What is an Advantage of a MA Plan?

[SouthernComfort]

Medi-Medi, their cost are for the most part covered for services. Medicare only you are leaving your care decisions up to a private insurance company, in rural areas 6700(max out of pocket), limited formularies, you pay providers first... so what are the advantages?

 

[Todd King]

Medi-Medi, their cost are for the most part covered for services. Medicare only you are leaving your care decisions up to a private insurance company, in rural areas 6700(max out of pocket), limited formularies, you pay providers first... so what are the advantages?

Low to no premium, drug coverage included. Also includes some Dental, Vision, and Hearing...maybe a couple of more benefits.

 

[SouthernComfort]

I get that, but is that truly an advantage? In what scenario does someone come out better LIS and Medicaid do not pay a pdp premium anyway and most have the 104.90 added back to their social security check. So when is it better?

 

[Chazm]

I guess you are asking not about a mapd plan but someone who is dual eligible and gets a plan?
Advantages here in FL is a better network than Medicaid, gym membership, OTC benefits, trips to the doctor all at no cost

 

[yorkriver1]

OTC benefits on one HMO here are $35 monthly on mail order. Vitamins, heating pads, much more. Special Needs Plan designed for those Dual Eligible for Medicaid/Medicare has great zero OOP's on lots of services.
The HMO MAPD for chronic illness is good for those not on Medicaid, although it's a different plan.
Have 2 chronic illness prospects on SSDI who will benefit from MAPD, even with the high MOOP. One has only Original Medicare now, facing some big bills. There are some special benefits on the chronic care special needs MAPD HMO. Paid trips to care facilities for special services, etc. Under 65 SSDI on Medicare in my state have no good MedSupp options. MAPD is an advantage over Original Medicare for them.

 

[goillini52]

Medi-Medi, their cost are for the most part covered for services. Medicare only you are leaving your care decisions up to a private insurance company, in rural areas 6700(max out of pocket), limited formularies, you pay providers first... so what are the advantages?

I don't care for MA's, but another advantage is they're Guaranteed Issue.

 

[SportsNut]

Medi-Medi, their cost are for the most part covered for services. Medicare only you are leaving your care decisions up to a private insurance company, in rural areas 6700(max out of pocket), limited formularies, you pay providers first... so what are the advantages?

In addition to what Todd stated, the biggest diff is that Med A&B only you have NO stop loss on Part B expenses. In my mkt there are MAPD plans with 0 oop for PCP visits, moop of 3200, which in and of itself is a huge benefit to unlimited moop with Pt B only.

When you mix in Medi-Medi that is an entirely diff subject and cannot be lumped together in the same question, IMHO.

 

[jdeasy]

In addition to what Todd stated, the biggest diff is that Med A&B only you have NO stop loss on Part B expenses. In my mkt there are MAPD plans with 0 oop for PCP visits, moop of 3200, which in and of itself is a huge benefit to unlimited moop with Pt B only.

When you mix in Medi-Medi that is an entirely diff subject and cannot be lumped together in the same question, IMHO.

The op is talking about medi/medi people. Different story.

Depends on who he is asking about the advantage for? The advantage to the agent is that the agent gets paid. For the medi/medi person there is not much advantage. Even could be a disadvantage is the MA plan doesn't coordinate with medicaid.

Now, plans specifically designed for the duals can be an advantage. I never had an SNP's in my area to work with. I did have some in the Nashville, Tn area and I did used to drive down there to enroll people.

If there is a good SNP available then of course they should be looked at for the medi/medi.

We did have Wellcare's PFFS plan here about 5 years ago that coordinated with medicaid and gave the client dental, eyeglass coverage and a $40/mo stipend for incidentals. That was great for the medi/medis and they loved it. Went away end of '09 and nothing took it's place.

So, an MA/MAPD for the full medi/medi is not going to be much of an advantage to the enrollee.

 

[amazinagent]

If you have a client on partial Medicaid with a spend down/share of cost, there is a HUGE advantage! Generally they have MSP, LIS, drugs, no copays, dental, vision, hearing, OTC, gym membership, (meals on some plans), transportation & ME! Without an MAPD, they'd pay out of pocket until they reach their monthly share of cost which could be very high. With some docs refusing Medicaid (& Medicare in some cases), the network of the private insurance company could mean access to more doctors.

Each circumstance is different. And if your opinion of MAPD plans is negative, they'll pick up on it & shy away from it. A thorough needs assessment will show you & the client (especially a partial dual) the advantages of an Advantage plan.