Closing a book of business

[DonP]

Agents are showing some 15-22% med sup rate increases . Part d will Rocket in 2024 . More migration to $0 mapd in 2024 . But mapd has increased daily copays from 5-8 days in many mkts . Inflation kicking ass

 

[DS4]

Because the current book of business has people who have become older and therefore have more lllnesses meaning more claims. They close that book and raise the rates to cover the increasing losses. Then, they open a new book with younger, healthier folks and charge a lower premium do to lower claims ratios. After a couple of years, rinse and repeat.

Just search the history of Mutual of Omaha....
And, pity the poor soles living in states without a birthday open enrollment. Because of their health status, they have to absorb the premium increases because they are stuck.

 

[Midlevel]

Closed books of business are my friend. Paying 300-400 for an F plan and can’t qualify for a different Med Sup. How about a 0.00 MAPD or
a Cost Plan for 110.00 with very few copays and dental, vision, gym, etc and no health questions?

 

[wehotex]

Because the current book of business has people who have become older and therefore have more lllnesses meaning more claims. They close that book and raise the rates to cover the increasing losses. Then, they open a new book with younger, healthier folks and charge a lower premium do to lower claims ratios. After a couple of years, rinse and repeat.

The local Aetna agent manager actually described the closed BOB as a POSITIVE with a straight face. I felt like laughing in her face.

 

[Bob L]

Just search the history of Mutual of Omaha....
And, pity the poor soles living in states without a birthday open enrollment. Because of their health status, they have to absorb the premium increases because they are stuck.

Soles? Sorry, LOL over that one!

One thing I have done several times to help clients paying $300-350/mo or more with an old MoO, Aflac, etc. policy that used to be $80/mo. If they've always had a Med supp, I move them to an MAPD using the five star SEP. (We have three carriers here this year with that rating.) They stay in it awhile, milk it for the extra dental, vision, and the like. Then I use their trial right to move them back to a supplement. But, shazam, their old policy isn't sold anymore -- so they can go waltzing into a new cheap policy with a different company, no questions asked.

Note that I do this to help clients, not for commission, since I usually won't make anything due to rapid disenrollment and little or none on GI Med supps. But I make friends for life who give out referrals. And, several times the clients have been so happy with the MAPD they stay all twelve months before exercising their trial right, or permanently. In that case, I do very well.

 

[wehotex]

Soles? Sorry, LOL over that one!

One thing I have done several times to help clients paying $300-350/mo or more with an old MoO, Aflac, etc. policy that used to be $80/mo. If they've always had a Med supp, I move them to an MAPD using the five star SEP. (We have three carriers here this year with that rating.) They stay in it awhile, milk it for the extra dental, vision, and the like. Then I use their trial right to move them back to a supplement. But, shazam, their old policy isn't sold anymore -- so they can go waltzing into a new cheap policy with a different company, no questions asked.

Note that I do this to help clients, not for commission, since I usually won't make anything due to rapid disenrollment and little or none on GI Med supps. But I make friends for life who give out referrals. And, several times the clients have been so happy with the MAPD they stay all twelve months before exercising their trial right, or permanently. In that case, I do very well.

Nice! Trial Right is the first time enrolled in an MAPD from supp REGARDLESS of the member’s age? Does the new Med Supp ever question if it’s their First Time using the Trial Right?

 

[Bob L]

Nice! Trial Right is the first time enrolled in an MAPD from supp REGARDLESS of the member’s age? Does the new Med Supp ever question if it’s their First Time using the Trial Right?

Yep, age is not a factor. If you cancel a Med supp to enroll in an MA/MAPD for the first time ever, you have one year to exercise your option to return to OM and get a supp GI and enroll in Part D also.

As to the second question, Med supp applications do ask the applicant if it's the first time they have been in a Medicare Advantage plan. If so, it's GI under the trial right.

Since you mentioned age, don't forget that if a beneficiary starts his Medicare before age 65, he gets a new open enrollment when he turns 65. That way someone on dialysis, for example, can get some relief with a cheap new Med supp from paying sky-high premiums on a <65 supp or maxing out the OOP every year with an MAPD.

One more thing on this trial right stuff. If you have the opposite situation, that is, you are discussing MA/MAPD options with a client who's new to Medicare, they have a one year trial right where they can leave their MA and get the Med supp of their choice (and simultaneously enroll in a standalone PDP to go with it). But watch the language carefully. The qualifier clause reads "You joined a Medicare Advantage Plan (like an HMO or PPO) or Programs of All-inclusive Care for the Elderly (PACE) when you were first eligible for Medicare Part A at 65..." This implies that the trial right is not available for someone who started his A and B at a different time, for example, leaving an employer plan at 68, etc. It only applies in the "usual" situation where a newly eligible person gets A and B when they turn 65. Watch the fine print on this stuff!!

 

[somarco]

Carriers responsible for covering risks should not be required to ignore risks.

MAPD doesn't have to worry about rate increases and adverse selection as long as they can . . .

Require prior authorization
Use algorithms to postpone/deny claims
Manipulate networks
Increase copays

Eliminating underwriting leads to unaffordable premiums (ACA, Medigap) and reduced access to care (MAPD)

There is no such thing as a free lunch

 

[DonP]

Yep, age is not a factor. If you cancel a Med supp to enroll in an MA/MAPD for the first time ever, you have one year to exercise your option to return to OM and get a supp GI and enroll in Part D also.

As to the second question, Med supp applications do ask the applicant if it's the first time they have been in a Medicare Advantage plan. If so, it's GI under the trial right.

Since you mentioned age, don't forget that if a beneficiary starts his Medicare before age 65, he gets a new open enrollment when he turns 65. That way someone on dialysis, for example, can get some relief with a cheap new Med supp from paying sky-high premiums on a <65 supp or maxing out the OOP every year with an MAPD.

One more thing on this trial right stuff. If you have the opposite situation, that is, you are discussing MA/MAPD options with a client who's new to Medicare, they have a one year trial right where they can leave their MA and get the Med supp of their choice (and simultaneously enroll in a standalone PDP to go with it). But watch the language carefully. The qualifier clause reads "You joined a Medicare Advantage Plan (like an HMO or PPO) or Programs of All-inclusive Care for the Elderly (PACE) when you were first eligible for Medicare Part A at 65..." This implies that the trial right is not available for someone who started his A and B at a different time, for example, leaving an employer plan at 68, etc. It only applies in the "usual" situation where a newly eligible person gets A and B when they turn 65. Watch the fine print on this stuff!!

Trial right 1 is getting a mapd at age 65 and having 1 yr to switch to any med sup if your choosing .Trial right 2 is switching from a sup to mapd at any age then wanting to switch back within 1 yr . So if a person works till age 68 and gets their part b when they retire . I know they can’t enroll in a mapd and within 12 months use trial right one to go to a sup because there A and B dates different . But let’s say they bought a Sup at age 68 with different A and B dates . At age 75 they decide to try a mapd and don’t like it . Under trial right 2 don’t they have 12 months to return to their orginal sup ?

 

[ehall2]

This is called, "adverse selection." The company will be stuck with a book of unhealthy people because the healthy will go to a different company.