Medicaid Ending Question

[goillini52]

If we were constantly running into network issues we’d not be selling mapd .

Bingo

 

[rmhaire]

You’re telling me all the fe you sold in your life and probably a ton of contested claims you never had 1 life claim not paid?

I don't get any contested claims with life insurance. They're either dead or they ain't. And no, not one claim not paid. And that includes FE and a boat load of UL, WL and Term.

As for Medicare Supplements, if Medicare approves it, the company has to pay. So no problems there either.

The only problems I ever had is with Medicare and their Under Observation crap. MS doesn't pay those.

Years ago I took my mother to the ER. Lymphedema. They wouldn't treat her because of her age. 89 at the time.

Ambulance brought her home and I had the EMTs take her to our other hospital. They admitted her and kept for four or five days. Never saw a doctor, a PA or received any treatment. She was Under Observation.

A month or so later she gets a bill. I knew Medicare nor her MS was going to pay. I took the bill and wrote This Bill Is Under Observation with a red marker and mailed it back.

That was years ago and I'm still waiting to hear back.

 

[kgmom219]

Let me start by saying I'm not sticking up for DonP bc I don't want my name associated with him in any way.

Also, don't want to KYA but I just did an Aetna MAPD yesterday along with a $350/day GTL HI benefit that costs less then $30.00/month. She now has her hospital covered for the rest of her life and what she gets reimbursed, possibly $1750, goes towards her Max OOP of $3900.00. Now she has a really good drug plan, dental, vision, hearing, OTC and a gym membership. They are currently paying $1300.00/month for Obamacare with an $8700 max OOP. They will save $15,300.00/year on premiums. Do you think they care if they hit their MAX OOP of $3900.00? Also, many people have a nice chunk of change in their HSA account that can be used if they do incur copays. There is no doubt which way I will choose when I turn 65.

To be fair I presented all 3 options including Med Sup, Cost Plan and Aetna MAPD. 90% of them choose either an MAPD or a Cost Plan. I am fortunate to have so many options to present and let them choose. I don't try to steer them one way or the other. I realize other parts of the Country have crappy plans. Just my .02.

I hear you.

Issue #1 with this client is that his docs didn't match up to any of the MAPD's. The guy had a kidney transplant and is in heart failure. He's not switching docs.

Issue #2 is with a $30 HI, he's still looking at $2150 in OOP expenses on an HMO (and God Forbid he took an HMO vs PPO MAPD) and $2150 is still more than N and D. If you throw in the PPO OOP of $6700, it really gets stupid.

I realize you are an MAPD guy, but I also know that you are presenting them fairly. As long as people know that after 12 months they can't switch without underwriting, I'm good.

 

[somarco]

Amazing volley, mostly debating the merits of clients vs policyholders, and the have's vs the have nots.

My business model is unique in that BY CHOICE I don't have any MAPD clients. There are a few other agents here who do likewise, but some folks constantly jump on me because I don't do things the way they do.

The other two in this thread, @kgmom219 and @rmhaire, offer both Medigap and MAPD but have a preference for Medigap. I have never met either one but we have communicated privately, swapping ideas, asking questions, etc so I think I know them as well as anyone on the forum.

I respect them and their contributions to this forum. Most agents would do well to absorb as much of their knowledge as possible and learning why they do things a certain way, even if it is different from your model.

All three of us (plus a few others) do not attempt to sell or analyze prospect/client issues from strictly a PREMIUM perspective. In fact, I NEVER ask anyone what they can afford at any time during the dialogue. If my suggestion is not in their budget they will bring it up and I will suggest alternatives.

I talked with a lady yesterday who recently bought HDG but someone she talked with before her IEP expired suggested plan K, so she asked my opinion. I had no idea how the K plan works nor did I know the premium so I had to look it up.

Bottom line to her would be to pay $20 per month more and have a potential upside risk of $6940 vs $2700+Part B. That obviously is not a good choice and it makes me wonder why the other agent suggested it.

The agent that sold her the HDG said it was issued by the household name parent when in fact the policy is issued by a downstream subsidiary. She was not happy about that and wanted to switch immediately, but paused when I said her IEP expired 5 days ago.

She also was not happy that the writing agent failed to disclose that issue, but rather assured her she could cancel her policy during the FREE LOOK.

At this point she can pass underwriting but I did not press her to change. She is considering what she has been told by agents who are either ignorant or shysters. She may eventually contact me about changing, or she may not.

Either way, today she received copies of my last 2 newsletters plus the latest one that went out to clients and "active" prospects alike.

If/when she wants to make a change it will be on her terms, not mine.

 

[Midlevel]

I hear you.

Issue #1 with this client is that his docs didn't match up to any of the MAPD's. The guy had a kidney transplant and is in heart failure. He's not switching docs.

Issue #2 is with a $30 HI, he's still looking at $2150 in OOP expenses on an HMO (and God Forbid he took an HMO vs PPO MAPD) and $2150 is still more than N and D. If you throw in the PPO OOP of $6700, it really gets stupid.

I realize you are an MAPD guy, but I also know that you are presenting them fairly. As long as people know that after 12 months they can't switch without underwriting, I'm good.

I apologize bc I wasn't even thinking you were talking about this particular case when you said that. I thought it was a general statement. This post has been so long and drawn out I kind of forgot the original question. Ha

 

[DonP]

I don't get any contested claims with life insurance. They're either dead or they ain't. And no, not one claim not paid. And that includes FE and a boat load of UL, WL and Term.

As for Medicare Supplements, if Medicare approves it, the company has to pay. So no problems there either.

The only problems I ever had is with Medicare and their Under Observation crap. MS doesn't pay those.

Years ago I took my mother to the ER. Lymphedema. They wouldn't treat her because of her age. 89 at the time.

Ambulance brought her home and I had the EMTs take her to our other hospital. They admitted her and kept for four or five days. Never saw a doctor, a PA or received any treatment. She was Under Observation.

A month or so later she gets a bill. I knew Medicare nor her MS was going to pay. I took the bill and wrote This Bill Is Under Observation with a red marker and mailed it back.

That was years ago and I'm still waiting to hear back.

Well if full underwritten I could see . I guarantee you there’s not one high producing fe agent who hasn’t had a contested death claim denied if he’s been in the business 3-5 yrs

 

[LostDollar]

I talked with a lady yesterday who recently bought HDG but someone she talked with before her IEP expired suggested plan K, so she asked my opinion. I had no idea how the K plan works nor did I know the premium so I had to look it up.

Bottom line to her would be to pay $20 per month more and have a potential upside risk of $6940 vs $2700+Part B. That obviously is not a good choice and it makes me wonder why the other agent suggested it.
.

One possibility, the person suggesting Plan K was with a carrier that doesn't offer an HDG.

A thing I have been noticing in looking at sample prices in the printed medigap sample price list I got from my local ship office is UHC does not offer HDG but offers Plans K and L, so with UHC you have to go with K or L to get a lower cost product.

A second thing, I'm pretty vague on this but it seems to me like sometime back @sshafran was tossing out Plan K as an option to consider. I don't remember if he was saying, or asking for comment, and I don't remember his specific reasons for saying K was worth considering (if he was the one that brought it up).

A third thing, I am also very vague about, but it just seems to me like sometime in maybe the last 2 years there was some kind of "buzz" about a carrier getting ready to offer a plan K.

 

[kgmom219]

Im not talking about that client . I’m talking about the 20 clients she gets a month . Obviously these patients going to see the dr’s can see the dr with their plan . Are these all patients bitching they don’t like their plan? I don’t see how 20 people a month are telling their dr’s office “ I need help with my plan “ . Are these offices soliciting the patients ?

So today's referrals...

Small group from an attorney

Lady retiring needs coverage before T65 then Medicare from a financial planner

Guy from his sister (who I got from a financial planner) who needs ACA

Just a normal day.

 

[somarco]

One possibility, the person suggesting Plan K was with a carrier that doesn't offer an HDG.

A thing I have been noticing in looking at sample prices in the printed medigap sample price list I got from my local ship office is UHC does not offer HDG but offers Plans K and L, so with UHC you have to go with K or L to get a lower cost product.

A second thing, I'm pretty vague on this but it seems to me like sometime back @sshafran was tossing out Plan K as an option to consider. I don't remember if he was saying, or asking for comment, and I don't remember his specific reasons for saying K was worth considering (if he was the one that brought it up).

A third thing, I am also very vague about, but it just seems to me like sometime in maybe the last 2 years there was some kind of "buzz" about a carrier getting ready to offer a plan K.

Perhaps in other states the K plan is competitive on premium, but even so, the plan structure would be the same as I quoted . . . $6940 OOP. Even if the premium was half the HDG plan(s) you are still looking at more than 2x the OOP to save a pittance.

I don't see the logic behind offering/suggesting a K plan in ANY circumstance . . . unless the prospect is completely clueless about basic math.

 

[AgentGeneral]

Late to the party here, 8 pages in. Couldnt read it all.

Here, that kind of income posted from OP, it wouldn't be a question here so long as there's not much money in their bank account or other financial vehicles, to opt MAPD.

The hospitals and many facilities here have a one or two page form depending on hospital/facility for help with those co-pays. I have dozens of clients not on Medicaid getting there copays waived. So I'd check on that. Hospital Social workers and billing depts here are easy to work with. Also, facilities have given out gas cards, other vouchers and other help with cancer/more serious tx trips as an example. The client fills it out one time per year, show proof of bank account balance and not much more.

With that said, if they are going to PT or something similar twice a week that specific facility may or may not eat copays. Many do eat the copays. Never would have known this on my own, learned it early on by the clients themselves and see it time and time again.

So in this case it's a MAPD PPO with most appropriate Rx formulary