High Deductible Plan F VS MA Plan

[Dave020]

Since the Freedom Blue will pay both in and out of network (medicare reimbursement limits), how do you figure it wouldn't pay in other states? Also, all MAPD plans cover at the very least emergency coverage anywhere in the US. I believe this might be one of the rare times you are incorrect.

Rick

I assume that emergencies would always be covered since there really is no control over when and where they occur or the closest facility available.

As to the other, I was specifically told by Anthem last year, do not try and use this plan outside CA. It is state-specific according to senior services. Unless that has changed this year, that is what I got direct from the horse's mouth on Freedom Blue.

I believe I asked it in relation to someone living in another state part time during the year. They told me no way on coverage outside of CA on Freedom Blue.

I just sent this question to the RSM, I will let you know the response as soon as I get it.

 

[GreenSky]

Dave:

I sent this to my RSM as well. Now we need someone to break the inevitable tie!

Rick

 

[Dave020]

Being Friday at 5 PM, let's not count on getting an answer too quick.

I believe it has to do with the RPPO and LPPO designations for Anthem MA PPO plans. Freedom Blue is an RPPO, meaning regional PPO. I think that means the PPO only extends to the covered region (in this case CA only). Anthem also sells LPPO in other states which is LOCAL PPO, which restricts providers to a much smaller area than the RPPO (smaller service selection area within a state).

 

[The Rabbi]

If a person just wants catastophic coverage, then sell HD F. If they would rather have a MAPD, let them have it.

You are there to educate the prospect about the options they have and help them decide which would be better for their circumstances, not what you believe they should have.

It has a lot to do with their finances also. With an MA, if they don't use it, they don't lose it.

I have found that most people want the small stuff covered also.

 

[moonlightandmargaritas]

If a person just wants catastophic coverage, then sell HD F. If they would rather have a MAPD, let them have it.

A true prophet, if ever there was one...

 

[GreenSky]

Being Friday at 5 PM, let's not count on getting an answer too quick.

I believe it has to do with the RPPO and LPPO designations for Anthem MA PPO plans. Freedom Blue is an RPPO, meaning regional PPO. I think that means the PPO only extends to the covered region (in this case CA only). Anthem also sells LPPO in other states which is LOCAL PPO, which restricts providers to a much smaller area than the RPPO (smaller service selection area within a state).

Let's see if you have guts to make a bet with me. I'll bet you not one, but two pints of Guinness that you're wrong and I'm right.

By the way, the brochure says you can see any doctor in or out of network. In addition, the RPPO/LPPO is only based upon the service area for eligibility to join, not who you can or cannot see.

I realize you're new to insurance so I'll be kind.

Rick

 

[Dave020]

Let's see if you have guts to make a bet with me. I'll bet you not one, but two pints of Guinness that you're wrong and I'm right.

By the way, the brochure says you can see any doctor in or out of network. In addition, the RPPO/LPPO is only based upon the service area for eligibility to join, not who you can or cannot see.

I realize you're new to insurance so I'll be kind.

Rick

I am basing it on what Senior Sales Support told me. If it is, in fact, incorrect, then they gave bad information.

However, if in fact what they told me is incorrect, I will buy you two Guinnesses for proving the carrier wrong.

 

[azmedsupagent]

RABBI,
Yes, however part B would do a good job covering the small stuff while still within the deductible. I.E. A typicall doctor visit in AZ runs about $100 so a 20% coinsurance would be an out of pocket of $20. This is very comparable to an average MA. All the while if something catastrophic does happen the max out of pocket would be less than with an average MA... Correct...?

 

[retread]

.... the RPPO/LPPO is only based upon the service area for eligibility to join, not who you can or cannot see.

Rick, it is amazing that there are some agents that don't know this. Not only are we required to cite the eligibility rules in our sleep, but anyone reading the "Please read and sign agreement" paragraph (which I do for them every sale) would have to understand that there is no network when it comes to an emergency or urgent care.

Did these guys just by coincidence miss the same question on their certification tests?
---------------------------------------------------------------

I was getting ready to bash the slow learners again when I stopped to recognize that they don't have the advantage I have. I live a few blocks from the state line that splits a metropolitan area. PPOs around here range from some plans whose service areas cover both sides of the state line to some that are only one side of the state line or the other. Regardless of the "service area", any beneficiary enrolled in any PPO plan (all plans, not just BCBS or Coventry, etc.):

1) can go either side of the state line on self-referral if the provider is in the network directory and receive in-network coverage.
2) can go anywhere in the U.S. for self-referral routine care, but will be subject to out-of-network (OON) charges (20% co-insurance vs network co-pay).
3) will be covered anywhere in the U.S. in or out of network for urgent or emergency care for the plan co-pay for those services.
4) can go across the US border into Canada or Mexico if, at the time of the emergency the nearest hospital is across the border.

The big issue in selling plans in my area is the provider directory. Big plans like Coventry and Humana cover almost all hospitals in the area, and quite a few doctors are also in both of those plan networks, so the difference in the network is not significant. The smaller plans have a smaller number of providers, making OON more of a factor... But no MA member is restricted to a provider choice one side of the state line or the other regardless of his plan's service area as long as that provider is in his plan's provider directory (network).

The "service area" applies to enrollment eligibility, not provider access (per se).

(I suppose these slow learners don't know that ESRD is covered in MA plans if contracted AFTER ENROLLMENT either.)

 

[Dave020]

I only do IFP and Group, not Medicare. Sorry, I have never taken a certification test nor have any interest in selling in the senior market. Just trying to learn something.