MA vs. Supplement

[Delta76]

Basic question, I'm just getting into senior products:

When comparing MA plans to traditional supplements, the MA's are much less expensive. I'm told the disadvantages to MA plans are you assign your medicare rights to the company and possibly have a more limited network.

If the network is a fit, what is the disadvantage of assigning your rights? I believe you can switch carriers during the next open enrollment anyway. What am I missing?

I have the option to sell both for a number of companies, I just want to do right for the client.

 

[thewold]

My understanding is that you are right in that they assign their medicare benefits to the company the plan is under, meaning the company might have different allowable charges than Medicare. I was also told by a coventry representative that the doctor can chose to accept or not on a per visit basis. So even though they accept it this week for this procedure, they might not accept it next for a different procedure, meaning you would have to pay full price.

One advantage I do like about MA plans is the preventative care not covered by supps, the vision, dental and hearing and out of pocket limits.

I've gotten so many different answers about MA plans I don't what's what.

 

[MIBizInsurance]

Do a search or just browse this section as there a few threads on this subject with alot of good replies.

 

[senior-advisor-indiana]

Out of pocket limit is not an advantage for the MA plans. It costs thousands more.

 

[Cenla Agent]

It depends on the client's budget, health (can they qualify for a supp?), what supps and MA's are available in the area, etc. Some areas have MA's with higher premiums and Supps that are lower. Other areas, particularly larger metro areas, will have $0 premium HMO and other plans but will have high supp premiums.

 

[Winter_123]

Out of pocket limit is not an advantage for the MA plans. It costs thousands more.

What do you mean here? How so. Suppose you have zero plan premium and an MOOP of sat 3000. How does that cost more than original medicare assuming that the coinsurance rates are roughly similar.

Winter

 

[retread]

You are right, Winter. Under Original Medicare only, a beneficiary can conceivably rack up over $30K in medical expenses with just one or two major medical events, since it has no MOOP. That's why the need for Med Sups. Even though Med Sups do not have MOOP (except for the Hi-deductibles), they close the gap on this exposure, but never eliminate it.

Most MA plan beneficiaries will not come close to the MOOP in their plans because they pay such low co-pays that they will have to be in and out of the hospital and doctor offices constantly. This requires a certain degree of mobility, which leads to the supposition that they will have to be unordinarily unlucky. The probability of such multiple events needed to trigger the MOOP is low, but is there, (never-the-less), and affords some degree of financial security. It is a safety net that most Med Sups do not have.

 

[thewold]

Here's an example of why I like to MA plans over Supps, especially for healthy and older individuals. $0 yearly premium for the MA versus anywhere from $1200 to $3000 a year for the supp. If you have a healthy year, you've just saved that much. Two healthy years and you've saved the MOOP. If the premium is $3000 a year, such as F is with a lot of companies in my state for anyone over 75, then why not take the chance that they won't use it and save $3000. Even if they have a crappy year, they're gonna come out of pocket, what, $3000. Plus they have all the other benefits that original medicare and supps don't have.

Also, a person could reach the MOOP pretty easy in a year. Most plans I've seen, they are still responsible for 20% of all outpatient surgery. That only takes a $15000 to reach a $3000 MOOP. A colonscopy is freaking $3500, imagine a hip replacement or heart surgery.

 

[Guest]

So you are saying that an MA is more extensive coverage than Medicare with an F? That's not the way most of the guys who specialize in the senior market explain it (I'm not one of them, obviously.) Could you put up some numbers of an MA PPO vs. an F that I can easily follow. The ones given don't make sense to me.

Al

 

[senior-advisor-indiana]

What do you mean here? How so. Suppose you have zero plan premium and an MOOP of sat 3000. How does that cost more than original medicare assuming that the coinsurance rates are roughly similar.

Winter

One advantage I do like about MA plans is the preventative care not covered by supps, the vision, dental and hearing and out of pocket limits.

He was comparing med supps, not OM. You think it is hard to hit the max out of pocket? Look at coventry's 07 plan, 20% for OP surgery!!! Last I checked it cost 10K to get the gall bladder removed which would cost the client 2K right there.