It's happening, doctor opting out of Medicare

[rousemark]

Gosh, I wonder why all the Drs advised you to do that? Where Drs will really get hit hard is if OM actually starts looking at claims and puts a stop to the free for all that is OM. Then they will be telling patients MA plans are the only way to go. Don’t let them fool you, it’s about their best interests not yours. Luckily most people can see through their BS and actually think for themselves.

I did not address what their motives might be, only the fact is that is what they reccomend. Not one of them refuses new patients for having OM. Each of them does refuses at least one MA. For example, my orto dr does not accept any of the Humana MAs.

 

[axeman462]

I did not address what their motives might be, only the fact is that is what they reccomend. Not one of them refuses new patients for having OM. Each of them does refuses at least one MA. For example, my orto dr does not accept any of the Humana MAs.

 

[rmhaire]

View attachment 11080

OK. Since @rousemark and I are obviously to slow to keep up with your awesome point of view, why don't you elaborate where we went wrong.

And don't hold back. If it gets too tough, we'll get someone to explain it to us.

 

[axeman462]

OK. Since @rousemark and I are obviously to slow to keep up with your awesome point of view, why don't you elaborate where we went wrong.

And don't hold back. If it gets too tough, we'll get someone to explain it to us.

There's no point. Many of us on this forum have already tried. It continues to fall on deaf ears.
Just go back to the Medsupp Taliban.

When the other shoe drops, those of us who are true brokers, and looking out for our clients will be ready to advise.

 

[rousemark]

There's no point. Many of us on this forum have already tried. It continues to fall on deaf ears.
Just go back to the Medsupp Taliban.

When the other shoe drops, those of us who are true brokers, and looking out for our clients will be ready to advise.

There is no point because you know that your posts taken in context of the discussion make no sense.

 

[axeman462]

There is no point because you know that your posts taken in context of the discussion make no sense.

They make perfect sense, if actually read the entire thread with with an open mind.

The problem is, you and the rest of the Medsupp Only Taliban do not do that.

There are professionals here on this forum that are actually trying to share industry news with each other, and learn, and share experiences. So we can grow in our profession together and properly advise clients.

Some of us actually take this career seriously.

Then there are the cheerleaders. Who treat the products like team sports. Cheering on their one and only product that they sell; scouring the internet every night for more propaganda to support their views.
Those people do nothing to help on this forum, and nothing to keep our profession ahead of the curve. They only care about defending the only product they sell at all costs.

Those agents will go gone by the end of the decade, the canary on the coal mine is already gasping for air.

I truly hope the experiences I've had with these doctor offices are isolated, and ultimately outliers, but the information that had come to light makes me fear that it may not be. Our industry is very likely to be turned on its head in the coming years.

That being said, bless your heart.

 

[AgentGeneral]

Alright, so after reading your post, I decided to call the doctor offices that I knew opted out recently, but are still accepting MAPD.


First, what you were saying about the doctors must accept OM if they are accepting MAPD, Yes, that is true, in theory.

But what I have experienced here in Florida a few times now over the past year, mostly the past 6 months or so, and I confirmed with the phone calls to these doctor offices is that some doctors are not accepting OM for new patients.

These 3 office, did not actually Opt Out of Medicare, they are just weaning themselves off OM.

Here are a few bullet points I took from the conversations. One of the offices was very forthcoming. It almost felt like they wanted to educated the public on what was happening in their industry, and I encourage y’all to share the word, because I believe this will affect our industry in the coming years:

• Physician payments from Original Medicare have not kept up with inflation over the past 20 years, and it is getting harder for many doctor offices to keep the doors open.
• This particular office gave me a few specific examples:
  • Florida Blue 2023
    • $94,300 in charges, $73,500 in receipts, $20,800 in adjustments.
    • She says they are making an average of 23cents on every dollar of receipts
  • UHC 2023
    • $155,000 in charges, $124,000 in receipts, $31,000 in adjustments
    • They make an average of 38cents on every dollar of receipts
  • Original Medicare
    • $260,000 in charges, $163,800 in receipts, $96,200 in adjustments
    • They lose 31 cents on every dollar of receipts due to overhead related to OM regulations
• The extra red tape from Medicare causes the physicians to spend less time with the patient, and therefore, lower quality healthcare. It is the doctor's wish to provide only the highest quality service to the patients.

So here’s what happened with the customers.

The one in Tampa, is actually a potential new customer of mine. Had an MAPD, but switched to OM with a medsupp back in the Fall, after another agent promised her the world. Her doctor won’t see her now, because in his eyes, she is a new OM customer. His office does not want more OM customers.

The customer that started this thread, their doctor office (although they wouldn’t admit on the phone), seems to be encouraging patients to leave OM and either join their “private contract” or a PPO.

I'm not saying that this is the end of the world, or that OM is be no more. What I am saying is that the gravy train might be slowing down, and that the changes that must come to Medicare in the coming years, will create a real need for good Medicare brokers.

Yes, there ya go. Some of the best people for me to talk to and become friends with are billing dept people, social workers, doctors themselves and nurses. Not the only people I get info from...but you know what I mean. Med supp only people don't get the ins and outs of the complexity of MAPD. I'm learning still myself. I do know this, if I call anyone at a facility, any of the professions I mention, I get totally different answers than what a med supp only person will try to "sell" me.

It's never what they think..."med supp is all a doctor really wants to take, no PAs, hard to get paid, don't like the negotiated prices....nope. none of that.

It always comes down to whats going on in their geo market. Which leads me to this....again, for the umpteenth time:

Just the opposite in South GA. I've made the same phone calls and it's MA that they're not taking new patients on. OM has been no problem.

This might be the case in South GA, but I can tell you with certainty here in Michigan it's much more like florida. It's MAPD country all the way.

We do not make the rules as agents. We have to go with whats going on in our market. Revise, adjust, pivot.....

So do the physicians, facilities...etc. So the argument that MAPD vs OM/Supp whatever whatever doesn't work well in this forum bc everyone is spread out all over the country.....

When you want to know whats going on in other markets, which I doubt someone in South GA would, do the research in that market. I know that sounds stupid but b4 people say whats right here is the same there in your state is just dumb.

On a weekly basis I talk to the above forementioned people. NONE are against MAPD here. I have had doctors tell patients, "hey we take Humana PPO, not Wellcare or UHC HMO, ......" I've had a doctor here tell a patient to move to BCBSM PPO and try it and get off his OM....

Yes that's not appropriate in theory but it's done over and over and over again, depending on the Doc.

I do see here what OP is talking about....makes sense.

Also I fully know why docs like PPO over HMO, but I am not feeling like going into that...but there's a difference how they get paid.

Its always a business decision, not personal, which is why i don't flip out when most enrollees here WANT MAPD. Ok, but I do move more toward PPO. Most docs here will say, we prefer PPO, not anything else.....

How do I know this, bc I talk to doctors every week, many of whom are personal friends that I eat and break bread with regularly.

That gets wild too though as a therapist would much rather deal with BCBS, whereas a pulmonologist in the county over might prefer Humana.....has to do with the pay AND how quickly one pays over the other.....they aren't really moaning about not having a OM blank check persay. Or even PAs. Maybe they are in South Carolina or the upper echelons in suburbs of Texas, but not in rural Michigan.

This isn't an easy business, not near as easy as it should be ( politics and follow the money trail--not the agent trail) and sure as hell can't please everyone, but the arguments in here are about as ridiculous as it can be.

It's made personal, when it should just be business, and the constant bickering is just a waste of time.

Cherry O, off to write more MAPD and follow up on one Supp.

None of it's the end of the world, as Axe stated. If theyd let agents write the rules, it might be different....it's an ongoing revise, adjust, pivot. At least those who pay attention know what is changing long before it does.

 

[rmhaire]

When you want to know whats going on in other markets, which I doubt someone in South GA would, do the research in that market. I know that sounds stupid but b4 people say whats right here is the same there in your state is just dumb.

As for my post yesterday, all I said was that in South GA Original Medicare was still King. That was roughly 24 hours ago and nothing has changed. Facts are facts. No need to have an aneurysm.

And for the record, I'm licensed in 10 states. Michigan happens to be one of them. And yes for both MA and OM.

So, tell me again, what are you going to teach me about markets?

​

 

[DonP]

75% of America . Husband and wife $3k or less Combined social security. Of those 75% at least 75% have $3k or less in pension / retirement a month . So of 75% of America the top 25% less than $6 k a month in total income . Age 72 the avg plan g sup is $200 a month . Next yr pdp’s will sky to probably $100 a month min . That’s near $300 a month total . Add the $174.70 part B premium and the $20 a month part b deductible and were at $500 a month per person out of pocket . That’s $1000 a month per couple . On $6 k of income that’s 15% of gross income a month . The $6 k figure is probably the top 20% of all seniors . . They can hardly afford it much less the bottom 80% of seniors . Rouse a 45 yr ins agent was looking at switching to mapd for a yr as his $400 a month premium is hurting him . In a perfect world all would have a sup paying 100% . But that’s not reality .

 

[axeman462]

75% of America . Husband and wife $3k or less Combined social security. Of those 75% at least 75% have $3k or less in pension / retirement a month . So of 75% of America the top 25% less than $6 k a month in total income . Age 72 the avg plan g sup is $200 a month . Next yr pdp’s will sky to probably $100 a month min . That’s near $300 a month total . Add the $174.70 part B premium and the $20 a month part b deductible and were at $500 a month per person out of pocket . That’s $1000 a month per couple . On $6 k of income that’s 15% of gross income a month . The $6 k figure is probably the top 20% of all seniors . . They can hardly afford it much less the bottom 80% of seniors . Rouse a 45 yr ins agent was looking at switching to mapd for a yr as his $400 a month premium is hurting him . In a perfect world all would have a sup paying 100% . But that’s not reality .

Reality is a dirty word on this forum