MA compared to Original Medicare

[GreenSky]

The most expensive part of any MA plan is the lack of choice in your healthcare. Their is either a network or the potential for your doctor to not accept your plan. You need to balance any money saved with the loss of freedom.

How much is your health worth?

Rick

 

[scottfree]

The most expensive part of any MA plan is the lack of choice in your healthcare. Their is either a network or the potential for your doctor to not accept your plan. You need to balance any money saved with the loss of freedom.

How much is your health worth?

Rick

I really don't think that you can generalize MA plans like you do in that statement. California may have issues but where I am located there are is only one network where they do not except any MA plan. This network had already started limiting the amount of new Medicare clients it would except already. I have clients that were paying $150 a month and more for a supplement, then adding on a PDP of $20 with incomes of $1500 a month that may see a Dr. 4 times a year. They still see the same Dr's and now they are paying $120 a year for their healthcare. Now of course this is just an example but there are a lot of people that are extremely happy with these plans.

We mostly have PFFS plans and seldom do I get any complaints. These people do value their health and I would not do anything that would risk what kind of care they receive and I feel really good about these plans.

This of course is only my opinion and take it for what is worth

Scott

 

[GreenSky]

We mostly have PFFS plans and seldom do I get any complaints. These people do value their health and I would not do anything that would risk what kind of care they receive and I feel really good about these plans.

I write PFFS as well and in general you are correct. There is little problem.

However, if one of your clients has a brain tumor and the BEST doctor is Dr. Smith and Dr. Smith has a 100% success ratio and does 500 similar surgeries a year, who does your client want to see?

By the way, Dr. Smith accepts Medicare but refuses to become deemed with any PFFS company. Your client now sees the 2nd best doctor who does take the plan.

My statement was that there is a healthcare cost of going into any MA plan. If you can afford the premium of the supplement, you can be guaranteed that if the doctor accepts Medicare and accepts new patients, you can be seen. Not so with MA.

Either your doctor must be in a network or be willing to be deemed. If there are billing problems with the PFFS carrier, he can choose to stop seeing your client at any time. No notice needed.

Will I still sell MA plans. Of course! But my concern about healthcare still is valid.

Rick

 

[retread]

I would keep in mind also, that Original Medicare's deductible applies to EACH benefit period, and there is no max number of benefit periods. IOW, your client goes into the hospital under Orig. MC for 4 days, is discharged and is admitted again 3 mos. later. His hospital deductible alone is $1984, even if he stays only a couple more days. (The average hospital stay for a Medicare beneficiary is 3 1/2 days) With a MA plan that charges $275/day, his bill under the MA plan is at breakeven with Orig. MC at about the 3rd day of his second confinement. After that, the rest of the year his hospital bill will tap out with his MOOP under the MA plan, but continually incurs the $992 deductible each admittance if he remains in Orig.MC.

He still saves, but not a whole lot with such a high co-pay. Look for other plans that have lower hospital co-pays if his health is fragile. If he is healthy as a horse, a high hospital co-pay might be in his best interest. The rationale here, is that carriers are looking to contain their costs over the whole plan. With a high hospital co-pay, there should be some benefits in other places he could take advantage of. If not, I would think seriously about dumping that MA plan.

 

[senior-advisor-indiana]

It is not unlimited on the benefit periods with Original Medicare. The benfit period is 60 days. The max benfit periods would be 6. That would be hard to achieve.

 

[GreenSky]

It is not unlimited on the benefit periods with Original Medicare. The benfit period is 60 days. The max benfit periods would be 6. That would be hard to achieve.

I hate to correct you but it would actually by 5 benefit periods.

61 days between hospitalizations times 5 admissions is 305 days. Another 61 days is 366 days. So unless it's a leap year, it can only happen 5 times.

So it might be even harder to achieve than you stated.

Now don't you feel silly saying 6 was that maximum benefit period?

Rick

 

[senior-advisor-indiana]

I am glad it is 5 instead of 7 though. I was paranoid sticking my neck out like that. I figured it was off a little bit. I knew I could count on you Rick. I am still planning on sending the papers your way, just being a little slow about it.

 

[Frank Stastny]

The most expensive part of any MA plan is the lack of choice in your healthcare. Their is either a network or the potential for your doctor to not accept your plan. You need to balance any money saved with the loss of freedom.

How much is your health worth?

Rick

In my opinion you guys can rationalize the "cost" or "savings" all you want but what it really comes down to is exactly what Rick said above. "How much is your health worth?" I would add to that "how much is the quality of your life worth"?

Selling health insurance to seniors in rural America is totally different than selling to seniors who live in large metro areas.

I sell in rural areas and to me these discussions really seem to be about commission, not health care? The best, highest quality health care a senior can get is with traditional Medicare and a Med Supp policy. Every Medicare Part C plan has a risk factor of reducing the quality of care a senior can get.

Are we selling the best option for the highest quality health care if needed, or we selling the cheapest thing available that pays the most commission?

These discussions seem to assume that all seniors are poor, so poor that they can't afford a Med Supp policy. This seems to be the underlying theme and rational to justify selling PFFS plans. "We are saving these poor seniors money". Are agents in general really concerned about the prospects finances or are they looking at a $400 commission for a PFFS plan as opposed to $24 per month for a Med Supp policy? This is an increase of $112 in first year commission if a PFFS plan is sold instead of a Med Supp policy. Very appealing!

Which one is easier to get a signature on the app, a Med Supp policy or a PFFS plan. In a lot of counties PFFS plans are zero premium or under, I'm guessing, $50 per month. A Med Supp plan could be around $150 per month.

Med Supp policies have to be "sold", this can be a lot of work, and have a monthly premium. PFFS plans in a lot of areas are zero premium/free and there is very little "selling" involved.

I know a lot of former Med Supp agents who are now only "pushing" PFFS plans. Many of them are rolling their Med Supp clients into those plans. During private conversations they admit they are doing it for the commissions and ease of selling. Not because they honestly believe that their former Med Supp client is going to have an equal opportunity for the same quality health care.

There is definitely a place for PFFS plans but I do not think they are for all seniors. If agents are recommending them to seniors who have a very limited income I applaud them. If PFFS plans are being sold as "just as good as traditional Medicare and a Med Supp policy", or "better" then I believe those agents are thinking first of their commission and second about the quality of their client's health care options.

I know all of the arguments and justifications for selling PFFS plans to everyone but I'm sure I'm going to hear them again. However, I have still have not heard a logical one for taking a senior off of a Med Supp policy when they can easily afford it other than the first year commission is higher.

 

[Guest]

I sell in rural areas and to me these discussions really seem to be about commission, not health care? The best, highest quality health care a senior can get is with traditional Medicare and a Med Supp policy.

I agree.

Every Medicare Part C plan has a risk factor of reducing the quality of care a senior can get.

Could you explain your reasoning for or behind this statement? I realize that PFFS plans have a 'risk' that the provider will refuse service or balance bill. HMOs can restrict choice. Is that what you mean or is there more?

What is the 'risk factor' that could reduce quality of care in a large, urban PPO MA where just about all the docs are part of it... like the Blue Cross MA PPO in my area? (Not arguing, just inquiring.)


Al

 

[Frank Stastny]

...simply tell them the truth; "with a advantage plan, your Medicare card will be worthless. You will no longer be in Medicare."

That is exactly what I believe you should tell them and exactly what I say. The agents who take exception with that are "splitting hairs" and confusing their prospects or trying to mislead them.

Seniors are not in this business and they do not understand it. To tell a senior that they still have "Medicare" if they take an Advantage Plan is going to lead them to believe that their Medicare card "still works" and they can still use it.

Traditional Medicare is what they know as "Medicare". They also know what an HMO and a PPO are. Most still don't understand PFFS plans.

If they take an MA plan they will no longer have "Medicare" as they know and understand it. To tell them any thing different is going to greatly mislead and confuse them. That is what can get an agent in trouble with their client. Not what you are telling them. However, just for the sake of argument you could change your statement to read, "You will no longer be in Medicare as you know it".

No one can argue with that, and telling them that their Medicare Card will be "worthless" is the best way to help them understand it.

Good job!