High Deductible Plan F VS MA Plan

[retread]

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.

Sorry, didn't realize you were not MA certified. You shouldn't venture to offer advice if you are trying to learn.... perhaps if you had posed your statement as a question...?

I now realize you probably are familiar with the Blues under 65 plans... (good guess?)... but you shouldn't jump to the conclusion that the same rules apply after 65. Medicare is a Federal insurance plan, and as such covers beneficiaries coast to coast. Medicare Advantage plans are an enhancement of Original Medicare's (OM) benefits. The basic regulatory rule that applies to all Federal laws is that you can liberalize the benefits, but you can't restrict them below the level set by the Feds. So carriers that design MA contracts that replace OM under the Part C provision will work differently than that same carrier's under 65 plan that is not subject to CMS rules. However, networks are networks.... but OON is not limited in Medicare PPOs. HMOs are another breed of cat, and I am not going there.

 

[Dave020]

It was meant as a question to Rick since I refer all of my Medicare cases to him. I forgot to put a question mark on it.

 

[retread]

It was meant as a question to Rick since I refer all of my Medicare cases to him. I forgot to put a question mark on it.

Yeah, right... nice try!

Hey... we are all tired after the AEP rush... thank you for not taking offense. I could have been a little more relaxed with my reply... I'm just grouchy these days. Deal with it!!!

 

[Dave020]

No, seriously, I refer all of my Medicare cases to Rick. I don't write them. He will owe me many lunches (not at Fuddruckers btw). Not joking here, I send them all to Rick. He's a senior guy and I'm a HIPAA guy.

 

[retread]

No, seriously, I refer all of my Medicare cases to Rick. I don't write them. He will owe me many lunches (not at Fuddruckers btw). Not joking here, I send them all to Rick. He's a senior guy and I'm a HIPAA guy.

I don't trust anyone from the '60s. Too much acid and mary jane.

 

[Dave020]

LOL, Rick is lucid enough, at least as lucid as the seniors around CA LOL. They have flashbacks too!

One thing, I did not venture an opinion, I quoted what I was told by Anthem BC (then Blue Cross CA) directly about the MAPD PPO plan. If they told me wrong, then ok it is their error. I sold a couple when they first came out in the pre-65 disabled market and the situation came up with a prospect living 1/2 year in CA 1/2 year in OR. BCC told me staight up that FB MAPD PPO would have no coverage across the border in OR, they could not use the plan up there. If that is wrong, then it is on Anthem's end. I will wait for RSM to advise.

 

[moonlightandmargaritas]

He will owe me many lunches (not at Fuddruckers btw).

Years ago I had a VP level boss who when doing a "market visit" would suggest places like Chili's for our expense account dinners...

Not a frickin' chance.

 

[Dave020]

Ate at Fudgepackers twice in my life, you know the one that is or used to be on Fowler Avenue, Paul? Both times I was so sick I had to leave work and spent considerable hours in Pepto Bismal. Ugh! Pick your own burger, my a**

 

[retread]

LOL, Rick is lucid enough, at least as lucid as the seniors around CA LOL. They have flashbacks too!

One thing, I did not venture an opinion, I quoted what I was told by Anthem BC (then Blue Cross CA) directly about the MAPD PPO plan. If they told me wrong, then ok it is their error. I sold a couple when they first came out in the pre-65 disabled market and the situation came up with a prospect living 1/2 year in CA 1/2 year in OR. BCC told me staight up that FB MAPD PPO would have no coverage across the border in OR, they could not use the plan up there. If that is wrong, then it is on Anthem's end. I will wait for RSM to advise.

I don't know what this guy is talking about... I wouldn't put much money on his credibility (there! I used that word correctly in an insurance forum!!).

The eligibility criteria for MA plans is threefold: 1) Must live in the service area 2) Must have both Part A and B of Medicare 3) Must NOT have ESRD.

In the first requirement, living in the service area is hard to find defined in writing, but if my memory serves me correctly I believe it is 6 months. This makes sense... but I wouldn't put too much faith in it though, since not much of what CMS does is logical.

I do know that Med Sups do not have any problem whatsoever with the service area restrictions that MA plans have. Second to that are the PFFS MA plans, since they have no networks (at the present time).

HMOs and PPOs are networks, so they tend to tie one down to local access to take advantage of the low flat dollar co-pays contracted through the pre-negotiated network discounts. OON requires 20% co-insurance (sans contract) and therefore negates the savings benefits of the MA.

(Next year we will begin to see PFFS plans developing networks)
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Ate at Fudgepackers twice in my life, you know the one that is or used to be on Fowler Avenue, Paul? Both times I was so sick I had to leave work and spent considerable hours in Pepto Bismal. Ugh! Pick your own burger, my a**

Must have something to do with the cleanliness of the facilities of this place. I eat often at Fuddrucker's close by my house, and have for over 10 years... so far, no problems as you describe... and I love the ability to load my burger up with lettuce and tomatoe.

Last night, my wife and I ate at a Red Robin that just opened not long ago a couple of blocks away from Fuddrucker's. Red Robin is new to KC, but I ate at several in CA back in the 90's when I flew into CA often and knew they were good. I think their burgers and fries are much better than Fudd's but a couple dollars higher. Both still beat McD's, Wendy's, BK, etc. I will eat at the trough for lunch, but if I take my wife out, it is Fudd's or Robin's on the cheap... If I am feelin' like struttin', I take her to Cheezecake Factory or a good BBQ place (dozens of them in KC). Gotta watch my pennies these days!