An Open Letter To Insurance Executive Lurkers.....

[annon123]

If their MA shuts down in their area they do not have to pass underwriting.

I wasn't talking about that. I was talking about they were on a MA, started having more medical problems, then wanted on OM for lower costs if they were going to get anywhere near their MA's MOOP, wanted more doctors and facilities in network, including top centers that aren't in their current network...

 

[LurkerBroker]

I hear you on the migration, but disagree on the not being good for sick people. I've had numerous people with cancers, chronic diseases, etc. on them with no issue. It just depends on the area of the country and the strength of the plan. It's tough to make blanket statements on Medicare Advantage because the plans can be so different and things can vary a lot by the area of the country you're in.

It’s good for them but in an entitled country no one wants to pay for anything anymore. MOOPs drive people back to OM+Medigap. “Oh geez, I have to now pay. Let me go back to Medigap and impact everyone else’s premiums with my new shiny SEP”.

 

[sshafran]

A lot of chronically ill people will migrate to med supp which will affect claims ratios and raise premiums. Speaking from experience, MA is a good deal for n healthy people. Not so much for sick people .

I've already written several GIs.

If Humana cut the plan, I try to Humana GI Plan G. If Aetna cut the plan, I try to place them with Aetna.

The poor MAs need to take on the GI.

 

[MedicareWAA]

I have experienced both. The MOOP with most plans is greater than the annual premiums for a plan G and PDP... even at my age 80. Then you have the problems of networks, preauthorizations, etc. I needed home health care with OM and there was no problem getting for as long as needed. When I needed it with the MA they only approved 18 visits for nursing, Occupational, Speech and Physical therapies. Then they would not accept the HHC agencies recertification. Plus, there was only one HHC agency in network in my area and it was the worst in the area. The nurses and therapists were great but the administration was horrible.

You’re right in many parts of the country but there are many other places where the MA + PDP premiums are less than the MSUP premium. And with the IRA, it’s common to see some $0 premium MA drug benefits hit the cap after spending like $450 out of pocket. Way better than any standalone PDP.

MSUP isn’t about saving money. It’s about not being locked into a network or stuck fighting for prior auths.

 

[LurkerBroker]

I've already written several GIs.

If Humana cut the plan, I try to Humana GI Plan G. If Aetna cut the plan, I try to place them with Aetna.

The poor MAs need to take on the GI.

Yes - MA should absorb since they are simply passing the unprofitable business to another part of their operation. While brand loyalty is a good thing, I would venture to guess that neither Humana Med Supp or Aetna Med Supp is thrilled about getting that member under a GI event. GI business puts pressure on the open block and drives higher rate increases in order to absorb. Now, your other members are looking for a lower priced product and we wash, rinse, repeat all over again.

 

[rousemark]

It’s good for them but in an entitled country no one wants to pay for anything anymore. MOOPs drive people back to OM+Medigap. “Oh geez, I have to now pay. Let me go back to Medigap and impact everyone else’s premiums with my new shiny SEP”.

You make it sound as if the med supp is free. They still have to pay for the med supp and pdp.

 

[annon123]

You’re right in many parts of the country but there are many other places where the MA + PDP premiums are less than the MSUP premium. And with the IRA, it’s common to see some $0 premium MA drug benefits hit the cap after spending like $450 out of pocket. Way better than any standalone PDP.

MSUP isn’t about saving money. It’s about not being locked into a network or stuck fighting for prior auths.

Yes the prior authorization thing is a real issue and can seriously negatively impact care and delay care. It can also force patients to try other, typically cheaper, treatment(s) and then fail them prior to being approved for the one their doctor felt was the best choice for them to begin with.

I read a study the other day that the delay for approvals (and even worse with denials and the appeal time) for many cancer patients (article was about cancer patients) with MA's is enough to negatively affect outcomes. With many issues, not just cancer, you can't wait 30-60 days to start treatment, have surgery, etc. to have the best outcome with fewer complications, etc.

The other thing that matters is getting care at the best place you can for your particular issue. Research also documents over and over that this matters. In that case, as indicated by MedicareWAA, it IS about networks. While some people are lucky to live in (mostly very large) cities with highly ranked medical systems, many do not. In some instances there are none in the entire state. Then you have some very hard choices.

And going out of network to get that care can be about money too. Some MA's don't even cover out of network. Some have $10-14000 MOOP's for out of network care. With many places if you are out of network you have to pay your copay up front prior to getting treatment. That can make getting out of network care unaffordable for many even if it is covered. Then OM + sup is way cheaper even factoring in premiums.

 

[somarco]

Plan exits open the doors to an SEP giving everyone the ability to now get a Medigap plan.

How many agents will pursue that situation if there is no compensation?

A FEW states and a FEW carriers pay full comp on GI business but (IMO) not enough to create a flood of folks converting to OM + Medigap.

While brand loyalty is a good thing,

Other than the "ARP" brand, I don't see many folks loving Humana, Aetna, BX, etc. so much that they will stick with that carrier through thick & thin.

 

[LurkerBroker]

You make it sound as if the med supp is free. They still have to pay for the med supp and pdp.

They do have to pay - but its no fun explaining to your existing Supp clients who took their plan at t65 that their rates are now going to be impacted by the influx of pent up GI demand. I expect to see larger rate increases following this AEP.

 

[sshafran]

Yes the prior authorization thing is a real issue and can seriously negatively impact care and delay care. It can also force patients to try other, typically cheaper, treatment(s) and then fail them prior to being approved for the one their doctor felt was the best choice for them to begin with.

I read a study the other day that the delay for approvals (and even worse with denials and the appeal time) for many cancer patients (article was about cancer patients) with MA's is enough to negatively affect outcomes. With many issues, not just cancer, you can't wait 30-60 days to start treatment, have surgery, etc. to have the best outcome with fewer complications, etc.

The other thing that matters is getting care at the best place you can for your particular issue. Research also documents over and over that this matters. In that case, as indicated by MedicareWAA, it IS about networks. While some people are lucky to live in (mostly very large) cities with highly ranked medical systems, many do not. In some instances there are none in the entire state. Then you have some very hard choices.

And going out of network to get that care can be about money too. Some MA's don't even cover out of network. Some have $10-14000 MOOP's for out of network care. With many places if you are out of network you have to pay your copay up front prior to getting treatment. That can make getting out of network care unaffordable for many even if it is covered. Then OM + sup is way cheaper even factoring in premiums.

Today, I talked to three of my Tricare for Life clients on MA Only PPO policies.

One is on dialysis. The other two have "normal" health conditions.

Asked all three: Any problems? Any issues? Any complaints?

All three (including dialysis lady): no, it's great! No issues.



Crazy, because I thought the MA restricted all of their medical care...

Someone should tell them.