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- #11
What's right, what's wrong
- Thread starter somarco
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- 1,070
You want informative. Here:
There are four parts to Medicare:
A. Hospital - no premium
B. Outpatient-min. $96.40 mo. Doesn't change every year. Services are available on an 80/20 split. NO MAX OOP.
C. Medicare Advantage - private plans, like group, that are funded and regulated by CMS. Offered as HMO, PPO, PFFS,and POS.
D. Drug plan
There are supplement policies. CMS designed plans A thru L to supplement Medicare deductibles and copays in different ways. The insurance companies put a premium to each plan they offer. They can get expensive so many people take MA with a drug plan. In Florida it is normal not to pay a premium. The plans adjust copays every year based on the economy and claims and submit them to CMS for approval.
I sure hope my high school Medicare presentation suits you. It works for my prospects.
Believe it or not, CMS has a great website: www.medicare.gov Everything is there, more than you will want to know.
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Well, to actually ANSWER Bob's very observant question, it is simply that the government hates people making money off of their money and as such will do nothing to encourage it to grow and prosper on the government dime.
So long as private carriers are collecting premium and doling out the services (IFP, Group, Supplements), then all is well in the world. As soon as Uncle Sugar is ponying up the dough, then they want to run it themselves (and eventually run it into the ground).
I know of no government site where I can buy and IFP plan or a small group or large group plan. I know of no state or federal mandate that tells a private insurer my value or how I can be compensated from any premiums that private insurer collects from the subscriber.
YET, any senior can go to medicare.gov and purchase any Medicare plan (MA, MAPD, Supplement and/or Part D) directly from the government through the same private carrier.
Government sees agents as an extra expense milking the cash cow of their funding, and they don't like it one bit.
The carriers by and large are doing the best they can within the contraints of this system by trying to find an acceptable and appropriate level of compensation to satisfy both parties. CMS and government would like to see agents go away. You see this on state level as well, what is compensation for Major Risk, Healthy Families, CHIP or Medicaid? Exactly.
So we have a system in place and growing where our government feels that either they or carrier-direct under their direction are the best resource to help seniors pick and switch plans.
"we're the government, we're here to help".
So long as private carriers are collecting premium and doling out the services (IFP, Group, Supplements), then all is well in the world. As soon as Uncle Sugar is ponying up the dough, then they want to run it themselves (and eventually run it into the ground).
I know of no government site where I can buy and IFP plan or a small group or large group plan. I know of no state or federal mandate that tells a private insurer my value or how I can be compensated from any premiums that private insurer collects from the subscriber.
YET, any senior can go to medicare.gov and purchase any Medicare plan (MA, MAPD, Supplement and/or Part D) directly from the government through the same private carrier.
Government sees agents as an extra expense milking the cash cow of their funding, and they don't like it one bit.
The carriers by and large are doing the best they can within the contraints of this system by trying to find an acceptable and appropriate level of compensation to satisfy both parties. CMS and government would like to see agents go away. You see this on state level as well, what is compensation for Major Risk, Healthy Families, CHIP or Medicaid? Exactly.
So we have a system in place and growing where our government feels that either they or carrier-direct under their direction are the best resource to help seniors pick and switch plans.
"we're the government, we're here to help".
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- 1,704
Even the dim wits, half wits and nitwits amongst us have light bulbs going off " Warning, Warning, Mr. Robinson!"
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- #16
This is what is so scary.
The little bit I know about Medicare and Tricare is frightening to say the least. The government sets the rules about who is covered and under what circumstances. They ration care by deciding which procedures are covered and how much providers will be paid for their services.
In spite of this, it seems like the public, including medical providers, want this to expand.
For the life of me I fail to see why anyone would want this to continue, much less expand.
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See...he fell off the earth too.
Rabbi, I think you're short summary is closest in accuracy than the others offered, but even yours misses on a few minor points. Please don't be offended, but I insist on using prescribed terminology and am not as loose as you are. Here I go:
There are four parts to Medicare:
A. Hospital - no premium
Not going to take issue here, I just say Part A is Hospital Insurance. Premiums are "pre-paid" from your work record by having your paycheck docked for 10 years or more and tracked by SSA...
B. Outpatient-min. $96.40 mo. Doesn't change every year. Services are available on an 80/20 split. NO MAX OOP.
Here's where I disagree... Premiums go up almost every year, except next year remains at $96.40. Every senior you talk to will understand the criticism: "We get a COLA only to have the government turn around and take it right back in higher Medicare premiums"... well, next year they won't. And although Medicare doesn't publish a MOOP, it can be calculated: $90,000!
C. Medicare Advantage - private plans, like group, that are funded and regulated by CMS. Offered as HMO, PPO, PFFS,and POS.
You are very close to what I say... Actually Original Medicare is akin to Basic Medical, or Catastrophic insurance, and needs a Supplement to cover your remaining medical expenses... Parts A and B are like Med-Surg plans and pay fee-for-service, whereas Part C plans are more like group insurance, which is comprehensive, just like you used to have. Some people refer to them as "co-pay plans" and offer preventive health care, and may also include drug coverage which we refer to as Part D of Medicare, but most of all, offer added benefits that Original Medicare and a Supplement do not.
D. Drug plan
Same here.
I expanded quite a bit over your short and sweet version for Bob's benefit, because I know he works IFP and Group. I do take the time to prep my clients with a short summary of insurance before I launch into Medicare so they can see I know more than just one aspect of Health Insurance, otherwise they wouldn't know the terminology, and hence, the concepts that I use.
This approach may not fit everyone.... but I leave room to pick up referrals for other products, and at the same time build credibility about my professional expertise in health insurance.
Now don't get me wrong... this is not my complete home presentation. I have it completely written out and use it as a checklist as I go down the page, point by point. It is designed such that every required point by CMS is covered, and although I talk fast, it still takes 2 hours. The checklist keeps me focused, compliant, and is a guide to help me pick up where I left off if I need to respond to a question.
Comments I have received are usually "I never had this explained to me before" or "I always wandered about that".... Last Friday I had a client that never enrolled in a PDP and wanted the $0 premium plan. When I described the Part D penalty and how much it would cost her, she said "the Humana person never mentioned that to me"... She accepted my plan, knowing it would mean about $9.30/mo and not the $0 it advertised. The point being (Bob, if you are still with me) is that it is important to cover all the points CMS asks, which takes a lot of study. Any agent that walks into the Medicare Advantage arena without doing his due diligence is asking for a violation.
I should say also, that so far I have closed every presentation that I have made this year, except for those on retiree group insurance with low premiums, or on Medicaid in counties that do not have a state COB plan, and in those instances I specifically recommend them to stay with what they have.
My presentation gets me many accolades, referrals, and occasionally a cup of coffee and a donut! When I leave, I know no other agent coming behind me is going to stand a chance.
edit: I think it goes without saying that if I discover in the census gathering I do at the start, if someone has group insurance or otherwise ineligible or not suited, I cut to the chase and give them the bottom line. It's over in about :15 min or less. Then I chew the fat a little, and often leave with them gladly referring me to others.
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Nice post retread. similar presentation to mine. That's why it takes us 2 hrs.
Now if i could get a speed dial version maybe 45 mins is all i really need.
Now if i could get a speed dial version maybe 45 mins is all i really need.
