Worried Plan F Prospects (2022) - MAPD for 2023 + nightmare

[AgentGeneral]

Two of my local "older" (80s) prospects came to my office last year - they were paying for Plan F, couldn't pass UW (didn't ask, could just tell by Rx list, cane, etc.). Plan F was going up to $400+ per person for 2023.

It was getting difficult to buy groceries. Seriously. It was. They don't live in the gated golf course community with $300 HOA fees.... he worked blue collar, she raised the kids... they drive a 2010 vehicle. They carry cash around because that's how they pay for things. We have a little deli nearby that a lot of people eat at - she mentioned that they'll go there and grab a sandwich and split it as a treat because it's so expensive now.

They had a normal list of providers for most prospects that age - several each.

AEP 2022 for 2023: Put them in a $0 MAPD plan w/ just over $5,600 Max OOP. Saved a ton on their Med Supp and PDP costs.

They came by today.

He had an aneurysm in 2023 and their health has declined even more. She said it's been a major year medically. Lots of doctors - she said every time she turns around there is another appointment.

She kept track of her copays throughout the year because I told her to - I knew in the back of my mind that we could do trial right and I explained that to her several times: "if this MAPD doesn't work, I promise I can get you Plan F back as long as you have never had a MAPD plan."

Worried in 2022 about the MAPD plan for 2023. Several meetings with me last year during AEP - gave it a chance.

Came in today - she said they would never even think about going back to Plan F. Sure, they paid copays - but it was night and day.

Paying for Plan F was a nightmare (her words, not mine). Grateful for alternative health insurance options.

Nice.

Only just finishing up 3rd AEP and I've moved so many I can't count them all now. Most of those were all around 300-400 month mark of F premium. Most in a very similar situation. Only had one so far come back and ask if he should switch back before his trial was up. Told him I'd be right down (he's 2 miles from my house) to help switch him back if he wanted. Nope. He stayed put. He gets it. His family gets it. We did the math several times, both last year and this year. Saved a substantial amount. Around $5k

This guy had breast cancer treatment all through 2023. Not one issue with PAs. Loads of examples like this. He never even felt or knew of the PAs. Came no where near hitting his MOOP. Here if they are not on medicaid and have not much in the bank theyre getting copays waived more often than not--just a two page annual form gets this done..so far so good. Not just that but there are plenty of assistance programs out there for just about every condition --

Only time the guy mentioned anything cost related was his Xarelto when October rolled around (sorry med supp won't fix that).... He uses his dental, otc and food card (we have a plan with food benefits even for those not on medicaid at all) and enjoys that.

This is exactly why I love what I do. I am ready for whatever a client needs help with. I never have to say , "oh, I'll have to refer you out, bc I can't do this or that...."

If I were a med supp only person, I'd probably not be saying that too loudly anymore. At least around here, theyre considered dinosaurs.

 

[AgentGeneral]

Sorry that last remark about med supp/dinosaurs wsnt very nice. I'm just so over the MAPD med supp pot stirring. I guess just can't rationalize with some people and get them to understand there is no one size fits all plan.

 

[rmhaire]

Sorry that last remark about med supp/dinosaurs wsnt very nice. I'm just so over the MAPD med supp pot stirring. I guess just can't rationalize with some people and get them to understand there is no one size fits all plan.

Ran into an 82 year old last month. Has a plan F with Anthem and paying around $250 a month. Didn't even bother getting his wife's premium. Happy as a clam and I couldn't move him with a tow truck. All kinds of people out there.

 

[sshafran]

Ran into an 82 year old last month. Has a plan F with Anthem and paying around $250 a month. Didn't even bother getting his wife's premium. Happy as a clam and I couldn't move him with a tow truck. All kinds of people out there.

Had a lady paying $380/mo for F. Got her Level 2 F w/ UHC around $300 (can't remember exact amount). Loves F - no copays and not wanting to change that.

 

[AgentGeneral]

Right. I see F and G and N around. Just don't talk much about it ... It doesn't feel like many, probably bc Ive been talking to hundreds of people a year in my short newbie-ish 3 years.

left a 95 yr old woman a few hours ago on F. Her Elixir pdp gone for 2024. Just moved her PDP. All tier 1 meds, one tier 2, told her stay put. Mostly bc I wasn't sure she was comprehending anything even though she seemed sharp as far as organization went with her docs, meds, etc. The caretaker daughter I wasn't sure about either as far as comprehending....so said stay put, her premium was $200s and she could continue to afford it and probably wouldn't have qualified for copays waived. Going to write her son in April MAPD/GTL combo.

Last week, met with a couple living together 72 yr old female, T65 male. Shes super healthy wanted to stay on her F. I put the T65 male on BCBSM MAPD/GTL combo-he's also healthy just tier 1 meds. This isn't that uncommon with one or the other wanting something different. Lots of couples just cohabitate these days and do their own thing. I don't push. maybe next year. I'd lay money she will turn next yr.

Just remembered another couple last week. Left a husband on med supp/pdp, Wife put herself on MAPD before I got there and was about to put her husband on one and got herself confused and called me. I just ran her meds and docs and moved her into a different MAPD more suitable. That one was a bit odd, bc she was going on MAPD whether I did it or not, I just guided her into another one that will work more favorably for her needs. Recommended she keep husband on his supp/pdp. Had my reasons....I don't push.

Another one last week, 89 yr old woman stayed on F, moved her son onto MAPD. Hes newly dual, she's not. I leave people on F, but move way more than stay. Always up to them. I don't push.

Another last week 78 F moved to MAPD from F. One with an F premium outpacing the MOOP of MAPD. Common. This one is very common at the moment. Had a handful of these last week.

Out of the past three years, I have done the stats around here on my own biz. It's close to 1 in 50 that go with supp/pdp out of the gate the rest MAPD. Haven't counted the ones I've left, but it isn't many, a couple dozen maybe that I've talked to F2F, maybe more over the phone I knew better than to bother meeting with....

I talk to many people on the phone daily, 7 days a week lately. Some just want to gather info and some have F or G or even N. I simply listen, ask questions, answer questions, listen some more tell them stay where you are if that's what I think and to call me next year. Next. still writing 15 plus a week throughout the entirety of AEP- a good number t65 MAPD/GTL combos. A good number are switches from F or G to MAPD.

No arm twisting at all.

Time for bed. Til Dec 7th, hitting it hard.