MA vs. Supplement

[senior-advisor-indiana]

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

The plan F covers everything but At Home Rec., and Preventivve care. Preventive care is a worthless benefit. I have few clients on the plan F. Most are on the E or D plan. THe most my clients have paid out of pocket for procedures is thier Part B ded of $131 this year. Banker's Life seems to be the only people around here selling J plans touting that they need the excess and preventitive. Funny how all they sold a year ago was E plans around here. They took a 30% increase on the E so they had to open up thier J plan.

 

[thewold]

As a former Bankers agent, the reason they are pushing J is because it is the cheapest plan they offer. It's cheaper than B,C,D,F, and G, so why would you sign them up for a D or E if J is cheaper. The added benefits are just selling points, they are still doing right by the client by giving them the least expensive.

And I'm not saying MAs are more extensive coverage. It just depends on the client's and what they want. I lay out the advantages and disadvantages of both plans. It goes about half and half as to what they chose.

I personally would chose the MA over the supp. That's just me. I like the idea of saving the premium dollars if I don't go to the doctor all year. Ultimately I let my clients decide. They can either take that risk or pay the premiums all year. Either way, they still get good coverage not matter which way they go.

 

[scottfree]

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.

A gall bladder OP may be 10k but the Medicare approved amout is probably more like 4k or less. So it would be like a $800 surgery. Now I don't know the exact Med approved amout but I had a client that had a OP foot surgery that had 4 procedures totaling 14k plus a Dr. cost of 3k. Medicare approved was $900 for the Dr. which she paid a $30 co-pay and the $14k approved amout was $1200. Total to her was $270. If she had had a sup she of course would have just paid her premium which if she still had it would have been 135 + 20 for her PDP so $155 for the month. Te sup would have paid 20% of the $2100 or $420. This was her only thing she had for the year other than 3 $30 co-pay before the surgery and a couple afterward. BTW she had a couple of routine check ups at $15 and also got her yearly Mam. and Pap exams for $0. She considered this a bad year and on the Humana plan she paid less than $500 for the year ($0 premium plan) vs $1800 if she had a sup. She of course could have had a better or worse year but she was happy to be on the Humana Plan.

She is planning to switch to a plan that does not have a % for OP such as Wellcare, Today's Option's or Unicare, I think the Humana Plan stinks now.

Anyway just bugging your world...

 

[GreenSky]

I personally would chose the MA over the supp. That's just me. I like the idea of saving the premium dollars if I don't go to the doctor all year. Ultimately I let my clients decide. They can either take that risk or pay the premiums all year. Either way, they still get good coverage not matter which way they go.

I agree. I let my clients decide.

However, the biggest cost of MA vs. Supplement is the risk factor. How much is your life worth?

I want choice in my medical care. If the doctor that can save my life is out of my HMO network, am I to die because I chose the wrong plan? If I choose the wrong plan for my wife or son,are they to suffer because they do not have the opportunity to see the best physican they can?

Let me pose the same question I do to my clients: "If your daughter (or wife, son, etc.) needed brain surgery and the best surgeon was at Stanford University, who do you want in the operating room?" You MIGHT see that surgeon in your HMO, you WILL see that surgeon in a PPO/Med Supp/etc.

When you compare the cost of a plan, you have to include the cost of your health, not just healthcare.

Rick

 

[retread]

Scottfree brings up a necessary point for us to consider regarding MOOP. These high-dollar procedures are quite inflated. My wife went into the hospital last year to have a knee replacement. We are on a PPO group health plan, not Medicare, but the principle is the same. The hospital billed the insurance company about $26,000 for a 3-day stay. The insurance "negotiated" a $1200 settlement, and we had to pay our $200 deductible. The hospital "wrote off" $24,600!

If you ask a hospital how much it costs for a per day admit, they will say on average, about $4000-$5000 (depending on the area of the country) for a semi-private room. ICU per diem rate will be closer to $15,000/day. Do they get it? Sometimes, but not from Medicare, and not from most insurance companies.

It would be very interesting to see the hospital tax records!

 

[senior-advisor-indiana]

I guess I forgot to mention the encounter I had with a bankers agent a couple weeks ago. He argued with me about how a D or E was horrible for the client and that everyone should have the plan J. So I asked him how long he had been with bankers and he said 4 years. Then I asked him, so you were selling the F plan 2 years ago or the E plan? MY D is $69 his J is $110. Any way he was studdering and said, well I converted most of them blah blah blah. He got the sale at the time but the lady just called me yesterday for me to come back out. The funniest thing is her husband has the banker's E plan.

Rick, I agree that the biggest cost is the risk. It doesn't matter what the plan says is the max out of pocket or what the co pays are. It matters if the doc accepts the plan. I have plenty of clients on MA's, most of them were on MA's before or just had medicare alone. I always pitch the supp first.

 

[retread]

I agree with you here, S-A-I. I do the same.

 

[Frank Stastny]

I agree. I let my clients decide.

However, the biggest cost of MA vs. Supplement is the risk factor. How much is your life worth? ...

...When you compare the cost of a plan, you have to include the cost of your health, not just healthcare.

Rick

I couldn't agree more. There are way too many agents selling "Price", not health care. Most of the seniors I have talked to over the last 14 years are only interested in one thing when it comes to health insurance, COST.

And, most of the agents I have known during that time are only interested in one thing, COMMISSION. If you put an agent who is only "commission minded" and a senior who is only "cost minded" in the same room, give them 15 minutes to make a decision, at the end of the 15 minutes the senior will have a PFFS plan and the agent will have a nice chunk of commission.

However, replace that "commission minded" agent with a "real" insurance agent and give them the same 15 minutes to make a decision the end result will be no decision/no sale. The "real" insurance agent will need a lot more than 15 minutes to explain the difference between the two.

My biggest problem with PFFS plans is that there are too many agents selling them that got into insurance just to "give away for free" PFFS plans with the promise of huge commissions.

I don't believe that an agent can throughly educate a prospect on the difference between a PFFS plan and Medicare and a Med Supp policy unless they throughly understand how traditional Medicare works. I'd be willing to bet that over 50% of agents selling PFFS plans today don't have a clue about how traditional Medicare really works or the potential problems with going with a PFFS plan.

Compared to traditional Medicare and a Med Supp policy, PFFS plans offer bargain basement health care. Before I would take a PFFS plan I would seriously consider traditional Medicare and no supplement policy.

If someone goes to the hospital this year with just Medicare they will have an out of pocket expense of $992.00 that will cover all of their hospital charges for 60 days regardless of how many times they are in and out of the hospital during those 60 days.

Their doctor charges will only cost them 20% of what Medicare approves, their "co-pay" if you want to call it that.

Regarding doctor visits, last time I checked, Medicare usually approves around $45.00 per visit. With only Medicare the patients 20% will amount to a "co-pay" of usually less then $10.00 per visit. All clinical laboratory services-blood tests for diagnostic services are covered 100% by Medicare. Skilled nursing care is covered 100% for the first 20 days. (It is very seldom that a person in in skilled nursing for more than 20 days.)

With just Medicare the person doesn't have to worry about the doctor "accepting" a PFFS plan or not. Most all doctors will accept Medicare. If they don't accept Medicare patients those same doctors most probably won't accept a PFFS plan.

Agents talk about "putting healthy prospects on a PFFS plan". How is it better for a "healthy" prospect to have a PFFS plan where the person has to worry about finding a doctor if they do become sick that will accept the plan than for the person to just have Medicare?

Most of the "arguments" in favor of PFFS plans seem to be agents trying to justify making a sizable first year commission.

Let's tell it as it is. PFFS plans are sub-standard health coverage compared to Medicare and a Med Supp because of the potential limitation of doctors in a lot of places still not accepting them. Then there are doctors who will accept them "today" but not "tomorrow".

If the prospect is "healthy" today does that prospect really need anything but Medicare? If the prospect isn't "healthy" is a PFFS plan really better for them than just Medicare? I don't think so.

With just Medicare at least the "un-healthy" prospect still can be assured of getting the best quality health care available from all doctors who accept Medicare. It would take a really sick person to rack up $3,000 of out of pocket expenses if all they had was just Medicare.

Isn't that one of the arguments for PFFS plans, that a person will very seldom reach their MOOP? Can't that same argument be used to recommend that the person only have just Medicare?

 

[Frank Stastny]

How many agents do you think there are who also compare PFFS plans with their co-pays to having just Medicare to their prospects?

I think that is an extremely fair comparison and should be pointed out to a prospect considering a PFFS plan. Especially if the PFFS plan has a monthly premium attached to it.

 

[dandan]

We need competition put back into Med Supp plans. We need to do away with Lettered A-L plans and do away with Part C. Companies should be able to create supplements and benefits like they used to.

Companies could offer plans with more preventive care, gym memberships, hearing, dental etc.

Competition naturally creates BETTER products.