Surgery Recommended Always a Knock Out?

yorkriver1

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1,734
Virginia
My client's spouse has MedSupp F, going up substantially. Says can't afford it. Is reluctant to schedule surgery for spouse due to no transportation.

I can't see any likelihood of a medsupp carrier saying yes to someone who has had knee replacement surgery recommended. Right?

My suggestion to them is to get help from local agency on aging for transportation.
 
Even if routine blood work was taken they would want to wait for results. Its just anything open and not complete will be a road block, If surgery therapy or test results
 
Does he have a Med Supp with a carrier who allows them to switch plans at any time without underwriting? There are a few out there.

He can't just get drop a Supp during Lock In for a MAPD without a SEP, such as qualifying for Extra Help, in some states a SPAP, etc.
 
Does he have a Med Supp with a carrier who allows them to switch plans at any time without underwriting? There are a few out there.

He can't just get drop a Supp during Lock In for a MAPD without a SEP, such as qualifying for Extra Help, in some states a SPAP, etc.

Why can't he just get drop a Supp during Lock In for a MAPD without a SEP, such as qualifying for Extra Help, in some states a SPAP, etc?

Is he different than other People who do drop Supp during Lock In for a MAPD without a SEP, such as qualifying for Extra Help, in some states a SPAP, etc?
 
Im not really sure what the question is now that I re-read it

If she is ALREADY in the Plan F they cannot refuse surgery

Not sure what the transportation issue is--to or from the Hospital?

If she can't afford a Plan F (and most people that are on them cant afford them) and the surgery does not have to be done in the next seven months, switch her to MAPD

OR if she has an SEP like Low income subsidy she can change now
 
I've talked a few clients out of dropping their Med Supps for a MAPD. After explaining the MAPD co-pays, MOOP and that physical therapy (except for one Aetna PPO in my area) visits are charged a specialist co-pay per visit, they opted to keep their Supp.
 
Plan F and a PDP from age 65 to 75--Premiums close to $30,000

MAPD for age 65 to 75--many are $0 premium

Over ten years 40 PCP visits $800
10 Specaialist visit $500
One Hospital stay two days $700
One hospital stay five days $1500
One hospital stay 21 days, ten days Rehab, 60 days home health $1800
Misc other charges say $500

Total expenditure MAPD $4800

Savings to someone on Social Security of over $25,000

I sell Med Supps to
* Clients with two homes (MAPD cannot have two PCPs)
* Clients with NUMEROUS Chronic conditions
* Clients that are rich as hell
* Clients that live in an area with no MAPD available
* Clients that cannot grasp how an MAPD works
* Clients that have NO risk tolerance

Woman with a Plan F from Billy Bob Life (some outfit I never heard of) was paying, with her PDP, over $4000 a year. She came to an MAPD meeting, WHY I dont know.

"But if I had the Advantage plan I'd never go to the Doctor!"


"OK I'll bite--why would that be?"

"Well it costs TEN DOLLARS to see the Doctor!"

"OK Ma'am I just want to be sure you understand---you are paying $4200 a year for the luxury of NOT paying ten dollars for an office visit?"

"Yeah but I dont pay ANYTHING now!"

"Ok ma'am we appreciate you coming, this plan, AND the plans from ABC, PDQ and BFD that you might see meetings for, are NOT for you. So keep your current plan and DONT go to those meetings. Thank you for your time"
 
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