MA dual eligibility - being pitched

[J.R.]

[FONT=verdana,Helvetica,Geneva,Swiss,SunSans-Regular,New Century Schlbk]Want to Switch Back from Your Advantage Program to Medicare? [/FONT][FONT=verdana,Helvetica,Geneva,Swiss,SunSans-Regular,New Century Schlbk]Basically, you're screwed, and must suffer until the end of the year. Remember: The insurance and drug companies wrote this bill. According to the Medicare Rights Center (MRC), however, an internal memo circulated recently within the Centers for Medicare and Medicaid Services allows disenrollment if you were signed up without your consent. Grounds for disenrollment also include statements by an agent that imply the plan is a Medicare supplement or Medigap policy, statements suggesting that the plan is accepted by all Medicare providers, or statements saying that you can switch back to Medicare any time you want. [/FONT]
[FONT=verdana,Helvetica,Geneva,Swiss,SunSans-Regular,New Century Schlbk]Call 1-800-Medicare. Tell them you qualify for a special enrollment period because you were misled into an unwanted plan. If you are dual-eligible, you can switch back within a month just by calling Medicare. Know, too, that a state has no obligations to pay for cost sharing for dual-eligibles enrolled in an Advantage plan. Questions? Call MRC at (800) 333-4114.[/FONT]

What would you want as a criteria if you were to sell MA plans Honest? Specifically, in your opinion, what questions do you think need to be asked and answered about any new MA plan from the perspective of the client and the agent? I appreciate your input.

 

[honestagent]

Fantastic post. Safe to say that I'm not selling **** until I have done insane research after my meeting this Tuesday. I'd be selling a HMO MA plan and from what I'm being told, as long as their doctors and caregivers are in network there's no harm done. I find is difficult to believe that anyone would approve any plan that would take the place of Medicaid and put the client in a worse position. Where the hell is the DOI? Where the hell is the government? If there's never a case where a MA plan would be an improvement over what they already have why even issue them in the first place?

Thanks. Basically, the key player and deal breaker in the hmo plans are the docs. Without a good vast network, you're sunk.

And in my area, are network is extremely limited. Also, eligibility is key here too. Sometimes, Medicaid folks lose their medicaid without them being informed due to insufficient reviews (annually or quarterly) and if they're not 'active' in the system, then you think you wrote a deal, but really you didn't b/c the case may be 'inactive.' And sometimes, Medicaid folks chose not to fill out their paperwork for their reviews and play the stupid card. And non active, means, non 'dual' until they can get it back (and that's a pain in the you know where and a very timely process). Regarding doctors, if the doc is not in the network, then one is asking for trouble if you 'change' the pcp because changing the pcp can result in changing medical treatments, delays in prior authorizations,don't forget specialists as many of these people have those too and several of them, in addition too delays in medications and or chaning meds all together! Quite a zoo and headache in one and I personally would prefer NOT to sell hmos. If you do it right, however, it can be very rewarding for all parties involved.

You the agent, decide, if 'switching' is really in one's best interest based again on one's health and the 'quality' of care a prospect is receiving. IE: If one's being seen here and there by these home health docs and is not receiving 'quality care' or being shuffled around from clinic to clinic and not being properly diagnosed, then it makes sense to assign a new good board certified doc in your network. Then the agent is doing good for the client. Or well, pick your adj. But, if one is really sick, and the doc is treating one well but the doc is not in the network, leave it alone or him or her alone. Now, if the doc. and patient have a history, but the patient is not being treated appropriately, and again, it's your expertise that's really going to sway or nae the deal, then switching is the option; but you have to convince the senior of that; and that is the challenging part because that senior may think he or she is getting 'quality' care where as in reality, he or she is not. And then that patient is clung to the 'relationship,' and not so much the care.

Dig deep. Ask a lot of questions on the front end. Paint the picture. Make the call.

Good luck. Let us know what you find, please.

p.s. Are there other product types besides hmo, like ppo or pffs with this carrier? I am curious.

 

[honestagent]

What would you want as a criteria if you were to sell MA plans Honest? Specifically, in your opinion, what questions do you think need to be asked and answered about any new MA plan from the perspective of the client and the agent? I appreciate your input.

You know what Salpro, any question I could conjure is really superflous and I'll tell you why. It's true, you do have many seniors who were 'confused' and were 'misled,' hence why all the contention surrounding pffs plans. Conversely, you have seniors who were NOT misled nor confused but those folks chose to play that card when the reality bulb flickered brightly with their out of pocket costs. CMS has it all wrong in my opinion with their more stringent approach toward re-cerfitifcation and for the most part faulting agents. That's not the solution.


There is a huge LACK OF BRANDING on these plans as well as education and advertisement to the docs and in the media. That alone, I feel, would take out much of the confusion. I remember when Part D first evolved and ABC News and other local media stations here had news' clips every night for weeks before and during the AEP in 2005 informing people of what it was and the choices they must make. Well, I wonder, why not for these Part D plus plans (be it pffs, ppo, hmo, and pos)? They spent money and time informing of the PDPs. Why not the health stuff too? It begs the question: Do they really want seniors being well informed? How profitable or unprofitable would it be for the gov., pharmacuetical industry, and docs?

But to answer your question, I really can't say at this point because when it boils down to it - whether a beneficiary was or was not confused at the point of sale, he or she can get out of the lock in period if he or she barks loudly enough to CMS. In reality, they're really not locked in but they would have to jump through quite a few hoops to be released as most agents know. So I really cannot contribute an answer to your question at this time.

Great question, btw. It really made me think. Thanks.

 

[arnguy]

There are a number of MA plans in the southeastern PA (Philadelphia and the four surrounding counties) area. The two biggest player are Keystone Health Plan East (a BX wholly owned subsidiary) and Aetna. The number of physicians and specialists in these two plans, in particular, is enormous. The demand for MA plans is so high that selling a Med Supp in this area is almost next to impossible. The basic MA plans went up in premium from $0 monthly to $15 monthly this year. Some of the other carriers still have the $0 plans, especially in Philadelphia county.

 

[midwestbroker]

When selling to the senior market, it really depends on what area you live in, as it has been touched by in this post.

Plan F in Orlando, FL is the same as Plan F in Kansas City, MO. However, the HMO they have there, even with the same carrier, while structured the same, can vary in co-pays and networks (of course networks, since it is a different part of the nation).

So, while HMO's and PPO's in Kansas City work great, they may stink in other parts of the nation. That is probably why the news did not cover the health side of Part D. The part D strucutre was the same nationwide.

 

[Frank Stastny]

What would you want as a criteria if you were to sell MA plans Honest? Specifically, in your opinion, what questions do you think need to be asked and answered about any new MA plan from the perspective of the client and the agent? I appreciate your input.

I think there is really only one question that needs to be asked. Does the prospect want to remain in control of their healthcare?

With an HMO the person is limited to only doctors and hospitals that are "in network". A doctor could be "in network" today and "tomorrow" decide that being a part of an HMO really sucks and drop out of it. The person then has to find a new doctor. They also have to get "permission" from their primary care physician to go see another doctor. If "permission" is not granted then the person would have to pay the cost themselves.

With a PFFS plan, since there is no network, finding a doctor who accepts the PFFS plan could pose a major problem especially for seniors who travel a lot and/or are "snow birds".

Traveling can also create a problem for those with an HMO. If they get sick "out of network" the HMO may refuse to authorize treatment and make that person come back and be treated by network doctors and hospitals. I have lots of accounts of that happening.

In my opinion, HMO's are far superior to PFFS plans and I'm not crazy about HMO's for those who can afford a Medicare Supplement policy.

However, if you are only talking about dual eligible people I think the only question to ask is. "Do you want more options of doctors to go to and are you interested in better availibility of quality health care than you have now?"

 

[midwestbroker]

However, if you are only talking about dual eligible people I think the only question to ask is. "Do you want more options of doctors to go to and are you interested in better availibility of quality health care than you have now?"

Frank, that is the magic question to a duel elig.

With HMO and PPO's there is always the chance of a doctor leaving the newtwork, but I do not see that too often in my market. Most of the docs that come and go are moving or retiring.

 

[Crabcake Johnny]

Don't know about all this but was speaking to my father about it and one of his friends is on Medicaid so he wanted to see if he'd be willing to talk to me. I just go off the phone with him about 15 minutes ago and the bottom line is he thinks Medicaid sucks and had a huge complaint about finding doctors who are current seeing Medicaid patients including the waiting time. From what he said, unless it's an emergency it's weeks before you can get in to see anyone. Many times he's be "diagnosed and treated" over the phone since it's clear the doctor really doesn't want to see him. It's like being grilled over the phone about exactly why he needs to see his doctor.

Granted, this is one patient. But from the tone of some of the posts people think Medicaid is the holy grail of health coverage and care.

Oh, and for what it's worth my father thinks Medicare in general sucks. Finding a doctor is harder and harder and he thinks the care as compared to when he had coverage through General Electric is horrible. As it stands now he drives 40 minutes to see his doctor.

 

[J.R.]

"However, if you are only talking about dual eligible people I think the only question to ask is. "Do you want more options of doctors to go to and are you interested in better availibility of quality health care than you have now?"

Great question Frank. Now a rebuttal to the agents who have sold these types of plans before from the consumer side assuming the HMO plan has a good network.

How is signing up people for a dual eligible plan going to benefit a member by having more options to doctors, as well as the availability of quality health care vs. what they currently have now. In other words, are the medi-medi members limited by certain limitations I;m know aware of right now?

The main advantages I see thus far, w/out knowing more information yet, is that the dual-eligibles can take greater pride in having their own doctor/health plan and not have the stigma attached to being a medicaid recipient. Same thing pretty much, but a different way of looking at things.

Secondly, If the networks check out that's a plus.

Lastly, the plans themselves may offer more benefits than what they currently are getting. Thoughts????

 

[Crabcake Johnny]

We get back to the largest slam on MA plan concerning agents is not checking to see if doctors are in network or using slam tactics like "you can see any doctor."

And while the spotlight has been shined on some of the agents we can say a small percentage of agents in all fields rip people off. It's just more reprehensible when it happens to seniors.

I cannot see a single reason not to take a senior off Medicaid and onto a HMO MA if their doctor takes the plan.