MA compared to Original Medicare

[Winter_123]

New to MA's question:

What is the most concise way to describe or understand what an MA does compared to Original Medicare-Parts A and B?

Obviously, some companies are offering a few more benefits beyond original medicare. But, in general it looks like MA's nickel and dime you more up front on hospital costs etc (whereas the original medicare deductible might have convered it all for shorter hospital stays). In return, the MA's offer require no payment past a certain number of hospital days and also cap the entire out of pocket somewhere around 2800-3500 give or take.

So, the naive question is, where are the areas where clients are most likely to run beyond the MOOP level if there is no cap? I could see the dollars piling up fast for hospital stays beyond 15 days (for example) which would otherwise covered by an MA but 15 days would cover the vast majority of stays. What are the other areas where clients have major exposure that an MA covers. How would you reply back to a client that says that they think that people are more likely to have a short hospital stay where the MA's pay less and the MOOP does not do much for them because they would have to go through a pile of co-pays, deductibles, and excess charges to get there.

Other than longer hospital stays, I don't have a feel for where the dollars pile up fast in a way that could really be helped with an MA. Sure the doctors visits add up and all of that but still you would have to do a lot to reach the moop. And then there a lab tests etc. Could someone offer up a couple scenarios that would help me to understand this better.

Thanks for any info.

Winter

 

[policy doctor]

You said it!! That is a naive question!! Every MA company has a booklet comparing their plans to original Medicare....and they are laid out in columns so all you have to do is read across. Now if you can't do that, I suggest another line of work.

 

[Winter_123]

You said it!! That is a naive question!! Every MA company has a booklet comparing their plans to original Medicare....and they are laid out in columns so all you have to do is read across. Now if you can't do that, I suggest another line of work.

In the same amount of time that you took to be superior,with me, you could have provided some real information from the front lines if you have any. I am well aware of what the booklets say. Often people with real experience are able to offer up a perspective and some watch-outs that go beyond printed material. In the same way, some people here ask questions about how certain agent contracts play out in the real world. Some reply by saying "why don't you just read the contract." Others are able to provide information about how some contracts have played out in the real world. Apparently, you are in the category of agents that doesnt need to know anything beyond the brochure and gets snippy with those who do.

Winter

 

[midwestbroker]

So are you asking what the advantage is of having a MA plan?

I cannot tell if you are selling for or against MA plans.

 

[Winter_123]

So are you asking what the advantage is of having a MA plan?

I cannot tell if you are selling for or against MA plans.

Was looking for information. The moop's seem high and was looking for examples of scenarios (other than extended hospital stay) where clients with original medicare are at the most risk of shooting over the capped amount if the cap were not there. In other words, where is the client most likely to get into trouble without a cap, hospital days aside. Are you seeing a lot of people with 6000 of co-pays for doctors and labs or what?

Winter

 

[Slick]

Regarding MOOP; most of my clients that have a "bad" year, will hit their MOOP.
The real problem seems to occur during hospital stays where one contributing doctor/group doesn't accept the PFFS. I have seen this happen with anesthesiology groups. They are then unregulated and can bill at their customer pay rate which in itself can equal the PFFS MOOP.
I have seen some big improvements in the 2008 offerings. Lower co-pays for hospitalization and out patient surgery. It seems that with some of these new plans, people will be able to have a "bad" year and still not hit their MOOP.
Tips for you, if you have a client that you believe should be on a medsup and not a PFFS, simply tell them the truth; "with a advantage plan, your Medicare card will be worthless. You will no longer be in Medicare."

 

[scottfree]

New to MA's question:

What is the most concise way to describe or understand what an MA does compared to Original Medicare-Parts A and B?

Obviously, some companies are offering a few more benefits beyond original medicare. But, in general it looks like MA's nickel and dime you more up front on hospital costs etc (whereas the original medicare deductible might have convered it all for shorter hospital stays). In return, the MA's offer require no payment past a certain number of hospital days and also cap the entire out of pocket somewhere around 2800-3500 give or take.

So, the naive question is, where are the areas where clients are most likely to run beyond the MOOP level if there is no cap? I could see the dollars piling up fast for hospital stays beyond 15 days (for example) which would otherwise covered by an MA but 15 days would cover the vast majority of stays. What are the other areas where clients have major exposure that an MA covers. How would you reply back to a client that says that they think that people are more likely to have a short hospital stay where the MA's pay less and the MOOP does not do much for them because they would have to go through a pile of co-pays, deductibles, and excess charges to get there.

Other than longer hospital stays, I don't have a feel for where the dollars pile up fast in a way that could really be helped with an MA. Sure the doctors visits add up and all of that but still you would have to do a lot to reach the moop. And then there a lab tests etc. Could someone offer up a couple scenarios that would help me to understand this better.

Thanks for any info.

Winter

Here is my thoughts on the subject..

One of the advantages of an MA or MAPD plan is you can receive extra benefits that you would not have with just Medicare or Medicare and a supplement.

Examples--I am using plans in my area--NW Arkansas

• Humana Gold Choice-$0 premium and you get a PDP plan with good co-pays and formulary
• Preventative services with no co-pay such as Pap Smears and Pelvic exams
• Prostate Cancer
• etc-All MA's have these
• Humana has Silver Sneakers-Gym Membership
• Humana had a $550 per Hospital stay which is all costs while admitted-Medicare only would be $992 Hospital plus 20% of all costs while admitted so even a two day stay could be thousands

Now a better example which I am excited for my clients is Wellcare Sonata it also has a $0 premium but no drugs-so add a $20 Humana PDP

• This plan has the preventative services with $0 co-pay
• $100 a day for up to 5 days-no additional for days 6 - 90
• Gym membership
• $1000 dental benefit
• $260 eyeware with $0 eye exam
• $1000 for hearing aids every 3 years(hearing aids are expensive but $1000 is better than nothing)
• Plus $30 a month in personal care items-vitamins, band-aids, ant-acids about 80 items total
• Dr Visits $5 and $10(medicare you pay the $131 deductable first, then 20%)

Hope this gives you at least my view on the subject

As you can see I do believe they have a great value.

There are others that believe supplements are the way to go and if someone I talk to wants one, I have a plan G or F and a PDP that they can get for about $130 a month or $1600 a year....whether they go to the doctor or not. I will say that in the 2 years I have been going this, it is funny how when I said ZERO premium people raised their eyebrows and loked at me and thought I was crazy. Now they ask about that zero plan and I can give them a choice with some great benefits!

Scott

 

[midwestbroker]

I would talk about the following:

Outpatient surgeries - A $3000 surgery would cost $600 under orig Medicare

Advanced imaging (MRI, CT scans, etc) - Those are all 20% - Depending on the MRI, the Medicare rate is $500 - $2000+ (I googled it)

 

[midwestbroker]

Slick -

I understand where you are coming from...but to protect yourself do not tell the client they no longer have Medicare. If they look in the Medicare and You Book (2007, page 35) it states that they still have Medicare. This can cause confusion and doubt in the consumer since you told them different.

I tell them that the carrier is basically sub contracted in to administer all the claims and administration. You still have Medicare but all it does it sit on the back burner funding the carrier to do everything.

 

[scottfree]

Regarding MOOP; most of my clients that have a "bad" year, will hit their MOOP.
The real problem seems to occur during hospital stays where one contributing doctor/group doesn't accept the PFFS. I have seen this happen with anesthesiology groups. They are then unregulated and can bill at their customer pay rate which in itself can equal the PFFS MOOP.
I have seen some big improvements in the 2008 offerings. Lower co-pays for hospitalization and out patient surgery. It seems that with some of these new plans, people will be able to have a "bad" year and still not hit their MOOP.
Tips for you, if you have a client that you believe should be on a medsup and not a PFFS, simply tell them the truth; "with a advantage plan, your Medicare card will be worthless. You will no longer be in Medicare."

I have to disagree a bit on your last statement..

"You will no longer be in Medicare."

They are not getting their bills paid by Medicare, but they are still ON Medicare. It is actually Medicare part C it is just a different way to recieve your Medicare benefits.

I have over 550 Humana and other PFFS clients and I have only had one client that has even come close to the $5000 MOOP and she had cancer. Her husband called to ask when treatments started what his worst case senerio was on the Gold Choice plan. I told him $5000 and he said that was what he was hoping and actually was happy to here this. Before I signed him and his wife up they had Medicare only. She is in remision right now and I have talked to them several times and they have thanked me for signing them up for Humana Gold (they just wanted the PDP when I first saw them)

Btw, they will be on Welcare for 08 which has a $3500 MOOP.

Below is copied right from the Medicare website..I underlined the first statement.


Medicare Advantage Plans are health plan options that are part of the Medicare program. If you join one of these plans, you generally get all your Medicare-covered health care through that plan. This coverage can include prescription drug coverage. Medicare Advantage Plans include:

• Medicare Health Maintenance Organization (HMOs)
• Preferred Provider Organizations (PPO)
• Private Fee-for-Service Plans
• Medicare Special Needs Plans

When you join a Medicare Advantage Plan, you use the health insurance card that you get from the plan for your health care. In most of these plans, generally there are extra benefits and lower copayments than in the Original Medicare Plan. However, you may have to see doctors that belong to the plan or go to certain hospitals to get services.
To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay your monthly Medicare Part B premium to Medicare. In addition, you might have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer.

Scott