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Medicare Advantage plans earn high marks from policyholders

Insurance Forums Staff

New research, released today from online private health insurance marketplace eHealth, shows that people enrolled in Medicare Advantage plans are highly satisfied with what they’ve got.

Among people who had who purchased a Medicare Advantage plan through eHealth’s website, 88% said they were “very” (63%) or “somewhat” (25%) satisfied with their coverage and just 6% were dissatisfied. Nearly the same percentage (86%) said they would recommend Medicare Advantage to a friend or family member; only 3% said they would not.

Santa Clara, Calif.-based eHealth, Inc. released results from a survey of more than 2,800 Medicare beneficiaries, exploring their satisfaction and experience with their Medicare Advantage plans.

Additional findings:

  • Most of those previously enrolled in Medicare Supplement (Medigap) still prefer Medicare Advantage: 59% of beneficiaries previously enrolled in Medigap say they are “more satisfied” with their Medicare Advantage plan; an additionally 23% are “equally satisfied.”
  • Most Medicare Advantage enrollees can’t afford the alternatives: Two thirds (67%) of those who chose Medicare Advantage over Medigap did so because Medigap was too expensive. If forced to find similar coverage elsewhere, 73% say they could afford monthly premiums of only $50 or less.
  • Most see Medicare Advantage as a prime example of public/private cooperation: More than six in 10 (61%) say Medicare Advantage is a good example of cooperation between government and private enterprise, while 5% disagree; only 13% feel regulation of Medicare Advantage plans should be increased.

Read the full report.

Medicare Advantage plans are offered by private insurance companies and cover Medicare Parts A and B benefits, typically filling many coverage gaps and offering additional benefits. Most Medicare Advantage plans also include Part D prescription drug coverage. Medicare Advantage plans are typically more affordable than Medicare Supplement and stand-alone Part D plans; many beneficiaries are able to enroll in $0-premium Medicare Advantage plans.

eHealth’s report is based on a voluntary survey of Medicare beneficiaries who purchased Medicare Advantage plans through eHealth. The survey was conducted in late May of 2022 and a total of 2,848 responses were collected.

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154 thoughts on “Medicare Advantage plans earn high marks from policyholders”

  1. How can this be? I thought all clients hated their MA plans due to Dr. networks, prior authorization and all the other terrible things. Maybe it's just certain agents that make it seem that way?

  2. When my MIL T65 I talked with her about med supp, But she purchases MA plan

    She loved it free this free that no premium, It was just the best

    then a couple years later both her and husb got Cancer, he ended up passing,

    after the issues and costs through this experience, she understood

    When she moved her we go GI for med supp

    She would never do MA again, and she is now a person who would never even entertain the thought of MA

  3. vic120

    When my MIL T65 I talked with her about med supp, But she purchases MA plan

    She loved it free this free that no premium, It was just the best

    then a couple years later both her and husb got Cancer, he ended up passing,

    after the issues and costs through this experience, she understood

    When she moved her we go GI for med supp

    She would never do MA again, and she is now a person who would never even entertain the thought of MA

    There is one of those aforementioned agents now.

  4. Midlevel

    There is one of those aforementioned agents now.

    ? I dont understand what you mean?

    MIL and husb?

    He died she is on dialysis now,

    No not agents if that what you meant

    though wouldnt make sense you asked that so I am guessing you meant something else?

  5. vic120

    When my MIL T65 I talked with her about med supp, But she purchases MA planE
    She loved it free this free that no premium, It was just the best

    then a couple years later both her and husb got Cancer

    this is why cancer plans are so good to offer.

    And exactly a main reason people complain about MAPD.

  6. AugustaMi

    this is why cancer plans are so good to offer.

    And exactly a main reason people complain about MAPD.

    cancer plan would not have make the out of network in network nor would it have taking away preauth waits

  7. I stayed out of this market for years bc of all the wildness–wasn't interested in AHIP, certs, low commish. My main guy who has large book of MAPD. He used to try to get me into Medicare for years. All the way from mid-late 2000s.

    He was a total plan G guy. Not anymore. I wish I would have listened to him way back when….he's well over 350k annually. Sells primarily MAPD with GTL. $4000 a month renewals just in GTL. So it's clear he's covering some bases. I've seen his statements. Not bragging for him and he never brags, we are friends and he shows me. I spend quite a bit of time with him just bc we worked together in U65 for years and live and play by each other in two states.

    Saw his wallet the other night and double-checked when he whipped it out at an event, we were in line for food….thought maybe he fibbed about what he has himself. He has HAP MAPD. It was sticking out of his wallet. LOL. So do all the other guys/gals I know who used to be ALL about Plan G. They also all have GTL to cover the cancer and some of the major co-pays.

    He swore he'd never sell MAPD back then.

    I read the back and forths on the MAPDs/med supps in here. Being new, and honestly because I was already skeptical, its interesting to me to know both sides inside and out.

    IRL I do ask a ton of questions. Even to anyone I know who has an MAPD. None are really complaining and when they do it's been more about the crappy dental (yes I detest dental and I'm not afraid to tell clients it sucks but itll give you "some" coverage).

    In the guy I referenced above, he claims very few people actually hit the MOOP, often docs eat the co-pays (he doesn't pitch that but says he knows from experience, and as new as I am I've seen this too), and when they do hit it, they usually have GTL to back it up and help fill the gaps.

    My own hubs is turning 65 Dec 2023, and to be honest, we have $ and either one would be fine. But I'm still not 100% what I should do with him. The more I read, the more confused I get. lol. Most days though, I'm leaning toward HAP/GTL. HAP is a nice MAPD (lower MOOP-Lower co-pays with Delta dental in MI). It also travels nice to places we go. hubs is very used to deductibles and ancillaries as are many business owners around here.

    Another observation is that I do see things with HMOs, in-network, out-of-network, referrals, authorizations getting much better….not near as bad as those things used to be…I also see a movement toward lower MOOP. Not all over yet, but it's expanding. Even in Mi, we do have the lower MOOPs, just not on the west side as far as I know…although even over there theres a $4500 Moop plan, HMO though which after reading all the fine print isn't near as bad as i would have thought.

    For good measure though, I've been getting up to speed on Med Supps…I dont wanna have to refer those out….this being new is still a learning thing every day.

    Not looking to get caught up here in a big debate, just saying from my own perspective. I have too many thoughts on the political side to even get started and no one would want to get me started on that…just like alcohol, I'm allergic to politics and break out in handcuffs. Yes, I admit that. And both those things together are really really bad. LOL.

  8. Midlevel

    How can this be? I thought all clients hated their MA plans due to Dr. networks, prior authorization and all the other terrible things. Maybe it's just certain agents that make it seem that way?

    Maybe because Ehealth chose the areas, demographics,etc. If Ehealth didn't sell MAPD and had commissioned the survey it might be credible.

  9. Midlevel

    There is one of those aforementioned agents now.

    Vic shared a real life personal experience. Hard to refute that. He also sells both MAPD and Med Supp so he isn't "one of those agents". It's ok to speak of the problems with any product we sell. I hope anyone who sells MAPD (I do) shares the few potential drawbacks with their clients. If you aren't, you are doing a disservice to the client.

    Those happiest with their MAPD plans are the ones who don't need much medical care. it's a win for them and a win for the insurance company. But ask anyone who is having delays because of pre-authorization or anyone who has been in and out of the hospital, going through chemo or dialysis and they will tell you they wish they had a Med Supp instead.

  10. vic120

    When my MIL T65 I talked with her about med supp, But she purchases MA plan

    She loved it free this free that no premium, It was just the best

    then a couple years later both her and husb got Cancer, he ended up passing,

    after the issues and costs through this experience, she understood

    When she moved her we go GI for med supp

    She would never do MA again, and she is now a person who would never even entertain the thought of MA

    There are a number of studies reflecting this pattern . . . your personal story supports the position that healthy people buy (and keep) MA plans while those who are sick often want to leave for more robust coverage with less OOP.

    Your story is anecdotal but not to be dismissed. The story below bears out your experience.

    The GAO report, released this spring, reviewed 126 Medicare Advantage plans and found that 35 of them had disproportionately high numbers of sicker people dropping out. Patients cited difficulty with access to "preferred doctors and hospitals" or other medical care as the leading reasons for leaving.
    As Seniors Get Sicker, They're More Likely To Drop Medicare Advantage Plans

    AugustaMi

    I wish I would have listened to him way back when….he's well over 350k annually. Sells primarily MAPD with GTL. $4000 a month renewals just in GTL.

    Many who are primarily MAPD agents like to talk about the Benjamins . . . and seem to be oblivious to pitfalls of managed care . . . perhaps the dollars in their mattresses help them sleep well at night . . .

    MAPD is fine until you need it but then the clock strikes midnight and your carriage becomes a pumpkin.

    Millwood

    Maybe because Ehealth chose the areas, demographics,etc. If Ehealth didn't sell MAPD and had commissioned the survey it might be credible.

    I too noted the article was slanted because it if a puff piece by eHealth.

    @sman post should be required reading for anyone in this market.

  11. Literally the first question I ask everyone is "What do you know about Medicare?" (I don't have to do much warm-up because they've already decided to trust me by calling.)

    We talk a little bit about their situation and what they know about Medicare. It almost always ends with "I don't know what to choose."

    My response is "Don't worry, WE'RE going to figure this out together."

    My next question is always (and in my opinion, the most important one) "Would you rather pay a little more upfront and pay less WHEN you need treatment or would you like to pay less upfront and pay more WHEN you need treatment?"

    The answer 80% of the time is I'd rather pay more up-front. That's before we even use the word "Medigap or Medicare Advantage."

    If they say more upfront, I immediately go to Plan G. No reason to show them MAPD.

    "Okay. So if you pay less upfront, would you be okay with networks where the insurance company tells you who you're allowed to see and you might have to get permission before you have treatment to save a little more money when you get treatment, or would you like to choose the doctor and hospitals and pay a little more when you use services?"

    That's the question that tells me HDG or MAPD.

    I sell HDG. I think I get roughly $250 first year with HDG and PDP and $200 in subsequent years (2, effin MI.)

    Two main questions tell you what the client wants. I usually have to answer about dental or gym memberships at some point… The dental one is easy… Medical is always more important than dental and I'm, personally, of the mind that you insure the big stuff and then self insure the smaller stuff.

    (One lady told me she had 100k in dental work she needed. She refused to go to dentures. I told her good luck… she'd never get a fraction of that much money out of dental insurance, even over years.)

    My point in all of this is you have to accept that sometimes you're going to get paid a Fiat. Sometimes you're going to sell the Cadillac. It's why I'm starting to shift my focus from being JUST a Medicare expert to being a person that helps people transition from the "working environment to a protected retirement."

    That includes multiple products both in and out of Medicare to protect things. Eventually, I want to branch out to LTC and get stronger on MYGA's and term. I just don't have an interest in FE or DSNP.

  12. Travis Price

    Literally the first question I ask everyone is "What do you know about Medicare?" (I don't have to do much warm-up because they've already decided to trust me by calling.)

    We talk a little bit about their situation and what they know about Medicare. It almost always ends with "I don't know what to choose."

    My response is "Don't worry, WE'RE going to figure this out together."

    My next question is always (and in my opinion, the most important one) "Would you rather pay a little more upfront and pay less WHEN you need treatment or would you like to pay less upfront and pay more WHEN you need treatment?"

    The answer 80% of the time is I'd rather pay more up-front. That's before we even use the word "Medigap or Medicare Advantage."

    If they say more upfront, I immediately go to Plan G. No reason to show them MAPD.

    "Okay. So if you pay less upfront, would you be okay with networks where the insurance company tells you who you're allowed to see and you might have to get permission before you have treatment to save a little more money when you get treatment, or would you like to choose the doctor and hospitals and pay a little more when you use services?"

    That's the question that tells me HDG or MAPD.

    I sell HDG. I think I get roughly $250 first year with HDG and PDP and $200 in subsequent years (2, effin MI.)

    Two main questions tell you what the client wants. I usually have to answer about dental or gym memberships at some point… The dental one is easy… Medical is always more important than dental and I'm, personally, of the mind that you insure the big stuff and then self insure the smaller stuff.

    (One lady told me she had 100k in dental work she needed. She refused to go to dentures. I told her good luck… she'd never get a fraction of that much money out of dental insurance, even over years.)

    My point in all of this is you have to accept that sometimes you're going to get paid a Fiat. Sometimes you're going to sell the Cadillac. It's why I'm starting to shift my focus from being JUST a Medicare expert to being a person that helps people transition from the "working environment to a protected retirement."

    That includes multiple products both in and out of Medicare to protect things. Eventually, I want to branch out to LTC and get stronger on MYGA's and term. I just don't have an interest in FE or DSNP.

    In many markets like Florida the terminology would be " MA option is the pay as go option and Med supp is the prepay option.Then discuss the minimum out of pocket with med supp ( aprox 2500) vs the moop of the MA ( 3-7k).Then explain with med supp you are paying aprox 2500 in premium to cover a risk of between 500-3500.Strictly speaking about the financial aspect MA is usually better risk managements.IMO the biggest points of the difference is the network and managed care downside of MA -however sometimes the coordinated care can be a good thing for some people

  13. Travis Price

    "Would you rather pay a little more upfront and pay less WHEN you need treatment or would you like to pay less upfront and pay more WHEN you need treatment?"

    Slightly different spin . . . "Do you want to pay your medical bills out of YOUR bank account, or would you rather let the insurance company absorb the risk and pay those bills for you?'.

  14. policywunk

    In many markets like Florida the terminology would be " MA option is the pay as go option and Med supp is the prepay option.Then discuss the minimum out of pocket with med supp ( aprox 2500) vs the moop of the MA ( 3-7k).Then explain with med supp you are paying aprox 2500 in premium to cover a risk of between 500-3500.Strictly speaking about the financial aspect MA is usually better risk managements.IMO the biggest points of the difference is the network and managed care downside of MA -however sometimes the coordinated care can be a good thing for some people

    That applies to FL (as you noted, in FL) in the vast majority of the US.. that's not the case.

  15. somarco

    There are a number of studies reflecting this pattern . . . your personal story supports the position that healthy people buy (and keep) MA plans while those who are sick often want to leave for more robust coverage with less OOP.

    Your story is anecdotal but not to be dismissed. The story below bears out your experience.

    The GAO report, released this spring, reviewed 126 Medicare Advantage plans and found that 35 of them had disproportionately high numbers of sicker people dropping out. Patients cited difficulty with access to "preferred doctors and hospitals" or other medical care as the leading reasons for leaving.
    As Seniors Get Sicker, They're More Likely To Drop Medicare Advantage Plans

    Many who are primarily MAPD agents like to talk about the Benjamins . . . and seem to be oblivious to pitfalls of managed care . . . perhaps the dollars in their mattresses help them sleep well at night . . .

    MAPD is fine until you need it but then the clock strikes midnight and your carriage becomes a pumpkin.

    I too noted the article was slanted because it if a puff piece by eHealth.

    @sman post should be required reading for anyone in this market.

    I knew that was coming. The benjamins remark. Makes me laugh. FTR, that was just MAPD/GTL. Between two offices in Mi, more than 100 agents, there are plenty who do both, and many more offerings (CI, DI, Life etc). The one I'm at there's 45-ish agents, and we don't fight with each other over who is doing their client better. The med supp only agents, are not med supp only now. thats for sure. Times are changing….and they will all say, it doesn't matter, do the med supp/pdp, or the MAPD whatever your client goes for…most will tell you, it's not that much different and not worth a few xtra buck either way…the ratio IS changing in their books and its not about the agent wanting MORE BENJIs. The ones who don't do Med supps anymore will surely give another agent that biz if that's what the client wants.

    I'm open to all sides. Med supps, yes I am going to be doing in very near future. I do know what's up even if I am new. So what would you suggest? walking away from helping someone bc they don't want a med supp and have been on MAPD for years. yah ok

    Oblivious isn't a term anyone who knows me would label me as…the cattiness of that doesn't bother me either. Good one.

    Onus for MAPD is not solely on agents. That's just silly.

    It's like a great blame game in here on agents who sell MAPD. As if agents came up with the idea. I can hear it now "well if you wouldn't sell it it wouldn't be an issue…" Yah ok. That's not the reality. Truth is, if I don't someone else will. That's the reality. But since MAPD agents are so money-grubbing, why wouldn't I go ahead and just do it.

    Money, yah I do this solely for the money. Right??!! Sorry, medicare in general isn't great commish any way you slice it. Yep, it will be a nice addition to what is in place for retirement after YEARS of doing it. I do work for money, but med supp/ PDP or MAPD, wouldn't make much difference in money in my POV. I wouldn't care. Just not there yet.

    SMH. Why post anything. This argument will go on until the end of both or either med supp and/or MAPD. Prob time to just sit back with the popcorn and get what I need and bail. Back in the day I never posted, just lurked. prob best that way..haha.

    The great debate of Med Supp vs MAPD. I do get why Med Supp is "superior" on one hand, but on the other there are some nice MAPD in my area and guess what, people who use it don't complain. And guess what else, people WANT IT and have been using it for years now. Not the fault of the agents, if you want to blame anyone, find another blame agent…it's there you just have to look.

  16. FWIW, I really don't care who sells what . . . I have my reasons for going the Medigap only route and won't be swayed . . . and I have 30+ years of managed care experience to make the case for letting the doc + patient make the medical decisions, not some pencil pusher in a home office.

    Agents who are MA only do seem to spend an inordinate amount of time trying to justify their position based on (real or perceived) 1099 totals.

    They also talk about giving the prospect what they want . . . and I am all for that as well . . . but I also know many folks are so confused they don't know what they want. Many have no idea there is a whole world out there where the doc is not under the thumbscrews of an insurance carrier telling them what they can and cannot do.

    So I take the time to explain the difference, using REAL WORLD examples, and let them decide.

    I also have no problem letting them go somewhere else if they want an MA plan. I will also show them the door if they appear to be a PITA. Let someone else deal with them, just not me.

    Last week a guy called, prospect from 4 years ago, and wanted me to change him from the Aetna plan that did not include "his" PCP as a par provider. He also mentioned he was incurring a lot of medical and Rx bills due to his Alzheimer's dx.

    I told him that I don't revisit situations where the prospect was given all the facts and decided to go in a different direction . . . but I did suggest contacting me in the fall and I would refer him to an agent that writes MA plans and perhaps he can find a plan that is a better fit.

    He responded with "Gee, you really are a great guy and I appreciate you offering to help me in the fall".

    Apparently his illness has progressed further than I expected . . .

    I make a very good living, doing things my way, and no intentions of ever changing.

    I also sleep well at night, even if my mattress is not as lumpy as some of the other agents who spend an inordinate amount of time boasting about app count and commission dollars.

  17. somarco

    Slightly different spin . . . "Do you want to pay your medical bills out of YOUR bank account, or would you rather let the insurance company absorb the risk and pay those bills for you?'.

    Slightly different spin…. "Do you want to pay the insurance company $1600/year out of YOUR bank account and then have a $233 deductible with no additional benefits or would you rather have no premium, no deductible, dental, vision, hearing, OTC, gym membership, 24/7 nurse hotline and then share the cost with the insurance company if you should have Dr visits, test, etc?

  18. AugustaMi

    I stayed out of this market for years bc of all the wildness–wasn't interested in AHIP, certs, low commish. My main guy who has large book of MAPD. He used to try to get me into Medicare for years. All the way from mid-late 2000s.

    He was a total plan G guy. Not anymore. I wish I would have listened to him way back when….he's well over 350k annually. Sells primarily MAPD with GTL. $4000 a month renewals just in GTL. So it's clear he's covering some bases. I've seen his statements. Not bragging for him and he never brags, we are friends and he shows me. I spend quite a bit of time with him just bc we worked together in U65 for years and live and play by each other in two states.

    Saw his wallet the other night and double-checked when he whipped it out at an event, we were in line for food….thought maybe he fibbed about what he has himself. He has HAP MAPD. It was sticking out of his wallet. LOL. So do all the other guys/gals I know who used to be ALL about Plan G. They also all have GTL to cover the cancer and some of the major co-pays.

    He swore he'd never sell MAPD back then.

    I read the back and forths on the MAPDs/med supps in here. Being new, and honestly because I was already skeptical, its interesting to me to know both sides inside and out.

    IRL I do ask a ton of questions. Even to anyone I know who has an MAPD. None are really complaining and when they do it's been more about the crappy dental (yes I detest dental and I'm not afraid to tell clients it sucks but itll give you "some" coverage).

    In the guy I referenced above, he claims very few people actually hit the MOOP, often docs eat the co-pays (he doesn't pitch that but says he knows from experience, and as new as I am I've seen this too), and when they do hit it, they usually have GTL to back it up and help fill the gaps.

    My own hubs is turning 65 Dec 2023, and to be honest, we have $ and either one would be fine. But I'm still not 100% what I should do with him. The more I read, the more confused I get. lol. Most days though, I'm leaning toward HAP/GTL. HAP is a nice MAPD (lower MOOP-Lower co-pays with Delta dental in MI). It also travels nice to places we go. hubs is very used to deductibles and ancillaries as are many business owners around here.

    Another observation is that I do see things with HMOs, in-network, out-of-network, referrals, authorizations getting much better….not near as bad as those things used to be…I also see a movement toward lower MOOP. Not all over yet, but it's expanding. Even in Mi, we do have the lower MOOPs, just not on the west side as far as I know…although even over there theres a $4500 Moop plan, HMO though which after reading all the fine print isn't near as bad as i would have thought.

    For good measure though, I've been getting up to speed on Med Supps…I dont wanna have to refer those out….this being new is still a learning thing every day.

    Not looking to get caught up here in a big debate, just saying from my own perspective. I have too many thoughts on the political side to even get started and no one would want to get me started on that…just like alcohol, I'm allergic to politics and break out in handcuffs. Yes, I admit that. And both those things together are really really bad. LOL.

    I'm having a bit of a brain fart…GTL?

  19. AugustaMi

    Onus for MAPD is not solely on agents. That's just silly.

    k.

    of course its not there have always been MA $$$ agents

    Its the TV commercials and other adds that caused the wave

    the agents that always were and the many that appeared in the last few years are just riding that wave

    In the beginning of it when I pulled live transfer leads The leads changed dramatically to everyone who connected was how do I get the part B money back from the govt, Some would even say upfront without changing plans

    Now If I reverted back to my training at the call center 2007 I might have done ok with them, But the bait is switch mentality is not anything I want and why I left, After they started eliminating Maj med on favor of indemnity plans

  20. Ok lets look at something else. The pdp plans are Atrocious and rates sky rocket on pdp plans . Taking into account $50a month avg pdp plans,$480 rx deductible and terrible tier ratings of drugs. The avg pdp plan can cost a client on heavy drug use including getting into donut hole $200 plus a month over a mapd rx plan. Then throw in $200 a month for a 72 yr old plan g and the part b detective at $20 a month. All of a sudden your at $420 a month . Again we all know med supp superir coverage but how many husband/wife’s can afford $840 a month with 7% a yr increases ? It come dow to I’d love a Ferrari but i can afford an accord .

  21. DonP

    Ok lets look at something else. The pdp plans are Atrocious and rates sky rocket on pdp plans . Taking into account $50a month avg pdp plans,$480 rx deductible and terrible tier ratings of drugs. The avg pdp plan can cost a client on heavy drug use including getting into donut hole $200 plus a month over a mapd rx plan. Then throw in $200 a month for a 72 yr old plan g and the part b detective at $20 a month. All of a sudden your at $420 a month . Again we all know med supp superir coverage but how many husband/wife’s can afford $840 a month with 7% a yr increases ? It come dow to I’d love a Ferrari but i can afford an accord .

    I can't speak for everyone else, but the drugs I usually run are minor and go to SilverScript at 8$ a month. Zero deductible for T1/2.

    Secondly the premium for a 72 year old here starts at 119$ a month with an eyeball average of around 140-150 a month.

    You don't actually run drug plans regularly, so youre talking out of your ass a bit, because you do DSNP almost exclusively.

    What happens when one of those MAPD people are doing chronic DME, or injections and spend 5, 6, 8k a year for just Medical, plus their RXs?

    Finally, and most importantly, you can always step down to managed care, which they will certainly hate in you scenario, but you can't always step up.

    Again, it shows weakness in you guys that pitch MAPD as some sort of saving grace. It's not in the vast majority of the country. It has a place, and is a tool at an agents disposal… but you should never start with the premise that you know what the client needs generally. Each client is different. Their interest and needs are different.

  22. Travis Price

    I can't speak for everyone else, but the drugs I usually run are minor and go to SilverScript at 8$ a month. Zero deductible for T1/2.

    Are you sure about that? In Illinois, only Tier 1 avoids the deductible. I assumed every state would be the same.

  23. Travis Price

    I can't speak for everyone else, but the drugs I usually run are minor and go to SilverScript at 8$ a month. Zero deductible for T1/2.

    Secondly the premium for a 72 year old here starts at 119$ a month with an eyeball average of around 140-150 a month.

    You don't actually run drug plans regularly, so youre talking out of your ass a bit, because you do DSNP almost exclusively.

    What happens when one of those MAPD people are doing chronic DME, or injections and spend 5, 6, 8k a year for just Medical, plus their RXs?

    Finally, and most importantly, you can always step down to managed care, which they will certainly hate in you scenario, but you can't always step up.

    Again, it shows weakness in you guys that pitch MAPD as some sort of saving grace. It's not in the vast majority of the country. It has a place, and is a tool at an agents disposal… but you should never start with the premise that you know what the client needs generally. Each client is different. Their interest and needs are different.

    Monkey is right its only tier one at least in most states I have checked in MI but it would be so in NC TN TX IL IN SC GA NY

    I would be shocked if it were not so in MI, Actually doing few MI recently med sup several client changes and ref

    Have you looked at National general lately got some good rates in MI right now

  24. goillini52

    Are you sure about that? In Illinois, only Tier 1 avoids the deductible. I assumed every state would be the same.

    I’m not following you . Many mapd plans have no rx deductibles on their plans and good tier stages on many drugs .

  25. DonP

    I’m not following you . Many mapd plans have no rx deductibles on their plans and good tier stages on many drugs .

    I was responding to Travis. He said SilverScript's cheap PDP plan had no deductible for Tier 2.

  26. DonP

    Ok lets look at something else. The pdp plans are Atrocious and rates sky rocket on pdp plans . Taking into account $50a month avg pdp plans,$480 rx deductible and terrible tier ratings of drugs. The avg pdp plan can cost a client on heavy drug use including getting into donut hole $200 plus a month over a mapd rx plan. Then throw in $200 a month for a 72 yr old plan g and the part b detective at $20 a month. All of a sudden your at $420 a month . Again we all know med supp superir coverage but how many husband/wife’s can afford $840 a month with 7% a yr increases ? It come dow to I’d love a Ferrari but i can afford an accord .

    I get what your saying. I always run meds, as I'm sure you do outside of your DSNPs.

    one of my first appts, I saved a woman appx $600 in Rx a month by switching her to HAP from Priority. Not the same as your above scenario, she was an MAPD, but I get your drift. HAP MAPD has a fantastic formulary in my area in MI. Also very nice MAPD with a fairly good buy up delta dental. Lower co-pays for sure for things like physical therapy, and lower MOOP in some cases. Doesn't take a rocket scientist to know how to run Rx costs even though med supp isn't primary focus at the moment. A few clicks and it's easy to see whats up with a PDP simply while running meds for MAPD. I agree with you.

    In above example, she didn't even know who her guy was that signed her up on the phone. Her 22 meds were far better fit on HAP. I considered it an orphaned plan as she said she hasn't heard from her phone jockey. You wouldn't know about HAP most likely. Its a mi plan. Here I try now to focus mostly on BCBS and HAP now, both great current options. But do have quite a few on Aetna and Humana.

    As for the great MAPD vs med supp convo, in here it's an exercise in futility. IRL, the older vet agents Im around seem to get it, and I will say this, there are plenty making the move over to doing MAPD and have been for awhile, and I guarantee that choice for most isn't solely about money. it's deeper than that.

    Med supp is superior, but how often is it the fit that works? Just a glance at what went down during my 1st AEP and since shows me it's hardly going to fit all situations. Not even all T65ers. yesterday I talked to a guy about a med supp….guy balked. Got the soa and they'll both be on HAP. They moved from FLA last week, T65 guy, just got his part b, wife already a humana dsnp. By adamant choice it'll be an MAPD. Both going on HAP. All I will say about that is its a very nice MAPD, lower co-pays on things like physical therapy, one of the nicest buy up dentals, lower moop in many cases, and one helluva Rx formulary (maybe the best in my area), travels nicely to FLA, Arizona, and texas.

    As for the med supp/Mapd convo for me in here though it's the last I'll waste time writing about it. It's clearly futile. Leaves a bad taste in my mouth for sure.

  27. sman

    Vic shared a real life personal experience. Hard to refute that. He also sells both MAPD and Med Supp so he isn't "one of those agents". It's ok to speak of the problems with any product we sell. I hope anyone who sells MAPD (I do) shares the few potential drawbacks with their clients. If you aren't, you are doing a disservice to the client.

    Those happiest with their MAPD plans are the ones who don't need much medical care. it's a win for them and a win for the insurance company. But ask anyone who is having delays because of pre-authorization or anyone who has been in and out of the hospital, going through chemo or dialysis and they will tell you they wish they had a Med Supp instead.

    I have medsupp client, plan f, in Apopka. Has cancer. Medicare keeps denying treatment. Doctors tell her she has less than 6 months to live.

    After reading all the horror stories about MAPD from the pros on this forum, I'm thinking about calling her and telling her just to be happy she ain't on MAPD, coz it could be worse some how…

  28. axeman462

    I have medsupp client, plan f, in Apopka. Has cancer. Medicare keeps denying treatment. Doctors tell her she has less than 6 months to live.

    Is she in hospice? Is the suggested treatment experimental, provisional or "off label" (non-standard for the type of cancer she has)?

  29. somarco

    Is she in hospice? Is the suggested treatment experimental, provisional or "off label" (non-standard for the type of cancer she has)?

    Nope, doctors told her medicare denied her the treatment because of her age.

  30. somarco

    Is she in hospice? Is the suggested treatment experimental, provisional or "off label" (non-standard for the type of cancer she has)?

    When you go to hospice, all treatment of the disease stops and only palliative care is covered.

    Hospice Care Coverage

    Doctors are likely lying to her. As that would be age discrimination.

  31. axeman462

    I have medsupp client, plan f, in Apopka. Has cancer. Medicare keeps denying treatment. Doctors tell her she has less than 6 months to live

    Something seems off about this story. She's either elected to hospice, which stops all cure treatment coverage for palliative coverage, or the treatment is not covered by the FDA.

    Hospice Care Coverage

    axeman462

    Nope, doctors told her medicare denied her the treatment because of her age.

    The doctors are giving her a line of crap. Medicare does not participate in age discrimination.

    https://www.medicare.gov/Pubs/pdf/11534-medicare-rights-and-protections.pdf

  32. AugustaMi

    Med supp is superior, but how often is it the fit that works? Just a glance at what went down during my 1st AEP and since shows me it's hardly going to fit all situations. Not even all T65ers. yesterday I talked to a guy about a med supp….guy balked.

    Here's the difference, no one on the Medigap side of this is making that argument. Literally every one of us is saying that it's better coverage, but as long as the client understands what they're signing up for.. then our job isn't to shove Medigap their throat; even if we don't offer MAPD.

    On the other hand, you have literally every MAPD-only agent swearing that Medigap isn't worth it because of money and every other excuse; which is just a smokescreen.

    HDG is literally MAPD in OM for medical. The cost in MI for Medico at age 75 for an NS M is 48$, plus 8-12$ (usually) for PDP for superior coverage. If you're trying to sell me that someone can't AFFORD 60$ a month.. I'm having a hard time believing that.

    If you're trying to sell someone a 130$ plan for G, I'm sure someone would balk.

    It's literally why none of these guys have a response to HDG. It's because they see they can make more money off of MAPD.

  33. Travis Price

    Something seems off about this story. She's either elected to hospice, which stops all cure treatment coverage for palliative coverage, or the treatment is not covered by the FDA.

    Hospice Care Coverage

    The doctors are giving her a line of crap. Medicare does not participate in age discrimination.

    https://www.medicare.gov/Pubs/pdf/11534-medicare-rights-and-protections.pdf

    Actually it makes perfect sense. Democrats hate old people, so they're trying to kill them all off by creating Death Panels for Medicare.

  34. axeman462

    Actually it makes perfect sense. Democrats hate old people, so they're trying to kill them all off by creating Death Panels for Medicare.

    My bad. We have two different goals. I was trying to figure out why Medicare denied something. You wanted to spew delusion with no basis in fact. Now I remember why you're on ignore. I feel bad for your clients.

  35. Midlevel

    How can this be? I thought all clients hated their MA plans due to Dr. networks, prior authorization and all the other terrible things. Maybe it's just certain agents that make it seem that way?

    Those are the ones that haven't used it for a serious condition yet.

  36. rousemark

    Those are the ones that haven't used it for a serious condition yet.

    I have a client on a Humana MA plan that just had extensive testing, surgery etc., and called to let me know how she was doing. I asked her about the coverage, and she said that she was thrilled with the way everything was handled, and she had very little out of pocket.

    You can't believe everything you read on here.

  37. rousemark

    Those are the ones that haven't used it for a serious condition yet.

    I have had many with serious illnesses on an MAPD plan. Had a person in hospital for 3 weeks last year with Covid. Has a copay of $390/day for 5 days. Also has a GTL Hospital plan that pays $300/day for 10 days. Boy was he upset when his bill was $178000.00 and he ended up making $1050. All these agents throwing out scare tactics to clients about MAPD are just doing their clients a disservice. It's OK to tell them they have to make sure Drs. etc are in network and they may need prior authorization for an MRI, CT scan, etc but to just flat out say you are going to hate the MAPD plan if you end up having claims is just absurd.

    Have had clients call after doing physical therapy after a knee surgery and said they ended up paying $800 copay for physical therapy. I remind them they haven't had a premium since 2012 and suddenly they realize they are probably doing OK still. I'm not saying everyone should be on an MAPD, I have people choose a Med Sup and have no problem with it. But to just try to scare them away from MAPD makes no sense to me, a lot of these people turning 65 have been on a plan with a high deductible and are used to copays, etc. already so why not give them the option of a Med Sup and an MAPD?

  38. bill3173

    I have a client on a Humana MA plan that just had extensive testing, surgery etc., and called to let me know how she was doing. I asked her about the coverage, and she said that she was thrilled with the way everything was handled, and she had very little out of pocket.

    She also JUST had surgery and testing. The claims processing is likely not completed yet. Pre-authorization is only approved for the services, not the actual expenses. It's why it takes time for Medicare to send you an MSN and why you shouldn't pay anything until you get it under OM.

    I'm not saying that you're going to run into additional costs. I'm just saying that the upfront costs aren't always the only ones.

    Furthermore, and just to put this into perspective, serious conditions aren't usually acute… they're chronic. An acute condition, with some testing a surgery, and maybe two follow-ups isn't going to be crazy.

    Cancer with chemo (70% of new diagnosis are over 65, FYI), diabetes requiring an insulin pump, conditions requiring injections (like macular edema), a stroke, copd requiring 02, digestive disorders causing chronic hospitalizations, circulatory issues, etc… Those are serious conditions and your client is going to hate you for those expenses.

    Again, the only people maximalizing one plan type over the other are people that ONLY sell MAPD. Everyone else is saying, Medigap is better coverage. If the person is more concerned about less complications, Medigap is the way to go. If they UNDERSTAND the limitations in MAPD, then they should do what they think is best; regardless if I offer it or not.

  39. goillini52

    I find that hard to believe. Did you do a 3 way call with her to Medicare?

    People say things, They interpret things

    Old people lose their memory skills In addition become overly suspicious sometimes

    I just had an incident today, Client has been with me 10 years we changed plans 4 times, We had many long conversations over the years

    Called today to save her $40 a month in premium, She hung up during voice signature, I called back and she said don't call me

    Her son called me telling me I cold called her she doesn't know me

    I talked him down he had me send him email but she is acting as if she has no idea who I am and im trying to scam her

  40. Travis Price

    Here's the difference, no one on the Medigap side of this is making that argument. Literally every one of us is saying that it's better coverage, but as long as the client understands what they're signing up for.. then our job isn't to shove Medigap their throat; even if we don't offer MAPD.

    On the other hand, you have literally every MAPD-only agent swearing that Medigap isn't worth it because of money and every other excuse; which is just a smokescreen.

    Literally every one of us is saying that it's better coverage, but as long as the client understands-

    you sure this is how it goes. Not from what I'm reading. Won't get into all the names and insinuations from just yesterday, shouldn't have to spell it out.

    you have literally every MAPD-only agent swearing that Medigap isn't worth it because of money and every other excuse

    No this is a stretch. Sure some bad apples. Seen a few through AEP, and called them out. Out of state phone jockeys. Overall, this isn't the case for the majority.

    Midlevel

    I have had many with serious illnesses on an MAPD plan. Had a person in hospital for 3 weeks last year with Covid. Has a copay of $390/day for 5 days. Also has a GTL Hospital plan that pays $300/day for 10 days. Boy was he upset when his bill was $178000.00 and he ended up making $1050. All these agents throwing out scare tactics to clients about MAPD are just doing their clients a disservice. It's OK to tell them they have to make sure Drs. etc are in network and they may need prior authorization for an MRI, CT scan, etc but to just flat out say you are going to hate the MAPD plan if you end up having claims is just absurd.

    Have had clients call after doing physical therapy after a knee surgery and said they ended up paying $800 copay for physical therapy. I remind them they haven't had a premium since 2012 and suddenly they realize they are probably doing OK still. I'm not saying everyone should be on an MAPD, I have people choose a Med Sup and have no problem with it. But to just try to scare them away from MAPD makes no sense to me, a lot of these people turning 65 have been on a plan with a high deductible and are used to copays, etc. already so why not give them the option of a Med Sup and an MAPD?

    This is the truth. Midlevel gets it. This is actually what we see. Yes, I'm new to medicare, but hardly oblivious (another insinuation from yesterday). Most the people I work with were G loyalists for years. I was there when they all made the switch around 2009 and tried to bring me with them, been around some of those people still for years. Worked with most of them from 2004-2018 in one way or the other doing my own thing. And do now again since AEP. Again, they switched over to MAPD for reasons having little to do with money, more to do with their books and continuing to grow as the landscape changed around them.

    Side Note: BTW, not to be an asshole Travis, you do have a nice lower MOOP in your area. Would go nicely with GTL. Very nice plan and don't even need authorizations for many things. PCP listed yes, but great formulary and nice bennies, co-pays, gas cards, food and otc card, none DSNP, etc. Just sayin…bc the other day you posted you didn't have a lower MOOP in that area. Oh and decent dental…guy just walked into my non-home office smiling to show me his partial…was totally happy with it. Yes, he had OOP, but he like many are used to OOP.

  41. Travis Price

    To be fair (and not saying this is your case) people exploit the old and poor. I'm overtly cautious too..

    Yes but she should know me well over 10 years like I said 4 switches, She used to love me Now she doesnt know me

  42. AugustaMi

    Literally every one of us is saying that it's better coverage, but as long as the client understands-

    you sure this is how it goes. Not from what I'm reading. Won't get into all the names and insinuations from just yesterday, shouldn't have to spell it out.

    you have literally every MAPD-only agent swearing that Medigap isn't worth it because of money and every other excuse

    No this is a stretch. Sure some bad apples. Seen a few through AEP, and called them out. Out of state phone jockeys. Overall, this isn't the case for the majority.

    This is the truth. Midlevel gets it. This is actually what we see. Yes, I'm new to medicare, but hardly oblivious (another insinuation from yesterday). Most the people I work with were G loyalists for years. I was there when they all made the switch around 2009 and tried to bring me with them, been around some of those people still for years. Worked with most of them from 2004-2018 in one way or the other doing my own thing. And do now again since AEP. Again, they switched over to MAPD for reasons having little to do with money, more to do with their books and continuing to grow as the landscape changed around them.

    Side Note: BTW, not to be an asshole Travis, you do have a nice lower MOOP in your area. Would go nicely with GTL. Very nice plan and don't even need authorizations for many things. PCP listed yes, but great formulary and nice bennies, co-pays, gas cards, food and otc card, none DSNP, etc. Just sayin…bc the other day you posted you didn't have a lower MOOP in that area. Oh and decent dental…guy just walked into my non-home office smiling to show me his partial…was totally happy with it. Yes, he had OOP, but he like many are used to OOP.

    A number of issues:

    1) I'm not referring to other conversations or "people you know." I'm speaking about this conversation. Broadening out the conversation for it to meet your narrative is disingenuous, at best. Same for "everyone one of us.." Meaning everyone in THIS conversation.

    You can lean heavily towards Medigap and still acknowledge that it's not your job to sell someone Medigap. You're in MI, most of our Medigap plans pay a 3-FYC and then it goes to shit. YOUR BOOK pays out more over time by sucking on the MAPD teet. Your clients, as they get older in most cases, pay exponentially more in services.

    I would make exponentially more money by just selling MAPD all day long. Scope, sign-up done. However, when something is free.. YOU ARE THE PRODUCT.

    2) If you're selling off of non-Medicare services, you're showing your "new to Medicare"-ness. MAPD non Medicare covered services are open to interpretation every year and change, quite often to the downside, when they've saturated an area. It works literally the same as Medigap plans that have no claims experience when they enter a new territory. They're cheap, then skyrocket. With MAPD bennies are great, claims are great, then cheapen as they have to pay out more.

    People don't generally switch plans unless they're nudged to (with Medigap it's cost, with MAPD it's when someone else shows up with a big shiny and agents shove it down beneficiaries' throats.)

    I've been in Medicare since 2004. I sold MAPD when it was first introduced. I sell MAPD now, under the right circumstances (meaning when the client is well-informed and wants to go that route.) I don't know what "GTL's Medicare Advantage plan" is, because it's not in the Plan Finder and it's not in a Google search. It's likely some shit your IMO sold you on because they're getting a fat bonus off of it since it's new in the market.

    As for justifying it's "okay" that people pay OOP because they're used to it is akin to how you boil a frog. You put it in normal water and slowly turn up the heat. It doesn't know any better until it's too late. But do you.

    People market to my clients all of the time. I've lost 1 in since 2016 and it was DSNP. If it was so horrible, and people really hated Medigap so much, I would have a much higher attrition rate.

    But hey, I'm open to looking at any plan that I don't know about and evaluating if it's a good fit.. but I don't sell new shit because I know the market.. not what new shiny thing that's thrown at me… because it's rarely in the best interest of the client.

  43. AugustaMi

    you sure this is how it goes. Not from what I'm reading. Won't get into all the names and insinuations from just yesterday, shouldn't have to spell it out.

    Yep. Because I've been around them longer than you have. So I happen to actually know what they're saying vs what you're interpreting.

    In most cases, what's happening is that you have a MAPD-only agent making comments about how Medigap is a waste of money and MAPD is "good enough." The argument is in direct response of those comments.. not that a client doesn't have the right to choose what's best for them and that they have to be sold Medigap.

    I've been in this market since 2004. I was here when the first MAPD products came out. I sell MAPD now when appropriate (meaning when the client knows the limitations of MAPD and makes the decision it's the best fit for them.)

    AugustaMi

    Seen a few through AEP, and called them out. Out of state phone jockeys. Overall, this isn't the case for the majority.

    Your statement is disingenuously broad. I'm speaking about this conversation only.

    AugustaMi

    Yes, I'm new to medicare, but hardly oblivious (another insinuation from yesterday).

    AugustaMi

    BTW, not to be an asshole Travis, you do have a nice lower MOOP in your area. Would go nicely with GTL. Very nice plan and don't even need authorizations for many things. PCP listed yes, but great formulary and nice bennies, co-pays, gas cards, food and otc card, none DSNP, etc. Just sayin…bc the other day you posted you didn't have a lower MOOP in that area. Oh and decent dental…guy just walked into my non-home office smiling to show me his partial…was totally happy with it. Yes, he had OOP, but he like many are used to OOP.

    "Not to be an asshole" but you're selling MAPD off of benefits that aren't protected by Medicare. That's pretty oblivious. A Google search and a Plan Finder search don't show GTL in my area. Which means it's relatively new.

    In order to gain market share, insurance companies start off with really attractive rates and benefits (not just MAPD, Medigap does it do.) Once they've hit a point of saturation and profitability, they start to scale back… increase rates, tighten claims, increased Moop, now a premium, all those extras go to shit, etc.

    AugustaMi

    Again, they switched over to MAPD for reasons having little to do with money, more to do with their books and continuing to grow as the landscape changed around them.

    Bullshit. Sorry, not sorry. As we both know, in MI it's more profitable to sell MAPD. Medigap (except for a few carriers and only one is competitive consistently) is stuck on a 3y FYC. After year three, the money goes to the shits. With FYC in MAPD and two years at renewal, it breaks even in comp… Year 4+ you get ahead with maybe an hour extra work annually and no costs, because you're just flipping your book to a new shiny carrier.

    I don't sell shiny shit. I sell proven shit. Even my MAPD plans are the heavier companies in the state, for the exception of BCBS.

    Why? Because my reputation is more important than selling the next new widget just to flip again.

    Again, I don't care if you sell MAPD. I sell MAPD. There's nothing inherently wrong with having an additional tool in the toolbox. However, selling that a hammer is right in every situation, even when you need a screwdriver, is pathetic.

  44. No one said anything about GTL being an MAPD. I'm sure the FMO does get a bonus, and I can sell it year round and sleep well at night doing so…I also gain more clients by doing that You know exactly what GTL is esp if youve been around since 2004.

    In your area there's BCBS/BCN MAPD. Would go nicely with GTL. I was mainly being facetious. Back days ago, I read a post where you said you do not have a lower Moop MAPD in your area. That's incorrect. You do actually and IT would go nicely with a GTL with cancer. I'm sure you won't get that though and will have every reason in the book why you wouldn't do it (don't need money, perfectly happy with having more free time, bcbs sucks, hard to contract with it's like a college course, yada yada, already at 100k per year and fine with that…literally, literally, literally everything you could think of—facetious).

    I have no idea what youre talking about– me "selling" off non medicare…twisting that is not cool.

    Youre very good at spinning things to fit your narrative, and that isn't cool. You did it twice. 1. you tried to spin that I think GTL was an MAPD,
    2. you spun it that I sell on non medicare crap. You completely made that narrative up.

    Neither are true.

    Im done with this….it's nonproductive.

  45. AugustaMi

    You are the biggest bullshitter in here, especially how you bullshit yourself.

    I love you too.

    It's cute that your run your mouth but aren't saying anything. If I'm such a bullshitter, be more specific how… I'm pretty open about adjusting if you can make a valid point. So far.. pretty oblivious of you.

    There's also MULTIPLE GTL's, there's a GTL Medigap plan. There's a GTL advantage plus… I don't know what you're referring to by just saying GTL because GTL is a company, not a product.. could be something I've never heard before, which is what I was saying.

    Let's just boil down to it. You're gun-ho about "GTL" with MAPD because you make close to $800 fyc. That's about what you get paid for all 3y FYC with most Plan G's in the state. If your client is happy about that.. awesome. If they're informed about the limitations of MAPD, awesome.. but saying it's not about primarily money is a lie… Even if you're lying to yourself.

    See the difference between your bullshit and my "bullshit?"

    It's called making a specific argument. Not just being vapid because it makes you think you're saying something.

  46. The survey is a push poll. What did they do? Send it to a bunch of clients under age 70?

    I sell both (barely) but I get both plans. Its important to present both. If there is a significant amount of savings on MAPD vs Part D on the meds, I explain that to the client.

    I love MAPD when they are dual, obviously. But other than that, I don't think it makes sense past age 70 or with health conditions.

    And I absolutely despise MAPD when they are broke, but not Medicaid broke and don't understand that the $0 premium PPO MAPD means they need $1500 for a hip replacement. If they are that broke, they obviously can't save money. But they can pay $100/month for N and D, so the hip replacement costs $233 instead.

    And I seriously don't understand adding a hospital indemnity and cancer plan vs selling them N in the first place. Unless the agent is more worried about their commission instead of what's best for the client….

  47. [

    AugustaMi

    ou do actually and IT would go nicely with a GTL with cancer. I'm sure you won't get that though and will have every reason in the book why you wouldn't do it (don't need money, perfectly happy with having more free time, bcbs sucks, hard to contract with it's like a college course, yada yada, already at 100k per year and fine with that…literally, literally, literally everything you could think of—facetious).

    The only reason I need to have is that I don't want to. I can already sell year-round now… so that's not an issue for me.

    Just to make an additional point, BCBS's MooP is 4,500$. That's in line with a few different HMO-POS's and the MooP is a smokescreen because almost no one hits it unless you're in a chronic condition… My argument was that the MooP's in FL are not the same as the MooP in MI or even with HDG, which is so incredibly low that it makes sense to offer MAPD over pretty much everything. Humana's zero-premium is pretty consistent if you acknowledge that most people don't hit MooP, so I don't need BCBS.

    If I make every excuse why I don't want to sell it, you make every excuse on why it's the best thing since sliced bread…

    My argument has been consistent. I don't use a hammer for every appointment. Not everyone should be on an MAPD and I'm not the person to tell them they should be… they're the person that makes the decision on what works for them… My job is to explain the potential pitfalls of one plan over another, what solutions I have to resolve those pitfalls, and to find the best plan for their decision.

    What YOU'RE (and people like you, because Midlevel "gets it") selling is that people aren't smart enough to think about their insurance decisions, so you just sell them what makes you the most money. Regardless of if it's the best fit, or what they're into or not.

  48. Travis Price

    What YOU'RE (and people like you, because Midlevel "gets it") selling is that people aren't smart enough to think about their insurance decisions, so you just sell them what makes you the most money. Regardless of if it's the best fit, or what they're into or not.

    I knew that would burn your *ss. God forbid someone agree with that nasty MAPD agent who also sells Med Sups and Cost Plans. I'm starting to think all you G plan only people aren't smart enough to keep track of all the options available now so let's just stick them on a G or N plan. Training starts in a couple weeks for us that offer all available options to our clients. Can't wait to see what exciting new benefits will be available in my area for 2023!

  49. AugustaMi

    No one said anything about GTL being an MAPD. I'm sure the FMO does get a bonus, and I can sell it year round and sleep well at night doing so…I also gain more clients by doing that You know exactly what GTL is esp if youve been around since 2004.

    In your area there's BCBS/BCN MAPD. Would go nicely with GTL. I was mainly being facetious. Back days ago, I read a post where you said you do not have a lower Moop MAPD in your area. That's incorrect. You do actually and IT would go nicely with a GTL with cancer. I'm sure you won't get that though and will have every reason in the book why you wouldn't do it (don't need money, perfectly happy with having more free time, bcbs sucks, hard to contract with it's like a college course, yada yada, already at 100k per year and fine with that…literally, literally, literally everything you could think of—facetious).

    I have no idea what youre talking about– me "selling" off non medicare…twisting that is not cool.

    Youre very good at spinning things to fit your narrative, and that isn't cool. You did it twice. 1. you tried to spin that I think GTL was an MAPD,
    2. you spun it that I sell on non medicare crap. You completely made that narrative up.

    Neither are true.

    Im done with this….it's nonproductive.

    You didn't quote, so I can't tell who you're pissed at. Travis?

  50. Midlevel

    I knew that would burn your *ss. God forbid someone agree with that nasty MAPD agent who also sells Med Sups and Cost Plans. I'm starting to think all you G plan only people aren't smart enough to keep track of all the options available now so let's just stick them on a G or N plan. Training starts in a couple weeks for us that offer all available options to our clients. Can't wait to see what exciting new benefits will be available in my area for 2023!

    Good lord, you really can't be that slow… either you're not reading (and I'm verbose so that what I'm saying is clear, but try to break it up for the internet) or you're twisting. So I'll try again to explain my position and hopefully, we can start fresh and the bickering (from all three of us) can stop.

    For probably the 5th time this week, I sell MAPD, HDG, and Plan G.

    I have 1 Plan N in my entire book. I don't even offer it because I don't think it's a very good value for the dollar amount. That may change in the future, but right now it's not something I like because of the coding issue when people have PT and the savings is like 20 dollars a month.

    Secondly, my personal preference to HDG over MAPD is backed by almost 18 years of independent studies completed by government officials concerning how managed care operates to cost-save and give people all those great benefits, as a selling point, that you're talking about at the expense of medical claims (which is access to quality care and overall more important.)

    However, my personal opinion rarely bleeds in how I use a needs-based approach to what the client wants. I literally posted my "script outline" of how I ask the prospect questions on their interests and I don't pitch products (Medigap or MAPD) that people objective are saying they don't want.

    My job isn't to sell anyone. My job is to figure out risk tolerance and match them to the best product available. MY book is about 40% MAPD, just FYI. I've lost 1 client since 2016, which was a DSNP that I didn't fight to keep.

    Considering agents and call centers are always marketing to someone else's clients, I have to be doing something right to lose 1 person in 6 years.

    Concerning MAPD, when they say they just want it, I try to figure out why that's where they're coming from and educate them on managed care. If they're educated and that's their direction, I don't refuse to complete the application or do any extra special fight to push them to Medigap.

    The ONLY time that happens is if there are a bunch of unknowns and I suggest going with the better medical coverage and stepping down if they find it isn't for them. I don't get paid "more" for Medigap, especially HDG.

    I don't care if someone agrees with you when it's from a place of actually understanding the market you're in. My professional experience (which isn't just Medicare private insurance) is Social Security Disability and Medicare for the Feds, meaning I actually worked with people needing chronic health treatment and how managed care (even in Medicare) takes every opportunity to put profits first by restricting access to quality care (actual limitations in care in the benefits AND in the claims process) when given the opportunity.

    My main issue isn't that you sell MAPD. It's that you make statements that appear to fundamentally push MAPD over everything else. It shows, IMO, a lack of understanding in the market you're in (or at least what most of the country has vs FL.. because FL is just a different universe.)

    Granted, maybe I'm clouded a bit because in MI MAPD pays more over time than a 3 year fyc for most carriers and really bad agents push MAPD on people that have zero business being on it and call me crying (literally) on how they're going to pay for expenses for serious chronic conditions. All in the name of making more money.

    That's on me for stereotyping agents that push MAPD so hard without understanding the major pitfalls of managed care. So for that I apologize.

  51. Travis Price

    Good lord, you really can't be that slow… either you're not reading (and I'm verbose so that what I'm saying is clear, but try to break it up for the internet) or you're twisting. So I'll try again to explain my position and hopefully, we can start fresh and the bickering (from all three of us) can stop.

    For probably the 5th time this week, I sell MAPD, HDG, and Plan G.

    I have 1 Plan N in my entire book. I don't even offer it because I don't think it's a very good value for the dollar amount. That may change in the future, but right now it's not something I like because of the coding issue when people have PT and the savings is like 20 dollars a month.

    Secondly, my personal preference to HDG over MAPD is backed by almost 18 years of independent studies completed by government officials concerning how managed care operates to cost-save and give people all those great benefits, as a selling point, that you're talking about at the expense of medical claims (which is access to quality care and overall more important.)

    However, my personal opinion rarely bleeds in how I use a needs-based approach to what the client wants. I literally posted my "script outline" of how I ask the prospect questions on their interests and I don't pitch products (Medigap or MAPD) that people objective are saying they don't want.

    My job isn't to sell anyone. My job is to figure out risk tolerance and match them to the best product available. MY book is about 40% MAPD, just FYI. I've lost 1 client since 2016, which was a DSNP that I didn't fight to keep.

    Considering agents and call centers are always marketing to someone else's clients, I have to be doing something right to lose 1 person in 6 years.

    Concerning MAPD, when they say they just want it, I try to figure out why that's where they're coming from and educate them on managed care. If they're educated and that's their direction, I don't refuse to complete the application or do any extra special fight to push them to Medigap.

    The ONLY time that happens is if there are a bunch of unknowns and I suggest going with the better medical coverage and stepping down if they find it isn't for them. I don't get paid "more" for Medigap, especially HDG.

    I don't care if someone agrees with you when it's from a place of actually understanding the market you're in. My professional experience (which isn't just Medicare private insurance) is Social Security Disability and Medicare for the Feds, meaning I actually worked with people needing chronic health treatment and how managed care (even in Medicare) takes every opportunity to put profits first by restricting access to quality care (actual limitations in care in the benefits AND in the claims process) when given the opportunity.

    My main issue isn't that you sell MAPD. It's that you make statements that appear to fundamentally push MAPD over everything else. It shows, IMO, a lack of understanding in the market you're in (or at least what most of the country has vs FL.. because FL is just a different universe.)

    Granted, maybe I'm clouded a bit because in MI MAPD pays more over time than a 3 year fyc for most carriers and really bad agents push MAPD on people that have zero business being on it and call me crying (literally) on how they're going to pay for expenses for serious chronic conditions. All in the name of making more money.

    That's on me for stereotyping agents that push MAPD so hard without understanding the major pitfalls of managed care. So for that I apologize.

    I just need to stay off the forums because not sure why I care what anyone else thinks or does with their business. I only know what the plans are like in my area and have built a pretty successful business over 22 years from scratch. I’m going to try to just become a reader of the forums about certain topics like the new recording of meetings etc that actually offer some insight and skip the posting. I already have high blood pressure and don’t need the additional stress. Ha. I also apologize if I have been a d**k,
    I’m really not like that in real life.

  52. Midlevel

    I just need to stay off the forums because not sure why I care what anyone else thinks or does with their business. I only know what the plans are like in my area and have built a pretty successful business over 22 years from scratch. I’m going to try to just become a reader of the forums about certain topics like the new recording of meetings etc that actually offer some insight and skip the posting. I already have high blood pressure and don’t need the additional stress. Ha. I also apologize if I have been a d**k,
    I’m really not like that in real life.:fibs:

    I've taken several long breaks from the Forum.

    Yep, your BP can rise in these threads. I actually had a stroke a couple of years ago while posting. I kept holding down keyssssss and it tookkkkk me several tries before I got it correct because my hand went limp. A few months later I took a 14 month break because the Libs on the Forum were making my BP rise. :yes:

  53. goillini52

    You didn't quote, so I can't tell who you're pissed at. Travis?

    As he knows, yes Travis!

    LOL not even that pissed. Compared to the men in my everyday real life, he's just irritating like a mosquito. I actually laugh at the rhetoric. It's f'n hysterical! Yes, out loud laughing! I mean really? Calling people out for liking to make money…if only my dad could see this shit…he's probably rolling over in his grave that I'm even responding nicely to that, not that I read it all, don't have to to know what it's about….futile.

    I first came in here back in 2009ish, got a ton of info, never posted. Left and went about my merry way–you know, to go make those benjis$$$. Then again in about 2012, same thing. Now since about Nov-ish I'm back again. Needed a few questions answered. Check, have my answers.

    This time I decided I'm more slowed down in the work/life sector and thought I'd start sharing. Well, I had the thought today when I left one office to go to another that coming back in here was sort of like a long time ago when I walked into a bar I hadn't been in for about 15 yrs. I was shocked to see some of the same regulars bellied up to the same bar, talking the same similar shit they were talking about 15 yrs prior. Not knocking anyone, just an observation. Yah there's Travis, same shit different day only now he's a little more verbose. I've learned from you Travis. sure did…T65 inbound.

    As I've said plenty of times now. I have learned in here, but overall, my learning this time around hit a plateau…about to go do what I always do…GO MAKE THOSE GD BENJIs! I already have plenty, but you know I'm a greedy, boasting, oblivious, home-office slugging, money-grubbing MAPD thumper now, and want more. And I'm proud of it. Proud of the rest I have done over the years too, so add that in with the rest of the adjectives that get thrown around LOUD AND PROUD.

    See ya's in another few years or ten!! Peace out!:wubclub:

    Ok my bad, I was too lazy to go quote out what was referring to what, sorry Goillini Monkey guy, much love to you. It'll either be understood or not. IDC, it's 3 am in the morning here, I'm tired…worked all day then went out with hubs to play all night.

  54. sorry Travis…much love to you too! I can be an ass and I have no regrets about that. I get it, you do MAPD. I did get that and really it wasn't all you that even got me started. Not even close.

    I did learn from you. Thank you. I am who I am, you are who you are…all good. No hard feelings.

    Also sorry again for not quoting with the little box. Long day and yes right now I am that lazy.

  55. And . . . here we go again

    Healthy people don't need insurance (including Medicare).

    Most sick people need some form of insurance which affords them access to care and the ability to pay medical bills without robbing a bank.

    And most healthy people will invariably see their health change, often significantly, before they leave this earth. By the time they NEED insurance it most likely cannot be purchased.

    "Free" plans come with a price. Sometimes it is in the form of higher OOP cost of care, sometimes it is limited access to care . . . and sometimes it is both.

    Most people have no idea what they have until they use their plan. That is when they find out they may not be able to use any provider without incurring higher OOP costs. It is also the time when they learn about how pre-authorization can result in diagnostic and treatment delays, and how fragile the plan they have is, and how it impacts their quality of life.

    One question in this thread seems to remain unresolved, and that is this one.

    "I have medsupp client, plan f, in Apopka. Has cancer. Medicare keeps denying treatment. Doctors tell her she has less than 6 months to live."

    We never found out if the person was in hospice care or not.

    Hospice or not, original Medicare does not deny treatment, but they may refuse to pay a claim. That is not the same as "denying treatment".

    Medicare does not have a pre-authorization process for care, other than DME.

    Somewhere along the facts got lost and this situation needs further explanation if it is to be a learning example.

    This may seem to be semantics to some, but it addresses the root cause of misunderstanding why some agents prefer a plan with unfettered access to care, and a way to cut the insurance carrier out of the treatment decision protocol.

    Perhaps denial of medical services is not an issue to some on this forum. The agent may not see it as a problem but you can believe the patient feels differently.

  56. Had referral appt yesterday . $800 k home and a professional . I was all ready to do my medsup / mapd spell knowing she’d want a med sup . Off the bat she said I want mapd . I went over all the copays and other potential costs . She said I’m crazy healthy . She was coming off a $5 k deductible group plan . She was on zero drugs . I begged her her to get a hospital policy with cancer rider . She didn’t want it .

  57. BibH

    Had referral appt yesterday . $800 k home and a professional . I was all ready to do my medsup / mapd spell knowing she’d want a med sup . Off the bat she said I want mapd . I went over all the copays and other potential costs . She said I’m crazy healthy . She was coming off a $5 k deductible group plan . She was on zero drugs . I begged her her to get a hospital policy with cancer rider . She didn’t want it .

    Why would you beg someone to purchase something?

  58. somarco

    Somewhere along the facts got lost and this situation needs further explanation if it is to be a learning example.

    This may seem to be semantics to some, but it addresses the root cause of misunderstanding why some agents prefer a plan with unfettered access to care, and a way to cut the insurance carrier out of the treatment decision protocol.

    This.

    Like I was trying to explain in my last post… My personality is to start by zooming way out to the Healthcare industry. Then looking at Medicare and how it fits into that system. Then private insurance in the Medicare system.

    I know that sounds like a pain in the ass… but I think the more information you have, the more informed you are, the more analytical you become and thus can make the very confusing process of people buying individual health insurance (often for the first time) easier FOR THEM long term.

    As DonP once said, maybe I should have been an engineer… but that's what we're doing. We're not really selling insurance. We're helping people create a system, now and in the future, to navigate a for-profit healthcare system that will take every every advantage to make money first.

    The small stuff, dental, otc, utilities cards, whatever, is a marketing ploy to get you to sign up. They're nice, but medical is ALWAYS the primary consideration. Your client doesn't think like that. They see the shiny.

    Your (general) job is to inform them of the bigger picture and then let them make decisions. Once they do, you find the best value based on their position in this system.

    I don't do a whole lot of rebuttals or overcoming objections. My job isn't to convince anyone to buy anything. My job is to make sure when they have a question and I answer, they come back later and say, "You were right."

    I'll be the first person to say that (especially online) I can come across as aggressive. It's not intentionally obtuse, I just speak very directly. However, we lose tone inflection and some other verbal cues that make it much softer in the way I'm saying it vs the way it reads. I think we all do that,lose verbal cues and shit comes off much more aggressive than it is.

    Sometimes I piss people off that I have a huge amount of respect for, and sometimes they piss me off. However, when I say something it's just in that post or thread about that conversation.

    I covered a lot of topics here, but my point is that my goal is to challenge thinking (mine and others) to help all of us think from other perspectives. I've changed my philosophy on a lot of things because what you're told and what's true differs greatly.

    Healthy debate, if you take it from a place of backing your position from a place of fact and openness to change your mind when appropriate, makes you a better person.. but that's just my .02.

  59. As he knows, yes Travis!

    Ok my bad, I was too lazy to go quote out what was referring to what, sorry Goillini Monkey guy, much love to you. It'll either be understood or not. IDC, it's 3 am in the morning here, I'm tired…worked all day then went out with hubs to play all night.[/QUOTE]

    Haha, you probably did quote, but since I have Travis on ignore, it didn't show who you were talking to. I still look at some of his comments. :laugh:

  60. goillini52

    Haha, you probably did quote, but since I have Travis on ignore, it didn't show who you were talking to. I still look at some of his comments.

    I'm only on ignore because we have a difference of opinion about politics. You think I'm liberal, which socially I am because I don't care what other people do. I think you're delusional because you believe in something that has no basis in fact.

    I don't ignore you because you have great insights about insurance. I separate politics because that's a personal belief system that everyone has a right to have an opinion on. We just happen to disagree.

    All I've ever asked for (albiet as I said, I speak quite frankly) is facts to support your argument. I explained why above. You should always question what you're told and you should make decisions off of objective information when that's how you establish policy.

  61. Travis Price

    I'm only on ignore because we have a difference of opinion about politics. You think I'm liberal, which socially I am because I don't care what other people do. I think you're delusional because you believe in something that has no basis in fact.

    I don't ignore you because you have great insights about insurance. I separate politics because that's a personal belief system that everyone has a right to have an opinion on. We just happen to disagree.

    All I've ever asked for (albiet as I said, I speak quite frankly) is facts to support your argument. I explained why above. You should always question what you're told and you should make decisions off of objective information when that's how you establish policy.

    Yes, it's your political views that I can live without.

    I see in your signature that you stopped talking politics. You also have a lot of good insurance posts, so I'm taking you off ignore……for the 4th time. :laugh:

  62. AugustaMi

    LOL not even that pissed. Compared to the men in my everyday real life, he's just irritating like a mosquito. I actually laugh at the rhetoric. It's f'n hysterical! Yes, out loud laughing! I mean really? Calling people out for liking to make money…if only my dad could see this shit…he's probably rolling over in his grave that I'm even responding nicely to that, not that I read it all, don't have to to know what it's about….futile.

    Making money isn't the argument, just for clarification. Making decisions on people's lives because you get paid more for one product over another is an issue, for me. That may not be you… but it's quite easy to lose the forest through the trees when the compensation system (only speaking for MI here) is so slanted towards MAPD.

    As I've noted MAPD is a great product for the right person. However, if someone is more cautious about claims processing and access to care, I'll lean towards Medigap any day of the week.

    For example, my dad has diabetes, history of heart issues (include a cabg), and a stroke that causes issues with speech. He should never be on an MAPD plan because he has chronic conditions and claims will be a nightmare for him, prior authorizations could be a real pita, and he needs access to all providers that accept Medicare, not just the ones that will accept BCBS's contract rate.

    A lot of MAPD agents will say something along the lines that he'll get all these great extras and the claims will be fine because that's what they're told. That's not accurate. It's proven not to be accurate as an overall product class.

    I would sign him up for HDG without issues because the system is set up more in the patient's favor when it comes to claims and networks. He loses these benies that are a marketing tool to sell him, but they're really small in comparison to the peace of mind. That's what he's paying the premium for. If he knows all this information and still wants an MAPD, then okay… I think that's stupid.. but he's an adult and knows the risks.

    Every client that I speak to I treat like my dad based on their situation and risk tolerance. If they make a decision that isn't what I'd do, they're adults. It's their risk.

    A lot of agents understand the insurance product they're selling (hopefully), but they rarely understand the program they're in. As I noted above, I look at the program, the client's needs, and the product.. in that order.

    Finally, I like to be challenged. It helps people grow. If you can make an argument that's objective, it can make me reconsider my position. If you can't make an objective argument, it's not really a great one…

    All "you's" are considered general, not specific to one person.

  63. Midlevel

    I just need to stay off the forums because not sure why I care what anyone else thinks or does with their business. I only know what the plans are like in my area and have built a pretty successful business over 22 years from scratch. I’m going to try to just become a reader of the forums about certain topics like the new recording of meetings etc that actually offer some insight and skip the posting. I already have high blood pressure and don’t need the additional stress. Ha. I also apologize if I have been a d**k,
    I’m really not like that in real life.

    I think we get wrapped up in what's in front of us. You know FL. I know MI.

    I know FL has the boss bitch of MAPD plans. MI (and most of the country) has the okay ones. I, personally, probably wouldn't sell Medigap as much in FL, depending on what's available. I would absolutely split it like I do in MI, because it's a question of the terms.

    I don't have anything personal against anyone here. We all have different perspectives and value that we bring. The closest person I've ever had what I consider a "rivalry" with is Don. Not because I honestly think he's a dick or anything.. but because he doesn't sell Medicare. He sells DSNP.

    He makes a lot of generalizations about the Medicare market off of DSNP, which is a whole different product that just happens to fall within Medicare… but it's like Medicare's step-cousin that lives across the country.

    I'm speaking about Medicare only.. because I think Medicaid is a pita and I don't want anything to do with it.

    So we butt heads because we're talking two different languages. Also there's the bragging thing, which makes my skin crawl… not because he's successful (which I'm happy for) but because it's his basis for everything…

    "You're a failure because you worked full-time for X amount of years and just went full time."

    Stuff like that will provoke the crap out of me.. because I have quite an excellent life and he doesn't know shit about that of my philosophy about money (meaning my risk tolerance and diversifying income streams… and frankly that I have horrible ADHD and have to have my hands in a lot of things to jump around.)

  64. goillini52

    Yes, it's your political views that I can live without.

    I see in your signature that you stopped talking politics. You also have a lot of good insurance posts, so I'm taking you off ignore……for the 4th time. :laugh:

    I can live (better) without anybody's political comments, but people here seem to want to force their opinions down everyone's throat. Most of the comments I've seen about political issues are pretty stupid, baseless, and presented as fact when they are not. This comes from both sides, not just one side like many on here believe.

  65. somarco

    Sounds a bit judgemental to me.

    I almost said it was stupid but that would be judgemental on my part . . .

    Yes, maybe it is a bit too judgmental and shouldn't have said stupid. Maybe ignorant would be a better word. Either way, I just think that people should keep their political opinions out of these threads unless it is in the 1000 posts forum or the like.

  66. Todd King

    Yes, maybe it is a bit too judgmental and shouldn't have said stupid. Maybe ignorant would be a better word. Either way, I just think that people should keep their political opinions out of these threads unless it is in the 1000 posts forum or the like.

    Tom, you know I love you and just saw and opportunity to deliver a glancing blow

  67. Travis Price

    I think we get wrapped up in what's in front of us. You know FL. I know MI.

    I know nothing about Florida. Ha. I am in the Midwest where we have pretty good MA plans and also an awesome Cost Plan to fall back on. Also good rates on Med Sups for the most part. I just had 2 clients move to FL and looked into getting licensed and figured out it wasn’t worth it for 2 clients pretty quickly.

  68. Midlevel

    I about fell over when I ran them a quote for a G plan for their zip code in Florida.

    Many of my clients who move to FL or NY keep their cov for some time when moving From most of my other states

  69. Midlevel

    I about fell over when I ran them a quote for a G plan for their zip code in Florida.

    Are they currently on a Med Supp? No need to change them if they are. Depending on the carrier, the premium could change once they move. If their current carrier offers Med Supps in Florida, the premium will change based on their new zip code. if the current carrier isn't in Florida, the rates should move based on what they do where they initially enrolled. If they're on MAPD, Florida has some plans that are rich in benefit. Not so much in northern Florida, but in South Florida it's hard to beat their MAPD plans with a Med Supp assuming they like their doctor options.

  70. Midlevel

    Both were on an MA plan with GTL. At least they will still have GTL with me and the 2.00/month commissions. 🙂

    Guess I should have read the entire thread before my reply.

  71. Just spent three days in thospital this week on observation status. This is a first for me. Juts exactly what would the MA plan pay for this stay. Since Medicare covers it under Part B, my med supp will pay 100% of what Medicare does not pay.

  72. rousemark

    Just spent three days in thospital this week on observation status. This is a first for me. Juts exactly what would the MA plan pay for this stay. Since Medicare covers it under Part B, my med supp will pay 100% of what Medicare does not pay.

    If you were one of my clients you would have paid a $395.00 copay and then would have gotten reimbursed for 3 days from GTL at $300.00/day so you would have made $505.00.

  73. Midlevel

    If you were one of my clients you would have paid a $395.00 copay and then would have gotten reimbursed for 3 days from GTL at $300.00/day so you would have made $505.00.

    Isn't that co pay per day? :err:

  74. rousemark

    Just spent three days in thospital this week on observation status. This is a first for me. Juts exactly what would the MA plan pay for this stay. Since Medicare covers it under Part B, my med supp will pay 100% of what Medicare does not pay.

    Hope all is ok Louis. :yes:

  75. Midlevel

    I know nothing about Florida. Ha. I am in the Midwest where we have pretty good MA plans and also an awesome Cost Plan to fall back on. Also good rates on Med Sups for the most part. I just had 2 clients move to FL and looked into getting licensed and figured out it wasn’t worth it for 2 clients pretty quickly.

    I was wrong. For some reason I thought you were in FL.

  76. Midlevel

    It’s a straight copay. If you were in the hospital as an inpatient it would be 395.00 per day.

    HI is the solution to your question Louis.

    Here it's relatively inexpensive and you really should pitch it to every MAPD client. It's still cheaper than Plan G and with Cancer it solves two big issues with MAPD.

  77. [QUOTE ="goillini52, post: 1426001, member: 46773"]Hope all is ok Louis. :yes:[/QUOTE]
    Problems with blood pressure being too low.. Am on O2 and have a peg tube in my stomach for feeding. Haven't taken anything by mouth in seven weeks.. Not even a cup of coffee. But, I am still here. At least my ribs have healed where they broke them giving me CPR when I flatlined a couple of weeks ago. I can sneeze without doubling over with pain. 🙂

  78. rousemark

    But was not an inpatient.. It was for observation.. Two different things.

    Not everyone who writes Medicare coverage understands how Medicare, or the plan they sell, really works.

    And the same applies to ancillary products . . .

    Inpatient, outpatient, at least you were near a hospital . . .

  79. rousemark

    But was not an inpatient.. It was for observation.. Two different things.

    Exactly why I said since you were observation you only pay the $395.00 and not $1185.00 like if you were an inpatient.

  80. somarco

    Not everyone who writes Medicare coverage understands how Medicare, or the plan they sell, really works.

    And the same applies to ancillary products . . .

    Inpatient, outpatient, at least you were near a hospital . . .

    Nice try, I was clear as to him paying $395.00 instead of the $1185.00 it would have been as an inpatient. Had to hurt a little for you that the plan would have actually made him money vs. being on a Med Sup. Damn, maybe the MA plans aren't so bad after all.

  81. goillini52

    What plan is that?

    Most MAPD plans I've seen have a flat dollar (one-time) copay for observation. The only strange part here is the number of days of observation mentioned in this thread. But if you look at MAPD plan EOC's, under observation it will show one copay and not a per day charge.

  82. Travis Price

    [

    Just to make an additional point, BCBS's MooP is 4,500$. That's in line with a few different HMO-POS's and the MooP is a smokescreen because almost no one hits it unless you're in a chronic condition… My argument was that the MooP's in FL are not the same as the MooP in MI or even with HDG, which is so incredibly low that it makes sense to offer MAPD over pretty much everything. Humana's zero-premium is pretty consistent if you acknowledge that most people don't hit MooP, so I don't need BCBS.

    What YOU'RE (and people like you, because Midlevel "gets it") selling is that people aren't smart enough to think about their insurance decisions, so you just sell them what makes you the most money. Regardless of if it's the best fit, or what they're into or not.

    Yep, correct and goes nicely with loaded GTL-minimum $5000 cancer.

    I saw yesterday Ascension has a MOOP with $2900. No. I won't be peddling that one. I'm clear on why that'd be a bad idea. Just happened across it running an inquiry for someone in Hemlock area yesterday. Just another sign for me that times are changing.

    Not a big deal Travis, but btwn the two, Humana and BCN, if someone on certain meds for glaucoma, macro-degen, drops or with skin conditions some Rx lotions and creams, hands down BCBS/BCN formulary will outperform, just for starters.

    I already see one outperforming the other even in my small book. I don't want to write a book but if you must have a few examples I will give them. I do have two real good examples even from my tiny under 100 MAPD book (not my only book, adding this to make sure you understand I am only new to Medicare, but hardly oblivious). Neither could have been put on med supp. I do appreciate Humana and will continue with them, but I have to have others for certain situations. AND, Yes I know the dif btwn HMO and PPO, As well as well-versed in managed care.

    I am not one who has ever "loved" BCBS/BCN. In fact quite the contrary. Even recently went about nuts wondering when I'd ever get paid (of course, bc that is one reason I work at all). But it turns out once I got with the right person it went super smooth. Then they took a handful of us to the Suites for Redwings as a nice gesture (not boasting just saying they are really trying to work now on a way better level with agents in the individual market).

    I dealt with BCBS/BCN from 2006-2018 in U65 and it wasn't fun. Only did it more for the cross-selling (no–not just for the money, but to cover those high-ass deductibles and help with the gaps). I consider it a major disservice to NOT offer ancillaries, although a bonus is money AND so is better retention (btw, I've always enjoyed a high retention rate no matter what I'm doing). I've done enough ancillaries to have SOLID conviction in the right carriers(not boasting and not posting my numbers, just sayin…many claims to know it's a SOLID plan). I know, you don't have issues with retention so won't bother with stats on this.

    I'm not trying to sell you on BCBS/BCN, but just relaying the facts that it's become like night and day almost overnight. Hope it lasts. Just something to consider.

    That last paragraph, I'll mostly leave alone. Only will say you're wrong again there.
    Oh man, just smack me…. dammit, that stupid DST SEP led me astray. :laugh:

    I saw the "I dont need BCBS" remark and went full stop and couldn't pass that up….

    Ok maybe I do need another month or so of handholding on the medicare side. See? I can be humble too when I need to be.

  83. AugustaMi

    goes nicely with loaded GTL-minimum $5000 cancer.

    I never understood this approach.

    MAPD + cancer + HI + whatever junk BS ancillary line you want to add on still leaves exposure to your client.

    Unless you are pushing CI (which hardly anyone talks about any more), the MA + ancillary doesn't cover heart attack, stroke, accidents, outpatient surgery . . . the list is almost endless.

    And I have seen LR reports on ancillary lines . . . not unusual to see 40 – 60% LR's. But of course the agent makes out like a bandit, padding the sale with high commission products that are almost pure profit to the carrier.

    And please spare me the stories of clients who bought a $40 premium plan, paid 2 months and then collected $10,000 in cash. How many have paid in for year and won't live long enough to even break even.

    Carriers love pushing the products because the older the policy the few claims . . . folks forget they have these things and never file a claim.

  84. somarco

    Unless you are pushing CI (which hardly anyone talks about any more), the MA + ancillary doesn't cover heart attack, stroke, accidents, outpatient surgery . . . the list is almost endless.

    You can add all of these things and more to HIP, but by the time you add all these riders, you're approaching the price of a Med Supp.

  85. somarco

    I never understood this approach.

    MAPD + cancer + HI + whatever junk BS ancillary line you want to add on still leaves exposure to your client.

    Unless you are pushing CI (which hardly anyone talks about any more), the MA + ancillary doesn't cover heart attack, stroke, accidents, outpatient surgery . . . the list is almost endless.

    And I have seen LR reports on ancillary lines . . . not unusual to see 40 – 60% LR's. But of course the agent makes out like a bandit, padding the sale with high commission products that are almost pure profit to the carrier.

    And please spare me the stories of clients who bought a $40 premium plan, paid 2 months and then collected $10,000 in cash. How many have paid in for year and won't live long enough to even break even.

    Carriers love pushing the products because the older the policy the few claims . . . folks forget they have these things and never file a claim.

    I understand fully.

    I do love CI, did it for years one that paid out for cancer, stroke, heart attack and more…with a ROP. I also got into DI with ROP. I AM going back to this. That's a promise. stopped everything for 3 yrs for my own personal reasons. Getting back at it, but at the moment just getting this going. I only focus on one thing at a time…also for the record, I am sitting here as of today with three med supps ready to go that no one has bit on. Not bc I don't talk about it. Go ahead and debate that but its the truth.

    I have absolutely had people have claims and have done everything from talk to cancer patients right in their hospital rooms to checks for death. They never forgot who to call when a claim came up. And knew exactly what their policies were for.

    The quickest anyone got a claim paid was about 16 months later if memory serves me. Assurity for a pancreatic cancer claim. Long time ago and one of my first payouts. I have not had one that paid out twice but thought that would actually be a thing considering chemo tx can also cause stroke. I thought that would be something i'd encounter but haven't yet.

    I have zero stories about a $40 premium and a two-month in payout. I think the one aboves CI was $60 and it was more than 10K I wanna say 40k but can't remember and i'm to tired to try to retrieve that from my warped mental storage. Was preferred rated, never had health issues prior. I still think and talk about this when people say, "oh I don't need that, I'm healthy"…yah I use these stories. This lady was tip-top the day I wrote her. I can tell prospects with conviction bc I know what I'm talking about. Theyre absolutely true and nothing sells like genuine conviction.

    I also had her on term. 250k.

    They were Grosse Isle folks, affluent area. Her son went away overseas shortly after the payouts for his medical degree. He's a doctor today. Hubby owns gas stations and was obviously grieving and still managed to show his appreciation and thanked me. He also "hired" the daughter to come in and run the place while he took some time off.

    Another young lady, in her 20s brain cancer. Hers I'd swear it was her environment, industrial Detroit area. Another lady early 30s skin cancer paid out. Another guy mid 50s paid out, heart attack. These one's all survived.

    I agree. I wish there was more for the stroke, heart attacks for seniors…can only offer what I have and know about and what's out there.

    I would like to get back shortly to U65 and go back to that…just can't do it all at once. I'm busier than I want to be at the moment. Yes, I make more money doing this and LOVE it esp when I HELP the client.

    The people I have dealt with since October are MAPD mindset and that's that. Can't push a med supp down their throats. Maybe bc I'm running DMs.. idk. So if they're in front of me, that's better than where they would be with MAPD only. I feel badly for those that don't qualify and do want it…but can only do so much. I just had one ask me for it, but she has to wait another year bc of underwriting.

    Soon I'll have more of those CI clients aging in…

    I myself am on Assurity CI with a ROP, and life, so are my family members who see the value. Hubs is loaded up on CI/DI and Life ROPs.

    As for the medicare subject and HI with Cancer, I do it bc they want an MAPD or was already on an MAPD and that's what they want to stay on. The HI/Cancer I have is GI to 68. And that's better than not having more protection It's simple. Should I stand there and argue with a client who likes their MAPD and try to get them to switch? I am not trying to be facetious, but every single person I see wants MAPD or already has it. I had to explain to a FLA just this week to a person the differences btwn alot (MAPD/Med Supp/ and differences btwn her FLa MAPD and how Mi MAPD will be different) bc they were adamant about a MI MAPD, her hubs just turned 65, boom they don't care, they WANT that MAPD. And if I continued, I'd lose it altogether. Some of them do not even want me talking about med supp.

    I am sure I'll be doing supps, it will at some point be inevitable. Remember, I just started the Medicare side. Can I at least catch my breath? I'm following what you's are dishing. I'm not dead set against it. I just hooked up with a local P and C and he believes more in med supp. I'm thinking that is when I'll jumpstart that leg of this adventure.

    I think what's up here is that I am new to this side of Ins. Alot is getting lost in translation. I bought in and got going on DMs and have more coming as I type. Many of those are already MAPD people and those people like it. And the referrals I get from them, they want what their friend/family member has….you see??….we are on two different planes right now.

    Peace. Ok I'm off to bed to my comfy mattress. I need a good night's sleep. That's all I got tonight. I'm officially out of steam.

    But lemme guess b4 you post back that you'll think I'm pushing MAPD hardcore. I assure you that's not true.

  86. goillini52

    You can add all of these things and more to HIP, but by the time you add all these riders, you're approaching the price of a Med Supp.

    Still I am finding with the price reduction I can get accident, Surgery copays covered as well as hosp and cancer for between $50 and $70 mostly in the low $60's

    With medico seems I can do lower but minus the accident benefit

    It still leaves some exposure, and does nothing for preuth and network issues, even PPO's can be refused service for out of network I have seen it

    Its a good product for those dead set on MA ,its better then MA alone, But its not equal to med supp

    Because of all the exposure many more are going MA then they used to, At least I can provide the best coverage they are willing to pay for

    Some wont do any extra, some only the hosp for $25 or $30, some will go for the whole thing

    Speaking of people who are set MA is the way to go, After hearing of the differences

    I will still say to them if it were my parents, I would go med supp. But I will still provide the best I can if they decide to go MA

    Its not always about the money either for some, They can get so set on this one had it that doc recommended it, I want GYM that I will never go to, Dental, glasses, I want what my friends have, this list is endless

  87. goillini52

    You can add all of these things and more to HIP, but by the time you add all these riders, you're approaching the price of a Med Supp.

    Which speaks to the other issue, about how much are you really getting for your buck?

    When I worked the U65 market almost all my clients had HD plans . . . some were HSA qualified, some not. Humana had a sweet HD plan with some doc copays (2 per year?) and a $7500 deductible. It was price competitive with HSA compliant plans but had a few doc copays and maybe an ER benefit as well.

    I never added HI, cancer or dental to the plans because I didn't see the value in them plus the premium kicked it up close to, or above, the more traditional copay plans with a lower deductible.

    When folks asked for a $2500 ded plan with copays & ER their total OOP was usually $5k – $6k and a much higher premium than the $7500 Humana plan . . . so most opted for the Humana plan.

    Of course at that time all we had to offer were PPO plans plus a few stinky HMO's . . . the only HMO I wrote was KP. It was actually quite good as long as you colored between the lines and didn't try to go OON.

    I never sold based on "affordability" but rather, taught them how to look at value for the $$$.

    This never changed when I transitioned to the Medicare market but now I had a way for them to escape managed care.

    The two primary complaints from clients were rate increases and managed care, especially hidden providers on hospital admission claims. Rate increases were tempered by shifting their focus to HD plans . . . never found a way to combat hidden provider surprise claims.

    Rate increases in the Medigap side are tempered by choosing carriers with long term stability. That means excluding carriers that play the musical chairs game and showcase their downstream carrier brands with low entry rates and then yank them from the state after 3 or 4 years.

    Only got burned once on that deal and that was with Equitable.

    I learned quickly to avoid carriers that are new to the Medigap side as well as carriers that would write anyone who could fog a mirror.

    "Package" sales . . . medical + dental + vision + + + . . . generate a nice paycheck but never increase the value for the client over taking a simple approach to managing their health care dollars.

    If there was a way to avoid the PDP LEP most of my clients would not have a drug plan. Probably 80% of them get little or no value from the PDP but the rules of engagement dictates they buy one so most of them are on a $7 SilverScript plan they never use.

  88. Midlevel

    Both were on an MA plan with GTL. At least they will still have GTL with me and the 2.00/month commissions. 🙂

    But they can get a sweet MAPD here. Probably better than what they had.

  89. My argument will always be this:

    Someone with chronic conditions, like Mac D or glaucoma, should probably not be on MAPD. Those injections are more expensive than just buying Medigap, not having to deal with the additional gap issues, and moving on.

    Once you explain that MAPD will put them on the hook for that 20% (200-1000 every 4-6 weeks) their tune will change.

  90. somarco

    If there was a way to avoid the PDP LEP most of my clients would not have a drug plan. Probably 80% of them get little or no value from the PDP but the rules of engagement dictates they buy one so most of them are on a $7 SilverScript plan they never use.

    (caveat, not an agent)

    AND, those of us choosing to remain on Original Medicare and have a PDP, would be paying substantially more for the PDP than we are now.

  91. AugustaMi

    I have zero stories about a $40 premium and a two-month in payout. I think the one aboves CI was $60 and it was more than 10K I wanna say 40k but can't remember and i'm to tired to try to retrieve that from my warped mental storage. Was preferred rated, never had health issues prior. I still think and talk about this when people say, "oh I don't need that, I'm healthy"…yah I use these stories. This lady was tip-top the day I wrote her. I can tell prospects with conviction bc I know what I'm talking about. Theyre absolutely true and nothing sells like genuine conviction.

    (caveat, NOT an agent)

    Some of that was perhaps hyperbole on somarco's part but I think the comment is conceptually valid for two reasons.

    First, I think that every agent selling MA and related supplementary products is going to have stories about how the supplementary product, or products, they sell have benefited clients. I would suspect that to be a basic selling concept that would be covered in threads involving conducting sales interviews with prospects for your insurance products.

    If the MA agents are allowed to present those ideas, then it is also fair for somarco to be allowed to comment along the lines that insurance companies are in business to make money and the products are priced based on actuarial computations showing the insurance companies what their likely claims experience will be. That would mean there are also likely to be a noticeable number of policy holders who pay premiums but do not receive any significant financial returns from the policy.

    Second, his comments about cross selling are directly in line with my own (somewhat dated) direct experience. In 2017 I took a several day online agent training class conducted by a national senior market FMO. In that class, cross selling was strongly encouraged and promoted–possibly to the extent that if you were a contracted agent and asked the FMO people for help in improving your sales, you would have been less likely to get significant help if you weren't cross selling than you would have if you were cross selling.

    It seems to me like the FMO trainers identified 5 broad areas of products to cross sell and said each agent should choose 2 and attempt to work presentations for those into each sales interview appointment. I no longer remember if they had specific comments for something that should be done if the prospect focused particularly on MA or MAPD.

    As I said, that was in 2017. I don't know what points are made in current versions of that training. However I would expect that the broad acquisition of FMO's by Integrity would be increasing FMO pressure on their contracted agents to cross sell because that would be one easy way for FMO's to improve their standings in internal Integrity FMO sales competitions.

  92. somarco

    Carriers love pushing the products because the older the policy the few claims . . . folks forget they have these things and never file a claim.

    Caveat, not an agent.

    I suspect it goes beyond just forgetting.

    kgmom in some recent thread or post, asked me if I had a POA and if my family had copies of my Medicare card (and by extension Medigap card). They don't. Something I need to take care of.

    My home health care policy changes premium based on 5 year age bands. It is starting to get pretty pricey-at least in my estimation-for my finances.But, IF I choose to keep it in force, at the point I might have a need for it, if my memory or communication abilities are affected, no one else is even going to know there is something to look for. kgmom would be giving me a tut-tut or maybe even a rap across the knuckles for that one. But my point is there are likely lots of other people in that same situation.

  93. There's always going to be some exposure.

    When someone finds something that will shut out all exposure, fill me in.

    Chaz, Some of these MAPDs showing up in Mi are quite nice. just saw one creep up with a $2900 MOOP. Not one I'd want to offer. Another one is HAP in Mi. not in all areas, but sweet. Rx-wise/co pay wise it stands out. Once the dust settles in this new journey, I'll probably be primarily HAP and BCBS peddler and keep Humana and Aetna for certain situations. I contracted with a few others so far, that just don't cut it…

    Yes, supp is better, but I've run into some wild stories with that too.
    I've never went the route of "MA is better", but I will fill in a few of the problems with it when I can.

    While some don't see the value in ancillaries, that's ok. I do. I can't wrap my head around the other side of the coin–.I also don't look at GTL as the end all be all, but it will perform just fine. Does what it's supposed to do.

    As for dental, I won't even go there and don't much even with a client other than to tell them it mostly sux. There is a decent one, it's in the above-mentioned HAP plan. In more than 18 yrs I sold ONE stand-alone dental. Done with anything dental convo. I agree that's short bus ridic.

    I'm out today…it's euchre day at VFW. Going DonP style for a minute this morn…few stops to make with some DMs right close I have a good feeling about. Let the cringing begin. 😀

    Peace!

  94. sman

    Most MAPD plans I've seen have a flat dollar (one-time) copay for observation. The only strange part here is the number of days of observation mentioned in this thread. But if you look at MAPD plan EOC's, under observation it will show one copay and not a per day charge.

    Yes, most plans I've seen is a flat $90 co pay for observation.

  95. AugustaMi

    There's always going to be some exposure.

    When someone finds something that will shut out all exposure, fill me in.

    Chaz, Some of these MAPDs showing up in Mi are quite nice. just saw one creep up with a $2900 MOOP. Not one I'd want to offer. Another one is HAP in Mi. not in all areas, but sweet. Rx-wise/co pay wise it stands out. Once the dust settles in this new journey, I'll probably be primarily HAP and BCBS peddler and keep Humana and Aetna for certain situations. I contracted with a few others so far, that just don't cut it…

    Yes, supp is better, but I've run into some wild stories with that too. No time to bother with that today, but I hear it often when I say, "you WILL get somewhat nickel and dimed with an MAPD" almost always I hear back, "I get some of that anyway with my gap" or "I did anyway when I had gap". I haven't gotten to the bottom of why this is….maybe I never will.

    I've never went the route of "MA is better", but I will fill in a few of the problems with it when I can.

    While some don't see the value in ancillaries, that's ok. I do. I can't wrap my head around the other side of the coin–.I also don't look at GTL as the end all be all, but it will perform just fine. Does what it's supposed to do.

    As for dental, I won't even go there and don't much even with a client other than to tell them it mostly sux. There is a decent one, it's in the above-mentioned HAP plan. In more than 18 yrs I sold ONE stand-alone dental. Done with anything dental convo. I agree that's short bus ridic.

    I'm out today…it's euchre day at VFW. Going DonP style for a minute this morn…few stops to make with some DMs right close I have a good feeling about. Let the cringing begin. 😀

    Peace!

    Go to Medicare dot gov, type in zip code 33101 and be amazed. No other state competes.

  96. Chazm

    Go to Medicare dot gov, type in zip code 33101 and be amazed. No other state competes.

    See your posts off and on, and it just occurs to me to wonder, are most of your T65's longer term FL residents or do you get transplants too?

  97. LostDollar

    See your posts off and on, and it just occurs to me to wonder, are most of your T65's longer term FL residents or do you get transplants too?

    Most people in FL are from somewhere else, period.

  98. LostDollar

    It seems to me like the FMO trainers identified 5 broad areas of products to cross sell and said each agent should choose 2 and attempt to work presentations for those into each sales interview appointment. I no longer remember if they had specific comments for something that should be done if the prospect focused particularly on MA or MAPD.

    To be fair…you almost HAVE to cross-sell HI with most MAPD. Otherwise, when your client has a 1k+ hospital stay, which odds are they will at least once, they're going to be pissed.

  99. AugustaMi

    There's always going to be some exposure.

    Never suggested there was . . . just can't figure out why sell a product with an OOP that may not be manageable then backfill it with junk that still leaves gaps.

    Oh wait . . . it's the commission from pairing MAPD with half a dozen add-on plans.

    Back to the CI plans, the last time I looked at them most were term policies with a CI rider. The CI benefit payout was considered and ADB and unless the beneficiary was expected to die within 2 years the benefit was subject to taxation.

    Only a few of the plans were actually filed as health insurance . . . one was Omaha . . . very nice plan but underwriting was a bear.

  100. Midlevel

    i usually see 90.00 for ER visit but more like 350-400 for observation. Different everywhere I suppose.

    How much is that for Medigap again ;)? Just teasing.

    I agree with Bob. I don't sell price or additional benefits. I focus on medical and value. Doesn't mean I don't see the value with MAPD… I just think it has to be the right fit.

  101. Midlevel

    Exactly why I said since you were observation you only pay the $395.00 and not $1185.00 like if you were an inpatient.

    Bit with my med supp, there is 0 co pay since I have already met my part deductible with office calls.

  102. My premiums for a Plan G, PDP, a DVH and the Part B Deductible are now at $4,300 a year. Wellcare has a free MAPD with a $3,450/$5,150. MOOP. Makes me think about it.

    The only problem I'd have, is it's managed care. Managed care is great if you can't afford a Med Supp, or don't have to use it.

  103. goillini52

    My premiums for a Plan G, PDP, a DVH and the Part B Deductible are now at $4,300 a year. Wellcare has a free MAPD with a $3,450/$5,150. MOOP. Makes me think about it.

    The only problem I'd have, is it's managed care. Managed care is great if you can't afford a Med Supp, or don't have to use it.

    One thing I will say, I have a doc in NY who deals with cancer and other major illness who on occasion refers to me

    They do a lot of part B meds and things like that

    Yes they do prefer med supp

    But do take MA plans, but if MA plan they do prefer UHC and Aeta by miles over Humana and WellCare for preauth reasons

  104. rousemark

    Bit with my med supp, there is 0 co pay since I have already met my part deductible with office calls.

    Awesome, does the Med Sup have a premium at all? You had asked what you would pay if you would have been on an MA plan. Like I said you would have made 500.00 if you would have had the 0.00 premium MAPD and 31.04 GTL HI plan. If you feel more comfortable with a Med Sup then that’s what you should stay on. I was just answering your original questions. Hope you are doing better!

  105. Midlevel

    Awesome, does the Med Sup have a premium at all? You had asked what you would pay if you would have been on an MA plan. Like I said you would have made 500.00 if you would have had the 0.00 premium MAPD and 31.04 GTL HI plan. If you feel more comfortable with a Med Sup then that’s what you should stay on. I was just answering your original questions. Hope you are doing better!

    What if the hospital he was in was out of network? 🙂

  106. goillini52

    What if the hospital he was in was out of network? 🙂

    We have a Humana PPO in Florida that charges the same in or out of network. It’s definitely not common and the plan is $11. But it’s definitely nice to have in my bag.

  107. Chazm

    We have a Humana PPO in Florida that charges the same in or out of network. It’s definitely not common and the plan is $11. But it’s definitely nice to have in my bag.

    Does the provider have to "opt in" and sign a form indicating they will accept the reimbursement formula?

  108. Ga has an awesome Humana plan 0/$15 in or out of network and I sell it big . Almost every dr already accepts Humana but never had 1 issue were oon won’t bill .Mapd will continue growing and those who refuse to sell it will see their book die over time

  109. Chazm

    We have a Humana PPO in Florida that charges the same in or out of network. It’s definitely not common and the plan is $11. But it’s definitely nice to have in my bag.

    Florida seems to be in a league of their own with MAPD's.

  110. goillini52

    Florida seems to be in a league of their own with MAPD's.

    No doubt.. That's why I don't debate MAPD vs Medigap with someone in FL. It's just the Mecca of MAPD. I'd probably be in it heavier if I lived there.

  111. Travis Price

    No doubt.. That's why I don't debate MAPD vs Medigap with someone in FL. It's just the Mecca of MAPD. I'd probably be in it heavier if I lived there.

    So why in the World did you bust my *ss the last 2 weeks and you thought I was in Florida?
    Haha

  112. Midlevel

    So why in the World did you bust my *ss the last 2 weeks and you thought I was in Florida?
    Haha

    Because you were making generalizations about the entire market. I was very clear busting your ass that FL is different than the majority of the US.

    I never argued that Medigap in FL is "better" than MAPD.

  113. Travis Price

    No doubt.. That's why I don't debate MAPD vs Medigap with someone in FL. It's just the Mecca of MAPD. I'd probably be in it heavier if I lived there.

    there is more to the story too

    Networks can be very different from HMO to HMO

    there are some good PPO's depending

    its hard work, I stopped marketing there years ago, 2014 maybe, though I still get referrals on occasion

    But I used to get clients calling 20 times during AEP I just went to this seminar what about this what about that, going in the same circles coming to the same conclusion just to repeat again in a few days to a week, I just went to dinner and betty said blah blah

    I don't miss it in the least

  114. vic120

    there is more to the story too

    Networks can be very different from HMO to HMO

    there are some good PPO's depending

    its hard work, I stopped marketing there years ago, 2014 maybe, though I still get referrals on occasion

    But I used to get clients calling 20 times during AEP I just went to this seminar what about this what about that, going in the same circles coming to the same conclusion just to repeat again in a few days to a week, I just went to dinner and betty said blah blah

    I don't miss it in the least

    Generally speaking, MAPD plans are usually better in FL than they are in the majority of the country. You can make the argument that it depends, but pretty much everything we do depends on the individual and what's available to them.

    Forest through trees and all.

  115. somarco

    Does the provider have to "opt in" and sign a form indicating they will accept the reimbursement formula?

    I inform the client that it doesn’t mean you can go to any doctor. They must ask the provider if they are willing to bill their PPO out of network.

  116. Chazm

    I inform the client that it doesn’t mean you can go to any doctor. They must ask the provider if they are willing to bill their PPO out of network.

    Good for you. That appears to be more than many of the agents say to their clients . . . some (seem) to make it appear as if you can use your plan anywhere with impunity.

  117. Chazm

    We have a Humana PPO in Florida that charges the same in or out of network. It’s definitely not common and the plan is $11. But it’s definitely nice to have in my bag.

    Humana has that same type ppo same price in and out of network . To this day when moving someone from another company to it i have not checked a dr one time to see if network . I’ve not received 1 call a dr out of network won’t take it .

  118. DonP

    Humana has that same type ppo same price in and out of network . To this day when moving someone from another company to it i have not checked a dr one time to see if network . I’ve not received 1 call a dr out of network won’t take it .

    Is that a flex? Seems like a moron move.

  119. Travis Price

    Is that a flex? Seems like a moron move.

    Humana has had them in one area or another most years, Usually one county or so

    one thing is they are usually expensive, But less expensive then a supp

    I have had a few love the idea of paying less then a supp getting dental vision and the like

    I do warn though they can change any given year, And this plan in particular I have seen go away in various area's it doesn't usually stay too many years

    Used to have in NY not anymore, There were 2 or 3 counties here in the south that no longer have it I forget which states

    I just used one in NC for a MA client who moved to NC from GA, Just so she can see a good amount of doctors in the new area, However we do plan to move to a lower cost option this AEP

    One thing is it is enticing for Med Supp clients, Who usually cant pass underwriting and when the plan goes away who is going to want to do the GI

    Most wouldnt, I try to warn these types that they are making a choice, and it the plan hasn't lasted in my experience

  120. somarco

    Good for you. That appears to be more than many of the agents say to their clients . . . some (seem) to make it appear as if you can use your plan anywhere with impunity.

    The Medicare.gov website has made it seem that way for years. People don’t even believe that when you explain it to them until they find out out in the wild. All the printed materials say “any doctor in or out of network” which has never been true.

  121. DonP

    Humana has that same type ppo same price in and out of network . To this day when moving someone from another company to it i have not checked a dr one time to see if network . I’ve not received 1 call a dr out of network won’t take it .

    It may have worked thus far, but it's reckless to not check networks for doctors. You're doing a potential disservice to your clients. I assure you there are doctors who will not accept the plan.

  122. sman

    It may have worked thus far, but it's reckless to not check networks for doctors. You're doing a potential disservice to your clients. I assure you there are doctors who will not accept the plan.

    In addition if there is a complaint the 1st thing they will look for and ask the client is did the agent check doctors before doing app

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