MA plans under attack

May 7, 2007

  1. Crabcake Johnny
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    Crabcake Johnny Guru

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    My wife just showed me an scathing article in the Baltimore Sun about agents employing slam tactics to sign up seniors in MA plans. I wish I would link the article but it bascially slammed the plans in general, calling them worse then Medicare then detailing agent incentives such as trips to hard-close seniors.

    Doing some research I see other's have reported the same:

    http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=44732

    http://www.emaxhealth.com/72/11806.html


    http://www.dallasnews.com/sharedcontent/dws/bus/stories/050107dnbusmedicareswitches.365bd1a.html
     
  2. policy doctor
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    Yeah, and it keeps getting worse.

    Richard Foster, chief actuary for Medicare, said "the additional payments to Medicare Advantage plans, above and beyond the costs" of traditional Medicare, are leading to higher premiums for all beneficiaries and are depleting the Hospital Insurance Trust Fund for Medicare"

    So where was this guy, Foster, when they were designing the Medicare Advantage plans, huh? Now it's depleting the trust fund!! Should have run their models before they launched this Pandora's Box! Hah!!

    I still think this is all by design....Social Security being depleted, our national assets being depleted, jobs being depleted, military, everything. Better learn a foreign language, because you may be job-hunting elsewhere.
     
  3. Crabcake Johnny
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    Crabcake Johnny Guru

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    Anyone who can tell me where MA plans fit in? With the small amount of research I've done (with no formal training) it appears that MA plans are more expensive, offer less benefits, higher copays, less choice of providers and generally do not stack up against Medicare. I'm sure the newspapers haven't done a single hour of actual research but can an expert here tell me why MA plans are better than Medicare?
     
  4. Guest
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    By CMS regulations an MA plan is required to meet or exceed Medicare benefit levels. CMS will not approve an MA plan that does not meet this requirement.
    MA plans are not intended to replace Medicare, but rather give someone an alternative to Medicare supplement coverage.
    MA premiums are lower than supplements and that is the main reason people like them.
    MA plans fit in here:
    1. Unhealthy seniors who can not get a supplement or have missed their open enrollment
    2. Any senior who can not afford a supplement
    3. Wealthy seniors who want coverage for catastrophic more than for sniffles
    4. Under 65 medicare enrollees that can not get a supplement

    MA plans are not underwritten, are cheap, and have OOP maximums. I only write Private Fee for Service plans that do not limit members to an HMO or PPO network. The OOP max makes it a better choice than having Medicare only since most (all that I have seen) have better coverage than just Medicare.

    Still..medicare supplements are my first choice.
     
    Last edited by a moderator: May 7, 2007
    Guest, May 7, 2007
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  5. Bob_The_Insurance_Guy
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    Very simple. Medicare Advantage Plans are nothing more than Major Medical Plans for the elderly. When you go to the doctor, you pay the dr. copay. when you get eyewear, you pay the copay for the frames, lenses, and exam. Predictable amounts.

    You don't pay an amount upfront, every month, for something you may, or may not, use.

    Are medicare advantage plans for everyone. NO

    Are there overpayments? Not to those of us who did our homework. I know how much CMS is paying each company for each medicare beneficiary. Is it an exorbatent (sp?) amount. YOU BETCHA!

    WHY?

    Because Medicare Advantage Plans, unlike Life, DI, LTC, or some Health Plans, are IMMEDIATE CLAIM plans. They don't have the luxury of having the money sit 5, 10, 15 years earning interest, before it is used.

    I am actually glad that article came out in the NY Times. I had a seminar at 11:00 this morning, and opened up with it, to show people how unscrupulous, unethical agents, who have no moral compass, take advantage of the elderly. That is why I do seminars, which includes NO product or company specific material. All I have are pages 33,35,41,54, and 72 copied from the Medicare and You 2007 book.

    I go over, not only Medicare Advantage Plans, but Medigap Plans as well.

    In fact (and I told this to my audience this morning), if I were a Medicare beneficiary, I would want my insurance company to have the most money possible, so that they would be better off, financially, to cover the expenses they need to.

    For those of you who remember when LTC went from being just Nursing Home care to the product it is today, there were many articles of the same magnitude, warning people that this was just a hoax, and to stay clear of it.

    Same with MSA's that turned into HSA's (in fact, they still are getting bad press).

    We live in an immediate gratification vicitmful society. We want it for free, when it comes to health care. However, we will spend $1.29 for a bottle of water that we can get from our tap at home.

    Medicare Advantage plans have been around for years. Unlike the Zero Premium Life Insurance, these companies tell you who they are, upfront.

    Like LTC, there are many moving parts to this product, and it is not one that you can RESPONSIBLY sell, by just getting signed up, and getting a lead card.

    As to offering less benefits, John, please show me a Med Supp plan that gives you preventive care, yearly physicals, coverage for eyewear, dental, or a 24hr nurse advice line. As for higher premiums, most plans are either zero premium, or anywhere from $45 to $125 (less than most Med Supp plans).

    Show me a Med Supp plan that offers a diabetic preventive foot care, Metformin for 0-$25 dollars (ref: Care Improvement Plan: state of GA/SC)

    Are there going to be people who fall through the cracks? Yes.

    There are people that fall through the cracks now, with major medical coverage.

    As for a choice of providers, John. One simple question you ask of the doctor, not the medicare beneficiary, "For your current patients, do you work with Medicare Advantage Plans offered through...?" This is a call you make in the home, or prior to meeting with the Medicare Beneficiary. Most of the time the answer is yes. If they say no, then try another plan, or move them to Med Supps for a higher amount.

    As to how it stacks up against Medicare, go to www.medicare.gov and choose a plan and do a side by side comparison. I won't waste my time with that here.

    Medicare Advantage plans are for:

    1. People who don't want to spend $150 to $200 a month on a Med Supp
    2. People who want predictable costs (and it is your job as the agent to go through the explanation of benefits and show them that cost, not to lie to them, and tell them that a dr. copay is $5 when it's actually $15)
    3. Someone who wants a limit (just like with major medical) for hospital and surgical services. In some cases - not all - the doctor copays and other services go towards satisfying the deductible
    4. Middle income America - not the poor, who have Medicaid, nor the wealthy, who can buy their own services better than the government can
    Let's see...

    Have I covered all the bases?

    Oh, yes, the research done by the media. When has anyone, ourselves included, ever worried about the research done by the media? We'd rather hear the sensationalized reports.

    When the Olympic Park bombing took place, here in Atlanta, during the Olympics, Richard Jewel was the #1 target by the media. They camped out in his apartment complex, followed him around, and harrased him. When it was found out that it wasn't him, no one reported that, beyond the local media here - and not even some of them. The story died, and no one cared about him any more.

    So, as a local, syndicated talk show host here in town says, "don't believe everything you read or hear. Do your own research."
     
  6. sman
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    Well, I'm no expert and always question anyone who claims to be. Let me preface this response by stating that I ALWAYS recommend a Medicare Supplement over an MA plan. With that said, some people just can't afford a Medicare Supplement. Here in Georgia, there is a plan that I feel is an acceptable trade off. It's a Private Fee for Service plan (allows you to see any doctor or hospital that accepts the plans payment - most any doctor who accepts Medicare will accept a PFFS plan as they are reimbursed the exact amount that Medicare reimburses). This plan has a $35 per month premium. It limits the insureds total out of pocket for the year to $2500 (there is no limit on Medicare). It has a hospital copay of $150 (not $992 like Medicare). It has a primary care copay of $5 and a specialist copay of $15. Emergency room copay is $35. Outpatient surgery copay of $50 (not 20% like Medicare). These are just a few of the benefits.

    I'm sure there are some agents doing some unscrupulous things. Just like there are with your favorite carrier, Assurant. If 40% of the sales in Georgia are the "Right" plans, that tells me there are some bad things going on with agents.

    The same goes for MA plans, there are some good plans and not so good plans. And anytime there's money involved, you're going to have people doing unethical things. But let's not throw the baby out with the bath water. I'm sure the plans will change once the government reducing funding. And I guess that will create another opportunity for all of us.

    Another area it may fit is for those that have cancelled a Med Supp due to premium and find they need to limit their out of pocket exposure but can't qualify for a new Med Supp or afford one. It is definitely not for everyone. Just as a high deductible health plan isn't for everyone. It has it's place.
     
    sman, May 7, 2007
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  7. sman
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    Well said Bob. I'd love to find out about your seminars and what it is you are doing and the type of numbers you are producing from the seminars. Not that you'd want to give away any trade secrets, but I think we're far enough away from one another where we wouldn't be stepping on each other's toes. I'm about 25 miles south of Hartsfield (Sharpsburg, GA). If not, I completely understand.
     
    sman, May 7, 2007
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  8. Crabcake Johnny
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    Exactly what I wanted to know. As usual the media has their head up their ass.
     
  9. Bob_The_Insurance_Guy
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    Not a problem. I have no secrets, and there are so many Medicare Beneficiaries to work with, you wouldn't be competition. Just another, well-trained, qualified professional.

    Is Catfish Hollow still around? At the corner of 54 and 72, I think. Early on in my career, I had some clients down that way, and we would stop in there for lunch. I'd then tool down the road, into Newnan, and meet someone for an early dinner at Sprayberry's. We'd then cross under 85 and go to a place, called "The Sports Bar", next to what used to be Dakota's, which I think turned into Folks, and I don't know what it is now.

    Great people down that way. IM me, and we'll talk, offline.
     
  10. Guest
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    I agree with all you said except for item #4. I have written MA plans for upper class people who want health insurance for catastrophic coverage...like a high ded plan. I have also written them for the very poor who are on medicaid...Wellcare's Duet plan is a dual eligible plan that just gives them some extra benefits like vision, dental, hearing, $20/mo allowance for otc products.
     
    Guest, May 7, 2007
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