Status of PFFS Plans

[dlvhi]

I was told by someone today that PFFS plans are going away after 2013.

I reviewed available information and see the 2012 requirement that PFFS plans in an area where there are two or more network plans must have a network themselves.

in other words, many PFFS plans were faced with the choice of getting a network or going away. But I don't think all PFFS plans go away after 2013.

I think she may have been confused with Cost plans, which do go away after next year....

Anyone know the answer for sure on PFFS plans after 2012?

Thanks

 

[pbbaseball]

there are still several places that have PFFS next year. if I had to guess, just in NC, we have probably 10-15 counties with PFFS options for 2013

 

[dlvhi]

Thanks for the reply. Where I am we have one PFFS for next year, they developed a network in order to be able to do that. It might be a good option for some people, but didn't want to spend too much time on if all PFFS were going away after 2013.
I think the info I was given was wrong....

 

[Stephen]

I think that I remember hearing that PFFS plans had to have a network by 2013 or go away, but don't quote me on that.

 

[Dowejonez]

It might be a good option for some people, but didn't want to spend too much time on if all PFFS were going away after 2013.
I think the info I was given was wrong....

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There are going to be some people who will benefit from having a stand alone PDP coupled with the PFFS plan.

In a sense all of the MA/MAPD plans go away every year, as they are all on a yearly contract.

Adding the network qualifier to them gives your client at least some providers to be able to count on

 

[SportsNut]

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There are going to be some people who will benefit from having a stand alone PDP coupled with the PFFS plan.

In a sense all of the MA/MAPD plans go away every year, as they are all on a yearly contract.

Adding the network qualifier to them gives your client at least some providers to be able to count on

I guess I don't see why anyone would benefit from PFFS and PDP vs. MAPD, at least in metro areas. Maybe more rural, not sure. In fact of the comparisons that I've done in the past two days for Rx the MAPD plans are blowing away stand alone PDP's in a big way. BIG cost savings on Rx in the MAPD plans over the stand alone PDP's... I am surprised.

Yep, MAPD plans go away every year but so do PFFS plans too, or at least can contractually chg just like any other MA plan... it is an MA plan after all. Of course Medicare itself is a PFFS system, but not to be confused by the PFFS MA plans that we are discussing here.

By adding the network qualifier are you merely converting the PFFS plan into a PPO...? In network discount and out of network the provider can decide if they will take it or not... so this would be a slight diff to PPO for out of network. Seems that providers are moving away from accepting the PFFS MA plans; it has been written about on here as well as seeing it in the rural areas. PFFS needs to go away IMO.

 

[Stephen]

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There are going to be some people who will benefit from having a stand alone PDP coupled with the PFFS plan.

In a sense all of the MA/MAPD plans go away every year, as they are all on a yearly contract.

Adding the network qualifier to them gives your client at least some providers to be able to count on

The problem with a stand alone PFFS with a PDP is that the retention rate is just so crappy. Without having to go out and find a new drug plan it is just too easy to have a change of heart and go back to original Medicare.

 

[Dowejonez]

The problem with a stand alone PFFS with a PDP is that the retention rate is just so crappy. Without having to go out and find a new drug plan it is just too easy to have a change of heart and go back to original Medicare.

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So if your client has an odd drug list, and she saves an extra $300 using the stand alone PFFS / PDP over the next best choice which happens to be an MAPD, you will write her up on the MAPD with the better retention rate?

 

[pbbaseball]

depending on where you live, some ma only pffs plans have part b buy downs. i had several in sc last year, where i put them on america's first choice, which had a $20 buy down part b rebate, and then used that $20 to buy a $24 first health pdp plan, so they got all their tier 1 generics for free (plus the $4 premium). afc didn't have the greatest drug plan last year down there. don't overlook options like that if those plans are available.

another good angle for those is for those is some will offer tier 1 drugs for free through the mail, so for those customers with a LIS, you might be better off putting them on a pdp/zero premium ma only pffs combo, and then using the LIS money to pay for the pdp plan. Of course use medicare.gov to make sure the pdp that you put them on will be zero for them, as all plans don't work well with the LIS

 

[Stephen]

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So if your client has an odd drug list, and she saves an extra $300 using the stand alone PFFS / PDP over the next best choice which happens to be an MAPD, you will write her up on the MAPD with the better retention rate?

If you feel the need to put words in my mouth that I haven't said, while using a very hypothetical scenario, then I must have offended you, and for that I apologize.

I never said that there is no benefit at any time to a stand alone PFFS plan anywhere in the country, I simply stated the fact that retention rates with stand alone PFFS plans are not very good which should also be taken into consideration.