Medicare Advantage Investments

Feb 12, 2007

  1. DaveMel

    DaveMel New Member

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    Hey Folks,

    I am Melmunch's brother, and I am looking into some Medicare Advantage Investments.

    I am relatively new to the field, and I was hoping some of you experts can answer some questions I have, and perhaps point me in the right direction.

    1) How much is Medicare currently paying per member. Is this number set in stone, or privately negotiated?
    2)I heard that Medicare is talking about reducing the amount they pay per member, does anyone know how far along this process is, or where to find that out?
    3)Does anyone recall any Medicare Advantage Providers being bought out by larger Medicare Advantage Groups, and do you recall some identifying information I can use to track down those press releases?
    4) Is there any source of statistics which show the margins Medicare Advantage Providers typically operate on, preferably with a breakdown of age and health level.
    5) Is most of the marketing out there targeting seniors, or are there those who target their children and caretakers.
    6) Is there a list out there of all the Medicare advantage providers, and how many members they have?
    7) What is the typical payment structure offered to Insurance brokers for signing up Medicare Advantage members. Are these standard, or does it vary by provider.
    8) Are there any medical networks which actively offer their services to Medicare Advantage Providers (like a private label)?
    9) Are there significant differences between providers in different regions?
    DaveMel, Feb 12, 2007
  2. Guest

    Guest Guest

    I'm afraid this is outside of my scope of knowledge in the MA field for the most part. I can tell you what I do know:

    1) Roughly $500 per member and it is set in stone every year.
    2) Medicare is not talking about it but the Democrats are. There are some strong political battles with managed care now. In my opinion it is here to stay. It is working. It is reducing Medicare costs and It is helping low-income seniors tremendously. The Dems will have a hard time fighting the MA plans--but they want more money to go to covering child healthcare.
    3) I don't know
    4) I don't know but would be intersted in knowing myself
    5) Most marketing is targeting seniors although there are a few companies targeting Special Needs Plans (SNPs)--these are Medicare/Medicaid eligibles or institutionalized individuals
    6) Yes, but I do not have it. You should be able to search the net and find this
    7) Typically first year commission is $250-$400, then as low as $60 and as high as $200 for renewal years. Varies by carrier
    8) I don't know
    9) Yes! There are significant differences in availability and price. However, benefits for "Plan 1" by "Carrier A" are the same wherever that plan is offered.
    Guest, Feb 12, 2007
  3. midwestbroker

    midwestbroker Guru

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    1) The figure that I have heard is about $500 as well.

    2) I have heard that Medicare is overpaying the insurance companies, but if they were to reduce benefits, it would be told to the carriers prior to them releasing their 2008 plans to Medicare for approval. That way they could structure their premium to the rate.

    3) I know that Coventry and First Health have merged. There are a lot of local HMO's in metros that we may have never heard of and only operate in only a few counties. Google some of their names on the news side and that should tell you

    4) I do not know that carriers would release that information to the public. If they did I would look at their financial reports.

    5) Seniors / disabled people pre 65 who have Medicare

    6) You can go to and look up providers by area, and I do believe that they will report to you the # of members they have.

    7) Vary by carrier, but usually from $250 - $330 per sale is what I have seen. Charge backs would happen within the first 2 months if the member drops the plan.

    8) I assume you mean local networks providing services to local MA plans. I am sure that is what happens and depends if the carrier is a HMO or PPO.

    9) Yes. The best place to find that out is, or get some carrier info. I know that PFFS plans usually have the same plans across the country, and have the premiums in the summary of benefits. One county may be $0 premium, and the next could be $100 for the same plan.

    Hope that helps
  4. policy doctor

    policy doctor Guru

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    Hey Munch's bro!! And to any one else in the senior mkt/Medicare.

    Here is a fun web site but I encourage you to sign up for their newsletters. They have sent a ton of info on these enrollments, Part d, medicare woes, etc, etc.....You get the picture!1

    Look up www. They also provide links, articles.... enjoy!
  5. Bob_The_Insurance_Guy

    Bob_The_Insurance_Guy Guru

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    1. $600 to $800 per person per month
    2. No idea
    3. None being bought out
    4. No
    5. Seniors (CMS dictates who to market to)
    6. Chapter 13 of "Medicare and You - 2007"
    7. Varies by provider
    8. No
    9. Don't know