Medicare Misinformation

Jul 11, 2019

  1. Travis Price
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    I know I'm stepping on a landmine, but in the name of accuracy.

    MACRA was introduced by a Republican Texas Congressman and passed with bipartisan support.
     
    Last edited: Jul 11, 2019
  2. vic120
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    I def don't know all the specifics, I just remember at the time with the Medicare fix Obama said something to the effect one of the big issues with Medicare is too many seniors have 1st dollar coverage and that he change that

    Because he said that the problem with first dollar coverage is seniors go to the doctor too much when they don't need too

    Beyond that I don't know any of the specifics of how and why of macra, I know there is a lot more too it

    I more pay attention too what is effected real world What plans can be sold what cant and how that will affect clients
     
    vic120, Jul 11, 2019
    #12
  3. Travis Price
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    Travis Price Guru

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    Actions - H.R.2 - 114th Congress (2015-2016): Medicare Access and CHIP Reauthorization Act of 2015

    So, I get where you're coming from in the real world. However, I would argue that blaming Obama for MACRA and removing first dollar coverage is a little murky.

    Republicans and Democrats overwhelmingly voted for the removal of first dollar coverage.
     
  4. vic120
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    I’m certainly not going to argue It was on national television he said what he said

    I’m sure a lot of Republicans are a part it out to

    I don’t think there are too many good politicians on either side

    But I certainly don’t wanna argue About politics
     
    vic120, Jul 11, 2019
    #14
  5. somarco
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    somarco GA Medicare Expert

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    The video is directed at consumers, not agents. With crap lik
     
    somarco, Jul 11, 2019
    #15
  6. rousemark
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    rousemark Still Here!

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    I continually see people making a comparison of MAs and Med Supps by saying the MA is 0 premium and the Med Supp is $xxxx. That is comparing apples to oranges. The only fair comparison is to compare a MA with traditional medicare by itself which the MA replaces... If you have Medicare and a plan G, you will not have all the deductibles and co insurance that you will have with a MA so of course, you will pay more..
     
  7. Newby
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    In other news Water is wet.

    Do you not remember when President Obama was running for president the first time? This is almost word for word how he explained it in his speeches. He was going to get rid of that awful Republican scam called Medicare Advantage. Until he got elected and then figured out who he was going to disrupt that plan.

    Democratic politicians hate Medicare Advantage with a passion. It pulls funds from the single-payer Medicare system and gives them to privatized for-profit insurance companies. That is the devil to them. But their big problem is that their voter base loves Medicare Advantage. So until they can figure out a way to make real Medicare free for everyone and with no co-pays or deductibles and include a drug plan they have to tolerate the system that we have.
     
    Newby, Jul 11, 2019
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  8. LostDollar
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    Actually, I'm not sure that is correct. I think that over the last 18 months or so, there have probably been more agents speaking for selling plans requiring ahip certification, than against.

    And then you add all the FE agents cross selling free Medicare plans to their FE clients, I would suspect there are a lot more forum agents selling MAPD than not.
     
  9. somarco
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    somarco GA Medicare Expert

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    Possibly, can't say one way or the other.

    I do know that in some areas MA plans dominate. Good benefits, low OOP, decent networks.

    Still there ARE limits on access to care. Policyholders can't go anywhere they want. Networks do change from year to year. "Your" doctor(s) may be in network this year but not next.

    Some folks have medical conditions that require specialized care and there may only be a handful of providers in your area that offer that kind of treatment. There are patients who have a level of trust with their provider that cannot bridge saving $$$ to follow the path allowed by the HMO.

    Chronic care is one area where the doctor-patient relationship is invaluable. I have insulin dependent diabetics including those with pumps. They have no desire to find another endo just because their insurance carrier and doc part ways.

    The choice of plans is not JUST dollars and cents. Too many agents either ignore this aspect or don't understand it.

    When I talk with prospective clients I always talk about access to care. I can't recall a single time when they were pitched an MA plan and they said "Oh yeah, the agent/carrier mentioned that but I don't think it will be a problem".

    More often than not they had no idea how the managed care plans work. For that matter, neither does the doctor's office. When a patient mentions they will be going on Medicare they are usually told "No problem, we take Medicare". Sometimes they will add "But we DON'T take Aetna (Humana, Cigna . . . whomever)."

    Original Medicare offers unfettered access to care anywhere in the country. This includes specialty centers like Mayo, Sloan-Kettering, MD Anderson, etc.

    The same cannot be said about MA plans.

    There is also the prior authorization issue. Something shared by almost every managed care plan, but NOT by traditional Medicare.

    80 percent of Medicare Advantage enrollees are in plans that require prior authorization for at least one Medicare-covered service

    Prior Authorization in Medicare Advantage Plans: How Often Is It Used?

    How Prior Authorization Can Impede Access to Care in Medicare Advantage - Medicare Rights Blog

    This goes hand in glove with claim denials. The problem is so big the OIG is investigating MA claim rejections.

    The study found that 82% of the wrongful denials arose from appeals by providers for payment for services already rendered. While that is not surprising in a third-party payor system, what is surprising is the failure of insurer trade association AHIP to treat it as a significant issue.
    Most medicare advantage denials really are wrong - And the biggest victims are the providers: A just-released report by the Office of Inspector General of the U. S. Department of Health & Human Services shows that most coverage denials from insurers and plans in the Medicare Advantage program were flat-out wrong.

    If someone is in the middle of a major claim the LAST THING they need or want is to fight their insurance carrier over treatment plan or claim payments.

    I get calls all throughout the year from people who have MA plans and they want to change. The two biggest complaints are:
    • I can't afford them
    • They won't pay my claims
    Can't afford does not mean the premium is too high. It means they cannot afford to pay for care.

    The second issue, about claim denial, is addressed above.

    Are MA plans evil or wrong for everyone?

    No, but most people don't understand what they have until it is too late to do anything about it. When you are faced with denial of care or big medical bills that is the worst time in the world to find out your insurance isn't working.

    Do I like MA plans?

    Nope. Wouldn't have one.

    Do I SELL only Medigap?

    No, I don't sell anything but I do explain how the plans work and give my prospects a choice.

    Most people who find me already know they want original Medicare and a Medigap plan. The only thing I have to do at that time is SHOW them how I can help more than some bozo in a call center. Or the home office rep that is telling you how great their plans are and last week they were asking if you wanted fries with your order.

    In addition to informing people about how Medicare works . . . and access to care . . . and prior authorization . . . and claim denials . . . I also talk about Part D.

    I have several videos about Medicare Part D including one that specifically addresses drug plan deductibles. Quite a few agents either don't understand the deductible or know how to explain it.

    Of course the easy thing is to only sell a plan that does not have a deductible. It doesn't matter that the beneficiary will not only pay higher premiums but will also pay more for their Rx with a no deductible PDP. It was just easier to sell than taking the time to educate your client about drug plans.

    I also show them how to save money, and sometimes avoid the donut hole, by purchasing some of their med's outside the plan.

    It would be so much easier if all I did was sell the PERCEIVED benefits of $0 premium plans, the lowest premium Medigap plan and only Part D without a deductible.

    But then I would be like all the other 99 agents out there who are calling incessantly or knocking on their door to sell anything for a buck.
     
    Last edited: Jul 12, 2019
    somarco, Jul 12, 2019
    #19
  10. MedicareMillionair
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    It may be comparing apples and oranges, but that’s undoubtedly the comparison most will make. You can count on that.

    I think the issue is more about whether you have access. I’d hate to have a plan that wouldn’t allow me to visit the medical professionals that are best able to help me.

    HMO’s vs PPO’s vs Original Medicare(any Dr or facility that accepts Medicare) might be a better argument.

    “Oh, you need heart surgery but can’t visit the best surgeon at the best facility?”
     
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