Aetna Buys Humana

[LostDollar]

Incorrect. There is no Medicare plus MA.

Rick

I made some edits to try to be more clear with what I was saying.

 

[FLM2]

However one has no need to think about MA until one considers how to pay for the 20% of Medicare approved health treatment that original Medicare will not pay for. Then you get down to weighing dollar and coverage costs of Medicare Health Insurance via Medicare (rules) plus Original Medicare (insurance) plus Medigap or Medicare Health Insurance via Medicare (rules) plus MA.

I give up-according to your statements Medicare Part A covers 100% (or 80% depending on how one interprets your assertion) when the reality is completely different.

Medicare Part A, for the record, has a deductible that is $1316 per benefit period in 2017-this means that is possible that a Medicare beneficiary could have to pay the deductible as many as 4 or 5X in a calendar year if they were readmitted multiple times and the admissions were timed in such a way as to start a new benefit period. It is unlikely that this would happen but, since the law is written in this manner, is entirely possible.

I am going to let others deal with you from now on-the mods should really delete your account since this is, by name, an 'Insurance Brokers and Agents Forum' and you are neither.

 

[goillini52]

I am going to let others deal with you from now on-the mods should really delete your account since this is, by name, an 'Insurance Brokers and Agents Forum' and you are neither.

LD might get on your nerves, but you're wrong on that one.

"Largest Insurance Forum on the net - discussion and advice on all insurance products, for agents and consumers".

 

[LostDollar]

I give up-according to your statements Medicare Part A covers 100% (or 80% depending on how one interprets your assertion) when the reality is completely different.

Medicare Part A, for the record, has a deductible that is $1316 per benefit period in 2017-this means that is possible that a Medicare beneficiary could have to pay the deductible as many as 4 or 5X in a calendar year if they were readmitted multiple times and the admissions were timed in such a way as to start a new benefit period. It is unlikely that this would happen but, since the law is written in this manner, is entirely possible.

I am going to let others deal with you from now on-the mods should really delete your account since this is, by name, an 'Insurance Brokers and Agents Forum' and you are neither.

The terms Deductible, Coinsurance and Out-of-Pocket have always terrified me because I did not understand them well.

What I seem to have done is taken one portion of a chart (relating to Part B) in the KS supplement shopper's guide and used that as a "gloss" to allow me to approach Medicare and those terms. When I take one of Medicare's specific definitions of the word "Co-Insurance" and use that as a cover term for all the variations of Deductibles and Co-Insurance present in the Part A and Part B components of Original Medicare Insurance Coverage I can easily be attacked for lack of understanding. In addition the concept I wanted to present can easily be ignored.

What your comments have shown me is that it is incumbent upon me to develop a more cogent explanation of my disagreement with Yagents' position using the terms Deductible, Coinsurance and Out-of-Pocket rather than specific numeric definitions of those terms.

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https://www.cms.gov/Medicare/Health...Info/index.html?redirect=/HealthPlansGenInfo/

This is a CMS link. The document indicates that when Part C was established it was known as the Medicare + Choice program.

This suggests that even though I had clumsily worded explanations and some inaccurate details, my contention that Part C was an addition to, and not a replacement of, Medicare was in line with the intent of the legislation which established Part C.

 

[FLM2]

The terms Deductible, Coinsurance and Out-of-Pocket have always terrified me because I did not understand them well.

What I seem to have done is taken one portion of a chart (relating to Part B) in the KS supplement shopper's guide and used that as a "gloss" to allow me to approach Medicare and those terms. When I take one of Medicare's specific definitions of the word "Co-Insurance" and use that as a cover term for all the variations of Deductibles and Co-Insurance present in the Part A and Part B components of Original Medicare Insurance Coverage I can easily be attacked for lack of understanding. In addition the concept I wanted to present can easily be ignored.

What your comments have shown me is that it is incumbent upon me to develop a more cogent explanation of my disagreement with Yagents' position using the terms Deductible, Coinsurance and Out-of-Pocket rather than specific numeric definitions of those terms.

----------

https://www.cms.gov/Medicare/Health...Info/index.html?redirect=/HealthPlansGenInfo/

This is a CMS link. The document indicates that when Part C was established it was known as the Medicare + Choice program.

This suggests that even though I had clumsily worded explanations and some inaccurate details, my contention that Part C was an addition to, and not a replacement of, Medicare was in line with the intent of the legislation which established Part C.

I'm not trying to pick fights with you over this, it's just that Medicare rules have no 'intentions', they just have rules that often make little or no sense until you accept the fact that 'it is what it is'.

Those of us who deal with these things daily in the real world have developed an understanding of how this all works, it's virtually impossible to reach that level of expertise until you've had your feet held to the fire for awhile.

I've personally spent hundreds of hours getting certified over the years-AHIP, CE, and Carrier certifications-the material is all pretty much the same but I still need to do it each year and pass the exams or I lose my renewal commissions and can't market to new clients.

When I do seminars for groups of Medicare eligibles or one on one meetings all I can do (or any other licensed agent) is provide facts within the CMS marketing guidelines whether I think the guidelines make any sense or not.

When someone asks 'which is the best plan' I can't answer the question in a logical manner, I can just deflect and quote the CMS rules about not making these types of comments; when a client tells me a friend wants to speak with me about Medicare all I can is say, 'have them call or email me'; if someone wants to speak with me about MAPD or PDP plans I need for them to wait 48 hours and sign a Scope of Appointment in advance.

None of these requirements are logical but reflect the CMS response to agents abusing the system in the past-if I sound over protective about this topic it's the direct result of wondering how many more restrictions might be implemented by CMS in the future should misinformation continue to be an issue.

 

[FLM2]

I'm really surprised no one has commented about the end of the Aetna-Humana merger, this is really good news for those of us who offer MAPD plans from both companies and would like to see a competitive market continue.

 

[wehotex]

I'm really surprised no one has commented about the end of the Aetna-Humana merger, this is really good news for those of us who offer MAPD plans from both companies and would like to see a competitive market continue.

A even more competitive market would be if they forced UHC to sell all of its acquisitions.