MA vs. Supplement

[Frank Stastny]

OMG, Let's all hail the only "REAL" INSURANCE AGENT!! Frank!


I am going to send all my clients to you since anyone that sells MA plans are just in it for the money. I take it you donate all your commissions to charity.


I just love the comment on the 15 min presentation for MA plans, if that is all you think it takes then I believe you need to get some training on these products.


So you would choose Medicare only over these plans? You had better stop donating your commisions so you can afford that open heart sugery or bypass that you end up having from all the crow you ate in your earlier years. Probably only cost you about 80k but if you had been on an MA plan that I have sold, it would have only cost $550 for the hospital and Dr. Hey, you may have even avoided it if you had gone to those finess classes to stay in shape. Bargain basement plans, get a clue! My clients have not skipped a beat in their healthcare. I could or would not put someone at risk.


And where do you get the idea of HUGE COMMISSIONS? Plans I sell and have sold range from $240 to $400 first year with a huge second year commissions of 100 to 150. I guess you don't make near that on your Med Sup plans, but then I forgot you donate what you make on your sales.


The MOOP on the MA plans doesn't get hit very much but I have talked to people that have hit $2000 plus in costs for the year and if they had been on Original Medicare would have blown through 5, 6 and even 15k in bills.


I am sick of people thinking that agents that sell these plans are doing it for the big frickin commisions when the ones that make the most money are agents that sell only sups and make much more money.


BTW, I do sell Sups and I sell the least expensive ones from quality companies and give my clients the "CHOICE TO CHOOSE" I also let them know that if they don't like the plan, they have the right to get back into their old sp if it is still around. BTW, I have even helped someone that was on an AFLAC sup ($225 month)in 2006 that could not pass underwriting to get on a United World ($104 month) so they joined an MA and since AFLAC does not sell that plan anymore in my state, I now have them on United World whih is $115 a month now since this is a rule that Medicare has if a plan does not sell anymore in the state.


Well I guess I am just a lowly agent that knows nothing and in it for just the HUGE commission.

Do you think my comments were directed to you? I find that interesting.

My comments were about the agents who answered the ad that said "Make $150,000 first year, work from home, paid weekly, etc."

They are the reason that PFFS plans were suspended earlier this year.

Are you saying that as a responsible, concerned, ethical and professional insurance agent that you don't have a problem with the agents who are slamming PFFS plans just to get the $400 up front, first year commission? I do not refer to these people as "real agents". Most of the agents on this board are "real agents". Aren't you also? If so then you should be just as incensed as I am about what some of them are doing. I know agents like Rick and Senior are.

Yes, $400.00 when an app is turned in for a PFFS plan is a HUGE commission compared to an as earned commission of $20 per month when a Med Supp is sold. However, the Med Supp plan will pay a whole lot more over the next 10 years.

 

[scottfree]

Frank, My reaction was a bit much, when I read it I felt that you were grouping "all agents" that sold MA plans as unscrupulous, uneducated on Medicare and in it for the quick buck. I do work for a commission but I also take care of my clients. I have aged the last 2 years helping people that have had billing problem to the person that found out that they no longer had a RX plan because of someone like you talk about enrolled them on an MA plan and forgot or I believe wanted to sell a ZERO plan. If he had told them that now they have to pay for their Rx plan he would not have gotten the sale. I even had some *** tell a client she could drop her health insurance plan because she could sign up now on an MA because she had her Medicare card. Problem was still had 3 months till she turned 65. She actually called me up right after they left and wondered why I didn't tell her that.

Anyway, I do like the MA plans in my area and give clients a choice. I am also putting people back or giving them the option to go back on their sup because if they don't go back now during the first year of trying an MA they may ever pass underwriting and get back on one.

I am looking forward to April when by that time I will wiped out and ready for a 2 week or more break.

I apologize for jumping on that post...
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[Frank Stastny]

Scott,

No worries mate.

I don't like PFFS plans in my area because there are still a lot of doctors who will not accept them yet there are "agents" trying to sell the hell out of them telling people that a PFFS plan is "just like their Medicare and Med Supp policy". I have a real problem with that. They are doing it just for the money. I like to make money just as much as the next guy but I don't have to do it at my clients expense. I'm sure you don't either.

Many agents placing PFFS plans seem to think that every prospect is dirt poor and only cares about the cost of their insurance. Look back at all the posts. Everyone talks about how cheap PFFS plans are compared to a Med Supp. No one talks about all the potential pit-falls of a PFFS plan over a Med Supp. I believe there are many.

People can run into problems with a PFFS plan that they won't if they have a Med Supp. Especially those who travel a lot. I believe that there is a place for PFFS plans but they are not the end all be all of health insurance for seniors. PFFS plans are just another option that a senior can consider.

Not all people on Medicare only care about the cost of their insurance. I try to educate my prospects and help them make a well informed, intelligent decision regarding their health care based on where they live and what their life style is.

If I believe a PFFS plan is something they should consider I will tell them that, however, if I believe that it is not in their best interest I will advise them strongly to stay with a Med Supp. I have even told a prospect that if he insists on a PFFS plan that he should probably contact another agent.

This person lived in "BFE" Missouri and I knew for a fact that unless he was willing to drive to St. Louis for medical care that he was going to have problems finding doctors other than his primary care physician that would accept the PFFS plan. I didn't need the headaches that I could see coming.

 

[Cenla Agent]

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.

Since such a comparison is in the summary of benefits for every MA plan, they certainly should, and if I'm not mistaken it is required under CMS. Last year Humana had a "suitability worksheet" to give to prospective enrollees where they could compare their current coverage (whether Supp or O.M.) to the MA plan they were considering as well as estimating out of pocket costs based on their health history.

 

[retread]

Since such a comparison is in the summary of benefits for every MA plan, they certainly should, and if I'm not mistaken it is required under CMS.

This is an excellent point. Frank doesn't sell many MA plans, so he may not be aware that ALL MA plans list OM alongside the proposed MA benefits in the SOB that is REQUIRED to be left with the prospect.

What is interesting, is that although comparison between OM and the specific MA plan is obligatory, it is forbidden to compare this same info with another MA plan!

 

[Cenla Agent]

The deductible is $131 for 2007, $135 for 2008. Yes they do have to meet the deductible before they get the part B services.

scottfree, seems like you are reading Frank wrong. Maybe you should go back and read his post and steam down a little bit. Obviously he is not talking about you if you did not jump in this biz to ride the PFFS rollercoaster. MA's are better commission than supps. Unless you just leave your clients on the same plan every year ( which if you did then you are not doing the correct thing). So that is $350-$450 every year There hasn't been a plan in IN that has been the top dawg every year. Its been Secure Horizons 06, Pyramid 07, Pyramid and Coventry ( depending on county) 08. Unless you like to sell the new players like chesapeake or cigna.

The FYC for MA in many cases is better than FYC Supp commissions. But keep in mind the renewals, which for supps are typically the same for the first several years, whereas with MA it is usually less than $20. So the only way MA commission is better in the long run is for the clowns who flip their book of business every year and are just in it for the commission.

 

[Cenla Agent]

This is an excellent point. Frank doesn't sell many MA plans, so he may not be aware that ALL MA plans list OM alongside the proposed MA benefits in the SOB that is REQUIRED to be left with the prospect.

What is interesting, is that although comparison between OM and the specific MA plan is obligatory, it is forbidden to compare this same info with another MA plan!

Happy MA selling for 2008 and maybe 2009 (since a new Pres. won't take ofc. until that Jan.) but IMO all bets are off for 2010 if a donkey gets in. Sure, if plans pull out the member will have a guar issue option for a supp, but many MA enrollees cannot afford one which is why they chose an MA in the first place. They are who will be hurt the most with this scenario.


After having become quite familiar with Medicare and VA over the past few years, I can't imagine anyone familiar with these programs thinks everyone should have govt. run healthcare.

 

[Frank Stastny]

This is an excellent point. Frank doesn't sell many MA plans, so he may not be aware that ALL MA plans list OM alongside the proposed MA benefits in the SOB that is REQUIRED to be left with the prospect.

What is interesting, is that although comparison between OM and the specific MA plan is obligatory, it is forbidden to compare this same info with another MA plan!

I am very much aware of the information. I have read all of the information, know where it is and even understand it.

I not only point it out but I take the time to explain the importance of it to make sure the prospect throughly understands it. My point was that I do not believe that a lot of agents are taking the time to do this.

There is a HUGE difference between simply leaving a booklet with way too much confusing information in it for a lot of seniors to easily understand and claiming that the prospect has been "informed" and pointing out and explaining the information during a presentation.

If one is on a Med Supp appt and the agent leaves a Medicare Guide book does this mean that the agent has "informed" the prospect of the information it contains. I hardly think so.

You said it is "obligatory" indicating that it is something agents must do. Now, everyone who actually believes that all agents are doing it because it is "obligatory" raise their hands.

Now, all of you who believe that an agent, who is trying to place a PFFS plan, isn't going to explain the differences in plans to a prospect who has received information from several PFFS plans raise your hands.

I am there to help the prospect make a well informed, intelligent decision, you better believe that I am going to point the strong and weak points when the prospect asks me for help deciding. Isn't that what we do as agents or are we only there to "take the order"? If CMS expects seniors to throughly understand the information all by themselves without the benefit of knowledgeable help then shame on CMS.

My last PFFS appt took almost two hours before I was comfortable that the prospect throughly understood the difference in a PFFS plan and Medicare and a Med Supp policy.

 

[retread]

I hear you, Frank! I just spent 6 hours with a client (only 66) trying to get required info to complete his application! You remember the character in The Carol Burnett Show played by Tim Conway of the old man? He made progress shuffling his feet by the inch. This is what I was confronted with. Took over an hour to find his Medicare card. It was in the wallet he searched for most of that time.

My point is, that most of the info in the SOB is not understandable to many. This guy had recovered from a stroke, and was fairly intelligent, but impaired. His POA was present and I spoke to him through her. I had her read aloud the POA box, so I would know if she understood the terms. She couldn't pronounce "authorized", so I doubt if she knew what it meant. The amount of explanation I had to give was equivalent to schooling 3rd graders. I left the SOB because it is required, knowing full well it will not be read. I did my best to convey all the material in it applicable to their situation in the time I had (6 hours).

The program I enrolled him in was a managed care PPO (SNP), which he desparately needed, even though he is on Medicaid. He has diabetes, among other ailments, and this program is the only one I know of that will send a doctor to his house if he needs one. Furthermore this SNP is co-ordinated with Medicaid so that he will probably not spend more than $30 per month for all his health care, including Rx. I think even that may be picked up by Medicaid.

BTW, the 6 hours at his house did not include the drive from mine to his (1 1/2 hrs each way). Yes, it takes dedication to the task more than desire for a quick commission to do this, and you and I both know not many are willing to do this, but if not me, who else?

Back to my earlier point, we must abide by regulations, and that means leaving the SOB with the client. Take it a step further, it presupposes this material will be discussed, which I did. How much the client retains is uncontrollable. I think most agents will leave the required material. I don't know for sure, but I am persuaded that they do. I am not as skeptical about this as you seem to be, but you are more experienced than I, and you could very well be correct.

My second point was: the regulations forbid us to compare the plan we present with competing plans. I find this illogical, but nevertheless I abide by the rule.

My objection is thus: If CMS is really interested in protecting the senior, they would allow side by side comparison of all plans by the agent, just as they, themselves, do on the government website. Problem is, most of these seniors do not have computers, or have any inclination to search the web at the local library. They are intimidated by this technology. If I could let them see all the plans side by side, they would be able to make an informed choice. As it stands, CMS is attempting to force agents to decide what their prospect needs, and come up with a plan in the agent's mind is in their client's best interest. This is taking the risk of having an agent choose what is in his best interest and only displaying that to the client. The regulations, as they presently stand, only serves the best interest of the beneficiary if the agent is a saint.

Now, shall we all sing "When the Saints Go Marching In"?

 

[bdkiechler]

It just depends if your MA is a PPO, HMO, or PFFS plan. Most of these companies have all but some do not. With the PFFS plans, a doc can accept or decline at any time.

The rule, I think goes, "if the doctor accepts Medicare and agrees to accept the plans, "terms and payments". But the doc can refuse anytime.
He might see your client 2 or 3 times and then turn him down flat.

I am very upset by all these rules that do not seem to be for the seniors benefit. I guess I am just as confused as they are.

BD