MA vs. Supplement

[Cenla Agent]

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

Does anyone know of any actual cases where a doctor decided to quit seeing a particular PFFS patient without quitting accepting PFFS in general?

I have heard of some hospitals no longer taking MA, but I haven't heard of any providers taking MA and then not doing it anymore for one client when their general practice is to accept it for others. I do know of at least one case where a provider accepted one of my PFFS clients when he normally did not do so because they had known each other for years and the patient's son was also a doctor.

 

[MAPDagent]

The one point I think everyone has to realize is that there is no one agent out there that can claim he or she knows all there is to know about every single one of the various MA plans and Med Supp plans being offered in the prospective client's county of permanent residence for any given plan year, and therefore be able to ascertain for said client the "best" health care arrangement for them. And even if there was such an agent, there's no way they could be contracted/appointed with all of the insurers because many of the contracts have an exclusivity clause, meaning you can't market competitor products.

So, that being said, all any one agent can aspire to do is select the company or companies that he or she wishes to represent, and help the prospective clients choose a plan that is best for them within the realm of choices you have to offer. Unlike Registered Investment Advisors, health insurance agents do not have a fiduciary responsibility to assure the client has the most appropriate plan for them. They just have to present the plans they represent in an honest and open manner.

I liken it to car sales...If I'm selling Fords, but I know for a fact that a certain Chevy model of vehicle is far more appropriate for the client, guess what...I'm not going to mention it to the client. Why? Because I sell Fords, that's why! But that's okay, that's the way sales works, and the buying public out there know that. It's a situation that a lot of agents grapple with, but it's just a fact of life.

 

[GreenSky]

So, that being said, all any one agent can aspire to do is select the company or companies that he or she wishes to represent, and help the prospective clients choose a plan that is best for them within the realm of choices you have to offer. Unlike Registered Investment Advisors, health insurance agents do not have a fiduciary responsibility to assure the client has the most appropriate plan for them. They just have to present the plans they represent in an honest and open manner.

CMS tends to back up what you say when they insist we only present the one plan we made the appointment to show.

However, I don't always know the right plan when I meet the prospect. As an independent agent, is it not my obligation to make recommendations? I think we do have a fiduciary responsibility - or at least that's how I operate.

If all we need to do is show the benefits, then the prospect might just as well go on-line and view all the plans and make their own decision.

Rick

 

[senior-advisor-indiana]

I have the best plans for the clients in the counties I work. THe captive places around here are not worth selling their products. If I did find out that my client needed a chevy instead of a ford I would tell them that. I would then get a contract with chevy and if I couldn't I would find someone that sold chevy's.

Why would you not offer the best plan? Only reason you should not is if you are new and captive and do not have a choice. Every agent I know have sold inferior plans when they started.

 

[MAPDagent]

SAI,

I don't think a captive agency distribution system automatically equates to inferior...captive (or career, or exclusively contracted, or whatever you want to call it) just means you work for one company, and as far as you and your company are concerned, the product you offer is the best there is.

I see nothing wrong with having an exclusive relationship with one company...that doesn't make an agent bad, or inexperienced, or unintelligent, it just means they prefer to represent one company and whatever the compensation model is that works for that agent. I don't feel guilty because there may be some other product out there that is better (and better is really a relative term...every product has it's pro's and con's).

And just so you know, I have nothing against independent agents at all; They're able to offer nearly any product they want in exchange for no leads, no benefits, no retirement plan, no expense reimbursement, etc., etc. Granted, the commissions are doubled, if not more, but it all depends on how you like your total compensation package to be set up.

GreenSky,

You're right...a medicare beneficiary would get far more unbiased and complete information by comparing plans on Medicare.gov...but I haven't met too many seniors that are willing or able to do that. If they want unbiased advice, they should talk to a SHIIP councelor. Talking to an agent (any agent) means they're only going to hear about the plans that agent has decided, for whatever reasons, to represent...and that agent can't represent all of them! It's just not possible.

 

[senior-advisor-indiana]

I cannot sell a plan knowing I could get the client a better one.

 

[GreenSky]

I cannot sell a plan knowing I could get the client a better one.

Absolutely agree. I want to sleep at night without feeling guilty.

Rick

 

[Cenla Agent]

I cannot sell a plan knowing I could get the client a better one.

I agree, but I'm sure you'll also agree that the "best" plan isn't necessarily limited to plan benefits and premiums, but also one that providers will accept. Plenty of MA plans looked good on paper last year until members started trying to go to the doctor.

 

[MAPDagent]

Wow...so you guys mean to tell me that any salesperson anywhere in the world that represents the products and/or services of only one particular company in a sea of competitors are somehow immoral because they aren't deciding for a prospective client which is the best choice of all choices available???


Holy crap! that means there's a whole lot of salespeople out there that are immoral then.
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[senior-advisor-indiana]

Wow...so you guys mean to tell me that any salesperson anywhere in the world that represents the products and/or services of only one particular company in a sea of competitors are somehow immoral because they aren't deciding for a prospective client which is the best choice of all choices available???


Holy crap! that means there's a whole lot of salespeople out there that are immoral then.
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I did not say that. I said I could not sell an inferior product when I know there is a better one out there. I have sold inferior products in the past. I did not know any better therefore it was not immoral. If you know that your clients can get better then that is on your shoulders.

If you want to sell your clients one product because you do not want to pay for leads, well I guess you aren't very smart. I understand if you are new to the game but if you are not then you should be able to provide your own leads.
Why don't you just tell your clients that you are giving them less benefits or paying more because the company you work for is providing you with extra benefits. That would go over well.