MAPD PPO vs Medigap?

[goillini52]

Chazm...are you replying to me? If so, I am probably not being clear enough for you to understand my points regarding PDP's and MAPD's.

You have to speak s l o w l y so Chaz an uderstand you.

 

[Tom S]

Gotcha

 

[WCMason]

Actually, I don’t think I’ve EVER seen a pdp Medicare comparison look better than MAPD. But again this is in FL and probably not anywhere else.

I also find that when I run the planfinder for prospects considering both MAPD and PDP the drug costs on MAPD plans are often lower.

As to the OP's question about differences, one problem with the MAPD drug coverage they often don't consider is that they have to take the drug plan it comes with; it's a package deal. They don't get to shop among a couple dozen or more drug plans like they can with a med supp paired with a PDP.

So, if the MAPD plan their doctor takes doesn't cover their drugs very well, but the plan that covers their drugs well their doctor doesn't take, they could get themselves in a situation where they have to choose whether to lose their doctor or pay more for their drugs. This is a dilemma they'll never have with a no networks med supp and a stand alone PDP they can change annually as their drug needs change without restricting their access to medical care. I don't steer people away from MA plans, but they do tend to like them less the more they look beyond the $0 premium.

 

[somarco]

My biggest concern about any Medicare Advantage Plan is that it is annually renewable, so benefits can change each year & if they are under going something serious health wise, they can not qualify for a med supp

As long as they don't have ESRD they can move to another MA plan.

I would be more concerned about network shift than benefit changes.

 

[somarco]

one problem with the MAPD drug coverage they often don't consider is that they have to take the drug plan it comes with; it's a package deal.

Yup.

It's off the rack coverage. No tailoring.

 

[DeeDee Whitlock]

As long as they don't have ESRD they can move to another MA plan.

I would be more concerned about network shift than benefit changes.

Most want a Medicare Supplement NOT Advantage plan most of the time when they start failing health they want FULL coverage & Medicare Advantage plans no longer fit the need

 

[somarco]

Most want a Medicare Supplement NOT Advantage plan most of the time when they start failing health they want FULL coverage & Medicare Advantage plans no longer fit the need

Oh I am very much aware of that, and have no problem telling them they can't get a Medigap plan now that the bills are coming due.

It really doesn't matter what they want.

 

[Tom S]

here here

 

[PattyBurgers]

It has much more to do with Florida. I have a plan that will cover all these at a $0 copay.

• Basaglar Kwikpen
• Fiasp Vial
• Fiasp Flextouch
• Levemir Vial
• Levemir Flextouch
• Novolin 70/30 Vial (excluding ReliOn Brand)
• Novolin 70/30 Flexpen (excludingReliOn Brand)
• Novolin N Vial (excluding ReliOn Brand)
• Novolin R Vial (excluding ReliOn Brand)
• Novolog Vial
• Novolog 70/30 Flexpen
• Novolog Flexpen
• Novolog Mix 70/30 Vial
• Novolog Penfill
• Tresiba Flextouch

Many plans cover tier 1 and tier 2 for $0 in the gap, including one PPO.

Actually, I don’t think I’ve EVER seen a pdp Medicare comparison look better than MAPD. But again this is in FL and probably not anywhere else.

I'm a 2nd AEP captive agent with UHC. Met with Mr and Mrs Prospect today. Currently on Plan F and SilverScript. Mr is taking Novolog Flexpen. His wife really wants our LPPO and it's a good fit for her. He's not really wanting to change (I don't think he should either) but she likes the idea of not having to pay a monthly premium if she doesn't have to. Chazm I know you are a Central FL agent with multiple carriers. Could you share which plans for zipcode 34985 would cover Novolog Flexpen? Not sure if you do over the phone sales but I don't know any agents in the area that aren't ICA with UHC.

Side note: I started with saying "I'm a 2nd AEP ICA with UHC" but that just seemed like too much!!

 

[Chazm]

I'm a 2nd AEP captive agent with UHC. Met with Mr and Mrs Prospect today. Currently on Plan F and SilverScript. Mr is taking Novolog Flexpen. His wife really wants our LPPO and it's a good fit for her. He's not really wanting to change (I don't think he should either) but she likes the idea of not having to pay a monthly premium if she doesn't have to. Chazm I know you are a Central FL agent with multiple carriers. Could you share which plans for zipcode 34985 would cover Novolog Flexpen? Not sure if you do over the phone sales but I don't know any agents in the area that aren't ICA with UHC.

Side note: I started with saying "I'm a 2nd AEP ICA with UHC" but that just seemed like too much!! View attachment 5597

I think I’ve let two clients in almost 11 years switch from a med supp to a MAPD. Out of 100% necessity.
If I met someone on Plan F and SS the only thing I would say is have a nice day. (assuming it’s a UHC/FL blue low priced etc)
Silver script in my opinion is better next year than this but I don’t know if they cover that insulin or not.
I don’t have time trying to move people just to move.
This attached email happened today