The Future "O" Medicare Advantage Program

[Russ]

I'm not quite sure where you sell Medicare Supplement policies or who you are contracted with but I live in Missouri and I don't know of any company that is charging $200 to $300 per month for Med Supps. I wrote a policy today for a woman 65, non smoker for $95.03 per month. Her husband is also turning 65 and his premium is $109.32 per month. Both took a Plan D, that gives them all the coverage they need since virtually all doctors in Missouri "Accept Assignment". BTW, my commission on those is 23%.

I have suggested to several people who have called me and asked about MA plans that they take a close look at just having Medicare Parts A and B. Actually that is very good coverage for someone who says they can't afford a Med Supp.

MA plans have a MOOP of usually between $2500 and $3000 don't they? With only just traditional Medicare that amount of money will pay a lot visits to the doctor considering the patient will only have to pay 20% of what Medicare approves.

I have heard numerous agents say that the reason they put their client in a MA/PFFS plan is "because they are healthy". They also stated that if their client "wasn't healthy" they would have recommended a Med Supp.

That makes no sense to me. If they are "healthy", and that is the real reason for putting them in an MA plan then why take them away from traditional Medicare? I think I know why but I may be wrong.

LOL...that's a good point in your last paragraph and I thought of that too...why take them away from traditional Medicare? The most logical reason is...MA plans have a stop-loss....traditional Medicare doesn't under part B(20% co-insurance w/no limit).

I talked to a lady yesterday that had an MA plan w/Wellcare....her doctor is obviously in their network. She was looking for an alternative and I offered AARP Secure Horizons. Problem is, her doctor isn't in their network. She decided to stay where she was at...at age 90 I can't blame her. Asking someone to change doctors that she's happy with at her age is asking too much.

Problem is...no hospitals in her county are on Wellcare's network and she didn't realize that(how could she not???). I talked M of O med-supp....she's going to talk to her son about it. One of those that uses a 3rd party to make a decision. Maybe she'll call me.....odds of that happening...less than 5%.

Then again, maybe she will....she goes out-of-state 2-3 times a year to visit a sister with health issues and her MA plan would leave her owing 30% of the charges if something came up while she was out of state.

 

[Joe Moore]

I'm not quite sure where you sell Medicare Supplement policies or who you are contracted with but I live in Missouri and I don't know of any company that is charging $200 to $300 per month for Med Supps. I wrote a policy today for a woman 65, non smoker for $95.03 per month. Her husband is also turning 65 and his premium is $109.32 per month. Both took a Plan D, that gives them all the coverage they need since virtually all doctors in Missouri "Accept Assignment". BTW, my commission on those is 23%.

I have suggested to several people who have called me and asked about MA plans that they take a close look at just having Medicare Parts A and B. Actually that is very good coverage for someone who says they can't afford a Med Supp.

MA plans have a MOOP of usually between $2500 and $3000 don't they? With only just traditional Medicare that amount of money will pay a lot visits to the doctor considering the patient will only have to pay 20% of what Medicare approves.

I have heard numerous agents say that the reason they put their client in a MA/PFFS plan is "because they are healthy". They also stated that if their client "wasn't healthy" they would have recommended a Med Supp.

That makes no sense to me. If they are "healthy", and that is the real reason for putting them in an MA plan then why take them away from traditional Medicare? I think I know why but I may be wrong.

Frank,

In Tennessee, very few clients are paying the $2-300 I was talking about. But some that are in an old block of business that has been closed, or an aging block are paying this amount. About 10 years ago I ran into a 90 year old lady that had been in a plan for 15-20 years and it had gone to $435/month. She could medically qualify for an easy underwritten plan for around $220/month.

I was not talking about the age 65 folks, I was referring to the ones that had more years on them and the med sups had become too pricey to be close to affordable. As you well know, sometimes health conditions prevent moving from one company to another. Yesterday afternoon we had a call from a local drug store asking if we could help with two 78-year olds with serious medical issues; he CHF and facing some heart procedure next week, her continual oxygen and in a wheelchair. Their total med sup & Part-D premium was $570/month. They had their Medicare Supplement since turning age 65.

I was able to move them to a MAPD for a total premium of $162/month, their doctors were all in network and their drugs were all covered. Another bonus per www.medicare.gov, she would save about $2000/year on her drugs, and him about $1000/year. They were subject to a $2400 each maximum-out-of-pocket medical limit each.

This is the type of situation I was referring to. The Medicare Supplement had simply become too costly, the return to Original Medicare was really not an option with no maximum out-of-pocket. Without the MAPD option, these folks would have been up old the proverbial creek without a paddle.


Joe

 

[jdeasy]

I'm not quite sure where you sell Medicare Supplement policies or who you are contracted with but I live in Missouri and I don't know of any company that is charging $200 to $300 per month for Med Supps. I wrote a policy today for a woman 65, non smoker for $95.03 per month. Her husband is also turning 65 and his premium is $109.32 per month. Both took a Plan D, that gives them all the coverage they need since virtually all doctors in Missouri "Accept Assignment". BTW, my commission on those is 23%.

I have suggested to several people who have called me and asked about MA plans that they take a close look at just having Medicare Parts A and B. Actually that is very good coverage for someone who says they can't afford a Med Supp.

MA plans have a MOOP of usually between $2500 and $3000 don't they? With only just traditional Medicare that amount of money will pay a lot visits to the doctor considering the patient will only have to pay 20% of what Medicare approves.

I have heard numerous agents say that the reason they put their client in a MA/PFFS plan is "because they are healthy". They also stated that if their client "wasn't healthy" they would have recommended a Med Supp.

That makes no sense to me. If they are "healthy", and that is the real reason for putting them in an MA plan then why take them away from traditional Medicare? I think I know why but I may be wrong.

It's not uncommon here in Ky and In for people to be paying over $200/mo for their med sup. There are more in the $175/mo range than anything else, but, many are over $200. The highest I've run across is $280/mo. I had a lady call me yesterday that's paying a little over $200/mo for her med sup. I could change her to Admiral for $120/mo., but, she can't qualify healthwise and we don't have any GI periods in Ky after the initial 6 mo. window.

I'm seeing a couple tomorrow and the husband pays $190/mo for his med sup and the wife pays $175. That $365/mo for the two of them is just killing them.

In everyone of these cases, the coverage of a med sup is the best plan for them, but, if they can't pay the premiums, the coverage is not very good. MA plans are great for these people even with co-pays. MOOP is a non issue as every company says that less than 1% of the members even get close to the MOOP. I've got about 700 MA clients now and I've never had even one get anywhere near the MOOP. Even on the plans with a $1500 MOOP.

I wish we had a yearly GI period as Missouri does. Not only could people get out of costly plans, there would be more incentive for companies to be price competitive.

We don't have PPO or HMO plans here either. PFFS is the order of the day. Those are not a problem here either. From my nearly 700 PFFS clients over western Ky and southern In., the next one that tells me that their Dr. would accept their card will be the first. I generally even call the enrollee's Dr. at the time of enrollment just to be sure it's not going to be a problem. At one last week, the clerk said, "we take every PFFS plan out there, we will not take any PPO or HMO". My curiosity got the best of me and I asked about Humana, {even though I don't represent Humana, but, they are pushing this new PPO heavily in our area}. The lady said, "we take Humana's PFFS, we do not and will not take Humana's PPO".

It's all about the area you serve. I wish med sups were the order of the day here as I much prefer them. I wish there was a better alternative than PFFS. I suppose I could move, I am licensed in Mo. Since I chose to not move, I will offer what's best. I am only servicing my prior committments though. I am getting out of the MA market because of all this mess. I'm not taking any new leads from anyone. Once I'm through with my list of people that promised to call, which should be sometime next week, I will only discuss MA plans with people that call me. I will go back to FE and a little med sup business. If Ky were to ever come up with the same kind of annual GI that Mo. has, the med sup business would explode here. Maybe that will happen anyway when the PFFS plans go away in 2011? I'm hoping that those people are all granted a GI period for that

 

[GreenSky]

I'm not quite sure where you sell Medicare Supplement policies or who you are contracted with but I live in Missouri and I don't know of any company that is charging $200 to $300 per month for Med Supps.

Frank:

For theose under 65, an MA may be the only option other than just Medicare. Some states don't even have the availablity of supplements for underage, and if they do, can be very pricey.

In California (as you know, the only state that matters), companies must write plans for all ages. In LA County, the cost for an underage beneficiary is about $250 for Plan F and not much less for other plans. A 75-80 year old will pay a similar amount.

You've been smelling clean air for too long. You need to get to the city where where "the back of your neck's getting dirty and gritty and people lookin' half dead."

Rick

 

[Russ]

Frank:

For theose under 65, an MA may be the only option other than just Medicare. Some states don't even have the availablity of supplements for underage, and if they do, can be very pricey.

In California (as you know, the only state that matters), companies must write plans for all ages. In LA County, the cost for an underage beneficiary is about $250 for Plan F and not much less for other plans. A 75-80 year old will pay a similar amount.

You've been smelling clean air for too long. You need to get to the city where where "the back of your neck's getting dirty and gritty and people lookin' half dead."

Rick

Where I live and mainly work, Florida, disability supplements aren't available. MA plans would be a good option, but I haven't written one to anyone under 65 yet. Actually I haven't pursued it.

When Florida offered disability supplements there were so many health questions it was next to impossible to qualify someone....a no-brainer...their on disability for some health reason.
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It's not uncommon here in Ky and In for people to be paying over $200/mo for their med sup. There are more in the $175/mo range than anything else, but, many are over $200. The highest I've run across is $280/mo. I had a lady call me yesterday that's paying a little over $200/mo for her med sup. I could change her to Admiral for $120/mo., but, she can't qualify healthwise and we don't have any GI periods in Ky after the initial 6 mo. window.

I'm seeing a couple tomorrow and the husband pays $190/mo for his med sup and the wife pays $175. That $365/mo for the two of them is just killing them.

In everyone of these cases, the coverage of a med sup is the best plan for them, but, if they can't pay the premiums, the coverage is not very good. MA plans are great for these people even with co-pays. MOOP is a non issue as every company says that less than 1% of the members even get close to the MOOP. I've got about 700 MA clients now and I've never had even one get anywhere near the MOOP. Even on the plans with a $1500 MOOP.

I wish we had a yearly GI period as Missouri does. Not only could people get out of costly plans, there would be more incentive for companies to be price competitive.

We don't have PPO or HMO plans here either. PFFS is the order of the day. Those are not a problem here either. From my nearly 700 PFFS clients over western Ky and southern In., the next one that tells me that their Dr. would accept their card will be the first. I generally even call the enrollee's Dr. at the time of enrollment just to be sure it's not going to be a problem. At one last week, the clerk said, "we take every PFFS plan out there, we will not take any PPO or HMO". My curiosity got the best of me and I asked about Humana, {even though I don't represent Humana, but, they are pushing this new PPO heavily in our area}. The lady said, "we take Humana's PFFS, we do not and will not take Humana's PPO".

It's all about the area you serve. I wish med sups were the order of the day here as I much prefer them. I wish there was a better alternative than PFFS. I suppose I could move, I am licensed in Mo. Since I chose to not move, I will offer what's best. I am only servicing my prior committments though. I am getting out of the MA market because of all this mess. I'm not taking any new leads from anyone. Once I'm through with my list of people that promised to call, which should be sometime next week, I will only discuss MA plans with people that call me. I will go back to FE and a little med sup business. If Ky were to ever come up with the same kind of annual GI that Mo. has, the med sup business would explode here. Maybe that will happen anyway when the PFFS plans go away in 2011? I'm hoping that those people are all granted a GI period for that

In south Florida, med-supps are as much as $400 a month, maybe more, for an 80 year-old male smoker. Fortunately I'm up in north Florida(prices are about half).

Not sure if you've looked or would be interested or if the underwriting is the same, but here in north Florida, AARP is very competitive and their only health question is...are on you kidney dialysis.

You've done real well for yourself with nearly 700 PFFS clients. The renewals you obviously get make choosing other sales options somewhat easier.

 

[Frank Stastny]

In California

You mean in the PRC (Peoples Republic of California) don't you?

You've been smelling clean air for too long. You need to get to the city where where "the back of your neck's getting dirty and gritty and people lookin' half dead.

I grew up in Chicago and live there for a long time after getting out of college. I've had all the fun I can handle with "the back of your neck's getting dirty and gritty".

I much prefer it getting RED.

 

[Dave020]

 

[MedSuppPro]

I am only servicing my prior committments though. I am getting out of the MA market because of all this mess. I'm not taking any new leads from anyone. Once I'm through with my list of people that promised to call, which should be sometime next week, I will only discuss MA plans with people that call me.

Yet another star agent whom throws in the towel.

JD I'm also reducing my efforts due to this CMS induced mess. CMS is partially to blame. I think we have seen proof that a carrier, at least one, asked for this bail-out. And they got it. Pay back time.

I ask anyone reading this post to provide an FMO that fought for us. Maybe Ritter?

Now that they got what they asked for, we shall see the bitter results. This has got to hurt sales! Carriers will feel the pain! And yes, FMO's will still get their overrides with a whole lot less volume.



PS Dave Rocks! Look at them sideburns.

 

[midwestbroker]

IMHO:

MA plans in areas where they have been for 5+ years (before the 2003 MMA act) will go on, business as usual. The rates my change but I do not see any major impact to come. They were around before all this without drug coverage to worry about, and they made ends meet.

In rural markets where they have been expanded to, I see some fine tuning and some less options for seniors, but I think options will still be there.

The more agents that get out, the better for me. I have been very busy this year (why I have not been so active on the boards) and the less agents out there the more business for me and my agents.

 

[retread]

This is the way I play it: If a prospect has a Part C plan, I offer a better one. If he/she has a Med Sup and wants to lower costs, I offer a less expensive plan, or suggest a MAPD (especially if they are healthy and over-paying both health and Rx plans. When proposing an MA plan to someone that has a Med Sup, I take the MA premium and MOOP, add them together and divide by 12. Then compare the cost of a Med Sup and PDP to see if it is reasonable to risk the exposure to MA co-pays. If more agents did this, they would realize that some MA plans are not as cost effective as Med Sups. And yes, some Med Sups are over-priced. But we are insurance agents, aren't we? Take the time to do the math.