HMOs PPOs and POSs MAs

[honestagent]

Are any of you selling these type of MAs?


I'm getting inundated in email from some of my FMOs to write this and I'm wondering how your experiences have been selling these type of products, assuming some folks on here are?

 

[GreenSky]

I'm pretty sure that virtually without exception these are MAPD plans. Unless you're dealing with dual eligibles, you can't do anything before 2008 effectives.

Well, I guess you and EVERY OTHER INSURANCE AGENT can go after people turning 65.

Rick

 

[Cenla Agent]

Are any of you selling these type of MAs?


I'm getting inundated in email from some of my FMOs to write this and I'm wondering how your experiences have been selling these type of products, assuming some folks on here are?

I have sold PPO's and HMO's. Not as many HMO's b/c of where I live since they are not available ohere. Before you contract check into what kind of network they have in your area.

A PPO may be a good option for those who have had a group or individual PPO in the past and are familiar with how they work. But it could be argued that a PPO is the most complicated plan of all for those unfamiliar with it since it pays out of network too, and they have to make sure the providers they are getting referred to are in the network too, which is something that some people may not consider.

At this point I actually lean toward saying that despite the restrictions, a HMO is probably the simplest of the MA's since it's very cut and dried. Either the provider is in the network and the plan will pay or it is not in the network and neither the company nor Medicare--that's the important point for them to understand--won't pay a dime, and the company can give you a list of who is in the network, whereas the PFFS only companies cannot tell you who accepts their plan, but can only tell you who has taken it at least once in the past. I think Humana's PFFS is an exception and IIRC the providers who are in any of their networks have to agree to take the PFFS too. If there are any other companies that offer different types of MA's they may work similarly.

 

[Cenla Agent]

I'm pretty sure that virtually without exception these are MAPD plans. Unless you're dealing with dual eligibles, you can't do anything before 2008 effectives.

Well, I guess you and EVERY OTHER INSURANCE AGENT can go after people turning 65.

Rick

There are HMO and PPO plans that are MA only, but unless the rules changed from 2006 to 2007, a PFFS is the only plan that can be sold as MA only and coupled with a stand alone Part D plan. The HMO and PPO plans CANNOT be coupled with a stand alone Part D plan and are designed primarily for VA beneficiaries who already have creditible drug coverage. Of course these plans could be sold to someone who has never enrolled in Part D.

 

[GreenSky]

There are HMO and PPO plans that are MA only, but unless the rules changed from 2006 to 2007, a PFFS is the only plan that can be sold as MA only and coupled with a stand alone Part D plan. The HMO and PPO plans CANNOT be coupled with a stand alone Part D plan and are designed primarily for VA beneficiaries who already have creditible drug coverage. Of course these plans could be sold to someone who has never enrolled in Part D.

Good point. Now that I think about it, there are Medicare HMO plans available without the Part D. I was not aware that you couldn't write a PDP along side of them.

Let me plead ignorance....when would an HMO without Part D be appropriate?

Rick

 

[Cenla Agent]

Good point. Now that I think about it, there are Medicare HMO plans available without the Part D. I was not aware that you couldn't write a PDP along side of them.

Let me plead ignorance....when would an HMO without Part D be appropriate?

Rick

1. Someone who has VA (and who is not 100% disabled) and doesn't want or need a PDP but would like some kind of alternative coverage to go to civilian providers at a better value than what's available with Medicare A & B. However this is becoming less worthwhile in many cases due to increasing difficulties that have been reported to me in getting outside prescriptions filled at the VA. In most areas they can get a HMO MAPD at a $0 premium anyway and they can still go to the VA if they want. I suppose that in some cases the HMO without Part D may have some additional benefits or lower copays, etc. compared to the one with Part D.

2. Someone who missed the enrollment period for the PDP but wants an MA. They can then switch to an MAPD during the AEP and of course then be subject to the penalty.

3. Someone who for whatever reason doesn't want a PDP but wants a PPO or HMO.

During 2005-06 when I was captive with Humana, we had a PPO MA only plan. I only remember selling two of them. One was to someone on VA, the other was to a woman who took it over a MAPD (against my advice) who didn't want to pay the extra cost for a MAPD, which was an extra $37. They did not offer the PPO MA Only plan here this year but I think they did offer a HMO without Rx coverage in the New Orleans area.

 

[midwestbroker]

I have sold the HMO without the part D plan mostly to people using the VA. Some only wanted the free gym membership, since they use the VA for everything.

Humana keeps that plan for those reasons. The will not do a PFFS MA only. They submit drug use to CMS for extra money since some are "higher risk". They use their drug usage for the documentation with CMS. Without the Part D, they would have no way to track it.

 

[honestagent]

Cenla, Good stuff. Thanks for the input. And yes, you're absolutely right on the HMOs and I appreciate your black and white layout of in and out of network and what does and does not pay. Thanks.

Midwest: Interesting how Humana uses their drugs to get more $$$$ oh I'm sorry; is that of what you imply? If yes, then why do you think Coventry was able to provide an MA and United Health, but Humana was or chose to not?

 

[Cenla Agent]

I have sold the HMO without the part D plan mostly to people using the VA. Some only wanted the free gym membership, since they use the VA for everything.

Humana keeps that plan for those reasons. The will not do a PFFS MA only. They submit drug use to CMS for extra money since some are "higher risk". They use their drug usage for the documentation with CMS. Without the Part D, they would have no way to track it.

Silver Sneakers (the gym membership) has sold alot of plans for Humana thru the years, especially the HMO in the metros. Many of the areas I've worked over the past couple of years were rural and there was no participating gym nearby.