- 19,666
It really depends on your area. Here in rural western Ky and southern In., PFFS were gold.
I wrote over 800 MA plans from 2006 thru 2008. I did not participate in this last AEP. All but 2 of those plans were PFFS. Most were stand alone PFFS, probably about 85%.
There is no network for PFFS. If a doctor or hospital takes the card and treats the patient, they are a "deemed" provider. However, they are only deemed for that one visit. They can refuse to treat that patient and they can treat that patient today and refuse to treat that same patient tomorrow. In areas where that happened, PFFS should not be sold. Until March of 2009, I could comfortably tell every single one of my clients that, if they had a doctor tell them that they would not accept the PFFS, they would be the first to have that happen. In March of 2009, a small clinic in Hopkinsville, Ky put up a sign that said "We will no longer accept PFFS plans from any company". They are still the only one that has taken that action. We have the largest medical provider in western Ky right in my area. They have almost 200 doctors in their facilities. They will accept PFFS plans from any company including Humana. I say including Humana because that same facility will not accept Humana's PPO.
We only have a handful of PPO's in the area, Humana, Anthem and a trial Today's Options PPO in a couple of counties. We have only one MA HMO plan and it's also in limited counties, none of those in Ky.
With that level of acceptance, PFFS were all the rage. You still can't get people to switch from a PFFS to a med sup unless the PFFS really raided their premiums like Today's Options did in Daviess County, Ky. They went to $104/mo for a stand alone MA PFFS and they cut benefits. The people there that could qualify for a med sup flocked to them in droves. The ones that couldn't went with Humana's PPO for $45/mo. or Sterling's stand alone PFFS for $39/mo.
The MA plans will slowly die out here as the PFFS plans go away. The people of this area nor the medical facilities of this area are keen on PPO or HMO plans. Most of my clients that were on Wellcare and Coventry plans chose to do without a plan when those plans ended on Dec. 31. Of course most of the Wellcare were full duals and there really wan't anything for them to go to. Wellcare was the only plan for them to start with.
I tell every client that a med sup is the way to go if they can pay the premiums. Most still chose the PFFS plans because they could save money and we didn't have the horror stories about non acceptance that were prevalent in other parts of the country.
I quit selling them because of CMS sales prevention rules and the companies collusion with CMS on those rules. Sticking their hands in my pocket was also a huge factor. The plans are just too labor intensive for what an agent gets paid. Even though we didn't have the problems of non acceptance, you still had to cover that possibility in detail with people. That scared them to the point that they spent many unneccesary worries over the possibility.
PPO/HMO plans would be much easier to explain and service if we had those options.
I'm one of the few in this area that quit dealing with them. I know some agents that had their busiest AEP yet and all they sold were PFFS.
The bottom line is that one must know the landscape for where they sell. If one doesn't know the area well, sell only med sups there because they are safe. I wouldn't begin to go to the Nashville, Tn. area, {only 100 miles from me}, and try to sell PFFS plans because I don't know how they are accepted there.
