Explaining MAPD vs Supplement

[rousemark]

You all should try being an unbiased insurance agent instead of trying to compare them by using analogies of restaurants, etc.

Show them how A,B,C and D of Medicare work and the cost of both options. Give them a Med Sup quote along with a print out of a stand alone PDP that covers their drugs the best. Tell them about the $257 Part B deductible once a year.

Then show them a $0 premium MAPD along with a GTL hospital plan that covers their hospital copay. Go over the plan guide showing all copays along with the dental, vision, etc. Look up any Drs they see and hospitals within 100 miles. Tell them they may need PA for certain procedures, surgeries, etc. Go over the drug coverage on the MAPD and then let them decide.

Not sure why all the analogies and scare tactics are needed. Your job is to present their options in an unbiased way and not steer them to what you think is best.

If a person is in the hospital 3 or 4 times in a year, doesthe GTL pay the co pays every time?

 

[Midlevel]

If a person is in the hospital 3 or 4 times in a year, doesthe GTL pay the co pays every time?

Follows same guidelines as Medicare. Out at least 60 days it pays again. Had a lady get over 7000.00 one year due to having hip surgery and kept getting infections throughout the year. She made alot of money being in the hospital that year. She had 300.00/day for 10 day period bc her MA plan had a 1000.00 deductible back then.

 

[annon123]

The odds of reaching the MOOP on an MAPD is like 3-5%.

Source?

A handful of research articles I just read state it is closer to 15-20% and one article mentioned it is higher if you exclude the dual eligibles (in some research these two groups are grouped together which doesn't make sense if you are looking at MOOP actually paid).

Of course many people won't reach the MOOP every year, but some will, and some will when something bad happens. The median age for getting cancer, for example, is 66 and when they get treated for that they'd have at least one or two years of meeting the MOOP at a minimum. Other years they may fall under that. The big question though is if they do have to pay the full amount can they actually afford to? And do they have in network, (as some will but many will not) the really good oncologists (to continue with the cancer example)?

Other research documents that 12% of people over 65 did not seek any medical care for major issues because they could not afford it (that would reduce the MOOP paid average and percent who paid it). 25% of adults 65+ cut back on other needs (food, utilities, medication, clothes) to pay for medical bills. And as people get older their health expenses tend to rise.

While some people eventually end up dual eligible, many do not. As a result the % of 65+ paying the full MOOP will rise with serious illnesses and as they age. The group that has the most problems paying for health care live below 400% of the poverty line but above where they can get medicaid help with premiums.

As an aside only 25% of people with incomes at 400+% of the poverty line had MAP's in 2022. The highest percent of people having MAP's were those at less than 200% of the poverty line which mean most of them would be dual eligible and likely for all fo them the cards for food, etc. would make a real difference in their finances/budget.

If people knew what their future would hold for health issues that would certainly help with decision making with respect to OM vs MAP's and total annual health care costs and whether or not they'd need to deal with network issues or not.

Just as with car insurance people, cancer insurance, disabilty insurance, etc., people buy it hoping they'll never have to use it but are grateful if they do have it if they needed it. Most hope they will be a profit center for the insurance company rather than need to use what they bought. I think that casting medicare choices this way helps people put the decision of what to purchase in a different light from pay as little as possible and hope nothing bad happens. Of course like all financial decisions many factors need balanced.