No MOoP, Mirage MOoP, Classic MOoP --What's In Your Wallet?

Oct 15, 2007

  1. MedSuppPro
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    If your out selling MA's, and the plan your recommending has NO Max Out of Pocket (MOoP), then you better make sure your E&O is up-to-date. Especially, if you have access to a plan that does.

    Or, are you showing prospects the plan with a MOoP Mirage? Mirage wording like: “Contact the plan for services that apply.” This should be on the David Letterman Show for the top 10 reasons to not trust you MA carrier. What?

    So, your sitting in a prospective client’s house, and then you open up your new 2008 MA brochure, and get to the MOoP part that has the added language: “Contact the plan for services that apply.” Then what do you say?

    Can’t CMS standardize the MOoP's so that it is or is not?

    Personally, I like the good old fashion Classic MOoP language. I can explain this.

    What's in your wallet?
     
  2. Cenla Agent
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    The last time I looked Sterling had no Maximum OOP but I haven't seen their 2008 plan. In some areas Humana's HMO has one and in others it does not. It has been that way for years. I understand that in Fla. Humana would have a MOOP one year and United wouldn't, and it would be reversed the next year.

    IMO this would not be an E&O issue unless the agent insinuated that there was a Max. OOP. This is why it is so important to stick to the script and not to use any unauthorized selling materials. Now it is certainly a potential issue if they are currently enrolled in an MA plan that has a MOOP and you are presenting one that doesn't have one.

    If they're that interested in Max. OOP I'd recommend a supplement unless they can't afford it or cannot qualify. Of course Original Medicare has no Max. OOP at all, which is one reason why an MA plan is often a better option than having A&B only with no supp.
     
  3. retread
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    Hey guys, it would be helpful if, when speaking of "Sterling", you would say either "Sterling Life" or "Sterling Investors". To my knowledge, Sterling Investors does not carry MA plans, so by deduction, I assume you are talking about Sterling Life MA plans. :)

    Also, Med Sups, except for High deductibles and Select plans, do not have MOOP, just as Original Medicare. Just my two cents. (and as someone else has said "with taxes, that will be $1.95):laugh:
     
    retread, Oct 16, 2007
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  4. midwestbroker
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    So, can some sue Medicare since they have no MOOP either?

    That should be covered in the SOB under the first benefit. If the agent does not cover it, or the client feels like they were misinformed, they can appeal to Medicare and get a SEP to change plans.
     
  5. MedSuppPro
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    I Just received my 2008 Coventry Advantra Freedom PFFS SOB (Statement of Benefits) and on pg. 41 it clearly states "ALL". Not half a loaf. "ALL"

    "Out of Pocket limit applies to ALL covered plan services except part D..."

    Now, that's as good as it gets.
     
  6. Cenla Agent
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    Well, since MA was the topic of discussion, your deduction was correct :)

    You are technically correct about supps, but they do pay the difference for the gaps the supp fills in, leaving the member with nothing out of pocket. So unless it's something not covered by Medicare, the supp will pay the difference.
     
  7. midwestbroker
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    That is why Coventry is getting ready to dethrone Humana in KC as the largest insurer of seniors with MA plans.
     
  8. Cenla Agent
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    No MOOP for Humana in KC?
     
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