What's right, what's wrong

[somarco]

I don't work this market, probably never will. I read some of the posts from the agent perspective and it doesn't seem happy.

But how about the consumer?

Tell me what is right, and what is wrong, from the consumer perspective with the over 65 market as far as supplemental plans go. I don't mean just traditional med supps, but all of the variations.

thx!

 

[The Rabbi]

Somarco, if you aren't going to work the market, there isn't much sense into going into all the nuts and bolts. There are all kinds of ways to supplement Medicare and what the client wants and can afford is all that counts.

I do well with the senior market but I am a very experienced and well trained professional businessman and I do it all from home.

 

[somarco]

Thanks for your response, but I was hoping for something informative.

Next!

 

[G.Gordon]

Thanks for your response, but I was hoping for something informative.

Next!

Then you might want to read this forum...

Sorry, but your asking a very broad question that could be answered from so many angles. Read, learn, then ask more pointed questions.

 

[moonlightandmargaritas]

Thanks for your response, but I was hoping for something informative.

Informative? The Rabbi?

Maybe if you're lookin' to hustle somebody into a used car...

 

[bluemarlin08]

Bob, I wish someone could enlighten me. I am asked almost daily about Medicare Part ABC etc, I really don't understand enough to point them in the right direction.

 

[theinuranceguy]

Quick run down from 2008:

Medicare Part A: Zero Premium: Covers Hospitalization ($1024 Deductible/100%Coinsurance)

Medicare Part B: $96.40 per month: Covers Outpatient Services ($135 Deductible/80% Coinsurance)

Medicare Part C: May or may not have premium, but its a privatized version of medicare. You continue to pay 96.40 but must follow new schedule of benefits. I.E. You may now pay $750 Ded. in hospital or have a flat copay at the dr.

Medicare Part D: Drug coverage. If bought alone, there will be a premium that can be taken directly out of SS check.

Those are the 4 parts of Medicare. Not to be confused with a traditional Medicare supplement, where someone would not pick up a Part C, and begin paying a premium for a plan that covers the gaps of A and B. Its not a privatized version of medicare, but a plan that literally fills in the gaps (IE- $1024 deductible in hospital and 20% not covered by Medicare)

Some Medicare PART C plans also include a Part D and still do not have a premium.

So, once you find yourself on medicare you have two choices:

Do I privatize my Medicare and allow an HMO or PPO to manage my medical insurance or do I continue to stay on original Medicare and pick up some "Gap Insurance"

___

Now how does an agent make a commission off of a plan that costs the consumer nothing?

Each Medicare advantage is different from county to county.

What medicare does is takes all the seniors enrolled into Medicare in one county and divides them into the monthly cost of all the bills they pay.

For example lets say Montgomery county has 100 people on Medicare and every month Medicare is paying $1,000 in Medical bills.


Medicare takes the 100 people devides them into $1,000 and determines that the average cost (the capitation fee) is $10 per senior. They then contract insurance companies to create Senior Health Plans that must be approved by CMS (Medicare). Once Medicare approves the plan (this plan may or maynot have a premium) they agree that for every enrollee on the plan CMS will pay the insurance company that capitation fee, in this situation that fee would be $10 per month.

The agent makes a commission off the capitation fee.

 

[Tina]

Bob, I wish someone could enlighten me. I am asked almost daily about Medicare Part ABC etc, I really don't understand enough to point them in the right direction.

BCBS has a very handy, one page chart on their website that compares the differences in coverage between each plan, and it's rather easy to understand. That's how I learned about what each supplement plan covers. Plan A only suppliments part A of medicare, plan B suppliments part B, and so on through the alphabet with different combinations of coverage. The suppliment coverage for each plan is the same across carriers (from my understanding, could be wrong). After someone knows what plan they need, the choice is in the carrier, the difference between carriers is initial premium, rate of premium increase, stability of company, and if they offer cross over coverage.

ie. (based on carriers and rates in my area) AARP has very low initial rates, but over time, their rate increases tend to be more than other carriers so in the long term, someone will pay more with them than BCBS. Lincoln Heritage tends to have the lowest inital rates and lower rate increases over all but lacks the name recognition so may be a more difficult sell (they're a Phoenix based company so not as big of an issue for me). In the long run they are the best choice for females because no other carrier beats their rates. For males that live past their late 70's, BCBS is a better choice since their rates are basically the same accross gender and age group after 70. If you have a husband and wife that both want plan F, with early enrollment discounts it would be better to put the husband on BCBS and the wife on Lincoln Heritage. They will both have the same suppliment coverage, and each will pay a lower premium than they would with the other carrier (again for my area, don't know about other states).

Each state's DOI web site has a page that lists the carriers for that state and what their premiums are, and an outline of what each suppliment plan covers (BCBS comparrison chart is more user friendly).

I asked a question similar to this in another thread. MA v Med Sup. There's some good answers in there to help people chose between whether or not a MA plan or Med Sup is better for them.

 

[somarco]

OK, thx, but not exactly what I was looking for.

What I see from browsing the forum is this.

CMS decides each year how much Medicare recipients will pay in copays, deductibles & premiums. They also decide what is covered, what isn't.

CMS tells the carriers what kind of plans they can offer, must approve each plan, including rates, marketing material and comp.

CMS sets the rules for what an agent can and cannot say and where they can conduct business.

CMS encourages the consumer to shop around every year because the rules change each January. But CMS also penalizes the agent who moves clients from one plan to another.

If the consumer feels they were cheated, all they have to do is complain to CMS and the agent get's in hot water. If CMS feels the client was misled, they can change to another plan without penalty.

It seems, but I could be wrong, there are about a dozen different med supp plans, 50 or so Plan D's and an equal or greater number of MA plans. So each year the consumer, with CMS' encouragement, is invited to talk to their doc, pharmacist and the guy sleeping under the bridge for direction.

From my perspective, it seems like CMS does everything they can to make it difficult, if not impossible, for the Medicare recipients to find the right plan. And if they do find the right one, next year everything changes.

How far off base am I?

 

[theinuranceguy]

Youre right on the money Bob.