MA Only Plans.......

Oct 6, 2015

  1. bill3173
    Offline

    bill3173 Guru

    Posts:
    2,448
    Likes Received:
    49
    State:
    North Carolina
    Ran into an odd situation today. A lady called me that I haven't spoken to in over a year, since she told me to buzz off, she didn't need my services (after five years of being her devoted servant). She had purchased an MA only Plan and was concerned because she didn't have other Rx coverage. She got this through an Agent. I asked her if they discussed it, and she replied that he sold her on the $0 premium, and skipped over the Moop and lack of Rx.

    Are agents actually getting away with this, and furthermore, why did the carrier not question it? I thought this sort of thing was a big No.
     
  2. senior-advisor-indiana
    Offline

    senior-advisor-indiana Guru

    Posts:
    11,282
    Likes Received:
    210
    State:
    Indiana
    Why is it a big NO? I run into quite a few people that have not and will not purchase a PDP.
     
  3. TwoCents
    Offline

    TwoCents Guru

    Posts:
    413
    Likes Received:
    118
    If carriers had to question every enrollment that came in, they'd never get anything done. After all a person can carry an MA-only (PFFS) with one carrier and a PDP with another. Or the person can have VA coverage. Additionally, if the enrollment was done with the agent getting credit for the sale, it would go through a verifcation process specifying that she enrolled into an MA-only. So in a way it falls back on the consumer to know what she's signing up for.
     
  4. GoPokes
    Offline

    GoPokes Guru

    Posts:
    1,216
    Likes Received:
    153
    State:
    Oklahoma
    Sometimes the client uses selective listening when being presented to, then turns around and blames the agent. I had an agent (I know the agent) replace a Medsup of mine recently, the lady said I never delivered her policy. Well low and behold I still had the signed delivery receipts for the medsupp and for the life insurance, each signed on separate days.

    Anyhow, customers don't always want Rx coverage. But I usually only see those cases when the customer has VA or tribal benefits, occasionally in other situations.
     
    GoPokes, Oct 6, 2015
    #4
  5. bill3173
    Offline

    bill3173 Guru

    Posts:
    2,448
    Likes Received:
    49
    State:
    North Carolina
    This is MA only (non pffs), no separate pdp allowed and she doesn't have other creditable Rx coverage, that's why I thought this a No from an agent.

    SAI if you're doing this, I am both shocked and disappointed.
     
  6. JimmyUt
    Offline

    JimmyUt Guru

    Posts:
    2,576
    Likes Received:
    16
    State:
    Utah
    I have a couple MA only clients on a PPO who has no other RX coverage. There is nothing wrong with that if the client either doesn't want the coverage, doesn't need the coverage, or doesn't want the penalty because they didn't take it 15 years ago.

    The carrier doesn't care to be honest.
     
    JimmyUt, Oct 6, 2015
    #6
  7. bill3173
    Offline

    bill3173 Guru

    Posts:
    2,448
    Likes Received:
    49
    State:
    North Carolina
    I really don't care what anyone else does (not really shocked or disappointed), but this lady and her friend both indicated that they were "tricked". They both thought that they had Rx coverage on their previously purchased pdp and one of the woman has already incurred $4K+ in Rx this year.

    I personally wouldn't want to be on the receiving end of a complaint like that one, so I don't write MA only unless they have some other form of coverage for Rx.

    So the carrier doesn't care if they made a complaint like that one against an agent? Btw, I've been doing pdp since the program started and picked up MA again last year, for the first time in several years. I have been on the receiving end of pdp complaints that were baseless, but nothing on the scale of what these two women are alleging, so I find it odd that it would be treated with such indifference...oh, rx no rx who's counting.
     
    Last edited: Oct 7, 2015
  8. JimmyUt
    Offline

    JimmyUt Guru

    Posts:
    2,576
    Likes Received:
    16
    State:
    Utah
    I wouldn't want to be the agent who wrote them. I always exhaust all avenues, but some folks don't want a big penalty if they never took the coverage. My clients on ma only are all over 80 and the agent before me never got them coverage. I have only had them for 5 years or so
     
    JimmyUt, Oct 7, 2015
    #8
  9. vic120
    Offline

    vic120 Guru

    Posts:
    2,724
    Likes Received:
    498
    State:
    Tennessee
    It would be a nono if the penalty was not explained. I have run into people who will not buy PDP but I always make sure I explain penalty

    Some do it because they are already facing penalty.some for other reasons some have poor judgement.

    Also keep in mind some with VA benefits don't need PDP
     
    vic120, Oct 7, 2015
    #9
  10. TwoCents
    Offline

    TwoCents Guru

    Posts:
    413
    Likes Received:
    118
    There's a difference between the carrier "caring" when the application comes in -- again, if they had to research every MA-only app that came in, they'd never get anything done -- and caring about the complaint against the agent. The carrier probably has an investigation unit and/or a team that reviews complaints filed against the plan through CMS. After all those complaints are rolled into the calculation for the stars rating.
     
Loading...