Obama Coming After Medicare Advantage

[azmedsupagent]

One issue you don't hear much about is Medicare fraud. In my years as an agent one thing that burns my ears is when I hear clients say they don't get billed for the 20% because the were told by the doctor to ignore any extra services billed to Medicare that they did not receive because they will not be responsible for them. This is more widespread than you might think. MA plans will not double bill themselves. Once the government pays that capitation fee they shift the accountability to the private company. Yes there are issues with overpayment and that should be looked at, but fraud may be an even bigger issue.

That is absolutley correct, and infact I do believe the double billing issue was addressed in the most recent legeslation HR6331. I am not sure on the specifics of that portion of the bill. Just imagine how much more fraud there would be if medicare cut physician re-embursment rates. If they are getting paid less for there work they may be more inclined to get "the most bang for thier time" which could mean even more fraud and bending the rules.

 

[retread]

Sounds like you did an excellent job navigating the red tape for your client and they are lucky to have you as an agent Im sure...

But, what about the rest of it? Copays, deductibles,referrals, pre authorization, HMO capitation rates for doctors etc... what effect do you see funding cuts having on these aspects of medicare advantage?

I think there are many ways carriers can respond to lowered capitation rates... they are doing it already. 1) eliminate or reduce commissions to sales agents 2) raise premiums and/or copays, especially on plans that experience high utilization 3) shift costly drugs to a higher tier and/or raise tier copays... which is what I was combatting in my previous post 4) drop the "value added extras" 5) reduce advertising costs... with the arrival of "Baby Boomers" that are 'net-savvy, shift to internet and email rather than TV and direct mail.

Of course, if I were "King for a day", I would do things differently....

 

[azmedsupagent]

I think there are many ways carriers can respond to lowered capitation rates... they are doing it already. 1) eliminate or reduce commissions to sales agents 2) raise premiums and/or copays, especially on plans that experience high utilization 3) shift costly drugs to a higher tier and/or raise tier copays... which is what I was combatting in my previous post 4) drop the "value added extras" 5) reduce advertising costs... with the arrival of "Baby Boomers" that are 'net-savvy, shift to internet and email rather than TV and direct mail.

Of course, if I were "King for a day", I would do things differently....

It's definatley obvious that things will look alot different in a few years for MA agents and enrollees and it's probably not going to be good change for either.

Would anyone say that getting into selling MA plans as a new agent is not a good long term business plan? I mean whats the sense in building a business on something that may or may not be around in a few years. If you build up a few hundred MA customers they could all be looking to leave the program in a few years when companies have to start cutting back on benefits. Or when commissions get so low its not even worth selling anymore so now you have to try selling them a supplement with a premium which is probably what you where selling against in the first place...

Any thoughts on this?

 

[retread]

It's definatley obvious that things will look alot different in a few years for MA agents and enrollees and it's probably not going to be good change for either.

Would anyone say that getting into selling MA plans as a new agent is not a good long term business plan? I mean whats the sense in building a business on something that may or may not be around in a few years. If you build up a few hundred MA customers they could all be looking to leave the program in a few years when companies have to start cutting back on benefits. Or when commissions get so low its not even worth selling anymore so now you have to try selling them a supplement with a premium which is probably what you where selling against in the first place...

Any thoughts on this?

This only applies if your vision is myopic. Building a book of business is always a good thing. Having clients you can call on for cross-sales is handy while you are expanding into other areas. That is what I am doing. I don't think MA has a long life, and I have already taken steps to expand my horizon.

 

[azmedsupagent]

This only applies if your vision is myopic. Building a book of business is always a good thing. Having clients you can call on for cross-sales is handy while you are expanding into other areas. That is what I am doing. I don't think MA has a long life, and I have already taken steps to expand my horizon.

So keeping that in mind, do you think its right to put hundreds of people, possibly with un insurable pre-existing conditions, into a health plan that may not be available at sometime in the future making it nearly impossible to get back on a supplement?

 

[retread]

So keeping that in mind, do you think its right to put hundreds of people, possibly with un insurable pre-existing conditions, into a health plan that may not be available at sometime in the future making it nearly impossible to get back on a supplement?

Perhaps I should have said "short life for agent sales"... I am sure the carriers will be selling them by internet sales for quite a while. It will be much cheaper to do this.

Secondly, not knowing how long this program will last should not be a factor any more than not knowing how much longer the beneficiary will live. Many, I am sure, will outlive MA but in the meantime this is a good program and affordable for many low income seniors. Might as well take "Advantage" of it while it lasts!

The first victims to succomb will be agents. MAs will outlast us by a long shot.

And for those who think they are providing seniors with the only viable insurance, they need to think beyond their noses.... Medicare itself has a relatively short life span. Estimates are 2018 at the moment. Social Security is not expected to last much beyond 2050 or so.... The practical thing to do is help those in the here and now. Look at the economy! If Obama cuts out Medicare funding, it will have an impact on more than MA plans!

 

[midwestbroker]

If it all happens like this thread thinks it is going to, here is what I see happening:

MA plans will be sold like they were 10+ years ago: in major metro areas (HMO and local PPO plans), only a few plans will be available, and will be sold mostly by a captive sales force.

The brokers will still be part of the mix in areas where they have been for some time, but the amount of brokers will be far less (good for me).

Why still sell them?

1. Build a book of biz (as mentioned prior, it is always good to have a book of biz)
2. What else are you going to do with a 79 y.o that cannot pass underwriting for a supplement and has only original Medicare and wants more coverage?
3. You will have a 5 year window of renewals coming in while you are still selling other products.

We can speculate all day long, but who knows what will happen. The MA bubble is about to burst. So did the real estate market, but I still know real estate agents making money.

 

[jdeasy]

If it all happens like this thread thinks it is going to, here is what I see happening:

MA plans will be sold like they were 10+ years ago: in major metro areas (HMO and local PPO plans), only a few plans will be available, and will be sold mostly by a captive sales force.

The brokers will still be part of the mix in areas where they have been for some time, but the amount of brokers will be far less (good for me).

Why still sell them?

1. Build a book of biz (as mentioned prior, it is always good to have a book of biz)
2. What else are you going to do with a 79 y.o that cannot pass underwriting for a supplement and has only original Medicare and wants more coverage?
3. You will have a 5 year window of renewals coming in while you are still selling other products.

We can speculate all day long, but who knows what will happen. The MA bubble is about to burst. So did the real estate market, but I still know real estate agents making money.

This is pretty much how I see it as well. The PFFS will go by the wayside. That sucks for my area because that's almost all we have. Humana is dabbling with a PPO here that's not being met with much success. Of course, it's a normal terrible plan from Humana. The only other one available is Anthem's PPO. It's limited in availability and it's also a terrible plan. Just a very little better than not having anything. It is universally accepted where Humana's is not.

I used to work the Nashville, Tn area some. I think the HMO plans will survive there.

 

[Joe Moore]

So keeping that in mind, do you think its right to put hundreds of people, possibly with un insurable pre-existing conditions, into a health plan that may not be available at sometime in the future making it nearly impossible to get back on a supplement?

The companies would fight the complete demise of the MA program. If the plan goes by the wayside, this would give a SEP to enter into a Medicare Supplement, if desired.
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Secondly, not knowing how long this program will last should not be a factor any more than not knowing how much longer the beneficiary will live. Many, I am sure, will outlive MA but in the meantime this is a good program and affordable for many low income seniors. Might as well take "Advantage" of it while it lasts!

The first victims to succomb will be agents. MAs will outlast us by a long shot.

I think it goes to "doing your best with the tools you have to work with"
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If it all happens like this thread thinks it is going to, here is what I see happening:

MA plans will be sold like they were 10+ years ago: in major metro areas (HMO and local PPO plans), only a few plans will be available, and will be sold mostly by a captive sales force.

The brokers will still be part of the mix in areas where they have been for some time, but the amount of brokers will be far less (good for me).

I have trouble agreeing with the doom and gloom.

These plans are in place and for the most part, working. If Medicare is expanded to younger ages, you may actually see an expansion of this program. Even if not expanded to younger ages, I believe you will see a Standardized Drug Formulary, Standardized Benefits, with a lot less confusing comparisons between the plans.

I can see a move more to the Medicare Supplement type standards. Put the actuaries to work, and see what price the products can be sold for.

As far as independent agents being evicted from this program, I don't see it. We are having people coming 50 miles away to our office because they are having trouble finding knowledgeable people in their area.
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Perhaps I should have said "short life for agent sales"... I am sure the carriers will be selling them by internet sales for quite a while. It will be much cheaper to do this.

Granted, a few friends and children help online BUT

Retread, about 95% of our local clients don't have an email address.

About 90% don't have a computer.

About 80% would have trouble finding the "on" button. By having to go to the "start" button to turn it off, 99% of these would never be able to turn it off.

I believe it will be a while before the carriers try to go it alone online.

 

[GreenSky]

about 95% of our local clients don't have an email address.

About 90% don't have a computer.

About 80% would have trouble finding the "on" button. By having to go to the "start" button to turn it off, 99% of these would never be able to turn it off.

That's not surprising about TN. 83% of the people still use outhouses, 71% have no electricity, and 98% don't have a toothbrush (for their one tooth).

Rick