When they can change without underwriting during AEP in any year, why would anyone stay in that plan?
Closing a book of business
- Thread starter LewB
- Start date
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 .
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.
Last edited:
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.
Absolutely correct -- age is not relevant in that situation.
- 1,802
This is an older thread, and I looked for what others have suggested/done about securing trial rights when the client enrolls, based on timing, etc. I am working with a couple of prospects who are retiring after their month of first qualifying for Medicare at age 65 and won't have trial rights ever unless they start with a Med Supp + PDP. Also, it is predicted that more people will be shopping this year.
I don't want to lean on the new retirees too hard and alienate them, but they won't ever have a trial right unless "the company hasn't followed the rules, or misled them", if they start with an MAPD. I mainly want them to know this rather than coming back later "why didn't you tell me", if they get really sick. "I am healthy." (what me worry)
Trial rights that apply to enrolling in a Med Supp past their open enrollment are on page 23 of Choosing a Medigap Policy.
Note that the last trial right: company not following the rules/misled them is 100% going to be only available if Medicare handles the enrollment, I bet.
The first two that we can use are:
(Trial right) You joined a Medicare Advantage Plan or Program of All‑inclusive Care for the Elderly(PACE) when you were first eligible for Medicare Part A at 65, and within the first year of joining, you decide you want to switch to Original Medicare. (I did have one carrier who was not too picky about that, like the open enrollment period after first turning 65==not UHC--they mean the month you got part A at 65)
(Trial right) You dropped a Medigap policy to join a Medicare Advantage Plan (or to switch to a Medicare SELECT policy) for the first time, you've been in the planless than a year, and you want to switch back.
I don't want to lean on the new retirees too hard and alienate them, but they won't ever have a trial right unless "the company hasn't followed the rules, or misled them", if they start with an MAPD. I mainly want them to know this rather than coming back later "why didn't you tell me", if they get really sick. "I am healthy." (what me worry)
Trial rights that apply to enrolling in a Med Supp past their open enrollment are on page 23 of Choosing a Medigap Policy.
Note that the last trial right: company not following the rules/misled them is 100% going to be only available if Medicare handles the enrollment, I bet.
The first two that we can use are:
(Trial right) You joined a Medicare Advantage Plan or Program of All‑inclusive Care for the Elderly(PACE) when you were first eligible for Medicare Part A at 65, and within the first year of joining, you decide you want to switch to Original Medicare. (I did have one carrier who was not too picky about that, like the open enrollment period after first turning 65==not UHC--they mean the month you got part A at 65)
(Trial right) You dropped a Medigap policy to join a Medicare Advantage Plan (or to switch to a Medicare SELECT policy) for the first time, you've been in the planless than a year, and you want to switch back.
- 1,802
Looking at options for some retirees, and considering this fall. I have not done this trial right (except once where no MedSupp would be affordable for the client) based on leaving a MediGap during AEP, not mid year as no 5 star plans here, and it may be a thing this AEP season, but more likely to be a longer term decision to stay on the MAPD, if based on affordability. The main glitch would be catastrophic illness soon after the switch. Can't control that.
- 7,142
Caveat, not an agent
"when you were first eligible for Medicare Part A at 65,"
Does that mean the whole IEP, or just the month one actually turns 65?
Similar threads
