Shark proof

[somarco]

I join the ranks of my clients next year

That gives you a completely different perspective from the youngsters selling a product they may not need for years.

I was 60 when I shifted to the Medicare market and had seen enough (too much, really) of how managed care (mangled care) negatively impacted the lives of the policyholders and covered participants.

One of my younger clients had a PPO plan (major med, this was long before MA plans existed). She was in her 30's and developed complications from her pregnancy. After spending 2 weeks in the hospital and undergoing numerous transfusions she was discharged and allowed to go home. Strict bed rest and daily supervision by a nurse for the next 3 months.

Her major med carrier balked at paying for "home health care" until I intervened. Several phone calls to folks in claims, medical oversight, marketing, etc resulted in the carrier reversing their decision and agreeing to cover home health which would include more transfusions.

This should not have required any outside intervention. A simple review of her claims and medical notes should have been obvious that her medical care was necessary.

This is a long way of saying I have good reason to want to avoid anything to do with managed care plans and why I crusade for the simplicity of OM because of the lack of government and carrier interference with health care needs of the patient.

Swiping from @DS4 . . . "The most valuable commodity I know of is information" Gordon Gekko

@mkblinzler your experience and knowledge will continue to help you relate to the folks who need someone with real world experience, not just a 10 day course in how to give away free stuff.

 

[Special Agent]

That's weird - Advantage/Select plans didn't exist until 1997. I, too, started with Combined, 1993 for me.

Health Plans - General Information | CMS

This page is an overview of the Health Plan General Information page.

www.cms.gov

The history of Medicare Plus Choice, now known as Medicare Advantage (MA), includes the following events:

• 1970s
  Beneficiaries could receive managed care from private insurance companies.
  
  
  
• 1997
  The Balanced Budget Act (BBA) established Medicare Part C, also known as Medicare+Choice (M+C), which allowed Medicare HMOs to participate. The BBA also authorized CMS to contract with public and private organizations to offer a variety of health plans.
  
  
  
• 2003
  The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) renamed the M+C program to Medicare Advantage (MA). The MMA also added a prescription drug benefit (Part D) to Medicare.
  
  
  
  

  A Brief History of Medicare: Medicare Advantage | RetireMed®

  The roots of Medicare Advantage (also known as Medicare Part C) go back to the 1970s.

  www.retiremed.com

 

[Fisher]

not just a 10 day course in how to give away free stuff.

A very accurate description of a lot of nonsense I've seen for the last 5-7 years or so.

 

[Fisher]

The history of Medicare Plus Choice, now known as Medicare Advantage (MA), includes the following events:

• 1970s
  Beneficiaries could receive managed care from private insurance companies.
  
  
  
• 1997
  The Balanced Budget Act (BBA) established Medicare Part C, also known as Medicare+Choice (M+C), which allowed Medicare HMOs to participate. The BBA also authorized CMS to contract with public and private organizations to offer a variety of health plans.
  
  
  
• 2003
  The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) renamed the M+C program to Medicare Advantage (MA). The MMA also added a prescription drug benefit (Part D) to Medicare.
  
  
  
  

  A Brief History of Medicare: Medicare Advantage | RetireMed®

  The roots of Medicare Advantage (also known as Medicare Part C) go back to the 1970s.

  www.retiremed.com

That RetireMed article has an inaccuracy or two.

-- What is the source of their 'managed care in the 70s' statement?

-- Part D coverage was not available until Jan 1, 2006. Their MMA wording is misleading.

 

[Special Agent]

That RetireMed article has an inaccuracy or two.

-- What is the source of their 'managed care in the 70s' statement?

-- Part D coverage was not available until Jan 1, 2006. Their MMA wording is misleading.

Not sure what they called it but in 1992 in Florida Humana definitely had a contract with CMS to provide privatized medicare plan that only sold by Humana captive agents.In 1997 Humana started calling it Medicare Choice and although they still only used captive agents to sell it they would pay independent agents 100.00 referral commish which i earned quite a bit of.The first time i actually ever enrolled someone in a medicare choice plan myself was about 1998 with a company called PCA Medicare in Florida.That was the very beginning of a Medicare Choice plans using non employee agents to sell these in these plans as far as i know.

 

[Fisher]

Stay on track - What is the source of their 'managed care in the 70s' statement?

 

[rmhaire]

That RetireMed article has an inaccuracy or two.

-- What is the source of their 'managed care in the 70s' statement?

-- Part D coverage was not available until Jan 1, 2006. Their MMA wording is misleading.

The reason we don't see much about MA back in the 70's is because there wasn't any.

The closest thing back then were the so called Select Plans offered by the supplement companies. It was their first attempt at networks and it went over like a lead balloon.

On the U65 side, we had hospitalization plans. A lot like a HIP plan today but with a $25,000 or $50,000 max.

I remember the first million dollar major med that came out. We thought that was the coolest thing since sliced bread.

 

[Special Agent]

Not sure what they called it but in 1992 in Florida Humana definitely had a contract with CMS to provide privatized medicare plan that only sold by Humana captive agents.In 1997 Humana started calling it Medicare Choice and although they still only used captive agents to sell it they would pay independent agents 100.00 referral commish which i earned quite a bit of.The first time i actually ever enrolled someone in a medicare choice plan myself was about 1998 with a company called PCA Medicare in Florida.That was the very beginning of a Medicare Choice plans using non employee agents to sell these in these plans as far as i know.

You ever heard of the medicare trust fund ? That's how it was financed just like MA just a different name

 

[somarco]

I remember the first million dollar major med that came out. We thought that was the coolest thing since sliced bread.

Seems like Pan Am had a major med in the late 70's. A $500 deductible comprehensive major med plan with a $10 or $15 monthly premium. I couldn't give those plans away. No one could ever imagine incurring that much in claims in a year so no need to buy the plan.