Anyone Have Experience with Humana PFFS Plans?

wehotex

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Houston, Tex
I live and work in San Antonio where HMOs are the most common option. I've never offered a PFFS here. I received a lead in nearby Hays Cty (Kyle, Tex) where there is a $0 premium PFFS without Part D. The humana website offers a "Find a Doctor" tab which gives the names of docs that are contracted. From your experience, would docs that don't show up on this website also accept Humana PFFS? My understanding of PFFS is that Medicare rates are paid, so why wouldn't nearly ALL providers accept this program?
 
I live and work in San Antonio where HMOs are the most common option. I've never offered a PFFS here. I received a lead in nearby Hays Cty (Kyle, Tex) where there is a $0 premium PFFS without Part D. The humana website offers a "Find a Doctor" tab which gives the names of docs that are contracted. From your experience, would docs that don't show up on this website also accept Humana PFFS? My understanding of PFFS is that Medicare rates are paid, so why wouldn't nearly ALL providers accept this program?

With PFFS, there is no contracting of doctors. If there were, it's not PFFS, it's PPO or HMO. There are some exceptions now with a few PFFS plans having a small network, but, the general rule with PFFS is that, docters are "deemed" providers.

They are deemed by agreeing to accept the plan on any given day. They can also accept it one day and then not the next day. It's an "at will" decision for the providers.

PFFS ruled the day in my area. We had no problem for 4 years with providers accepting the PFFS plans by every carrier. About two years ago we statted having problems with a few doctors deciding to not take the plans. Then Wellcare and Coventry bailed.

That is the whole problem with PFFS, the uncertainty of the process. Your client could go a doctor for years with no problems and then one day there's a sign in the office that says they don't take MA plans anymore. The client does not get an SEP for that.
 
That is the whole problem with PFFS, the uncertainty of the process. Your client could go a doctor for years with no problems and then one day there's a sign in the office that says they don't take MA plans anymore. The client does not get an SEP for that.

That is the primary reason I have never had any interest in selling them. I would rather see a senior only have traditional Medicare than take a PFFS plan. I also think the coverage is superior with just Medicare.

I know a lot of agents will disagree with me but most of my clients really wouldn't even need a Med Supp. Their out of pocket expenses would seldom be more than the premium they are paying. They are insuring themselves for the "just in case" type of problems, not the few doctor visits and tests that may be run each year. (Medicare pays 100% of the cost of diagnostic testing.)
 
That is the primary reason I have never had any interest in selling them. I would rather see a senior only have traditional Medicare than take a PFFS plan. I also think the coverage is superior with just Medicare.

I know a lot of agents will disagree with me but most of my clients really wouldn't even need a Med Supp. Their out of pocket expenses would seldom be more than the premium they are paying. They are insuring themselves for the "just in case" type of problems, not the few doctor visits and tests that may be run each year. (Medicare pays 100% of the cost of diagnostic testing.)

I agree with your point about considering the need for an MA Plan over OM. The only real advantage is spreading the hospital deductible out over a week's time with daily co-pays. The average hospital stay for seniors nationwide is 3.5 days. With a $1100-$1200 deductible before first dollar coverage, an MA plan can be easier on the budget.

The "Advantage" of MA plans have been done away with by CMS cutting funding of carriers to the point where most have dropped the Value Added features. I examine the hospital benefits of my MA plans, and if they stretch the co-pays out too far, or have too high of a daily co-pay, I suggest they stay with OM, especially if their MOOP is high.
 
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