A Medicare Advantage Dilemma

[theinuranceguy]

For all the veteran Medicare Advantage brokers, here is my dilemma.

About 90% of my clientele are on either an HMO or PPO, the other 10% are on a Medicare Supplement. This year has brought many changes to the HMO's and PPO's in the counties I work in, and some very big players have entered the counties that were not here last year.

My current book of business, the majority of who are in about 4 different plans, are seeing zero premium plans turn into $50 premium plans, they are seeing copays double, and drug benefits reduced.

Every year I look through all the plans and pick the ones I find best, I boil it down to about 4 or 5 plans that I feel best fit certain scenarios. The problem is that the plan that I find best, is a PFFS.

I am not a fan of PFFS's, but none of the HMO's or PPO's touch this thing. It is a zero premium plan, with the least co pay in the hospital (compared to other zero premium plans), best copay at the dr/specialist, second best drug benefit (behind a plan w/ a premium), it includes dental, eye glasses, and hearing aid coverage.

What am I to do? I have had a bad experience in the past with a so called SNP PFFS (wasn't really ever a SNP), so I am a little taken back, but if I call the Doctor and he/she says they accept it… should I sell it, although its been drilled in me not to do so?

Im telling ya, this plan is the bomb diggety.

 

[patch36]

Re: A Medicare Advantage Dilemma …

If it is the best product for your clients, sell it. But, if that PFFS does not have a network in 2011 and meets a few other conditions it will go away. So, a little research into that aspect may be needed before you can recommend it.

I suspect the PFFS has thought of this and will be meeting the requirements to stay past 2011, but it would be important to me if that were the case before I would sell it. I am lucky, we have a couple good PPO and HMO companies here in KC and none of the PFFS are appropriate or competitive.

 

[Frank Stastny]

Re: A Medicare Advantage Dilemma …

For all the veteran Medicare Advantage brokers, here is my dilemma.

About 90% of my clientele are on either an HMO or PPO, the other 10% are on a Medicare Supplement. This year has brought many changes to the HMO's and PPO's in the counties I work in, and some very big players have entered the counties that were not here last year.

My current book of business, the majority of who are in about 4 different plans, are seeing zero premium plans turn into $50 premium plans, they are seeing copays double, and drug benefits reduced.

Every year I look through all the plans and pick the ones I find best, I boil it down to about 4 or 5 plans that I feel best fit certain scenarios. The problem is that the plan that I find best, is a PFFS.

I am not a fan of PFFS's, but none of the HMO's or PPO's touch this thing. It is a zero premium plan, with the least co pay in the hospital (compared to other zero premium plans), best copay at the dr/specialist, second best drug benefit (behind a plan w/ a premium), it includes dental, eye glasses, and hearing aid coverage.

What am I to do? I have had a bad experience in the past with a so called SNP PFFS (wasn't really ever a SNP), so I am a little taken back, but if I call the Doctor and he/she says they accept it… should I sell it, although its been drilled in me not to do so?

Im telling ya, this plan is the bomb diggety.

It's not the PFFS plans that I really have the problem with. It is the availability of doctors who accept them in Missouri that is my main concern. Add to that the fact that doctors can jump into a PFFS plan and then leave at a moments notice without notifying patients ahead of time. If the doctor wakes up on "the wrong side of the bed" and over coffee decides he doesn't want to do that anymore then he doesn't have to. (I have talked to several agents in Missouri that say that has happened to their clients.)

Also, a lot of my clients travel to warmer climates in the winter. Who knows what they are going to find in the way of available medical providers who accept their PFFS plan in one of those sounthern states.

Just because "their" doctor, primary care physician if you will, accepts their PFFS plan it doesn't mean that a specialist in their area will. Maybe I'm erring too much on the side of caution. Possibly I should assume that if the specialist of their choice doesn't accept their PFFS plan that there will be another one in the area who does.

My friend, you are between a real rock and a hard place. With only 10% of your clients on a Med Supp that presents a real problem.

I experienced the same thing in the St. Louis area, "everyone" was with an HMO. At that time I didn't have the option of selling them. So, I started selling in the country where there were no HMO's. Doing so, I built one hell of a Med Supp clientel. Still have them. I have lost very few to PFFS plans.

The only thing I can suggest is get on the phone and start calling doctor's offices and ask if they accept PFFS plans and ask them which ones. The problem I have found in doing that is that the girl who answers the phone usually doesn't have a clue what you are talking about. I tried that and that is what I discovered.

I would think calling several hundred GP's and specialists will give you a good feel if a PFFS plan is viable for your clients and which ones are the most widly accepted.

Or, do as I have done, start selling Med Supps outside the area served by the HMO's and PPO's.

Get yourself a pickup truck, a can of skoal, hang out at the feed store on Saturday mornings kicking feed sacks and say "Gawd-damn" a lot. The country folk will love you.

Oh, don't forget to wear bib overalls, leave the side buttons unbuttoned, and wear a feed company hat. And don't wear your Cole Haan's.

 

[policy doctor]

Re: A Medicare Advantage Dilemma …

Yeah Frank, not everybody can be a "country boy" like you.

If i tried that schtick (being a girl) I'd sound like Hillary at that Black mtg where she faked a black accent and it bombed.

Got too much New York in me.

 

[midwestbroker]

Re: A Medicare Advantage Dilemma …

I will say that if your clients are on MA plans, and MA plans have been in the area for some time, then PFFS plans may not be as bad as you think.

The Dr's who take MA plans will just bill the PFFS carrier as usual. I would contact the PFFS plan carrier to see if they have any info you can have on hand for providers and how to bill them.

When CIP (Care Improvement Plus) came to the KC meto, I got a few letters from them designed to be given to providers that explained how to bill them with their electronic billing number, customer serivce numbers for billing offices to use to call with questions, etc.

 

[MedSuppPro]

Re: A Medicare Advantage Dilemma …

Frank,

Great post!!!

 

[theinuranceguy]

Re: A Medicare Advantage Dilemma …

Appreciate the feedback guys and gals, and I must say I was the most worried about Franks response LOL.

The PFFS plan Im talking about is one of Coventry's Advantra Plans...

What has been your guys experience with them?

 

[midwestbroker]

Frank makes an excellent point, and he is right on the money.

Coventry is one of the biggest carriers in the KC market, but they do so with a PPO, not a PFFS.

The thing about MA plans it is all where you are geographically. What works in KC may not be the case in OH.

Do what Frank said. Call the billing office at the Dr's office and see if they accept PFFS plans. If they do, then I would tell the client if the Dr decides not to accept the PFFS in the future, to talk with the Dr's office. They can decide to not take it for future clients but for existing clients. If the client has a good relationship with the Dr's office, then they may be ok. BUT, this is only if the client really wants the PFFS plan.


The client may not want to hear that, but just tell them that is how it is. They will respect you for that.

 

[Winter_123]

Re: A Medicare Advantage Dilemma …

Appreciate the feedback guys and gals, and I must say I was the most worried about Franks response LOL.

The PFFS plan Im talking about is one of Coventry's Advantra Plans...

What has been your guys experience with them?

I have no familiarity with them other than the fact that I have just set two med supp appointment with clients who called about rate increases on MA plans that caused them to fall out of the chair. Both Advantra plans. Does not bode well for that MA plan.

 

[Frank Stastny]

Re: A Medicare Advantage Dilemma …

I have no familiarity with them other than the fact that I have just set two med supp appointment with clients who called about rate increases on MA plans that caused them to fall out of the chair. Both Advantra plans. Does not bode well for that MA plan.

The biggest advantage to working the senior market is exactly the kind of situation you just described. I see this and similar situations as a huge plus for the agents working this market.

We already know that premiums are going to go up with both Med Supps and MA plans. You can take that to the bank.

You can also "take to the bank" your continued commission checks regardless of what happens. In theory once we get a client we should not lose that client because of increases. That is, if we represent enough companies to keep moving them to when premiums get too high.

If you have developed a good rapport with your clients, have their trust and stay in touch with them on a regular basis they will stay with you for ever. Most of them don't like change, especially changing agents.

The senior market is also great for prospecting and working "leads". We pretty much know that just because a prospect is happy with say Bankers Life today it doesn't mean they will be a year from now. On your initial contact with a prospect the first piece of info you want from them is the name of their current company. If that is all you get, that has been an extremely successful call and should lead to a sale within the next 12 to 24 months.

Keep every lead and contact with a prospect well organized and call them each time their company has an increase. These are the easiest people to turn into clients.

We know that premium increases are going to happen on a fairly regular basis. We also know that seniors are on a "fixed income" (even if it is $20,000 per month, haha) and are always looking to save a nickle. This makes the senior market amazingly easy and simple to work once you have a good database of prospects. I routinely sell prospects I talked to 12, 18, 24 and sometimes 36 months ago.