How is the $2000 MOOP calculated?
- Thread starter selfgen
- Start date
Jim Wright
Super Genius
- 187
It can be explained clearly. Agents have a choice to make. Throw your hands up and not help your clients understand it or let someone else explain it to them and take your business. Make a chart or a visual with examples. Even if they all don't get it, you're doing the best you can for you clients.
It's really not that difficult if you take the time.
MedicareWAA
Guru
- 370
To those who think this is too complicated to be understood … it’s not. It’s a “greater of” methodology.
There is a standard benefit design. Deductible is $590, then 25% coinsurance. No cost when the enrollee’s actual OOP reaches $2k.
The enrollee has XYZ plan. It may or may not be the same as the standard benefit design.
When the enrollee fills a script, they pay according to their plan’s benefit design. The government also looks to see how the drug WOULD have been covered in the crappiest plan (standard design).
The higher out of pocket outcome is the one that accumulates to the $2k. It doesn’t matter what the enrollee actually paid out of their own pocket.
There is a standard benefit design. Deductible is $590, then 25% coinsurance. No cost when the enrollee’s actual OOP reaches $2k.
The enrollee has XYZ plan. It may or may not be the same as the standard benefit design.
When the enrollee fills a script, they pay according to their plan’s benefit design. The government also looks to see how the drug WOULD have been covered in the crappiest plan (standard design).
The higher out of pocket outcome is the one that accumulates to the $2k. It doesn’t matter what the enrollee actually paid out of their own pocket.
I had an agent at one of our kickoff meetings ask if client needs to return their hearing aids if they decide to get new ones. Rep just said no, doubt they want their waxy hearing aids back. Trust me, we don’t want some of these agents trying to explain anything.
Not hard at all to explain if you print off the plan that has 25% Tier 3 with deductible and then the plan that has 0.00 deductible and 47.00 Tier 3. It lays it all out nicely. Example I have printed off are 2 drugs that cost 1600.00/month and client will pay a total of 376.00 for the entire year for 19000.00 worth of drugs.
Word. I've heard some doozies out there.
