MA v Med Sup

[Tina]

I live in Snow Bird City, AZ very close to the Mexico boarder which might change a few things when comparing whether or not an MA or Med sup plan is better since it diminishes some of the "extra perk value" of the MA plans, but I'm not sure, and would appreciate some thoughts.

I am new to this, but am only doing it part time (was considering going for the big AEP push, but with all the CMS crap early on, decided not to). My main client base is family and their friends since my parents, grandparents and their friends are all on original medicare, and obviously I want to put them on the plan that's best for them.

Of the MA plans, the best one is the 0 premium PPO, has $10 Dr co-pay, $500 hospital co-pay, no co-pay for basic preventative/routine care, $50 ER co-pay, MOOP is $2800, no part D. Since we are so close to Mexico, the vision, dental and hearing benefits from the plan, cost the same as they pay in Mexico and they don't see them as an extra benefit.

Med Sup Plan F is what seems comparative in coverage. With everything covered and the premium $2800, if all benefits are used from either plan, the cost in the end seems it would be the same for the client.

Obviously if someone is in good health, and only needs preventitive/routine care the PPO plan would be better and save money unless something happened. But there is no risk in getting it since the MOOP is the same as the Med Sup F premium. I know there is a discount if someone enrolls in the Med Sup early, and if they're not in good health and would use the MOOP of the MA plan, the Med Sup would be cheaper. Other than that, is there an advantage to going with one over the other?

(Other than not having to deal with the CMS BS)

 

[Frank Stastny]

I really can't comment on which would be better in that area since I am not familiar with the demographics. I can, however, tell you what I believe is the best choice for the prospects I talk to in rural Missouri.

Hands down it is a Med Supp policy. My only question would be why are you selling Plan F? Do the majority of doctors in your area not accept assignment?

If the doctors do accept assignment then there doesn't appear to be a good reason to sell Plan F unless the difference in premium between a Plan D and a Plan F is less than say $150.00 a year. Doctors in Missouri virtually all accept assignment so I recommend and sell Plan D.

 

[GreenSky]

Since the MA plan is a PPO, I don't see a downside in using it assuming that all the "prospective" doctors are in network. I'm not on Medicare and covered by a PPO so why would it be a bad choice for someone on Medicare?

Which PPO plan are we talking about?

Rick

 

[Tina]

The difference between Plan D and Plan F is only $120 yr. I figured since the part D deductible is $135 Plan F made more sense.
- - - - - - - - - - - - - - - - - -

Since the MA plan is a PPO, I don't see a downside in using it assuming that all the "prospective" doctors are in network. I'm not on Medicare and covered by a PPO so why would it be a bad choice for someone on Medicare?

Which PPO plan are we talking about?

Rick

Humana is the main PPO, and almost every Dr. in town is in the network. What you just said, was pretty much my thought process on the PPO.

I have an Aunt in Phoenix though and Coventry just rolled out a PPO there. It too is 0 premium, includes part D, but MOOP is $3500. Since she's healthy, it's a better plan for her, but because of the higher out of pocket, I wouldn't sell it to someone who has enough medical problems to hit $2800 out of pocket.
- - - - - - - - - - - - - - - - - -
I just saw the boycott Humana thread. I think Med Sup's will be the way to go with most people. After all, the Humana plan's MOOP is the same as the med sup premium for those that don't qualify for med sup early enrollment discount.

Except for my parents who are in great health (and are tech savvy, insisting on Humana), there won't be a noticible difference between Humana and Med Sup. And I won't need to deal with the CMS crap and have my family members and their friends "return" a form so I can explain the plans 48 hours later

Thanks for keeping this forum going guys and all the help you give! If it weren't for you I'd be pushing Humana like there's no tomorrow and still contracted with TAG

 

[retread]

The difference between Plan D and Plan F is only $120 yr. I figured since the part D deductible is $135 Plan F made more sense.
- - - - - - - - - - - - - - - - - -


Humana is the main PPO, and almost every Dr. in town is in the network. What you just said, was pretty much my thought process on the PPO.

I have an Aunt in Phoenix though and Coventry just rolled out a PPO there. It too is 0 premium, includes part D, but MOOP is $3500. Since she's healthy, it's a better plan for her, but because of the higher out of pocket, I wouldn't sell it to someone who has enough medical problems to hit $2800 out of pocket.
- - - - - - - - - - - - - - - - - -
I just saw the boycott Humana thread. I think Med Sup's will be the way to go with most people. After all, the Humana plan's MOOP is the same as the med sup premium for those that don't qualify for med sup early enrollment discount.

Except for my parents who are in great health (and are tech savvy, insisting on Humana), there won't be a noticible difference between Humana and Med Sup. And I won't need to deal with the CMS crap and have my family members and their friends "return" a form so I can explain the plans 48 hours later

Thanks for keeping this forum going guys and all the help you give! If it weren't for you I'd be pushing Humana like there's no tomorrow and still contracted with TAG

First of all, a Plan D Med Sup doesn't cover the Part B deductible, whereas Plan F does. So if the difference in price is only $120 between plans, you are only looking at $15 dollars a year more for the Plan D in paying for the deductible, but what you get in return is At Home Recovery, which Plan F does NOT cover, so figure that is what the $1/mo is costing. Forget "Part B excess charges"... Frank is right. Along with Frank, I would recommend a Plan D.

As far as MA versus Med Sup goes, you don't say the ages of the beneficiaries, but if they are in good health and can pass U/W, Med Sups will cover all their Medicare Covered expenses at 100%. If they are VERY tight with their income, only then would I consider an MA PPO. The real "Advantage" of MA is the value added benefits, and you have already taken that off the table.

(BTW: Are you really "boarding" Mexicans near the border? Just kidding!)

 

[Dave020]

First of all, a Plan D Med Sup doesn't cover the Part B deductible, whereas Plan F does. So if the difference in price is only $120 between plans, you are only looking at $15 dollars a year more for the Plan D in paying for the deductible, but what you get in return is At Home Recovery, which Plan F does NOT cover, so figure that is what the $1/mo is costing. Forget "Part B excess charges"... Frank is right. Along with Frank, I would recommend a Plan D.

As far as MA versus Med Sup goes, you don't say the ages of the beneficiaries, but if they are in good health and can pass U/W, Med Sups will cover all their Medicare Covered expenses at 100%. If they are VERY tight with their income, only then would I consider an MA PPO. The real "Advantage" of MA is the value added benefits, and you have already taken that off the table.

(BTW: Are you really "boarding" Mexicans near the border? Just kidding!)

I believe the at-home recovery benefit is limited to $1600 per year maximum benefit. J also offers preventative care, limited to $200 per year. Not really a great value either way.

 

[retread]

I believe the at-home recovery benefit is limited to $1600 per year maximum benefit. J also offers preventative care, limited to $200 per year. Not really a great value either way.

Yes, but you are only paying a small premium difference for it, in this case $15 a year, or $1.25 a month. I think it is worth it for $1600 coverage.

 

[Dave020]

Yes, but you are only paying a small premium difference for it, in this case $15 a year, or $1.25 a month. I think it is worth it for $1600 coverage.

True

 

[Tina]

So the cost/benefit comparison between Plan D and Plan F is likelihood they will need in home care v. likelihood they will receive care from a Dr. that does not accept assignment?

The median age of the town's population is 63 and I think all Dr.'s in town accept assignment (might be one that doesn't) so they are more likely to need in home care and plan D would be better.....

Since that's the case, does anyone know a good agency to contract Lincoln Heritage through? and how is their commission? I only have BCBS and MOH and they don't have a plan D out here

 

[retread]

So the cost/benefit comparison between Plan D and Plan F is likelihood they will need in home care v. likelihood they will receive care from a Dr. that does not accept assignment?

The median age of the town's population is 63 and I think all Dr.'s in town accept assignment (might be one that doesn't) so they are more likely to need in home care and plan D would be better.....

Since that's the case, does anyone know a good agency to contract Lincoln Heritage through? and how is their commission? I only have BCBS and MOH and they don't have a plan D out here

Well, you gotta play with the hand you're dealt, or get another deal.