The golden age of Medicare is over . Humana stock plunging.

[sman]

… you keep making these post like you control anything.

I think @Chazm is just saying we hear the doom and gloom most years about MAPD plans and it has yet to happen. The market just continues to grow. One thing is certain, even if there are cutbacks, there is always going to be one or two companies who will try and buy market share with better benefits. Not that Aetna needed to do it, but they bought a lot of market share this year with their plan design. It's likely going to hurt them in the short term, but may benefit in the long run.

WellCare bought market share with $0 and $0.50 premium PDP's.

This happens almost every year. No reason to expect it not to happen even with cutbacks. Sure, the benefits may be less, but there seems to always be one or two companies who do this each year or two. Until they prove otherwise, I'll assume this trend will continue even if it is with fewer benefits.

 

[DonP]

I think @Chazm is just saying we hear the doom and gloom most years about MAPD plans and it has yet to happen. The market just continues to grow. One thing is certain, even if there are cutbacks, there is always going to be one or two companies who will try and buy market share with better benefits. Not that Aetna needed to do it, but they bought a lot of market share this year with their plan design. It's likely going to hurt them in the short term, but may benefit in the long run.

WellCare bought market share with $0 and $0.50 premium PDP's.

This happens almost every year. No reason to expect it not to happen even with cutbacks. Sure, the benefits may be less, but there seems to always be one or two companies who do this each year or two. Until they prove otherwise, I'll assume this trend will continue even if it is with fewer benefits.

This is correct but I’ll tell you United never played this game and there loyalty and persistency 2 nd to none . Humana who’s lead the mapd pack the last 3 yrs is feeling the brunt of being poached by Aetna. I saw Aetna on the earnings call say there looking for 800 k new enrollments .Humana’s only looking for 100 k new enrollments . The problem with the chaos for an agent with a big book is you can’t move most if your clients chasing benefits . If you do your setting yourself up for heart ache . . 90% of the clients you moved would have never moved . Also 1/3 of the ones you moved will be calling you complain “ Humana paid for this why won’t Aetna “ . A. % of them will want to move back . I decided I’d wait till I see disenrollments and try to save then . Much easier

 

[InsuranceGuy29]

Never saw one of those as they aren't here but I heard thru the grapevine that they had limits like x dental implants per year - so I doubt many people found a way to "spend" all that dental. I'm sure though some with major dental needs went straight to it just for the dental.

There were some limits. The ones we had in my region weren't bulk benefits. There were some copays and caps involved, but someone that needed major dental work could easily run that up to $10,000 in a year.

Compared to the average of other companies, where you might be able to use $1,500 max, when all is said and done, that one benefit alone could definitely put a huge dent in their profitability, seeing as how MA insurers receive roughly $1,000/month from the Federal government to administer the program and take on the risk.

When you also have to pay for everyone's health issues/services, I just saw that dental number as insane. I worked with Cigna for a year on a business-building program they had (because their benefits were so insanely generous for my clients), but in the back of my mind I just knew there was no way this could be sustainable in the long term.

I also saw how the company was terribly run on the administrative side. Clueless doesn't even begin to describe that company.

 

[rmhaire]

Now remember, your plan pays the 20% out of pocket for chemo infusions and has no copays for hospitals, MRIs, or surgeries.

I do the same. I also add that some of those cancer iv bags are going to cost someone close to $10,000 or more per bag.

 

[sman]

This isn't "doom and gloom" but math and finance.

And this doesn't happen every year. CMS doesn't cut payments to MAPD's every year. Utlization rates don't exceed 90% for most plans every year. Rx costs aren't capped at $2,000 every year. They don't limit pre-authorizations every year.

The entire "happens every year" is a dumb argument.

And no one has said this is “doom and gloom”, only that this upcoming AEP will probably be extremely busy. But this is also an opportunity.

I get all of that. My point still stands. There is likely to be one or two carriers who stand out from the pack. That tends to happen every year or two.

 

[sman]

This is correct but I’ll tell you United never played this game and there loyalty and persistency 2 nd to none . Humana who’s lead the mapd pack the last 3 yrs is feeling the brunt of being poached by Aetna. I saw Aetna on the earnings call say there looking for 800 k new enrollments .Humana’s only looking for 100 k new enrollments . The problem with the chaos for an agent with a big book is you can’t move most if your clients chasing benefits . If you do your setting yourself up for heart ache . . 90% of the clients you moved would have never moved . Also 1/3 of the ones you moved will be calling you complain “ Humana paid for this why won’t Aetna “ . A. % of them will want to move back . I decided I’d wait till I see disenrollments and try to save then . Much easier

Personally, I always want to make sure my clients aren't being harmed by remaining on their current plan. That means reviewing benefits of their current plan versus other plans. Including prescription costs. I find my clients appreciate the confirmation that they should just remain on their current plan. I'm not out here trying to move my clients each year. But what I am trying to do is be a resource for my clients and make sure there aren't any surprises. I view it as a value added service. They know I am looking out for their best interest.

The problem with waiting until you see disenrollments and trying to save it is that can lead the client to question why you didn't tell them about this other plan. Or why you didn't tell them there would be an increase in the cost of a medication. I'd rather catch that on the front end than have them go to the pharmacy in January and find out that the medication they normally paid $47 for is now $100. Or worse, not even covered. If I were the client and my agent didn't inform me of this during AEP, I'd be upset.

But each agent has to do what they feel works best for them. I find this is what works for me.

 

[DonP]

Personally, I always want to make sure my clients aren't being harmed by remaining on their current plan. That means reviewing benefits of their current plan versus other plans. Including prescription costs. I find my clients appreciate the confirmation that they should just remain on their current plan. I'm not out here trying to move my clients each year. But what I am trying to do is be a resource for my clients and make sure there aren't any surprises. I view it as a value added service. They know I am looking out for their best interest.

The problem with waiting until you see disenrollments and trying to save it is that can lead the client to question why you didn't tell them about this other plan. Or why you didn't tell them there would be an increase in the cost of a medication. I'd rather catch that on the front end than have them go to the pharmacy in January and find out that the medication they normally paid $47 for is now $100. Or worse, not even covered. If I were the client and my agent didn't inform me of this during AEP, I'd be upset.

But each agent has to do what they feel works best for them. I find this is what works for me.

Your talking more about the actual health ins component. I’m talking more benefit component only . I’m not moving someone to Aetna because they have $750 more dental this year or the specialist copay is $5 less . I’ve yet to get 1 call were a drug was covered the yr before and is not covered the next yr . I call every client yearly pre aep which few agents do . I ask if there happy with there plan . No different than an agent sending out a pre aep letter saying if you want your rx run or not happy with your plan get on my calandar . I take an avg of 50 calls a week answering client questions.That’s my best retention tool .Answering all my calls very quickly.Like you said to each his own what works for each agent .

 

[sman]

Your talking about the actual health ins component. I’m talking benefit component only . I’m not moving someone to Aetna because they have $750 more dental this year or the specialist copay is $5 less . I’ve yet to get 1 call were a drug was covered the yr before and is not covered the next yr . I call every client yearly pre aep which few agents do . I ask if there happy with there plan . No different than an agent sending out a pre aep letter saying if you want your rx run or not happy with your plan get on my calandar . I take am avg of 50 calls a week answering client questions.That’s my best retention tool .Answering all my calls very quickly.

I don't get a call that a drug wasn't covered either...because I catch it beforehand. If you've never had a plan discontinue a medication or move one to a higher tier, you're the unicorn.

I never said anything about moving someone because of a slightly higher dental benefit or slightly lower doctor copay.

I also talk to every client every AEP. And get the same response from most "I'm happy with my plan". That doesn't stop me from reviewing to make sure there are no surprises the following year. Just because they are happy THIS year, doesn't mean the plan will be identical the following year.

I had a few clients this past AEP whose current plan would no longer cover a specific medication for 2024. They were happy with their plan. If I left it at that (them being happy with their plan), they would have been pretty upset in January when they went to get that medication filled.

As I said, we all have to do what we think is best for our business. Just because I do something different from you doesn't make it wrong. As a matter of fact, I don't think you are ever wrong when putting the clients best interest first. Even if it is additional work for the agent.

 

[sman]

You have no point just an ignorant opinion that you won’t own up to when you’re proven wrong.

Sure thing boss. It appears your only goal on this forum is to argue with everybody. Have fun with that.

 

[Chazm]

I promise you fla plans will also take a big hit . That hit could create chaos and much plan movement . Means if an agent has a big book he has to play defense big time . CO’s got hit hard and must retrench . There masters are the stock mkt and they demand profits .3 times a week since Jan 1st every email i get from Humana is about med sups and the bonus . They’re turning hard as they’re most exposed % wise than any other mapd company as that’s 90% of their business . Aetna,United and anthem have big med sup and commercial health ins businesses to smooth out the mapd chaos coming .

Don, I hear that every single year. If plans get better, everyone says people will switch because they hear of the better benefits they can get. If plans get worse, the same.
I’m on year 15 of offering med supps and mapd. 2025 will be no different then when plans took some hits in the early 2010’s.