I am starting a fresh thread on this subject rather than replying to some other post and having it buried.
I am not one to declare "PFFS" is dead. I think they will live on because of why they were developed to begin with, and that is to serve the rural population. The problem has been the way some agents have presented them.
The future for PFFS is that carriers will be required to have at least one PFFS plan contracted to a network in areas where more than one other MA network exists. IOW, a county has two MA networks: in this case, the PFFS carrier must contract with providers for a network, but can still offer an additional PFFS plan without a network (deemed provider contract) -- same plan as currently offered. The options for beneficiaries increase, since they now can choose plan 1 (networked PFFS) or plan 2 (deemed- no network- PFFS) as well as the other two competitors.
In more sparsely populated counties where there is either no network MA or only one to choose from, the PFFS carrier can offer only the deemed contract (no network) PFFS plan. I see this as a good attempt to help provide health insurance to all seniors. Med Sups are usually also available to those that can qualify and afford them.
I live in a metro area and find the HMO/PPO MA plans are most popular (and more viable) than PFFS. However, I came across one incident just last month in which one of the most highly reputable surgeons' practice (and most expensive) in the Midwest did not accept the PPO plan, but did accept the PFFS version from the same carrier.
I also know that an HMO/PPO plan will not help if you want the services of the Mayo Clinic, which is not only out of the "service area" but also demands the ability to "overbill". If I offer a Med Sup, I need to query/listen to the client and try to determine if they need a plan D or plan F. If, for example, they think they will want to use Mayo Clinic, it is plan F. There is a lot to be said for supplemental policies that co-ordinate claims and leave the beneficiary with no additional costs other than monthly premium. Some people demand that, and if they can afford it and qualify health-wise... great!
For those that can afford a Med Sup, I also consider an MSA plan. It can be more cost effective than a Med Sup for well-to-do clients with a good health history and savvy enough to manage their health care costs. The benefits pay 100% (like Med Sups) but after a $2500 deductible on their health plan (which is softened by a Medicare contribution of $1250 to their MSA). This leaves their exposure to only $1250, or roughly equivalent to the annual cost of a typical Med Sup, but rather than pay a premium to a carrier, accumulate (at tax free interest) savings that roll over to the next year. Also, they can withdraw this Medicare-provided money (after deductible) for "qualified" (IRS rules) expenses that CMS rules don't allow for (such as dental bills, LTC insurance, etc.) Not everyone is thrilled with the idea of the $2500 deductible, but smart investors will love it, once they understand how it works. People that had HSAs before aging into Medicare will demand it. A couple of caveats: they must be truly retired... no working income. And, like Med Sups, they must enroll in a PDP. Furthermore, other than IEP, the only enrollment allowed is during the AEP. (There is no OEP for PDPs or MSAs.) Lastly, they cannot contribute to their MSA like HSAs, and it is Medicare's money, so if they disenroll from the MSA, they have to give it back.
All rules for health insurance seem complicated, but a professional agent can explain them simply, if he/she knows the rules solid. That is the essence of professionalism, making something that appears to be complicated seem simple. Professional ethics demand professional knowledge of your products.
All I am saying is, that an agent needs to be alert to all options that a beneficiary may want or need in order to provide the best health care coverage for their senior years, and not fall in love with only one option.
I am not one to declare "PFFS" is dead. I think they will live on because of why they were developed to begin with, and that is to serve the rural population. The problem has been the way some agents have presented them.
The future for PFFS is that carriers will be required to have at least one PFFS plan contracted to a network in areas where more than one other MA network exists. IOW, a county has two MA networks: in this case, the PFFS carrier must contract with providers for a network, but can still offer an additional PFFS plan without a network (deemed provider contract) -- same plan as currently offered. The options for beneficiaries increase, since they now can choose plan 1 (networked PFFS) or plan 2 (deemed- no network- PFFS) as well as the other two competitors.
In more sparsely populated counties where there is either no network MA or only one to choose from, the PFFS carrier can offer only the deemed contract (no network) PFFS plan. I see this as a good attempt to help provide health insurance to all seniors. Med Sups are usually also available to those that can qualify and afford them.
I live in a metro area and find the HMO/PPO MA plans are most popular (and more viable) than PFFS. However, I came across one incident just last month in which one of the most highly reputable surgeons' practice (and most expensive) in the Midwest did not accept the PPO plan, but did accept the PFFS version from the same carrier.
I also know that an HMO/PPO plan will not help if you want the services of the Mayo Clinic, which is not only out of the "service area" but also demands the ability to "overbill". If I offer a Med Sup, I need to query/listen to the client and try to determine if they need a plan D or plan F. If, for example, they think they will want to use Mayo Clinic, it is plan F. There is a lot to be said for supplemental policies that co-ordinate claims and leave the beneficiary with no additional costs other than monthly premium. Some people demand that, and if they can afford it and qualify health-wise... great!
For those that can afford a Med Sup, I also consider an MSA plan. It can be more cost effective than a Med Sup for well-to-do clients with a good health history and savvy enough to manage their health care costs. The benefits pay 100% (like Med Sups) but after a $2500 deductible on their health plan (which is softened by a Medicare contribution of $1250 to their MSA). This leaves their exposure to only $1250, or roughly equivalent to the annual cost of a typical Med Sup, but rather than pay a premium to a carrier, accumulate (at tax free interest) savings that roll over to the next year. Also, they can withdraw this Medicare-provided money (after deductible) for "qualified" (IRS rules) expenses that CMS rules don't allow for (such as dental bills, LTC insurance, etc.) Not everyone is thrilled with the idea of the $2500 deductible, but smart investors will love it, once they understand how it works. People that had HSAs before aging into Medicare will demand it. A couple of caveats: they must be truly retired... no working income. And, like Med Sups, they must enroll in a PDP. Furthermore, other than IEP, the only enrollment allowed is during the AEP. (There is no OEP for PDPs or MSAs.) Lastly, they cannot contribute to their MSA like HSAs, and it is Medicare's money, so if they disenroll from the MSA, they have to give it back.
All rules for health insurance seem complicated, but a professional agent can explain them simply, if he/she knows the rules solid. That is the essence of professionalism, making something that appears to be complicated seem simple. Professional ethics demand professional knowledge of your products.
All I am saying is, that an agent needs to be alert to all options that a beneficiary may want or need in order to provide the best health care coverage for their senior years, and not fall in love with only one option.
