Did MMA 2003 Make MA's Worse...

[motorcyclegogo]

This week I've run into two cases where being on a MA is going to "hurt" the beneficiary.

Case 1. 77 year old man, used to be on medsup, but switched to MA two years ago due to price increases. Now he's in the nursing home and will be for at least five or six weeks. His Coventry MA pays for days 1-5 then it's on him for $165/day. Pair this with the hospital ded and other OOP's and that two years of premium savings will quickly be eatten up. At least they now have a chance to get a GI plan from MOO due to their extended GI for those exiting MA within two years.

Case 2. 69 year old man with bad kidney issues, but short of being ERSD. His MA is $250/day for hosp. for days 1-10, nursing home is only covered for days 1 and 2 then it's on him for $150/day. Of course all the bad stuff like radiation therapy etc are moved to the back where he's no more protected by MA than if he had Medicare alone.

My wondering is for those that have been in the MA business since before MMA 2003, do you see that plan design is worse even for those in metro areas now compared to a few years ago?

 

[DS4]

There is an upside and downside to Ma's. Your two cases are on the downside.
The upside to MA's, premiums are either zero or ??. If you stay in good health, you have saved yourself some money compared to a Med supp.
MA's are not for everyone. If the downside to a MA (hospital copay's, physician copay's & out of pocket max's) are too much to bare, they should be on a Med supp.

 

[retread]

This week I've run into two cases where being on a MA is going to "hurt" the beneficiary.

Case 1. 77 year old man, used to be on medsup, but switched to MA two years ago due to price increases. Now he's in the nursing home and will be for at least five or six weeks. His Coventry MA pays for days 1-5 then it's on him for $165/day. Pair this with the hospital ded and other OOP's and that two years of premium savings will quickly be eatten up. At least they now have a chance to get a GI plan from MOO due to their extended GI for those exiting MA within two years.

Case 2. 69 year old man with bad kidney issues, but short of being ERSD. His MA is $250/day for hosp. for days 1-10, nursing home is only covered for days 1 and 2 then it's on him for $150/day. Of course all the bad stuff like radiation therapy etc are moved to the back where he's no more protected by MA than if he had Medicare alone.

My wondering is for those that have been in the MA business since before MMA 2003, do you see that plan design is worse even for those in metro areas now compared to a few years ago?

You have a few things mixed up. First of all, there is no GI for someone in a MA over 12 months, not two years. Secondly, if you are talking about a nursing home and not a SNF, then that is long term care which neither MA nor Med Sups will cover as LTC is not a Medicare expense.

 

[HarryRenard]

You have a few things mixed up. First of all, there is no GI for someone in a MA over 12 months, not two years.

I thought Moo and aarp both offer a 24 month window for someone in an Ma plan to go back to a med supp no matter what company they had a med supp with before.

Is that not correct.....

 

[retread]

I thought Moo and aarp both offer a 24 month window for someone in an Ma plan to go back to a med supp no matter what company they had a med supp with before.

Is that not correct.....

If they do, that is not GI, it is liberal UW.

edit: I checked the UW guide to United World (KS), United of Omaha (MO), and Gerber (UW by MOO) and none allows for GI for MA trial right other than Federal Standards... 12 months. I don't have the UW guide for MOO because they aren't available in my states, but my guess is that it is the same as cited prior. As for AARP, they will sell anything to anybody. This is not GI, but UW policy. If someone can afford them, so be it.

 

[motorcyclegogo]

You have a few things mixed up. First of all, there is no GI for someone in a MA over 12 months, not two years. Secondly, if you are talking about a nursing home and not a SNF, then that is long term care which neither MA nor Med Sups will cover as LTC is not a Medicare expense.

Yes MOO offers GI for those in MA under two years. Call it what you will; Gi is Gi.

Nurshing home/snf... same thing in this conversation.

 

[Winter_123]

Yes MOO offers GI for those in MA under two years. Call it what you will; Gi is Gi.

.

GI is GI in this instance except that it is subject to the whims of Mutual of Omaha from year and is not embedded in law so folks going into an MA or holding off on returning to a supp should be careful. Of course state law can change too but not quite so whimsically.

[Not to complicate things, but there are a few Maine members here, so it is important to note that the right to return to the original supp after two years is embedded in Maine state law not just MOO rules. And MOO will take folks in who have been in a supp for less than two years regardless of who the carrier was for the original supp versus Maine law which only lets you go back to the supp or origin, unless you went into the MA during open enrollment and never had a supp in which case you revert back to open enrollment]

I think correct term for the MOO situation is "guaranteed acceptance" rather than "guaranteed issue" but I would agree that it does not make much difference in this conversation. Could in others.

 

[medicarebenefitsdirect]

If they do, that is not GI, it is liberal UW.

edit: I checked the UW guide to United World (KS), United of Omaha (MO), and Gerber (UW by MOO) and none allows for GI for MA trial right other than Federal Standards... 12 months. I don't have the UW guide for MOO because they aren't available in my states, but my guess is that it is the same as cited prior. As for AARP, they will sell anything to anybody. This is not GI, but UW policy. If someone can afford them, so be it.

MOO offers a 24-month GI period versus the standard 12 month that most offer. I have made a living this AEP by helping people in awlful Med. Advantage plans go back to a Med. Supp. using the 24 month GI offer from MOO.