Medicare Misinformation

[rousemark]

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?”

When it comes to choosing OM + MS or a MA, it amounts to the old FRAM oil filter commercial, "Pay me now or pay me later"..People seem to never learn there is no such thing as a "free" lunch..

 

[Vanessa Solano]

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 off 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 what 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 PDP 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.

This was so informative. I'm a total noob and while I had a whole other career before this, I def feel like I might have well have been offering fries with your order last week. I just ordered a MS eBook so i can learn as much as I can. I DO NOT want to give out wrong info!

 

[Newby]

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.

The only thing that agents have against Advantage Plans is that the politicians have made it way more difficult to navigate all the rules. It’s all artificial stuff put there to make it harder for agents to work with Advantage Plans than traditional Medicare. Other than that agents love it. No real underwriting hurdles and zero premiums. What’s not t like?

When you listen to politicians talk about it, it’s not hard to understand who doesn’t like it. And why they want it to be difficult to work with.

 

[vipoffer]

@MedicareMillionair and @somarco thanks so much for your insightful posts!

Like @Vanessa Solano, I'm also new to Medicare although I've been a licensed agent in the Under65 world since 2014. I certainly don't want to sound like "ignorance on fire" when I'm explaining OM, MS and MA to my clients and prospects. This forum has been so helpful to me lately. I'll continue to soak up the nuggets here so I can educate my clients and help them make the right decision for them.

 

[Chazm]

The only thing that agents have against Advantage Plans is that the politicians have made it way more difficult to navigate all the rules. It’s all artificial stuff put there to make it harder for agents to work with Advantage Plans than traditional Medicare. Other than that agents love it. No real underwriting hurdles and zero premiums. What’s not t like?

When you listen to politicians talk about it, it’s not hard to understand who doesn’t like it. And why they want it to be difficult to work with.

Just last week someone was saying that the dems never wanted to cut Medicare advantage plans. Wish I could find that post. Maybe it was 2 weeks

 

[vic120]

Just last week someone was saying that the dems never wanted to cut Medicare advantage plans. Wish I could find that post. Maybe it was 2 weeks

I remember that also but I cant place who or where

 

[goillini52]

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.

When I look at the MAPD plans in my kneck of the woods, other than the RX and the MOOP, I can't see much benefit that a MAPD would have over just having Medicare with no Med Supp.

 

[vic120]

When I look at the MAPD plans in my kneck of the woods, other than the RX and the MOOP, I can't see much benefit that a MAPD would have over just having Medicare with no Med Supp.

There are some area's in Il where Humana Gold has some good benefits $0 premium

However, in Il you have GI with BC, however, its expensive

Many times there are people who either can't pass underwriting and some who can't afford supp

However, in some area's especially in more rural area's, there are no good MA choices, When I see only 4 or 5 plans, and they are $70 and above with high copay's, In these area's I do very much agree

 

[somarco]

@Newby I will agree about the constraints placed on agents by CMS being a hindrance. I would probably go through the training and get appointed if the entire process wasn't such a PITA.

But I doubt I would actually sell any. Or if I did, it probably wouldn't be more than 3 or 4 per year.

So why bother?

Other than KP I don't see any plans in my area that are attractive. Even less appealing given the number of folks with chronic or serious health problems.

And I rarely have anyone tell me they can't afford a supplement plan. Not even HDF. I probably have 20 clients with HDF. Might be a few more.

Given the choice of HDF or a $0 premium MA plan I still believe HDF to be superior. For $60 per month they have better coverage than stand alone Medicare and better than any MA plan.

Just my take on things.

We don't have to agree and can still be friends.

 

[CrustyVet]

My beef with this video has nothing to do with Medigap vs MA. It is the other crap.

"Republicans drilled holes in Medicare"

Medicare is a creation of Democrat president LBJ. The "holes" in Medicare were baked in from the start. Not drilled by Republicans.

It is possible to broadcast a radio show or make a video that is accurate, unbiased and apolitical.

This one failed miserably on all accounts

You're so right on! I wanted to scream at these idiots, and I couldn't even listen to the whole thing. First off, they barely know what they are talking about, and then they add their political bias to the mix. The result...People who listened to this hoping to be enlightened were done a huge disservice.