Why are there so many rules to Medicare Advantage??

Dec 19, 2018

  1. somarco
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    somarco GA Medicare Expert

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    Too often agents that think the MA is a no-brainer talk about max OOP. While some will hit their OOP cap, and others blow through it because of non-par expenses, you don't have to be at deaths door for the numbers to work in your favor. I have clients that have had serious medical bills that would have easily run over $1,000 per year over several years with an MA plan. Compared to what they pay for their Medigap they are "making money" vs their OOP with an MA plan.

    And they can use any doc.

    I swapped my N plan ($96/mo premium) for an HDF ($56 premium) a few months ago. Didn't change to save the premium. Changed so I wouldn't incur xs charges if some day I need to go to Mayo or another specialty center where they don't take assignment.
     
    somarco, Dec 20, 2018
    #31
  2. goillini52
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    goillini52 MAGA...Eat More Bacon & BUILD THAT WALL!!!

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    Thank God that bacon cured my COPD, otherwise I'd be stuck with LBL if they raised their rates too much(they've been good).

    The only way I'd take a MA plan is if I took it, and did an immediate Trial Right into another company's Med Supp. Of course I'd look for a company that would take it BEFORE I did it. :laugh:
     
  3. Chazm
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    Chazm Guru

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    I’m in FL and we have a $2k moop PPO but even with that I’m putting my mom on plan N in two years when she starts Medicare.

    I’m glad there’s a lot of rules with MAPD though, keeps some agents out.
     
    Chazm, Dec 20, 2018
    #33
  4. somarco
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    somarco GA Medicare Expert

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    FYI, Mayo in Jax does not take assignment.

    I have south GA clients on F or G but no N plans.

    At least 2 of them have crossed into FL for treatment at Mayo (outpatient). Both have had over $100k in claims, but not all at Mayo.
     
    somarco, Dec 21, 2018
    #34
  5. goillini52
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    goillini52 MAGA...Eat More Bacon & BUILD THAT WALL!!!

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    I guess that a Mayo Clinic in their area should be taken into consideration when considering a Plan N. I only show Plan N when they can't afford Plan G. No Mayo's near me, but the hospital/clinic I go to was spun off of Mayo.
     
  6. Chazm
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    Chazm Guru

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    Yeah I lived in Jax for 2 years and only sold plan F for Med supps. G wasn’t a good option.
     
    Chazm, Dec 21, 2018
    #36
  7. somarco
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    somarco GA Medicare Expert

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    There may be other "private" clinics like Mayo that don't accept assignment. Mayo made the (insurance world) news a few years ago because of that.

    Many of the specialty (cancer for example) clinics and hospitals do not accept any MA plans either.
     
    somarco, Dec 21, 2018
    #37
  8. rousemark
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    rousemark Still Here!

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    But he said MAs do not limit care options. If the providers do not accept them and you do not have cash I would think you are pretty much limited as to your options. I am one that would have exceeded the MOP during several of the last few years, yet to look at me you would think I am in great health. Hopefully, still not at death's door..
     
  9. Life Hawk
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    Life Hawk Guru

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    And this is why I don't "produce" MA for profit... If one of my clients needs one or a PDP, I'll get them set up on Medicare.gov and sing them up on line...

    Stupid test... stupid rules... and way too much regulation...
     
  10. somarco
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    somarco GA Medicare Expert

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    Salesmen (and women) can say anything they want to get you to buy. But all that matters is what the contract says.

    If you have a PPO and use a non-par provider, your plan will pay something but the provider can balance bill up to (believe this is correct) the Medicare allowable charge.

    If you have an HMO and use a non-par provider your plan pays nothing unless it is an emergency. Provider bills you up to the allowable amount.

    So you CAN indeed use any provider when you have an MA plan but you will pay more for that care.

    Kind of defeats the purpose of having a $0 premium plan.
     
    somarco, Dec 21, 2018
    #40
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