If a person is in the hospital 3 or 4 times in a year, doesthe GTL pay the co pays every time?
Explaining MAPD vs Supplement
- Thread starter jack3454
- Start date
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.
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 by the insured, although they could look at what medcaid picked up).
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 hit it and 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 of 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.
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15-20% is laughable. Those of you that dislike MA plans have no idea how hard it is to hit the Max OOP. Most have the GTL Hospital plan so the hospital copays aren't coming out of their pocket anyway. Cancer is the main way to hit the max. My Aetna sales manager every year says it's between 1 and 2% that hit the max and I'm guessing he has access to the information. 15-20% is just another stupid scare tactic. I know of 3 of my clients that have hit the max in the last 15 years and they weren't even upset because of the thousands they had saved the last few years.
The man's had cancer like three times and is a college professor so forgive him if he doesn't know how to read an article.
But when faced with facts, don't forget to throw shit on the wall in order to move the goal posts. Free tooth paste and free Uber rides ought to do it.
You are so out of touch with reality it's funny. Not sure why you hate me so much but every time I post you are there to be a dick.
Articles are way more important than real life experiences? I think there are a bunch of fricken stupid agents on this forum. You all keep using your scare tactics and I will keep showing clients their options.
Here are the local MOOP's for all the Aetna MA's available locally:
1)
$14,000 In and Out-of-network
$9,350 In-network
2)
$14,000 In and Out-of-network
$7,900 In-network
3)
$14,000 In and Out-of-network
$9,350 In-network
Those are incredibly high. That would certainly reduce the % that would hit the max just because it is so much. I'd suspect some don't hit the max as they don't get some health care they need due to costs they can't afford. That would reduce the % of those hitting the max for reasons that have everything to do with how expensive the MOOP is. Even F premiums or G+ B's deductible would come to considerably less than these MOOP amounts.
A better comparison would be if your Aetna rep would tell you what percent of customers hit MOOP's one penny more than OM costs with premiums G (including B's deductible) or F supps.
Yes RESEARCH articles or articles based on RESEARCH are far closer to the "truth" than one person's real life experiences. Those individual real life experiences, while true for that one person, may well be well outside the norm, outside of the average for everyone else, be outliers, etc.
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I'm not out of touch and I certainly don't hate you. I don't even know you. But I can definitely be a dick.
I just told you that he'd had cancer like three friggin times. Is that not a real life experience?
There are several of us on here that happen to prefer OM over MA. But according to you that makes us fricken stupid and we're using scare tactics.
If that's so, then I guess that since you prefer MA over OM that would make you a fricken dumbass.
Can't have it just one way.
Or maybe an employee of Aetna who actually has the data. Keep reading those articles. Can't deal with all the idiots on this forum anymore. I have 800+ on MAPD's and had 3 meet their max but am supposed to believe 20% do? Get real.
