Medicare Advantage

[Frank Stastny]

On page 33 and 35 of the Medicare and You - 2007 book, published by the Centers for Medicare and Medicaid Services, it clearly states that, if you join a Medicare Advantage Plan, you are still in Medicare, and you retain all your rights under Medicare.

Am I missing something?

I don't have a copy of the 2007 book, but it has always been my experience that if I switch someone with an HMO to a Med Supp policy they have to contact Social Security and request that they be put back on Medicare. If they still "had Medicare" that wouldn't be necessary, don't you agree?

When someone signs up for a PFFS plan, they can no longer use their Medicare card since claims are no longer sent to Medicare.

I agree that they have the "same benefits" assuming that they pay all of the copays involved, but as far as them showing their Medicare card to a doctor who accepts a PFFS plan or an HMO is concerned the doctor does not need or request that information. Because, the claims no longer go to Medicare.

They still, always pay the cost of Part B but in reality no longer are able to use their Medicare card since Medicare no longer receives the Part B payment, that goes to the HMO or PFFS plan.

I guess I'm saying that I think the statement you interpreted from the 2007 book is misleading. That has been my experience in selling Med Supps to people on Advantage plans.

 

[Bob_The_Insurance_Guy]

Frank,

Please go to Medicare.gov - The Official U.S. Government Site for People with Medicare and download a copy of the book. Then, read it.

Thanks.

 

[policy doctor]

Exactly right. A senior who wants to return to Original Medicare must have CMS disenroll him from that Med Advantage Company, just as the reverse is true...CMS approves his enrollment into Med Advantage. CMS is like a clearing house and the Med Advantage co receives around $1000/mo to service that clients claims, if there are any. Hence that rumor of $10,000 being paid to a MA co when a senior enrolls.

Doesn't seem to matter if they go on a HMO, PPO or PFFS plan. Same am't of money.

What is crazy is how many varieties of MA plans. For example, I have 3 diff plans from Coventry to present in Georgia, but certain plans are specific to a specific county. Their Freedom 1 PFFS works like a med supp...Pay $98/month and your OOP is capped at 1,000k for the year.
Zero OK...FWIWco-pays for hosp and dr, $150 for ambulance, $50 for ER, and other minor expenses.

Freedom 2 and Freedom each have OOP of $3,000 with zero premium...
but different copays for dr and hosp. On both plans CLIENT pays 20% of Diaag Tests and Xrays (like mri's), outpatient surgery, durable medical equip & pays hefty for skilled nursing home in the 1st 20 days..

BTW...did you know that Coventry is allowing branding with Bankers Life & Casualty? Saw it today...Woman had her booklet from Coventry with Bankers name on it. Coventry office said they are affiliated with Conseco, but the svc rep had sketchy info. Forgot to ask if they can sell PFFS.

ok....fwiw

 

[senior-advisor-indiana]

I heard coventry was branding with Great American also. What whores!!!!

 

[Frank Stastny]

Frank,

Please go to Medicare.gov - The Official U.S. Government Site for People with Medicare and download a copy of the book. Then, read it.

Thanks.

Bob, I don't think you are making that up. I'm simply telling you what my experience has been with people who are with an HMO and want to switch to a Medicare Supplement policy.

The book can say they still are on Medicare but why then must the contact SS and request that they be put back on Medicare? When that happens, then SS stops sending the Part B premium to the HMO and once again sends it to Medicare.

I'm not trying to argue the point with you, simply telling you what SS has told me. People who are with an HMO no longer have Medicare and have to request they be reinsated to Medicare. If they had Medicare all along, why then would they have to ask to be reinstated in Medicare?

It's all about where the money goes and who pays the claims. Medicare isn't going to pay any claims if they are not getting the Part B premium.

How many people have you switched from an HMO to a Medicare Supplement policy? Why is it when a person belongs to an HMO the doctors never asks for the persons Medicare card? Advantage plans are a replacement for Medicare. Not something in addition to Medicare.

Just because it is written doesn't mean that it is stated clearly or even correctly. Even the Federal Govt. has been known to make mistakes or say things in a manner that is confusing.

I know what the book says, I also know what happens in the real world. Try moving someone from an HMO to a Medicare Supplement policy without having the person request that they be put back on Medicare.

To tell someone who joins an Advantage plan that they still also have Medicare is misleading. By definition that would mean that they have the option of going to an HMO doctor or they can select another doctor outside of the HMO network and use their Medicare card. That can't happen.

 

[Frank Stastny]

Bob,

Maybe this will help explain what I'm trying to say.

Think of Medicare as an insurance company. The cost of Medicare Part B is the premium that is paid to that insurance company.

If an individual signs up with a Medicare Advantage Plan then the Part B premium no longer is sent to Medicare by Social Security. The Part B premium is then sent to the Advantage Plan.

It is like someone having a policy with company A and then switching to company B. If company A is no longer getting paid premiums then company A will no longer pay any claims.

Now claims are paid by company B, they are now the ones getting the premium.

Would you say that the person still has insurance with company A even though company B is now getting paid the premiums instead of company A? Of course you wouldn't.

For that same reason, people who join an Advantage Plan no longer have Medicare regardless of what the book says. Medicare is no longer getting the Part B premiums. Social Security is the one who controls who gets the money, not CMS.

 

[midwestbroker]

The most effective way I have explained MA plans:

Medicare basically "sub contracts" insurance companies to administer plans to you and take care of all the claims and administration. In return, Medicare pays the insurance company a set fee per month per member to do so. You still have Medicare, but it is only being used to fund the MA plan.

In regards to dis enrollment, if you are wanting to put someone from a MAPD plan to a supplement, all you have to do is enroll them in a PDP plan. This will automatically dis enroll them from the MAPD since all they can have is one Part D plan at a time.

You could go through social security, but it wouldn't be to get Medicare back, rather to change the primary insurer to Medicare.

 

[2112Greg]

Try to look at it like this...

A senior has enrolled in Medicare at some point in the past. They get switched into a MA plan believing the pitch the "agent" gives them (in quotes because not all who sell these things are licensed agents). They have a medical situation and go to the doctor they've known and trusted for years to receive the care they need.

They go to check in and their account is pulled up on the computer. Lo and behold, they cannot charge Medicare any longer because Medicare isn't 'primary' any longer...some thing they've never heard of, and nothing the doctor's office accepts, is primary now.

Senior is confused, angry and on the hook or they go without because the MA isn't accepted by that dr's office.

MA plans are not COMPLETELY, 100% bad...it's just in the vast majority of cases they are...especially for seniors who don't live in metro areas where there is a greater likelihood of 'someone' taking the plan. That said, I've heard that no where in the DFW metroplex takes these things. And last I checked, Dallas ain't no small town.

 

[Slick]

What is crazy is how many varieties of MA plans. For example, I have 3 diff plans from Coventry to present in Georgia, but certain plans are specific to a specific county.

The government pays the PFFS carriers based on the experience of the beneficiaries location, similar to Medsup pricing.

 

[Slick]

Here's one that I've always wondered about...

The column heading "Estimated Annual Cost for People Like You".
Those numbers don't seem accurate at all. Does anyone have any info on how these numbers were calculated?