MA & Indemnity Plans

[somarco]

Are those "some people" licensed agents?

 

[Fisher]

Good grief, some folks just canNOT let things go. I wish I had so much time on my hands. Well no... I'm glad I don't.

 

[kstein]

Someone is a lil crabby it seams

 

[Experienced Agent]

So can Medigap, which is also GI and more comprehensive than MA + HIP. When this discussion comes up, the agents pushing MA+ always say their client can't afford Medigap. Either those agents are talking to really poor people or they are just assuming they can't afford the premium That also ignores the total need of the client. Do they current have docs and hospitals they use? How often do they go to the doc? What is their current outlay for health care? I never presume anything with a new prospect. This is why I ask if they have doctors they would like to continue using. How often do the go to the doctor? How many times have they been in the hospital in the last 10 years? Do they have any planned surgery or extensive testing? Monthly premium never comes up unless they initiate the discussion and even then I don't answer until I have a good picture of their situation. Even then, premium is the last item on the list to discuss. What amazes me are the agents that say "my clients can't afford a Medigap" but then sell a $0 MA plan and add on HIP, cancer, FE and anything else they can to earn a buck. No mention of why or even if they need these things. It comes across as simply a push to maximize commission dollars without regard to what the client needs or wants. The report (linked above) indicates 26% of hospital stays are for people 65 to 84. What it doesn't say if that involves multiple admissions which negates the argument that someone in that age bracket has a 1 in 4 chance of a hospital stay lasting 5 days on average. Averages are deceiving in themselves but that doesn't stop people from making inferences. In it's simplest form a 5 day average means some people stay 4 days or less while others stay 6 days or longer. The Part A deductible for 2016 is $1288. Divide that by 5 and that is $257 per day. If you want to play the 1 in 4 chance of a hospitalization then consider $1288 divided by 4 (years) and again by 5 days. The result is, if the average person who anticipates going in the hospital every 4 years and staying 5 days set aside $64 per year they would self fund that Part A deductible. But the Part A exposure is not the deal killer. It's Part B that you have to worry about. I tell people your exposure (original Medicare) for Part B is $166 (for 2016) then the remaining 20%. There is no cap on the 20%. You pay until you are well, run out of money, or die. We have already established their overall health, how they feel about keeping/choosing their own doc, and how much they spend on health care under their current arrangement. The only thing left at this point is to determine how they will cover their OOP risk after Medicare pays. We have a very simple discussion about the basics of Medicare. Nothing about deductibles, copay's or provider networks. Nothing about balance billing. We simply talk about the basics and then they decide what works for them I rarely have anyone say they can't afford the premium. Had that discussion 2 weeks ago with a lady on an MA plan that is withdrawing from the market. She was just diagnosed with stage 2 breast cancer. She has no idea how much her treatment will cost going forward (and neither do I) but she does feel like she could easily spend $2000 - $3000 or more during 2017. Since she is in a GI situation plan F is the best option. She will pay $153/mo for plan F and never have to worry about picking a doctor from a list of names she can't pronounce. She doesn't have to count pennies to see if she can afford follow up testing, chemo, etc. All she has to do at this point is budget $153 each month for health care. If all goes well for her, and I hope it does, she will probably go back to $0 for 2017 because she doesn't like to pay insurance premiums. No big deal. Of course if she calls me back in a few years when the cancer has come back, or something new crops up, I will probably have to tell her to keep what she has. And by then it is too late to buy a HIP, cancer plan or any of the other add-on policies some agents love to peddle.

WOW....This person is heavily invested in being right. I like the GTL product and my clients have benefited it. I've seen many people spend a whole lot more for insurance products for many years, never to use it. This is a very affordable product that the client is very likely to use. It's the one product I can expect to keep me busy with claim work. You can type too your blue in the face butler doesn't change the facts; agents and clients like this product.

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Spell check got the best of that post

 

[Midlevel]

Client called today and said she had fallen and broken her leg back in July and spent 2 1/2 weeks in the hospital and had to pay like $1500 and is now doing rehab that costs her $30 per time. Was wondering if there was any other insurance that she could get that would help so she don't have to pay so much. I said well if you were in the hospital we can submit the itemized hospital bill to GTL for your stay and they will reimburse you $300 for the 1st 10 days of your stay. Needless to say she is a happy camper she will be receiving a $3000 check in the next couple of weeks. Darn GTL, such a waste of money.

 

[GreenSky]

Client called today and said she had fallen and broken her leg back in July and spent 2 1/2 weeks in the hospital and had to pay like $1500 and is now doing rehab that costs her $30 per time. Was wondering if there was any other insurance that she could get that would help so she don't have to pay so much. I said well if you were in the hospital we can submit the itemized hospital bill to GTL for your stay and they will reimburse you $300 for the 1st 10 days of your stay. Needless to say she is a happy camper she will be receiving a $3000 check in the next couple of weeks. Darn GTL, such a waste of money.

How much would she pay with a supplement?

Just wondering.

Rick

 

[yorkriver1]

My Medicare book is 75 to 80% Supplements and the rest MAPD. Many of the MAPD clients would gladly pay the price of a supplement if they could get approved. But no one will take them.

I have an appointment today. He's on MAPD with Anthem. Doesn't like it. He would gladly take a Plan N but had a heart stint placed 6-months ago.

It would be nice if Humana or Anthem had a $150 per month MAPD option with $10 co-pays and $100 per hospital admission. It would sell. But it would have all the unhealthy people that couldn't get approved for a supplement as the buyers.

Humana had one of those, called the Reader's Digest plan, but I think the Max OOP was still fairly high. Thinking about the annual GI opportunity with MAPD, the adverse selection may have made those rich benefit MAPD's less attractive to offer.

 

[Midlevel]

Right around $3600/yr for an F plan and probably around $300 for a PDP. She would have to go with AARP UH because of health issues. But she wouldn't get to make $1420 by going to the hospital.

 

[yogooglethis]

Client called today and said she had fallen and broken her leg back in July and spent 2 1/2 weeks in the hospital and had to pay like $1500 and is now doing rehab that costs her $30 per time. Was wondering if there was any other insurance that she could get that would help so she don't have to pay so much. I said well if you were in the hospital we can submit the itemized hospital bill to GTL for your stay and they will reimburse you $300 for the 1st 10 days of your stay. Needless to say she is a happy camper she will be receiving a $3000 check in the next couple of weeks. Darn GTL, such a waste of money.

I sold a few GTl plans before they withdrew from the Fl market but it was usually either to a T65 GI prospect that was a hospital claim waiting to happen who could not/would not afford a med supp or it was used as a closing technique to shut up a good MA prospect who focused too much about MA IP copayments.Most of the time when I would explain they can " cover" their 1500.00 IP copayment exposure for a 500.00 premium they would realize it is not really worth it but a few prospects still wanted the GTl plan.

Think about it - paying about 500.00 in premium to cover an average MA IP exposure of 1500-2000.00 is very high insurance cost.The real exposure in MA plans up is OP services(,PT,radiation,part b drugs and diagnostics).Based on what the premium is for a per diem hospital indemnity plan imagine what the premium would be on a GTL indeminty policy that covered OP services. Probably way more than a Medicare Supplement would cost !

 

[kstein]

A few years back Continental Life had an indemnity plan that covered out patient services, including doctor visits.

It was pretty cheap, like $50-$75/ mo for the whole thing and it pays just like a med sup except back to the client.

I have one guy that gets reimbursed $40 or so each time he sees his doctor, reimbursed for x rats and tests, etc. He shows the card with his mapd card and the claims get processed correctly.

Sadly, they discontinued that plan once Genworth bought them.