Medicare Supplements Vs. Medicare Advantage

[Jessica Durphy]

You know, I'm kinda new to this whole thing! But I've found a passion for the Senior Market, and in my very RURAL area, there are no other agents selling Medicare Supps or MA's. I just need to know, WHAT IS BETTER??? Some say, MA are stupid and a waste of time and money! But they tend to cover things that Med Supps won't! I deal with a company called New Era, their part C plan doesn't have any coverage for Vision, Dental, or Prescriptions~ MA plans do! New Era is the only company that I work with thus far for the Supplements.... On the other hand, with MA, I am appointed with Highmark, and am in the process of getting appointed with Mutual of Omaha and AARP.

I think the Seniors like that the MA plans have the prescription drug built into the plan, they like the fact that they can get at least 1 cleaning (dental exam) a year, and hearing aid coverage, vision coverage...

I think both have their pros and cons, but can someone give me a little insight on why you think the one is better than the other?

My goal is to make money, yet do what is in the best interest of the Senior!

 

[GreenSky]

The best thing you can do is contract with www.ritterim.com. They offer most major carriers and will be happy to help you. Both of you are in PA.

Rick

 

[HarryRenard]

You also might want to do a search for the information you seek, I promise there is enough to keep you busy for days. And some of them are quite informative. Also I second the ritter suggestion his site will have a lot of helpful reading and when your ready you can give them a call to get started.
As for your question which is better, there really is not a perfect answer, 9 out of 10 times its gonna be completely situational.
Either way Good luck to you.

 

[jdeasy]

You know, I'm kinda new to this whole thing! But I've found a passion for the Senior Market, and in my very RURAL area, there are no other agents selling Medicare Supps or MA's. I just need to know, WHAT IS BETTER??? Some say, MA are stupid and a waste of time and money! But they tend to cover things that Med Supps won't! I deal with a company called New Era, their part C plan doesn't have any coverage for Vision, Dental, or Prescriptions~ MA plans do! New Era is the only company that I work with thus far for the Supplements.... On the other hand, with MA, I am appointed with Highmark, and am in the process of getting appointed with Mutual of Omaha and AARP.

I think the Seniors like that the MA plans have the prescription drug built into the plan, they like the fact that they can get at least 1 cleaning (dental exam) a year, and hearing aid coverage, vision coverage...

I think both have their pros and cons, but can someone give me a little insight on why you think the one is better than the other?

My goal is to make money, yet do what is in the best interest of the Senior!

You need a lot of training on med sups and MA/MAPD/PDP and on the differences.

You should get with an FMO that offers a lot of the training you need. Right now you have just enough information really make some huge mistakes.

 

[Tom Highway]

You may get a ton of answers on this, but from a sheer maintenance standpoint (you maintaining the member) I am seeing more and more that Medicare Advantage is a huge pain in the ass. I've done/am in the process of doing both MAPD and Med Supps, too.

Let me give you just one recent example.

Not too long ago, I enrolled this lady who is a dual eligible into a MAPD plan. Before you all go off on me for that, duals are my bread and butter, and I know how to put them in the right plan, and it is indeed a good plan for tem. Anyway, I had to make sure ALL her docs were in the plan's network, which was no easy task since she has several docs and a chiropractor.

Things roll along, and I have gotten several calls from this lady, pleased with the plan, and upset about some doctor issues that I reviewed over and over and over and over with her in the first place.

Thursday, I got 14 calls from her in about a 5 minute time span, and I'm not lying about that. She would call, hang up, call again, again, again. I was on an appt, so I didn't pick up, but when she FINALLY left a message, she said "hey, I need you to pick up, this is an EMERGENCY. I'm at my doctor's office, and they are not contracted with the plan". This just pissed me off, because of the multiple calls, and because of the flippant use of the word "emergency". No, lady, a head injury, chest pains, broken neck, THAT is an emergency. You sitting in a doctor's appt who you KNOW is not contracted in your medicare advantage network and trying to go see him anyway is NOT an emergency.

And this is just one issue among so many that can go wrong when a person has any minor problem with prescriptions, network docs, bills, denial of service, etc. And a person like this will not hesitate to try and throw me (you) under the bus, which is why I have to spend so much time documenting and covering my butt.

Med Supps, on the other hand - no "network", no bills/prior authorizations, or other such nonsense.

And add to that all the restrictions of who you can call, getting permission to call, scope of appt, recording conversations, etc.

So yeah, med supps are much more agent friendly, and, I dare say, easier and probably more cost effective for the seniors. There are people who MAPD is right for, but, overall, med supps are the way to go.

 

[Dowejonez]

The vision, dental and hearing benefits usually are not a viable point to consider when helping your client find the right product.

It's always best to make sure your client is aware of how much exposure they have and what kinds of claims will hit their OOP max. Make it a decision in their best interest....always. Sometimes you just have to leave it alone and walk away.

 

[Chazm]

To answer your question, neither is better than the other....IMHO.

Example. What if you meet a client who lives by herself and $600/month SS? Is the med supp better for her? Be prepared because chances are you will get a charge back if you sell her that.

Vision and Dental is just fluff. Not even real benefits

Be prepared to have a scope of appointment with you and just have the client sign it if you bring up MA at all, technically thats not even the correct way to do it but oh well.

 

[Jessica Durphy]

You need a lot of training on med sups and MA/MAPD/PDP and on the differences.

You should get with an FMO that offers a lot of the training you need. Right now you have just enough information really make some huge mistakes.

I'm learning! I love doing this and working with seniors! I'll admit, I'm not the PRO like some of you are, but I intend to be someday. I don't mind doing "homework"...
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You may get a ton of answers on this, but from a sheer maintenance standpoint (you maintaining the member) I am seeing more and more that Medicare Advantage is a huge pain in the ass. I've done/am in the process of doing both MAPD and Med Supps, too.

Let me give you just one recent example.

Not too long ago, I enrolled this lady who is a dual eligible into a MAPD plan. Before you all go off on me for that, duals are my bread and butter, and I know how to put them in the right plan, and it is indeed a good plan for tem. Anyway, I had to make sure ALL her docs were in the plan's network, which was no easy task since she has several docs and a chiropractor.

Things roll along, and I have gotten several calls from this lady, pleased with the plan, and upset about some doctor issues that I reviewed over and over and over and over with her in the first place.

Thursday, I got 14 calls from her in about a 5 minute time span, and I'm not lying about that. She would call, hang up, call again, again, again. I was on an appt, so I didn't pick up, but when she FINALLY left a message, she said "hey, I need you to pick up, this is an EMERGENCY. I'm at my doctor's office, and they are not contracted with the plan". This just pissed me off, because of the multiple calls, and because of the flippant use of the word "emergency". No, lady, a head injury, chest pains, broken neck, THAT is an emergency. You sitting in a doctor's appt who you KNOW is not contracted in your medicare advantage network and trying to go see him anyway is NOT an emergency.

And this is just one issue among so many that can go wrong when a person has any minor problem with prescriptions, network docs, bills, denial of service, etc. And a person like this will not hesitate to try and throw me (you) under the bus, which is why I have to spend so much time documenting and covering my butt.

Med Supps, on the other hand - no "network", no bills/prior authorizations, or other such nonsense.

And add to that all the restrictions of who you can call, getting permission to call, scope of appt, recording conversations, etc.

So yeah, med supps are much more agent friendly, and, I dare say, easier and probably more cost effective for the seniors. There are people who MAPD is right for, but, overall, med supps are the way to go.

I wouldn't go off on you for that!! I have sold about 12 MAPD plans, and so far, EVERYONE is truly happy with them. I've heard NO complaints.

My reasoning for asking is that, as I mentioned, in my area (so far) New Era offers the best price for Med Supps... but for these folks to buy a PDP on top of that, it costs them sometimes double what a MAPD plan is! That's what they look at... ALWAYS before I ever go to an appointment, I try to get as much information from a senior as I can, just by talking to them... I see what their needs are, I can get a feel of what's the most important to them, and then I try to go by that! If they are very concerned about how much is a copay, deductible, what's it going to cost for an ER visit, what if i have to take an ambulance, etc.... I just try to get them into something that will be best for their situation and pocket book...

I have a gentleman that in November he's going to change from his PFFS to New Era, because he gets his prescriptions from the VA or Walmart ($4.00)... so for him to get a Supp is SOOO much better, no copay,no deductible, no more money out of his pocket other than his monthly premium. (to him I hung the moon, he's referred so many folks to me.) I love the idea of a supp... but I just hate that the other portions folks ask me about I have to tell them, no this plan doesn't cover that! BUT with your permissions and signature, I can tell you about this other idea that I may have and it could possibly work for you....

 

[jdeasy]

I'm learning! I love doing this and working with seniors! I'll admit, I'm not the PRO like some of you are, but I intend to be someday. I don't mind doing "homework"...
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I wouldn't go off on you for that!! I have sold about 12 MAPD plans, and so far, EVERYONE is truly happy with them. I've heard NO complaints.

My reasoning for asking is that, as I mentioned, in my area (so far) New Era offers the best price for Med Supps... but for these folks to buy a PDP on top of that, it costs them sometimes double what a MAPD plan is! That's what they look at... ALWAYS before I ever go to an appointment, I try to get as much information from a senior as I can, just by talking to them... I see what their needs are, I can get a feel of what's the most important to them, and then I try to go by that! If they are very concerned about how much is a copay, deductible, what's it going to cost for an ER visit, what if i have to take an ambulance, etc.... I just try to get them into something that will be best for their situation and pocket book...

I have a gentleman that in November he's going to change from his PFFS to New Era, because he gets his prescriptions from the VA or Walmart ($4.00)... so for him to get a Supp is SOOO much better, no copay,no deductible, no more money out of his pocket other than his monthly premium. (to him I hung the moon, he's referred so many folks to me.) I love the idea of a supp... but I just hate that the other portions folks ask me about I have to tell them, no this plan doesn't cover that! BUT with your permissions and signature, I can tell you about this other idea that I may have and it could possibly work for you....

The majority of my my MA business has been duals and I've done over 800 MA plans. I can't imagine an instance where it would be in the dual eligible person's interest to ever enroll them in an MAPD. The time I could think it would be is for an SNP. Since we don't have any of those here in my area, there is never a reason to enroll a dual into an MAPD. You do a dis-service to an LIS person to enroll them into a $0 premium MAPD. They are going to get their PDP plan paid for if they are 100% LIS and they would get more benefits from a stand alone MA for their medical needs.

Of course, I am not a believer in MAPD for anyone. Of my over 800 MA plans, less than 10 are MAPD. A person will always have more choices if they are kept separate. What if they like the PDP part of the MAPD, but, not the rest? They will give up both to go somewhere else. What if they like the medical, but the MAPD formulary is not as inclusive as another PDP? They will give up the MAPD to get the more inclusive PDP.

What about now when Wellcare and Coventry are pulling out of the PFFS, but not the PDP. The people on MAPD plans with those two will have to make two changes. Many of my Wellcare and Coventry clients are now taking advantage of the right to get a med sup. The fact that I never put them in MAPD plans is now making it a much easier switch for me and for the clients.

The only time I could see it as a good thing to enroll someone into an MAPD would be when the person needed a PDP and couldn't afford one and there was a $0 or very low cost MAPD available for them. Even though I have sold many MA plans, I've always told my clients that there is nothing better than a med sup if they can handle the premiums. As for the exapmple that someone else gave about a person making only $600 per month. That person would be a QMB plus and on full medicaid. They would not need a med sup, an MA or a PDP. They may need help with chosing their PDP and you could jump thru many hoops for that $25 or you could let Medicare help them with the choice. They could benefit from an SNP if available.

 

[Chazm]

^you are right I would write them evercare for low income but I was just trying to give an example.....or I could say someone making $1k month and every cent is currently paying the bills. It wouldn't be smart to put them in a monthly plan when my MAPD is free