More insurance brokers would choose traditional Medicare over Medicare Advantage: Report

[kgmom219]

Curious as to why no level funded groups? I have a few. All fairly healthy. All getting a refund every year while saving a substantial amount over fully-insured plans. All of mine are with Aetna. What don't I know that I should know?

I totally get the savings.

I also had 2 very normal pregnancies that wound up with $100K+ NICU bills.

Its like Medicare Advantage vs Original Medicare. Everything is great when you are healthy. What happens when (not if) and its not? Do you have the cash flow, even with stop loss insurance, to survive?

 

[sman]

I totally get the savings.

I also had 2 very normal pregnancies that wound up with $100K+ NICU bills.

Its like Medicare Advantage vs Original Medicare. Everything is great when you are healthy. What happens when (not if) and its not? Do you have the cash flow, even with stop loss insurance, to survive?

What cash flow is needed? Are you talking about the individual person who has large claims? I mean, the deductible, coinsurance and MOOP is the deductible, coinsurance and MOOP. How is that different than a fully insured plan? A person with a $100k claim on this plan would be responsible for the MOOP. No different than a fully insured plan.

Sure, a large claim shows up in their rate increase at renewal. But isn't that the case with fully insured plans too?

Maybe we're looking at different "animals". If I'm missing something, I'd love to know. Certainly don't want to cause harm to a client.

 

[Russ]

I totally get the savings.

I also had 2 very normal pregnancies that wound up with $100K+ NICU bills.

Its like Medicare Advantage vs Original Medicare. Everything is great when you are healthy. What happens when (not if) and its not? Do you have the cash flow, even with stop loss insurance, to survive?

My annual OOP is $3900. I can pay it. I'm 65. Tobacco user. It would cost me $250-$300 a month at my age for supplement and PDP, so I would be paying almost as much as my OOP on MAPD.

Off topic....there's an SEP in Florida thru July 31st for illegal migration. That should be continuous

 

[Chazm]

Here's a problem with med-supps....Alabama just went up nearly 10% on supplements starting in June with UHC. Plus Alabama is attained age rates. I'm sure Florida will follow suit.

G is going up 4.5% in most areas here. I’m happy that it wasn’t bad. Just announced today

 

[scagnt83]

Curious as to why no level funded groups? I have a few. All fairly healthy. All getting a refund every year while saving a substantial amount over fully-insured plans. All of mine are with Aetna. What don't I know that I should know?

My big issue is being forced to switch if the sh*t hits the fan.

For a really small group, say under 10. A single large claim could cause rates to spike severely. When that happens, suddenly the fully insured option makes more financial sense. Which means the employer will be forced to switch back to their old fully insured plan... not a fun thing if you just sold them on these lower premiums a few years ago.

A larger group can absorb the occasional large claim better than a small group can. So it does not impact rate increases nearly as much.

 

[scagnt83]

What cash flow is needed? Are you talking about the individual person who has large claims? I mean, the deductible, coinsurance and MOOP is the deductible, coinsurance and MOOP. How is that different than a fully insured plan? A person with a $100k claim on this plan would be responsible for the MOOP. No different than a fully insured plan.

Sure, a large claim shows up in their rate increase at renewal. But isn't that the case with fully insured plans too?

Maybe we're looking at different "animals". If I'm missing something, I'd love to know. Certainly don't want to cause harm to a client.

Im not sure either. But I think some of the old SL policies had caps on them and the employer was on the hook for it over a certain amount. Or some of them had cost sharing requirements to some extent. idk.

From what ive seen, most now are not capped. They just make up for it at renewal.

---

And I think that all fully insured small groups are now treated as one big block of biz at renewal in all states. They have to be over a certain size for group specific renewals.

Its certainly the same with large groups. But I dont think the chance of increase is nearly as high with fully insured, level funded can have a much steeper increase.

 

[somarco]

I don’t think most agents sell MAPD exclusively.

Yeah, but I actually said exclusively OR their GO TO product.

Based on things I see those that use MAPD as their default product do so because . . .

They earn a higher FYC on MAPD vs Medigap
More opportunity to x-sell other lines
They don't have to ask the prospect for money up front
They don't understand how access to care might be a "thing" for some folks
They don't really understand the downside risk of MAPD as a 24/7 lifetime option
They know how to say "Would you rather pay $100+ per month or $0?"
They never learned how to ask questions to find out what the prospect wants

They really don't know how to offer a plan that is not managed care, has a premium, and doesn't have non-health insurance add-on cover

 

[Midlevel]

Based on things I see those that use MAPD as their default product do so because . . .

They are good agents and present all options to their clients
They don't use scare tactics to sway them one way or another
They educate the client about Dr networks and make sure all are in
They run their prescriptions and show them both the lowest stand alone and MAPD
They tell them is they want just the absolute best health insurance only, take Med Sup
They have hundreds of people on MAPD's that love them and refer people weekly
They tell them about the dental, vision, gym, OTC, hearing aids
They ask the client which way they would like to go and write the plan chosen

 

[somarco]

@Midlevel . . .

Keep in mind that "cost" plans only exist in a few areas . . .

In 2019, the federal government began discontinuing Medicare Cost plans in counties where two or more Medicare Advantage plans are available.

Medicare Cost plans are offered in only a handful of states and have largely been phased out in most parts of the country. According to March 2022 data from the Centers for Medicare & Medicaid Services, individuals were enrolled in Medicare Cost plans in these states:

California.

Illinois.

Minnesota.

New York.

Wisconsin.

Additionally, these states have confirmed they offer Medicare Cost plans in certain counties for qualifying individuals:

Iowa.

Nebraska.

Virginia.




Would you offer Medigap as an option if "cost" plans did not exist in your area?

Which would pay you more in FYC? Medigap or cost plans?

 

[Midlevel]

@Midlevel . . .

Keep in mind that "cost" plans only exist in a few areas . . .

In 2019, the federal government began discontinuing Medicare Cost plans in counties where two or more Medicare Advantage plans are available.

Medicare Cost plans are offered in only a handful of states and have largely been phased out in most parts of the country. According to March 2022 data from the Centers for Medicare & Medicaid Services, individuals were enrolled in Medicare Cost plans in these states:

California.

Illinois.

Minnesota.

New York.

Wisconsin.

Additionally, these states have confirmed they offer Medicare Cost plans in certain counties for qualifying individuals:

Iowa.

Nebraska.

Virginia.




Would you offer Medigap as an option if "cost" plans did not exist in your area?

Which would pay you more in FYC? Medigap or cost plans?

Not once did I mention Cost plans in my post. I said I tell them if they want just the best medical coverage choose a Med Sup. Cost plans are great for someone stuck on a high priced Med Sup but can’t qualify to switch and don’t want an MA plan. No health questions except ESRD.