MOOP's

BobbyMcGee

BobbyMcGee

Guru
100+ Post Club
475
Central Florida and Colorado
Anybody know what percentage of MA participants, nationally, regionally, whatever, hit their MOOP in any given year? In Fl., they generally range from 3400 to 6700, unless, of course it's a SNP, Dual, etc.
 
Not being a smart a$$, but what is the point?

Hitting the OOP only matters if it is you.

Also, the max OOP in most MA plans is an illusion. On a large claim you will undoubtedly slip out of network on more than one occasion.
 
I have been on this forum for years but my very first response. I am in the Kansas city area. MA's are Coventry, Humana and UHC in this town. About 60,000. I worked for Humana for 3 years and am independent now. I have about 350 clients. the clients that hit their Moop do it in 3 ways. Cancer, long skilled nursing or multiple long hospital stays. Cancer being the fastest (chemo). Chemo is the flaw in MA's. Most clients love MA's in my area but I always try to explain why it is important to purchase a side cancer policy for the MA flaw. I found a policy through GTL (Guarantee Trust Life) that I like to show. It is like a gap plan for MA. It is called Advantage Plus and pays a daily hospital benefit to fit the daily. Also, you can add up to a 10k lump sum cancer benefit and SNF. Just my two cents but people love MA in my area even though I like to sell a good plan N plan. I show both, explain both and let them decide. I am always a big fan of trying to explain why it is important to purchase a cancer/critical illness plan if they are going to go with MA.
 
BobbyMcGee said:
Anybody know what percentage of MA participants, nationally, regionally, whatever, hit their MOOP in any given year? In Fl., they generally range from 3400 to 6700, unless, of course it's a SNP, Dual, etc.
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I can tell you based on anecdotal feedback from my book of business,which would statistically would be enough clients to comprise a scientific random sample, that it's a very small percentage.

Again this is not scientific and I don't know about every one of my clients but of the of the ones I do talk to about 5-10 of my clients that do hit their moop.Most of my MA clients are on a plan with a 4900.00 Moop so my personal experience has been much less than 5%

Now I do know that every one of my Medicare supp client hit their Minumum Out of Pocket every year which in Fl is on average about $ 3000.00. when you include the part D premium.
 
Thanks. That's what I was looking for. Doesn't seem be a good source for this data, so that's why I came here to get some from agents.
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JayShinkle said:
I have been on this forum for years but my very first response. I am in the Kansas city area. MA's are Coventry, Humana and UHC in this town. About 60,000. I worked for Humana for 3 years and am independent now. I have about 350 clients. the clients that hit their Moop do it in 3 ways. Cancer, long skilled nursing or multiple long hospital stays. Cancer being the fastest (chemo). Chemo is the flaw in MA's. Most clients love MA's in my area but I always try to explain why it is important to purchase a side cancer policy for the MA flaw. I found a policy through GTL (Guarantee Trust Life) that I like to show. It is like a gap plan for MA. It is called Advantage Plus and pays a daily hospital benefit to fit the daily. Also, you can add up to a 10k lump sum cancer benefit and SNF. Just my two cents but people love MA in my area even though I like to sell a good plan N plan. I show both, explain both and let them decide. I am always a big fan of trying to explain why it is important to purchase a cancer/critical illness plan if they are going to go with MA.
Click to expand...

I have a similar approach with the MAPD's + Gtl. Cancer policies hard to come by in Fl.. Supps are great if they have the $ to pay for them.
 
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The MOOP here on the plans I represent is usually around $3900 or less. I have yet to have a client hit that figure because as you mentioned, most people that do fit within certain parameters, ie lots of hospitalizations, skilled nursing, or chemo. I even have a lady who acquired a strange immune deficiency from a bug bite in South America who is constantly getting infusion therapy every few months who has yet to hit it. In addition a large percentage of my folks are lower income, so most end up near medicaid if something bad happens.
 
One thing to look out for or educate your clients is that hospitals are keeping clients in outpatient observation They receive the same care but are not admitted. I have had clients with pacemakers put in had three day stay all outpatient. My father is a director of nursing for a nursing home. Told me they had three potential stroke clients turned down because they were outpatient at the hospital and did not qualify for skilled. The patient went home instead of paying the cash. As we move forward in the coming years I see this as a big deal. Clients can request to be impatient but if they are out patient gtl will not pay either on the advantage plus If they are outpatient more than likely they will hit the moop. Pacemaker in outpatient will hit the 5000 moop
 
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