medicaid. Other than there are more and more doctors who are refusing to take Medicaid patients.
I don't recall hearing any "horror stories" from people who are on Medicare. If anything, I hear lots of "good things" from people who are on Medicare and have a supplement.
If anyone has "horror stories" from people on Medicare I would like to know what they are. They may be out there and I just haven't heard them.
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