Closing a book of business

[rousemark]

Yes, they do. There are some old RPPOs around that are $150+ that are basically old $0 MAPDs from 2012.

When they can change without underwriting during AEP in any year, why would anyone stay in that plan?

 

[DonP]

When they can change without underwriting during AEP in any year, why would anyone stay in that plan?

It’s funny you ask that . The past 12 months I’ve run into 4 or so that were $60 plus old mapd plans on the books 7-10 yrs . The people know no better . They’ve never answered ads or talked to anyone . It’s like saying why is a perfectly healthy plan g person age 80 paying $400 when he could get the same plan for $250 ? Why is someone paying $350 for cable after 15 straight yrs of price hikes when with 1 phone call they could be paying $120 . 10-20% of people never shop around .

 

[somarco]

Do insurance companies Close Book / Dead Pool their Advantage plans like they do with Medigap as the policy holders get older and sicker?

MAPD can still have volatility but it isn't as noticeable as premium increases.

They still have network contraction, stepped up prior authorization, changes in step therapy for Rx, higher copays as well as extended copays which are usually applied to hospital admissions. And they can raise the MOOP subject to CMS guidelines.

The "D" in MAPD can add a deductible where there wasn't one before, formularies can change and with that come higher copay's, preferred pharmacy's can also change.

Very few people (including agents) bother to read the ANOC so folks often don't want to change because they assume everything this year carries over. As long as the premium is still $0 they see no reason to move . . . until they use their plan next year and are surprised.

 

[DonP]

MAPD can still have volatility but it isn't as noticeable as premium increases.

They still have network contraction, stepped up prior authorization, changes in step therapy for Rx, higher copays as well as extended copays which are usually applied to hospital admissions. And they can raise the MOOP subject to CMS guidelines.

The "D" in MAPD can add a deductible where there wasn't one before, formularies can change and with that come higher copay's, preferred pharmacy's can also change.

Very few people (including agents) bother to read the ANOC so folks often don't want to change because they assume everything this year carries over. As long as the premium is still $0 they see no reason to move . . . until they use their plan next year and are surprised.

Another bit of misinformation about mapd . The last 4 yrs the only plan adjustments I’ve seen are for the better . A great agent such as myself calls every customer yearly to go over the new plan and answer any questions.

 

[sshafran]

The last 4 yrs the only plan adjustments I’ve seen are for the better .

In (approx) 2012 in Columbus OH we were excited about a $0 MAPD PPO finally coming in. Very few $0 MAPDs during that time.

Now there are too many, and lower Max OOPs. (Check out Franklin County Ohio - tons of plans).

Moved to NC in 2018.

My county had 1 MAPD in '18, it was over $90. No $0 options.

An adjoining county had one $0 MAPD.

In 2023, my county now has 2 $0 MAPDs and one $0 w/ $50 giveback. A new $0 is coming next year, 2024. The adjoining county that only had one in 2018 has 6 $0 MAPDs now and 2 have givebacks.

[Not counting the $0 MSA that came in, MA-Only, or the SNPs - only talking traditional MAPDs -- but those also have expanded since 2018 in my area].

While it's possible, and likely in some areas that plans got worse, I have not seen it where I've marketed in my "back yard" or my former back yard.

I do think some plans get placed on the "back burner" and just phase out with people who just didn't change. Those plans can get worse.

 

[Bob L]

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 ?

Absolutely correct -- age is not relevant in that situation.

 

[somarco]

Monthly premium, or the lack thereof, is only one area of potential change. Ignoring the utilization side is a flaw in many sales presentations.