MA or MS? Age 63....

Discussion in 'Senior Insurance Forum' started by GoPokes, Sep 12, 2017.

  1. GoPokes
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    I know this we've debated this with age 65+ but since this is a bit different so I wanted to run this by you guys and get your opinions.

    Referral just called me Friday. Her husband is 63, A&B effective date 10/01/17 (next month).

    Zip 73624, Washita County.

    One MAPD, PPO, $177/month.

    Or plan A $240 and up, plus a PDP $28.

    Prescription copays are about the same either way (about $30/mo total)

    Since we never talk about Plan A vs a higher priced MAPD. I wanted to see what everyone else would say.
     
  2. Todd King
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    I think I would push the MAPD over a Plan A any day.
     
  3. TN_agent
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    My advice would be based on the reason for disability and their risk tolerance (whether or not hospitalizations and/or a lot Part B expenses may be likely in the next 2 years) as well as how good the MAPD is (co-pays, MOOP, etc). I wouldn't recommend based on premium alone.

    If this person has 4 specialist visits a month, the co-pays alone will probably negate the possible savings of going with an MAPD. Not to mention having a network. if they are pretty healthy (I have plenty of those who are "disabled"), I don't know that the benefits of the A are worth the extra $1200 a year if their health is good and their risk tolerance is high.

    When T65 happens, would put them on supp though.
     
  4. kgmom219
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    Network. Network. Network.

    Will the disability cause Part B claims greater than the premium (and copay) differential?

    If the network is decent and they only see a doc a few times a year, MAPD til 65, then Plan G.
     
  5. sman
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    I'm guessing there is a low MAPD penetration rate in that county if there's only one plan and it's $177 per month.
     
  6. FLM2
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    I looked up the plan, it is a Humana Regional PPO so the network should at least be decent and it can be used outside of the plan service area as well.

    The premium is $177 but the Part D plan is about $35 so the medical premium is $141.

    The two big holes in a Plan A are the hospital deductible and Skilled Nursing copay, if there was risk that both would be used on an annual basis the MAPD plan would possibly make sense but I would present both and leave the decision to the client.
     
  7. DS4
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    RPPO has Out of Pocket Spending Limit: $10,000 In and Out-of-network
    $6,700 In-network
    Going with Medicare, and, Plan A, your annual out of pocket costs would probably be less than $6700 or $10,000.
     
  8. Labesky
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    Is there a PFFS in the area?
     
  9. FLM2
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    Two posters already said there is ONE plan, and only ONE plan available in the area.

    Besides, even if there was a PFFS plan available, that is the absolute worst choice anyone can make for MAPD-rather than give you the reasons why that is the case you need to do your own research and learn something.
     
  10. sman
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    I believe there are also two MA only plans. A Humana PFFS plan ($66 monthly premium) and a Humana PPO plan ($0 monthly premium). Not that changes anything in this scenario.
     

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