Turning 65 seniors increasingly favor lower-cost Medigap options

[sshafran]

In premium. JS. There's more to healthcare expenses than just insurance premium. YMMV

True.

I'm thinking of 1 lady right now - T65 in 2012.

Looked up her drug list in S&S.

For her $0 MAPD, her rx's for 2022 will be $380. Lowest Part D estimate (including premium) is $756. (double). And it's like this year after year....

She doesn't pay for dental (2x yearly consistently for years). There's value there - at least $400/yr.

She utilizes the OTC benefits. Saves over having to buy preventative stuff at CVS. There's value in that...

At 75, she's not paying $200+ for Plan G (had she picked G at 65 @ $100/mo, we likely wouldn't have been able to change - insulin-dependent diabetic and $200+ would likely be her cost). There's value in re-capturing that monthly cost.

All these things (in my mind) have a cumulative effect over a 25 year period on someone earning $1,800/mo. If MAPD saves them even $100/mo (which is conservative), that's $30,000 in savings by age 90.

That's a lot of years hitting the dreaded out-of-pocket maximum (which is only $4,500).

She's never come close and she's been an insulin-dependent diabetic for a while now.

--

In my mind - with those 25+ levers, I really do think most people will come out ahead w/ MAPD over 25 years. Could be wrong, but I don't think so.

 

[DS4]

A huge book of HDGs ... I'd rather go sell siding.

I have 61 High Deductible Plan F's. I use HD F as a loss leader to get to the big $$$$$! Their Part D!!!

 

[kgmom219]

And I have no issue with this other than med supp affordability at age 90 if they weren't able to change carriers due to UW issues. It's high, plus a lot of cheddar on premiums for the 25 year ramp up period to get to 90...

Grandma quote #2 "That premium is ridiculous. But I can't travel anymore, eat out or anything else fun. Might as well make my health care easy since that's all I do, anyway."

She died at age 90, after 10 years of at home dialysis. Mental facilities were 100% until the last 3 months.

Financial Planners have used $500/month per person as the standard for years. And it still works over the 35 years, averaged out

 

[sshafran]

How much do you suppose those 90 year old's will be paying OOP for healthcare?

Those 90 yr olds on MAPD will be paying:
(a) $450 per month less, per person, in premium ($5,400 in savings)
(b) 50% of the cost on their Rx's ($850/yr+ in savings)
So those 90 yr olds on MAPD are starting $6k ahead of their Med Supp + Part D counterparts.

+ copays according to the summary of benefits. The vast majority do not hit the Max OOP. Let's call it $5000 on average if they have a lot of claims.

I'm still not seeing the downside.

And I'm not trying to be obtuse.

 

[Travis Price]

I

Those 90 yr olds on MAPD will be paying:
(a) $450 per month less, per person, in premium ($5,400 in savings)
(b) 50% of the cost on their Rx's ($850/yr+ in savings)
So those 90 yr olds on MAPD are starting $6k ahead of their Med Supp + Part D counterparts.

+ copays according to the summary of benefits. The vast majority do not hit the Max OOP. Let's call it $5000 on average if they have a lot of claims.

I'm still not seeing the downside.

And I'm not trying to be obtuse.

My thing is also client comfort. For example, I had a guy with DM and some heart issues that wanted to stay away from Part C. We sold him Part G + PDP, but he's on a crazy expensive injectable for DM.

After I reran his drugs with MAPD, I thought there was some significant savings and called (he's still in IEP) and broke it down. His answer, I have 4m of the injectable and I think I want to talk to my doctor because there's a generic coming out soon, and also changing drugs around. Can we run this during AEP?

Yep.

He doesn't want Part C. There are shortcomings, obviously. Sometimes they just feel more comfortable with MEDIGAP and they're willing to pay for it.

I had the same thing happen with Humana vs Wellcare. Wife would save 200 dollars a month using Humana PDP. Husband heard "bad things" about Humana and despite explaining that Medicare Part D is different than U65 health insurance, he wanted Wellcare. I ended up sending him to Wellcare and took the loss of commission (because I don't want that under my name), but it's their call.

 

[sshafran]

I

My thing is also client comfort. For example, I had a guy with DM and some heart issues that wanted to stay away from Part C. We sold him Part G + PDP, but he's on a crazy expensive injectable for DM.

After I reran his drugs with MAPD, I thought there was some significant savings and called (he's still in IEP) and broke it down. His answer, I have 4m of the injectable and I think I want to talk to my doctor because there's a generic coming out soon, and also changing drugs around. Can we run this during AEP?

Yep.

He doesn't want Part C. There are shortcomings, obviously. Sometimes they just feel more comfortable with MEDIGAP and they're willing to pay for it.

I had the same thing happen with Humana vs Wellcare. Wife would save 200 dollars a month using Humana PDP. Husband heard "bad things" about Humana and despite explaining that Medicare Part D is different than U65 health insurance, he wanted Wellcare. I ended up sending him to Wellcare and took the loss of commission (because I don't want that under my name), but it's their call.

Yes, no argument here. My T65s still go 60% med supp. Risk tolerance and feeling good about the insurance matters - it's another lever.

 

[Midlevel]

Those 90 yr olds on MAPD will be paying:
(a) $450 per month less, per person, in premium ($5,400 in savings)
(b) 50% of the cost on their Rx's ($850/yr+ in savings)
So those 90 yr olds on MAPD are starting $6k ahead of their Med Supp + Part D counterparts.

+ copays according to the summary of benefits. The vast majority do not hit the Max OOP. Let's call it $5000 on average if they have a lot of claims.

I'm still not seeing the downside.

And I'm not trying to be obtuse.

You will never get it across to them so you are wasting your time. They are so set in their ways they still think they are better off paying more for a Med Sup than what the OOP max is on an MAPD. Not to mention all the extra stuff you mentioned. They are just like the nurses that tell everyone MA plans are the devil and avoid them. I have over 600 people that say otherwise. Maybe I’m just lucky in my area but haven’t had any problem with networks or preapproval for years.

In 10 years when it’s 65% MA and 35% Med Sup these same people will be on here saying Med Sups are the only way even though Part B deductible will probably be 400.00 and premiums who knows how high. Not to mention Part D ded up to 650.00 and still no deductible on MAPD.

 

[gregj]

As I'm certified to offer both, it's always what's best for the client.

feels like you probably should have led with this

 

[Travis Price]

feels like you probably should have led with this

I think that I'm pretty vocal that I'm certified to offer MAPD and my philosophy is out there too..

I shouldn't have to say on every post or convo that I can sell MAPD...

Ymmv

 

[somarco]

Too bad those 90 yr old folks with Medigap plans have no place to go. If only there was a low/no premium option for them, that would allow them to keep their doctors, and underwriting isn't required . . .