Medicare Plan "F" or ???

[sshafran]

Just yesterday one of my clients who got Medicare early due to disability and I were talking about her upcoming T65.

She has been on an MAPD for years since it was the only option.

Her Rx's on MAPD yearly estimate are $1,200. Her Rx's on the "best" stand alone PDP: $1,950.

So... 750 more for her Rx's.
... $1,200 more yearly for her Medical w/ the new Plan G.
... her MAPD had decent dental - now she'll pay $360ish for dental. She's passing on vision since she just used her MAPD for free glasses.

She will pay $2,310 more right off the bat to move from $0 MAPD to Plan G + PDP + Dental.

But it is worth it to her because of (a) frequent speciality copays, (b) 2 scheduled surgeries, and (c) she wants to no longer look at network issues. But #1 was specialist copays as she has 2+ monthly.

It's not always about the $.

I can say this: I was a little surprised that she is changing - I just hope the med supp doesn't go up too quickly in price as it's a stretch for her to do the monthly.

 

[sshafran]

Just yesterday one of my clients who got Medicare early due to disability and I were talking about her upcoming T65.

She has been on an MAPD for years since it was the only option.

Her Rx's on MAPD yearly estimate are $1,200. Her Rx's on the "best" stand alone PDP: $1,950.

So... 750 more for her Rx's.
... $1,200 more yearly for her Medical w/ the new Plan G.
... her MAPD had decent dental - now she'll pay $360ish for dental. She's passing on vision since she just used her MAPD for free glasses.

She will pay $2,310 more right off the bat to move from $0 MAPD to Plan G + PDP + Dental.

But it is worth it to her because of (a) frequent speciality copays, (b) 2 scheduled surgeries, and (c) she wants to no longer look at network issues. But #1 was specialist copays as she has 2+ monthly.

It's not always about the $.

I can say this: I was a little surprised that she is changing - I just hope the med supp doesn't go up too quickly in price as it's a stretch for her to do the monthly.

In fact - every year we've reviewed she has said, "I can't wait to turn 65 & get a supplement so that I can stop worrying about the copays."

 

[sshafran]

Last thing (and I know I'm rambling... apologies) - this particular client is probably in the top 3% of medical users out there. So this is not the norm.

I really find MAPD plans to be a suitable fit in a ton of situations. The industry is shifting towards MAPD. The statistics are what they are... more and more are choosing MAPD.

 

[Travis Price]

Last thing (and I know I'm rambling... apologies) - this particular client is probably in the top 3% of medical users out there. So this is not the norm.

I really find MAPD plans to be a suitable fit in a ton of situations. The industry is shifting towards MAPD. The statistics are what they are... more and more are choosing MAPD.

This is absolutely true, and there's a huge argument that it's due to marketing. However, each situation is different.

My job is to explain the difference, but ultimately the client is in charge.

 

[sshafran]

This is absolutely true, and there's a huge argument that it's due to marketing. However, each situation is different.

My job is to explain the difference, but ultimately the client is in charge.

Yeah I think it is due (in part) to marketing.

I also find it (in my own mind) difficult to spend $1,400 in premium (N + PDP) when another option is spend $0 w/ a $5,500 max risk.

I'm simplifying yes.

But I'm not that far off to think of it in terms of "would I spend $1,400+++ or take the $5k risk? (And enjoy some nice extras!).

I get "access to care" is really important to some people. For those - buy a med supp. To others (like myself) providers are a dime a dozen and I doubt I'd be unable to find a qualified provider in a large network.

Roll the dice...

 

[somarco]

I get "access to care" is really important to some people. For those - buy a med supp. To others (like myself) providers are a dime a dozen and I doubt I'd be unable to find a qualified provider in a large network.

Roll the dice...

Attitude towards access to care changes with your health and age.

When I worked the U65 health insurance market I had a similar view about providers. Most of my clients were women with small children. I quickly found that they did not want to change GYN or Ped doctors and would willingly pay a higher premium for a plan with a lower deductible and copay's, especially if they could keep their doctors.

They also have no desire to change dentists just because a dental plan looks good but the ability to use the plan requires them to use a different dentist.

Sick people, especially those with chronic conditions, don't want to be told they can't continue using a doctor they trust.

Many older folks are risk averse and many are less willing to follow a path that can expose them to unexpected large outlays of cash. They make a budget and plan to stick with it.

The thought of having to come up with $5k or more OOP plus change providers is something they will avoid at all costs. When their health changes they don't want to find the cheapest provider and they don't want an insurance carrier telling them that the plan will not pay for a test or procedure.

Pre-authorization is not something they want to deal with when they are in pain or have a cancer diagnosis.

Some agents would rather project their own attitudes about money management and access to care on their clients rather than asking the client what THEY would want in a situation. That works until your client is facing a crisis and they suddenly realize their plan doesn't work the way they thought it should.

I had a call from a lady yesterday who was upset that this plan I "sold" here did not allow her to use any doctor. Someone at this doctor office told her they don't take insurance from that carrier.

I had to explain to her that a Medigap can be used anywhere and the staff at this office probably ASSUMED her plan was an Advantage plan.

This doesn't come up often, maybe once a year or so, but it happens.

I say this all the time, but it is true.

I don't SELL I educate and explain their options, then let them decide. Many new prospect find me by way of YT and are pre-sold on the idea of "if you like your doctor you can keep your doctor". They understand that the ability to budget for large expenses by paying a premium is preferable (to them) than having expensive surprises.

 

[vic120]

Mostly a delusion in the mind of the agent.

For some maybe I don't, For that reason, I still am over 75% Medsupp and the MA clients I have won't complain too much to me about common MA cost share or network. as I went over and warned the only cost-share complaining they give is some things that might vary from one MA to another

 

[sshafran]

Attitude towards access to care changes with your health and age.

When I worked the U65 health insurance market I had a similar view about providers. Most of my clients were women with small children. I quickly found that they did not want to change GYN or Ped doctors and would willingly pay a higher premium for a plan with a lower deductible and copay's, especially if they could keep their doctors.

They also have no desire to change dentists just because a dental plan looks good but the ability to use the plan requires them to use a different dentist.

Sick people, especially those with chronic conditions, don't want to be told they can't continue using a doctor they trust.

Many older folks are risk averse and many are less willing to follow a path that can expose them to unexpected large outlays of cash. They make a budget and plan to stick with it.

The thought of having to come up with $5k or more OOP plus change providers is something they will avoid at all costs. When their health changes they don't want to find the cheapest provider and they don't want an insurance carrier telling them that the plan will not pay for a test or procedure.

Pre-authorization is not something they want to deal with when they are in pain or have a cancer diagnosis.

Some agents would rather project their own attitudes about money management and access to care on their clients rather than asking the client what THEY would want in a situation. That works until your client is facing a crisis and they suddenly realize their plan doesn't work the way they thought it should.

I had a call from a lady yesterday who was upset that this plan I "sold" here did not allow her to use any doctor. Someone at this doctor office told her they don't take insurance from that carrier.

I had to explain to her that a Medigap can be used anywhere and the staff at this office probably ASSUMED her plan was an Advantage plan.

This doesn't come up often, maybe once a year or so, but it happens.

I say this all the time, but it is true.

I don't SELL I educate and explain their options, then let them decide. Many new prospect find me by way of YT and are pre-sold on the idea of "if you like your doctor you can keep your doctor". They understand that the ability to budget for large expenses by paying a premium is preferable (to them) than having expensive surprises.

I would certainly agree that my own thoughts about what's important can cloud things.


When I talk about Advantage plans with people -- I purposefully tell them about 2xs a major hospital in Ohio (OSU - including the James Cancer Center) messed around with networks.
- They used to just take Aetna MAPD - that was it
- Then they switched to Aetna PPO only - no Aetna HMO
--- I had to switch my HMO clients to PPO during AEP - frustrating
- Then they opened up to a few more carrier - including Medical Mutual of Ohio
- Then this year (2021), dropped MMofOH - so now my MMofOH clients were frustrated and had to change.

I have more stories -- like when OhioHealth (a major network) stopped taking Anthem BCBS (a major carrier)... network issues are real and they can and do cause real frustration and if not dealt with - harm by impeding access to care.


I know I talk about this with prospects. But they still choose MAPD sometimes. Why? Do I not emphasize the downsides enough or are they not that big of a concern to them?
---

What's interesting is this (and maybe not important as anecdotally it just is what it is): In the examples above (OSU network issues - OhioHealth/Anthem issues) I don't remember any of them who were directly affected by the network debacles wanting to jump ship on MedAdv and switch to Med Supp. All of them simply switched from one $0 mapd to another $0 mapd w/ the network "fixed."

Maybe we just put a bandaid on when it needed something better? I don't know. It's certainly not that I don't offer med supp - I always offer med supp.

 

[somarco]

I know I talk about this with prospects. But they still choose MAPD sometimes. Why? Do I not emphasize the downsides enough or are they not that big of a concern to them?

I was not calling you out, Scott. Just pointing out things that SOME agents, who think MAPD is the ONLY way or BEST way for everyone might need to step back and reconsider their approach.

The forever banned Rick B always got after me about how MAPD plans in some parts of the country, specifically CA in his case, were actually very good.

His attitude changed when his health changed and he went on Medicare. He bought an HD plan and has become a convert to the "Why Medigap might be a better choice" approach.

For those who want to follow the "numbers", look how many folks willingly gave up their freedom to follow the Faucian advice that masks and house arrests prevent the spread of the CCP virus.

Newsom's idea of preventing the virus is what is done now isn't working so we need to do even more of the same. We also are expected to believe that if you get home before 10PM you won't get the virus.

 

[sshafran]

I was not calling you out, Scott.

I get it - didn't think you were. Just being introspective and wondering if my thinking about the issues is projected too much, or wondering if I don't emphasize the possible downsides enough.

I could probably add a little more emphasis on it. Not sure that would change the outcome of what they choose but I probably do need to tweak the conversations a bit.