Hot Medicare News

[Yagents]

I wasn’t referring to you about giving them false information. I was talking in general a lot of agents do it to persuade them to Med Sups. But having Drs. tell clients to stay away from them is not the way to do business in my opinion. Like I’ve said many times all Drs, Hospitals, skilled nursing, etc want everyone on OM and Med Sups so they can do whatever they please like the good old days. I always tell clients to ask them if they are willing to pay their Med Sup premiums. So far no takers.

Gosh, I would prefer to take my doctors recommendation of care, vs an insurance company dictating what treatment is allowed.

And last I heard, doctors can move in and our of network each year. That would suck if I had a serious health condition.

 

[Midlevel]

So Drs. Know more then we do about insurance? You better take some extra training. Drs. see one thing and that’s ease of getting paid as much as possible.

 

[somarco]

f "just go ahead and buy the low rate now and I'll shop your rates each year and you can change in a year or two" does not seem like it might go as smoothly as the sales patter suggests.

If you live in a GI state, or birthday/anniversary rule state, that approach might work . . . otherwise it is just a trick like using the "free look" close

 

[Travis Price]

There literally is no argument when you compare access to treatment w/ MAPD and Medigap. Straight from OIG, 4 years apart.. nothing is different.

https://oig.hhs.gov/oei/reports/OEI-09-18-00260.pdf
Medicare Advantage Appeal Outcomes and Audit Findings Raise Concerns About Service and Payment Denials Report (OEI-09-16-00410) 09-25-2018

Good news... they overturn 75% of denials.. Nothing like holding off treatment or paying out of pocket in hopes for reimbursement because you have to go through the appeals process to get the services you're entitled to under Medicare.

But, just fear-mongering... no government studies to back that up. ::eyeroll::

 

[somarco]

I wasn’t referring to you about giving them false information. I was talking in general a lot of agents do it to persuade them to Med Sups.

Give an example of "false information" from agents selling Medigap.

Are you suggesting that agents selling MAPD are completely transparent about things like non-par providers, pre-authorization, claim delays and denials, referrals, OON OOP . . . etc.?

 

[Yagents]

So Drs. Know more then we do about insurance? You better take some extra training. Drs. see one thing and that’s ease of getting paid as much as possible.

Read my post, I'm speaking about the health care treatment the doctor advises, without the insurance type or company coming into the equation.

Example. Doctor says i don't like the looks of that lump, u need an MRI now. Insurance company disagrees and delays or declines the pre auth. Who is right? I would hate for the delay to cause harm to my client or myself.

It's already an issue with drug plans, and pre auth. Why expand it and include doctors and caregivers?

 

[somarco]

There literally is no argument when you compare access to treatment w/ MAPD and Medigap. Straight from OIG, 4 years apart.. nothing is different.

https://oig.hhs.gov/oei/reports/OEI-09-18-00260.pdf
Medicare Advantage Appeal Outcomes and Audit Findings Raise Concerns About Service and Payment Denials Report (OEI-09-16-00410) 09-25-2018

Good news... they overturn 75% of denials.. Nothing like holding off treatment or paying out of pocket in hopes for reimbursement because you have to go through the appeals process to get the services you're entitled to under Medicare.

But, just fear-mongering... no government studies to back that up. ::eyeroll::

It always gets me when agents ever so casually say "Just appeal it". Like everyone has the time, expertise and ability to appeal claim denials.

And don't say it is up to the provider to appeal. They don't have the time or staff to appeal claim denials.

Also, MAPD plans are not included in ABN protections.

 

[Travis Price]

It always gets me when agents ever so casually say "Just appeal it". Like everyone has the time, expertise and ability to appeal claim denials.

I don't know how MAPD plans work in regards to processing time... but SSA Disability (for the client) is a real pita. When I would review appeals, it would start from the beginning of the case and work forward. Granted, that's more in-depth, but it's really dishonest of agents to sell that access to care isn't a major issue in MAPD.

It's not JUST provider access. It's getting shit paid.

Just a question for MAPD pushers (and I don't mean people that offer MAPD, I'm talking about PUSHERS)

If the insurance company refused to pay you 18% of the time, and you had to appeal to money you were entitled to, would you keep offering that company?

If not, why would you actively throw your clients into the same bus?

"Because they can't afford better medical coverage?" Bullshit.
"Because I get paid more?" Bingo.

Again, I don't hate the concept of MAPD, but in the framework of Medicare and how it works? It's definitely not my first choice.

That might mean I get paid 10 dollars a month for HDG+PDP, but is the client ultimately better off? Yep.

(Considering the claims that HDG ends up paying out.. they could increase the commission a bit though...)

 

[Yagents]

I wonder why they won't spend a billion on med supp market? Profit margins may be the answer.

"Humana is moving forward with its plan to invest $1 billion into its Medicare Advantage business, executives said during an earnings call Wednesday."

Humana records $930M quarterly profit as Medicare Advantage rolls grow 5%

 

[sman]

Oh no, I’m being attacked by all the Med Sup lovers. You guys keep doing you, in 10 years you will all be wondering how the business passed you all by. Keep telling yourselves all these falsehoods and pass them right along to all your poor clients. 70% MA by 2030 but they are terrible plans. Get your heads out do the sand.

There will be 80 million people on Medicare by 2030. Even if we reach 70% on MAPD, that still leaves a large number for Med Supp. There is plenty of room for both products. I know you may not believe this, but there are actually some Medicare beneficiaries who prefer a Med Supp over a MAPD.

 

[LostDollar]

So Drs. Know more then we do about insurance? You better take some extra training. Drs. see one thing and that’s ease of getting paid as much as possible.

Caveat, not an agent.
I don't see that as much different than insurance agents having concerns about the commission levels of products they sell.