Is There a Cheap Medigap Supp Plan A for U65 in Texas?

[goillini52]

I am dealing with a similar situation to wehotex. Called reserve national a couple weeks ago because i was getting the same results on CSG. Reserve national says they are captive and they only offer Plan A for U65 (i was specifically asking about oklahoma). Whoever I talked to didnt know what CSG was. They said they'd have an agent call me, Im still waiting...

Kemper seems to be one of those companies that make money in spite of themselves. Very inept.

 

[kgmom219]

What procedure is covered by Medicare but not MA?

Don't be timid. Ask.

I would be curious to know what is covered by Mcare but not MA.

In the one I did, it was the specific chemo drug that I needed the Part B coverage on. Couldn't find an MA pIan to cover it.

 

[yogooglethis]

In the one I did, it was the specific chemo drug that I needed the Part B coverage on. Couldn't find an MA pIan to cover it.

My understanding is that any part B drug covered under original has to be covered under MA ,. How did you determine a part b drug wasn't covered under a MA plans part B benefits? i have never seen a list of covered part B drugs for an MA nor never had to look it up because if it's covered by medicare its covered by MA and thats all I need to know.I have enrolled more people than most agents I know in MA plans and have never had an issue with this.Of course I educate the client on the benefit of a med supp paying the 20% for pat B drugs instead of the client paying 20% like they normally would on a MA but sometimes they have no choice and have to go with MA because of underwriting issues .

 

[kgmom219]

My understanding is that any part B drug covered under original has to be covered under MA ,. How did you determine a part b drug wasn't covered under a MA plans part B benefits? i have never seen a list of covered part B drugs for an MA nor never had to look it up because if it's covered by medicare its covered by MA and thats all I need to know.I have enrolled more people than most agents I know in MA plans and have never had an issue with this.Of course I educate the client on the benefit of a med supp paying the 20% for pat B drugs instead of the client paying 20% like they normally would on a MA but sometimes they have no choice and have to go with MA because of underwriting issues .

The pharmacy at UTSW said MA wouldn't cover it.

I went to a friend who is a VP at an FMO for Scott and White and UHC, he went to them and they said it wouldn't be covered. (I don't sell MA)

Then her docs told her she would need to find docs on MA. Issue resolved. She's not changing providers.

The woman has been fighting brain cancer for almost 10 years. She has a monthly MRI, then they determine the next months plan and meds. Changing docs really isn't an option.

I think its great that you think MA is fabulous and it certainly has its place, but the argument that it covers everything Medicare covers is bogus and misleading.

2 women needed a hip replacement

#1 has Plan G. Sees the orthopedist, has an xray and MRI in the office, then schedules the surgery. Takes 6 days. She goes to the top hospital in town, stays 5 days, pain management docs attend to her, private room, etc. She goes home and home health attends to her needs for 6 weeks. Then additional PT for 8 weeks. Costs $149, plus the $1400 annual premium.

#2 has a UHC MAPD. She goes to see her PCP. Gets a referral. Takes 2 weeks to get in and its a 20 mile drive (and in Dallas traffic, thats an issue). The xray can be done in office, but not the MRI. Plus we have to get approval. Takes 4 working days for the prior auth. Then 3 more to get it scheduled at an in network MRI provider. Then permission from UHC to perform the hip replacement. After permission is received, it takes 3 more weeks before the hospital they want her to use has an opening. She gets in and has the surgery at a hospital I wouldn't take my dog to. They require her to leave in 48 hours. Then she goes home and starts having complications that appear on day 3 post-op. She has to go back and be admitted. It takes 6 months to get to where she can even start PT, then she has to fight when she needs more than 10 visits. She's still limping and in pain. Total cost: $3K

#1 is my mother
#2 is my "almost" MIL

MAPD may cover everything, but at what cost?

 

[grod]

Kemper seems to be one of those companies that make money in spite of themselves. Very inept.

Yep, but they pay full commissions on GI business. Not many do these days.

 

[somarco]

http://www.medicareinteractive.org/wp-content/uploads/2015/08/B-vs-D-chart.pdf

 

[goillini52]

Yep, but they pay full commissions on GI business. Not many do these days.

Well, that's one good thing about them.

 

[yogooglethis]

The pharmacy at UTSW said MA wouldn't cover it.

I went to a friend who is a VP at an FMO for Scott and White and UHC, he went to them and they said it wouldn't be covered. (I don't sell MA)

Then her docs told her she would need to find docs on MA. Issue resolved. She's not changing providers.

The woman has been fighting brain cancer for almost 10 years. She has a monthly MRI, then they determine the next months plan and meds. Changing docs really isn't an option.

I think its great that you think MA is fabulous and it certainly has its place, but the argument that it covers everything Medicare covers is bogus and misleading.

2 women needed a hip replacement

#1 has Plan G. Sees the orthopedist, has an xray and MRI in the office, then schedules the surgery. Takes 6 days. She goes to the top hospital in town, stays 5 days, pain management docs attend to her, private room, etc. She goes home and home health attends to her needs for 6 weeks. Then additional PT for 8 weeks. Costs $149, plus the $1400 annual premium.

#2 has a UHC MAPD. She goes to see her PCP. Gets a referral. Takes 2 weeks to get in and its a 20 mile drive (and in Dallas traffic, thats an issue). The xray can be done in office, but not the MRI. Plus we have to get approval. Takes 4 working days for the prior auth. Then 3 more to get it scheduled at an in network MRI provider. Then permission from UHC to perform the hip replacement. After permission is received, it takes 3 more weeks before the hospital they want her to use has an opening. She gets in and has the surgery at a hospital I wouldn't take my dog to. They require her to leave in 48 hours. Then she goes home and starts having complications that appear on day 3 post-op. She has to go back and be admitted. It takes 6 months to get to where she can even start PT, then she has to fight when she needs more than 10 visits. She's still limping and in pain. Total cost: $3K

#1 is my mother
#2 is my "almost" MIL

MAPD may cover everything, but at what cost?

.I think the most fabulous plan is the most suitable plan and since I have written a ton of both MA and med supp in the last 20 plus years I think I understand the pros and cons of both pretty well..The most fabulous plan would be a plan F with a zero premium with part D included but since that isn't available I help each client decide what's best for their individual needs.

My point about the part B drug was that the pharmacy dept. of the MA plan is not going to tell you what is medically covered under part B including part B drugs- they deal with outpatient drugs and yes there are some drugs that can be covered under both part D and B.Just a guess but that is probably where the confusion arose when they called UHC.


disclaimer. I only sell in Florida and MA plans here are good and seem to be getting better each year and med supp premiums are fairly high so your milage may vary