Medicare Part B Giveback

[GoPokes]

When referring to the MOOP, I have heard of some issues in the past with one particular person. Told to me by another agent. I believe it was in regards the "approved and covered" language. The guy had an HMO. He wanted care from a particular facility for a serious condition, yet the HMO said, no, we wont approve it, so the MOOP didnt apply. He was out of pocket for the everything he wanted. The individual was very wealthy and got the care he wanted, but he also brought a hellstorm against the insurance company.

 

[agentjhc]

When referring to the MOOP, I have heard of some issues in the past with one particular person. Told to me by another agent. I believe it was in regards the "approved and covered" language. The guy had an HMO. He wanted care from a particular facility for a serious condition, yet the HMO said, no, we wont approve it, so the MOOP didnt apply. He was out of pocket for the everything he wanted. The individual was very wealthy and got the care he wanted, but he also brought a hellstorm against the insurance company.

Why I prefer MS. Did the facility accept Medicare?

 

[GreenSky]

When referring to the MOOP, I have heard of some issues in the past with one particular person. Told to me by another agent. I believe it was in regards the "approved and covered" language. The guy had an HMO. He wanted care from a particular facility for a serious condition, yet the HMO said, no, we wont approve it, so the MOOP didnt apply. He was out of pocket for the everything he wanted. The individual was very wealthy and got the care he wanted, but he also brought a hellstorm against the insurance company.

This is what happens when cheap bastards care more about cost than benefit.

A few weeks ago a friend was bragging that his HMO as terrific. Had all his doctors. Then he took a fall and paid out of pocket for a SNF because the ones in the HMO network were hell holes. I suggested he "move" out of the area and get a supp effective 6/1. It's now 6/7 and nothing.

Rick

 

[yorkriver1]

All these comments are good to consider.

When I talk to clients who are on SSDI, and close to T65, we discuss their ability to buy a Medicare Supplement. Even those with tight budgets usually find a way to get, say, Plan N or G.
If I can convince a client who could qualify for a Medicare Supplement to buy that instead of an HMO or PPO, I do it. One recent case just wouldn't budge, due to doc recommending the MAPD, had to be PPO due to network. I even tried High Deductible F, no go. Documented record to show it was offered.
That said, if it's selling an MAPD or nothing, and I have offered alternatives, then MAPD.
I have not sold a Medicare B refund option plan, as most in the target demographic would probably choose MedSupp.
The low hanging fruit of copays in MAPD is appealing to some, even compared to meeting the $183 Part B deductible. For some, the MOOP is hard to imagine.

 

[The Rabbi]

It's the agent's responsibility to educate the consumer on the features and benefits of their options. Of course MS is the best but not always affordable. In Fl. 90% of my book is PPO and I used it while traveling the country for 4 years. One of my agents knew he was going to need a hip so during AEP he switched from PPO to MS for the year.

 

[GoPokes]

It's the agent's responsibility to educate the consumer on the features and benefits of their options. Of course MS is the best but not always affordable. In Fl. 90% of my book is PPO and I used it while traveling the country for 4 years. One of my agents knew he was going to need a hip so during AEP he switched from PPO to MS for the year.

I agree, i do sell both MA and MS. I can see how both plans are superior to whats available to the under 65 individual market (not on medicare). So as somebody ages in, the benefits of MA can look pretty good. Most of my MA biz is lower income.

There have been times when a prospect couldn't afford a plan G ($85/$95 around here), but didnt like the network of the mapd, so we settled on a plan K ($40), plus a PDP ($22), and it worked nicely. I think the plan K+PDP can make fair competition for some MAPD's .

 

[LostDollar]

I had wondered about Plans K and L as alternatives to a HI-F when someone is considering an MA plan. It looks like the relationships are different where you are than in KS. Using the avg rates in KS' last year's shopper's guide, HI-F rates come up better than plan K or L. Don't remember for sure, but I think your PDP rate falls between my Walmart and Silverscript options.

thanks for the post and info.

 

[Northeast Agent]

How did someone who "knew he was going to need a hip so during AEP he switched from PPO to MS for the year" pass underwriting? Was he using a Trial Right or lives in a state that has GI?

 

[JFS55]

HDF is probably the best plan for those with limited means. If eligible and can afford that. HDF>MAPD almost all day long.

 

[agentjhc]

HDF is probably the best plan for those with limited means. If eligible and can afford that. HDF>MAPD almost all day long.

Seems logical. No network. $2200 MOOP.