Explaining MAPD vs Supplement

[annon123]

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.

And that employee needs to compare apples to apples. No one with a supp will even come remotely close to reaching $7900 in MOOP (the lowest of the three Aetna plans available locally). As I said above, the real question would be how many/what percent are paying MORE than they'd pay with a supp's premiums and, if applicable the deductible MOOP. I'd bet my last dollar that that is a lot more than 1-2%.

 

[rmhaire]

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.

An Aetna employee and we're the idiots?

 

[Midlevel]

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.

So 1 guy had cancer 3 times so no one in the US should be on a MA plan? Call me a dumbass but I present both options and let the client choose. You are stuck in your ways at age 80 and do whatever you want. Just not sure why you have to attack me every time I post something. And then I say I'm done posting and you tell me please don't because I enjoy your posts?

 

[Midlevel]

And that employee needs to compare apples to apples. No one with a supp will even come remotely close to reaching $7900 in MOOP (the lowest of the three Aetna plans available locally). As I said above, the real question would be how many/what percent are paying MORE than they'd pay with a supp's premiums and, if applicable the deductible MOOP. I'd bet my last dollar that that is a lot more than 1-2%.

Not sure where you live but 3900.00 - 4500.00 is the max where I offer plans. And by the time you take premiums , shitty drug plan along with dental, vision, hearing aids, OTC, gym membership in account it's usually worth more than the MAX OOP anyway. You do you.

 

[annon123]

Not sure where you live but 3900.00 - 4500.00 is the max where I offer plans. And by the time you take premiums , shitty drug plan along with dental, vision, hearing aids, OTC, gym membership in account it's usually worth more than the MAX OOP anyway. You do you.

You are right. Those need included. Use AARP UHC G as that has gym, vision, dental, and hearing discounts. Not all D's are problematic (although more of them are in 2025) Locally 2 still have $0 meds on tiers one and two (although none still have $5 or so on tier 3, all locally have switched to a percent), and prior to 2025 far more did. So use their premium costs and add in some OTC money. In fact use the premium for those over 80 to figure the comparison.

I have no idea why the MOOP's are so expensive locally yet so much cheaper for your area other than I live in the armpit of the nation state for health care where people tend to be sicker and have shorter lifespans... and this state didn't expand medicaid so more 65+ come into medicare with more problems that aren't under control, so I'd suspect when they finally have insurance they'd use it more both because they can now and because they have a pile of medical issues that need addressed..

 

[rmhaire]

So 1 guy had cancer 3 times so no one in the US should be on a MA plan? Call me a dumbass but I present both options and let the client choose. You are stuck in your ways at age 80 and do whatever you want. Just not sure why you have to attack me every time I post something. And then I say I'm done posting and you tell me please don't because I enjoy your posts?

Damn you're a testy little shit.

And where did I say no one should be on an MA plan? I didn't.

Dude. I sell the damn things. Including Aetna.

And I'm not 80, I'm 71. But you're right about doing whatever I want.

And I'm also on Medicare. With a plan G. And I don't have a HIP plan because I don't need one. I don't need to put lipstick on a pig.

And I don't attack you every time you post something. Just when you trash supplements and OM.

And I do enjoy your posts. Just not the trash ones.

Want some advice?

Vote Republican. It'll toughen your ass up.

 

[EckoRomeo]

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.

I've picked up on your argument style. You demand a source while quoting your own anonymous source followed by paragraphs of your own opinion based on said anonymous source.

Nice try.

Post your 15-20% "research" articles. If you're going to constantly demand sources then show your work.

 

[rousemark]

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.

Not hard to ht the MOOP.. I had MAPD for 4 months and managed to hit it.

 

[rousemark]

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.

Are you sure he has the data? Would not be the first time a company rep made things up to suit his pitch.

 

[AmCoble]

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.

I wouldn't say using an analogy is being biased. It helps some see things and understand how it works a bit better. We always go through the ABC and D of Medicare, but some still tend to get them confused. Using something relatable and helping your clients understand what they are purchasing is being an excellent agent. Not ensuring complete understanding is not doing your job.

I would agree scare tactics that some agents use are not needed and only do the client harm in the long run. At the end of the day, it is what the client feels is best for them that counts.