A dying agents warning ‼️
- Thread starter Duaine
- Start date
First, I'm 99% Med Supp for those over 65. Second, I am referral only. Both financial planner and clients. Sometimes I get people who find me from a news article, but that's it.
80% of my clients pay or appeal IRMAA.
I can get Plan N in TX with PDP for $125/month. I can't put a hospital indemnity and whatever else crapola on top of MAPD for that.
When I get someone on the phone making above $2500 in SSA but no real savings, then MAPD is stupid. They made enough money to get decent SSA but clearly can't save their money. "Do you want to pay $125 a month then never worry about a hospital bill after $250 or do you want to pay $0 and know that if you spend 6 days in the hospital its around $1800? Plus, if you decide to go back to Medicare Advantage, its no problem. We can do that every year. If you want to go in reverse, it requires underwriting".
I work very, very hard to present Medicare 101 without bias. But its game over with one of these 3 statements:
1. You are assigning your rights from Original Medicare over to a private company
2. To switch from Medicare Advantage to Medicare Supplement it requires underwriting after the first 12 months.
3. The out of network benefit on the MAPD PPO requires the doctor or provider to accept the Advantage Plan, there is nothing that requires them to do so.
If they want MAPD, I give them MAPD. But NO ONE ever calls me and says "you didn't tell me that". Ever. (And if they do, I forward them an email they replied to)
80% of my clients pay or appeal IRMAA.
I can get Plan N in TX with PDP for $125/month. I can't put a hospital indemnity and whatever else crapola on top of MAPD for that.
When I get someone on the phone making above $2500 in SSA but no real savings, then MAPD is stupid. They made enough money to get decent SSA but clearly can't save their money. "Do you want to pay $125 a month then never worry about a hospital bill after $250 or do you want to pay $0 and know that if you spend 6 days in the hospital its around $1800? Plus, if you decide to go back to Medicare Advantage, its no problem. We can do that every year. If you want to go in reverse, it requires underwriting".
I work very, very hard to present Medicare 101 without bias. But its game over with one of these 3 statements:
1. You are assigning your rights from Original Medicare over to a private company
2. To switch from Medicare Advantage to Medicare Supplement it requires underwriting after the first 12 months.
3. The out of network benefit on the MAPD PPO requires the doctor or provider to accept the Advantage Plan, there is nothing that requires them to do so.
If they want MAPD, I give them MAPD. But NO ONE ever calls me and says "you didn't tell me that". Ever. (And if they do, I forward them an email they replied to)
Special Agent
Guru
- 476
You had me until " You are assigning your rights from Original Medicare over to a private company" that sounds scary no wonder they all buy med supps
seeing plans up to $6900
there is truth in that statement however
That's exactly what you're doing. Assigning rights. Replacing MC. Really?
MedicareWAA
Guru
- 377
This is not true. Good lord.
You’re still in the Medicare program. You still have all the rights and protections that come along with having Medicare, but you will access your benefits through a private company with a Medicare contract. The plan has a network and there are rules. It is managed care. Your doctor may need to get permission before fixing you certain care.
Pretty sure the Good Lord has nothing to do with it. Last time I checked, He had a supplement.
If you're on a MA plan and have an appeal, who handles that appeal? And if you're on a MA plan, can you still go to your state's ombudsman for help?
Yes, you do have the rights and and protections that come with medicare. But the decision process is different.
What are the rights and protections?
I am sure that is rhetorical.
The CARRIER handles the appeal. Medicare does not get involved until the member has exhausted all other means through the carrier.
To appeal a Medicare Advantage plan's decision, you can request a reconsideration within 60 days of receiving the initial denial notice:
If you're dissatisfied with the reconsideration determination, you can appeal to the next level. The Medicare appeals process has five levels: Redetermination, Reconsideration, Administrative Law Judge hearing, Medicare Appeals Council review, and Judicial review in U.S. District Court.
If you are in a Medicare Advantage plan, you can appeal the plan's decision to not pay for, not allow, or stop a service that you think should be covered or provided.
You may contact your plan or consult your plan materials for detailed information about requesting an appeal and your appeal rights.
How to Request an Appeal (i.e., "request for reconsideration")
Your Medicare Advantage plan must inform you in writing on how to request an appeal.
At Level 1, your appeal is called a request for reconsideration.
You may request reconsideration by your Medicare Advantage plan within 60 days of being notified by your Medicare Advantage plan of its initial decision to not pay for, not allow, or stop a service ("organization determination").
Please note that the Office of Medicare Hearings and Appeals is responsible only for the Level 3 claims appeals and certain Medicare entitlement appeals and Part B premium appeals. OMHA is not responsible for levels 1, 2, 4, and 5 of the appeals process. OMHA provides additional information on other levels of appeals to help you understand the appeals process in a broad context.
Sounds like fun . . .
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