The only time it matters is when YOU are the one that has to pay for it.
Frankly, if you are selling based on how many MAY hit the OOP max you are completely missing the boat.
There are enough people that will hit $3k+ to make the ceiling a concern.
How many of your clients MAPD plans are being dropped?
- Thread starter kak6407
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The only time it matters is when YOU are the one that has to pay for it.
Frankly, if you are selling based on how many MAY hit the OOP max you are completely missing the boat.
There are enough people that will hit $3k+ to make the ceiling a concern.
just-a-client
Expert
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I've wondered about the OTC. Out here in California, a number of supplements have so-called "innovative benefits" (vision, hearing, OTC, sometimes personal emergency devices, nurse lines, Silver Sneakers...). My supplement has no such extras.
I figure if I was able to use all those innovative benefits, it could make the plan practically free. But then - would I use many of them? And, what's the quality and actual value of the extras? Details are skimpy.
For OTC, the only details I've ever seen was indeed a catalog from Blue Shield of CA. (It wasn't that easy to find.) It's not like you could walk in and buy qualifying stuff from any pharmacy, like with an FSA. And the catalogs are totally generic - they don't list brands.
Sure, I'd be fine with generic ibuprofen, but what exactly are "bandaids"? I like the flexible kind, and don't like the CVS generics. Many kinds are on the market - obviously because people actually do have preferences!!
And, they have contact lens disinfecting solution. What kind?? They aren't interchangeable. Etc., etc. etc.!
And if it's all incredibly overpriced, you'd use up the OTC allowance in no time, making it nearly worthless.
So, I keep an eye on this but have stuck with my supplement each year during my birthday rule period. Its premium is still in the top 2 for my age - if I ignore the value of the innovative stuff.
(And I guess just like MAPD, they can discontinue those extras at any time. Blue Shield already closed down their "G Inspire" plan that was just a few years old, which was very popular - their deal with AAA offering a free annual membership was discontinued. However - at least from what I was able to find, they graciously allowed everyone from Inspire into their "G Extra" plan, which was similarly priced and had all the other same extras.)
I guess part of my question then is, is OTC always handled in that crappy user-unfriendly way? Picky people should stay away, then.
And, is it true in some states agents can't discuss innovative benefits when selling plans?
And, do you factor any of these benefits into your thinking, or are the only concerns rates, rate history and stability, insurer quality, keeping plans open, etc.? I suppose if you found 2 plans very similar in all of those respects, the extras would certainly be a tie-breaker.
I think the odds of hitting that are higher than that. The risk of getting, for example, a major cancer, is far higher than that in the 65+ age group (slightly over half the new cancer diagnoses are in that age group). Stokes can be pretty expensive as can major heart disease needing treatment beyond meds, alzheimer's... There are other major diseases where treatment costs a lot. Being in ICU for any length of time time will do it...
This short article (written for another purpose) gives the average cost of some diseases and surgeries. With all of them the MOOP would likely be hit.
The Most Expensive Medical Diseases and Procedures | USC EMHA Online
Medical costs are an issue of global concern for both patients and their providers. Learn about the most expensive medical procedures and their costs.
Of course even if we know the odds we don't know if we, personally, will be the ones who land in the "unlucky" group or not. If people can't financially afford to be unlucky then they need a plan where they can afford the MOOP if they are unlucky (as somarco said it matters if you are the one who has to pay it).
And that, of course, in my opinion that is what buying insurance all is about. Covering worst case. You pay and hope you never have to use it (so hope you are a personal "profit center" for the insurance company)... but if worst case happens and you have to use it you are grateful that you have it.
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Can't. The dog ate it.
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They want to lose the clients, that's the entire point.
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