Part C

[dandan]

I'm sorry if you feel I'm bashing MA plans, I am more trying to understand them.

I mentioned a few of my concerns is all and just wanted your educated opinions.

I also went through certification with a company and was told Doctors may accept you as a patient with a PFFS, and if you go back a week later he can decide not to accept you, they said they can accept or not accept you at will.

A couple other Questions.
If you go on an appointment with hmm lets say BCBS and after doing the needs analysis you find Humana is a better fit what do you do?

If you have a client that only wants PDP and they don't offer to tell you what meds they take what do you do?

 

[dandan]

? anybody

 

[arnguy]

In the Philadelphia 5-County Metropolitan Area, MA plans have been around for many years and enjoy wide popularity. This is where US Healthcare started in business selling HMO's before they were sold to Aetna. Today there is heavy competition between Aetna and Blue Cross in the Part C arena. There are a few other players within the city limits of Philly. Most MA subscribers I know are happy with them. I understand that Blue Cross will be adding a PFFS Plan for 2008.

 

[midwestbroker]

Retread - You can contract with BCBS of Kansas City, but you have to go through a blue chip brokerage, like Financial Associates in Overland Park (that is who I have my contract through).

Dandan -

If you find that another plan is a better fit, then you should tell the client just that. I know agents who sell each MA plan here and will kick it to them, as they do the same.

With PDP, if they do not offer to tell you their drugs, just hand them the formulary and tell them they can find how they are tiered in there.

I have had only a couple of people that would not give me any info about themselves (like they were in a stand off). All you can do is review the benefits, tell them how to enroll and ask if that is what they want.

 

[senior-advisor-indiana]

If they won't tell you thier meds then tell them to kiss off. Its not worth the money to talk to them. They don't trust you anyway if they won't tell you that. I have never had anyone keep thier meds from me though.

 

[GreenSky]

If they won't tell you thier meds then tell them to kiss off. Its not worth the money to talk to them. They don't trust you anyway if they won't tell you that. I have never had anyone keep thier meds from me though.

Agreed. I've never met a senior who wasn't proud of all their medication!

By the way, you spell it "their". Just being helpful until the spell check is on line.

Rick

 

[senior-advisor-indiana]

I switch it up everytime..... Guess that one is wrong.

 

[Cenla Agent]

No, you're not the only one...but all too often, agents will place them in an MA plan before a regular supp. only to find out their client cannot get the care they had before, Medicare has been replaced and they are pissed off. Agent makes a bundle, though. Bad deal for the client...so I don't deal with them. In fact, I do the opposite...I get them OFF these plans and back to original Medicare and a good Part D.

See my post in this forum about the FBI raiding Wellcare...these things are about to explode, IMO.

As I've posted previously, there is almost no reason for someone to be in Original Medicare only vs. a PDP. Unless you are also selling these people a Medicare Supplement to replace their MA (which you did not specify here), you are almost always doing them a disservice unless they have Medicaid.

 

[dandan]

Midwest,
CMS does not allow comparing plans, so If I go in with a plan, I have to give a complete presentation. If during that presentation I realize a different plan is in their best interest I am not allowed to tell them.

This is a CMS regulation I'm confused about, and on the medication, CMS does not allow me to ask what meds they take.

 

[Cenla Agent]

Midwest,
CMS does not allow comparing plans, so If I go in with a plan, I have to give a complete presentation. If during that presentation I realize a different plan is in their best interest I am not allowed to tell them.

This is a CMS regulation I'm confused about, and on the medication, CMS does not allow me to ask what meds they take.

That is correct. Normally in the course of a presentation they will tell you. But if they don't, you are not allowed to ask them something like "what medications are you taking" because it could be seen as cherry picking. Likewise with MA you cannot ask "How is your health" "When was the last time you were in the hospital" etc.