Med Supp Opportunities for PLEXing MA plan members

[Surancedawg]

Due to the demographics of my lead sources, I rarely write med supps. But I have done a few recently thanks to all the PLEXing MA plans. This has been a huge boon to some folks with pre-existing conditions serious enough that they would have zero chance of medically qualifying for one. Such as the beneficiary I enrolled the other day who had a Humana Open Network PPO plan with an in & out-of-network $2900 MOOP. He's undergoing cancer treatment at a Mayo Clinic. He hit his MOOP of course, and he got billed for the Part B Excess Fees in addition to the $2900 MOOP! He was very happy to hear that a Plan G will cover those fees. And I've had other PLEXed MA members with congestive heart failure, etc who thought nothing of paying $300/mo+ for a Plan G or F when confronted with the alternative of a 7,8 or 9K MOOP on an MA plan.

The concern is, with all these seriously ill folks moving from MA -> Med Supp with GI Rights, what's the impact going to be on the Med Supps' risk pools?

 

[axeman462]

I reckon it's not good. But do you really think there's enough to screw with the actuaries?

 

[Surancedawg]

I guess not for just one plan year, if this mass PLEXing were to become an annual thing, maybe so.

 

[axeman462]

I guess not for just one plan year, if this mass PLEXing were to become an annual thing, maybe so.

Hard markets don't last forever. Another 1, maybe 2 more years and the bull rally will resume

 

[DonP]

I guess not for just one plan year, if this mass PLEXing were to become an annual thing, maybe so.

You get full comp on Gi? Most states its $25. I’ve also reevaluated mapd in middle income people . Outside Fl many moops are now $9300 . Many plan N’s start at $125-$140 age 65. Throw in $0 premium WellCare and a mapd makes no financial sense for anyone with a little money . To this day I’ve had very very very few complaints about getting any treatment with mapd . The dollars and cents make little sense anymore . It’s weird this yr I’ve gotten zero calls from med sup people to move to a mapd .

 

[LurkerBroker]

Due to the demographics of my lead sources, I rarely write med supps. But I have done a few recently thanks to all the PLEXing MA plans. This has been a huge boon to some folks with pre-existing conditions serious enough that they would have zero chance of medically qualifying for one. Such as the beneficiary I enrolled the other day who had a Humana Open Network PPO plan with an in & out-of-network $2900 MOOP. He's undergoing cancer treatment at a Mayo Clinic. He hit his MOOP of course, and he got billed for the Part B Excess Fees in addition to the $2900 MOOP! He was very happy to hear that a Plan G will cover those fees. And I've had other PLEXed MA members with congestive heart failure, etc who thought nothing of paying $300/mo+ for a Plan G or F when confronted with the alternative of a 7,8 or 9K MOOP on an MA plan.

The concern is, with all these seriously ill folks moving from MA -> Med Supp with GI Rights, what's the impact going to be on the Med Supps' risk pools?

It will have a tremendous impact. Most PLEX biz or GI for that matter carries on average loss ratios well above 150% in aggregate from the market rep discussions I have seen. Historically, Medicare supplement total membership has maintained a relatively flat overall membership keeping up with morbidity, lapses, and the ever present 5% of the membership who find their way to Medicare advantage. This year, I would estimate that the SEP complex move from MA back to original Medicare and Medicare supplement is running 5 to 6 times higher than what we might have seen over the last 10 years. Medicare advantage does have its benefits, but the unintended consequences of carrier actions driving the pent up utilization demand to Medicare supplement is inexcusable when considering Medicare supplement is more like an insurance product than it is a healthcare plan. Someone once said, you don’t go out and buy flood insurance right before the rain comes and expect to be covered. Medicare supplement should be treated the same.

 

[hockeyday]

You get full comp on Gi? Most states its $25. I’ve also reevaluated mapd in middle income people . Outside Fl many moops are now $9300 . Many plan N’s start at $125-$140 age 65. Throw in $0 premium WellCare and a mapd makes no financial sense for anyone with a little money . To this day I’ve had very very very few complaints about getting any treatment with mapd . The dollars and cents make little sense anymore . It’s weird this yr I’ve gotten zero calls from med sup people to move to a mapd .

Plan n in Mi, females 75 male 80, don't understand why every does not do this