T65 with Rheumatoid Arthritis...

[windi]

Hope I can get some advice here...

I have a lady turning 65 who has RA. She's been on the same medication for 10 years and suddenly it isn't working anymore. Sounds like she might be put on Embril, which is know is expensive, to say the least...

I met with the couple, and the husband has BCBS. He's decided that she should get BCBS as well, damn the cost, because he knows the name and feels more comfortable with them. I tried hard to get through his thick skull that any of the supplemental companies would work and I could get them much better rates somewhere else AND that she will never be able to change to another med supp after her OEP is done, but he's adamant. Fine, his money.....

Here's the deal though, they spoke with her doctor yesterday and her doctor was spinning all this BS about how expensive it was going to be and how she may have to have infusements at the hospital instead of self injecting and they were going to have to pay this money and told them that her dad, who is T65, and just diagnosed with cancer last month, got this plan where he's paying like $800 a month and getting it all covered. Naturally, they call me up and ask me how expensive this was going to be for them and whether they should follow their doctor's advice...

Now, I'm fairly new at this, but won't Plan F cover all that? Even if she does have to go to the hospital or doctor's office for injections or infusions or whatnot? I don't want to assure them it's all covered and then find out they will have out of pocket expenses I don't know about!


Also, they are trying to figure out what PDP would work for them. Now, I don't sell it, and they had some guy print out the papers from Medicare.gov with each of the three drugs she *may* be on, so they'd know how much it cost. That's the best I know would know what to do. Obviously, their big fear is picking a PDP and paying too much, and picking the BCBS Plan F, and still incurring lots of OOP expenses.

And no, I don't have the name of whatever insurance their doctor is putting her dad on (or has put her dad on) but it sounds to me like the doctor has no idea about med supps and how they work. Am I wrong?

Again, I know I sound pretty ignorant, but I've been doing this for a grand total of 2 months! So bear with me!!!

 

[MrMack]

Also, they are trying to figure out what PDP would work for them. Now, I don't sell it, and they had some guy print out the papers from Medicare.gov with each of the three drugs she *may* be on, so they'd know how much it cost. That's the best I know would know what to do. Obviously, their big fear is picking a PDP and paying too much, and picking the BCBS Plan F, and still incurring lots of OOP expenses.


They can talk with a local pharmacist and run a list of drug plans. Good news is they can switch in a few months if it is not working well for them. Oct. 15 - Dec. 7 for a Jan. 1 effective date. Also in your area if there are any 5 STAR drug plans then they can switch the very next month. You can determine this by going to www.medicare.gov and entering zip code. Drug plans will change every year and likely they will take different drugs as well. This can be changed often.

 

[Chazm]

I kind of got lost in reading what you are saying but if she's getting some procedure done that the doctor is recommending then it will be covered by medicare and the med supp.
No reason to pay $800/month to get that covered.

 

[senior-advisor-indiana]

It will actually be cheaper for her to get injections at the hospital than paying for them under Part D.

 

[billyg]

It will actually be cheaper for her to get injections at the hospital than paying for them under Part D.

True, so long as the RA treatments are a qualified Part B expense, which they likely are if they are required to be administered in a medical office. I have 3 or 4 clients in this situation. You can have the DR confirm.

 

[G.Gordon]

The first fact is that you don't have control of the situation. They are not buying YOU or your product. Game over. Next!

If someone is already dead set on going the other way why are you still working on it?

 

[windi]

The first fact is that you don't have control of the situation. They are not buying YOU or your product. Game over. Next!

If someone is already dead set on going the other way why are you still working on it?

They are buying the med supp from me. That's not the issue so much as them wanting verification that going with a plan f will actually cover their expenses, because the doctor seemed to think they'd have other charges.

They are not buying a PDP from me because I don't sell them, I was just hoping that someone had experience with PDPs and could give me advice to pass on to them.
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It will actually be cheaper for her to get injections at the hospital than paying for them under Part D.

That's what I was thinking as they were telling me all this! But I wasn't going to say that without being sure of it.

I'm meeting with the gal who's been helping get started tomorrow so I'll be running this by her as well. I do appreciate the feedback!
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They can talk with a local pharmacist and run a list of drug plans. Good news is they can switch in a few months if it is not working well for them. Oct. 15 - Dec. 7 for a Jan. 1 effective date. Also in your area if there are any 5 STAR drug plans then they can switch the very next month. You can determine this by going to www.medicare.gov and entering zip code. Drug plans will change every year and likely they will take different drugs as well. This can be changed often.

Thank you! That's a good idea and I'll let them know...she is relieved that she will have a chance to change it at the end of this year if she needs to...

 

[Midlevel]

U really need to start contracting for PDP's so you can help the client with all of their Medicare needs. Just gives other agent's a real good way to take your client's Med Sup or MAPD while they help her with her Prescription Drug Plan. I can't imagine telling a client I don't do PDP's because they are too hard to keep up with or I don't get paid enough. Nobody likes doing them but I believe they are part of our job as agents.

 

[windi]

U really need to start contracting for PDP's so you can help the client with all of their Medicare needs. Just gives other agent's a real good way to take your client's Med Sup or MAPD while they help her with her Prescription Drug Plan. I can't imagine telling a client I don't do PDP's because they are too hard to keep up with or I don't get paid enough. Nobody likes doing them but I believe they are part of our job as agents.

Not saying I won't contract to do that, but I haven't yet. I am just BARELY in the business, and not just the senior business, but insurances, sales, any of it..... I was a stay at home mom for years and before that worked in the horse industry, teaching therapeutic riding to handicapped people.

All of this is overwhelming to me and I decided that I'd keep it simple by getting started just in Med Supps until I got more comfortable, and then branch out from there. I am just starting to research and learn about FE, and will also consider PDPs and MA. Quick question, and this shows how new I am, do I have to be licensed in MA to do PDPs? Actually, I'll just ask the lady who's been helping me. I see her today and we are talking about my next step in training.....

 

[G.Gordon]

YOU can help with PDP selection by running the drugs on Medicare.gov and being the "complete" authority on the matter of Medicare related insurance in their eyes. Even if you are not "contracted" with the plans.
Sorry for earlier, it was not clear that you were writing the BCBS product. I've written folks on what they say they want in the face of facts presented them on the standard design and function of Medicare supplements. Some times their comfort level is worth a few bucks.

I do agree with others. Any injections done at a hospital that are medicare approved will be paid at 100% between the two insurances. Be respectfull and calmly say that you are not a doctor and the doctor is not a licensed insurance agent that works with Medicare related insurances. Go on to say that most doc's never see the billing process or even know which plans their own office accepts without asking their billing dept themselves. Not a dig at the doc, but a statement of fact backed by experience.