Acceptable "Pivot Questions" from Medigap to MAPD

[thomasm]

Explain, please. Why are Advantage plans a threat to seniors? If it's such a threat, why is it an option in the first place? Where does all the Medicare Advantage hate come from? I understand Advantage plans cannot be solicited, but why does it instill the need for "protection"? Geez.

Nothing wrong with MA. I meant protection from unscrupulous insurance salesmen. Government usually only steps in after a few bad apples ruin it for the rest of us! I've heard prior to 2008, MA was the wild wild west!

 

[midwestbroker]

Quick history on MA:

Managed care plans have been around since the early 1970's for Medicare. In 1983 (I think that was the year, could have been 1982) congress agreed to fund these plans at 95% capitation rate. In the 1997 balance budget act, they became Medicare+Choice. Then in the Medicare Modernization Act of 2003 (MMA) they became Medicare Advantage.

Up to 2006 (when the MMA rolled out) plans were mostly local HMO's and were offered in densely populated areas. One of MMA's goals was to have Medicare Advantage plans available to just about every senior, so they introduced PFFS plans (this is also one of the reasons they were funded higher than the usual 95% to entice carriers to branch out).

The problem came when agents started selling PFFS plans like Medicare supplements (since there was "no network"). Many providers chose not to accept the plans and seniors started to complain in droves to Medicare. The rules came down and now, due to problems a number of years back, we cannot cold call or bring up MA plans.

I know of agents that use the Medicare and You book at their appointments and show them page 16 (2014 edition) where there is a graph on options for additional Medicare options. They point to the side of Medicare supplements. If they (the prospect) ask about the other side, they brought it up. HOWEVER, as it was mentioned, the true intent of an appointment that was generated by a cold contact (cold call, door knock, advertising that did not address Medicare Advantage,etc) has to be a Medicare supplement in this example or it is considered a CMS violation.

And of course once it goes to a MA appointment, there are protocols for agents to follow to remain compliant.

Hope this helps....

 

[unic.consulting]

Quick history on MA:

Managed care plans have been around since the early 1970's for Medicare. In 1983 (I think that was the year, could have been 1982) congress agreed to fund these plans at 95% capitation rate. In the 1997 balance budget act, they became Medicare+Choice. Then in the Medicare Modernization Act of 2003 (MMA) they became Medicare Advantage.

Up to 2006 (when the MMA rolled out) plans were mostly local HMO's and were offered in densely populated areas. One of MMA's goals was to have Medicare Advantage plans available to just about every senior, so they introduced PFFS plans (this is also one of the reasons they were funded higher than the usual 95% to entice carriers to branch out).

The problem came when agents started selling PFFS plans like Medicare supplements (since there was "no network"). Many providers chose not to accept the plans and seniors started to complain in droves to Medicare. The rules came down and now, due to problems a number of years back, we cannot cold call or bring up MA plans.

I know of agents that use the Medicare and You book at their appointments and show them page 16 (2014 edition) where there is a graph on options for additional Medicare options. They point to the side of Medicare supplements. If they (the prospect) ask about the other side, they brought it up. HOWEVER, as it was mentioned, the true intent of an appointment that was generated by a cold contact (cold call, door knock, advertising that did not address Medicare Advantage,etc) has to be a Medicare supplement in this example or it is considered a CMS violation.

And of course once it goes to a MA appointment, there are protocols for agents to follow to remain compliant.

Hope this helps....

Probably the best summary I've seen.

 

[jdeasy]

Quick history on MA:

Managed care plans have been around since the early 1970's for Medicare. In 1983 (I think that was the year, could have been 1982) congress agreed to fund these plans at 95% capitation rate. In the 1997 balance budget act, they became Medicare+Choice. Then in the Medicare Modernization Act of 2003 (MMA) they became Medicare Advantage.

Up to 2006 (when the MMA rolled out) plans were mostly local HMO's and were offered in densely populated areas. One of MMA's goals was to have Medicare Advantage plans available to just about every senior, so they introduced PFFS plans (this is also one of the reasons they were funded higher than the usual 95% to entice carriers to branch out).

The problem came when agents started selling PFFS plans like Medicare supplements (since there was "no network"). Many providers chose not to accept the plans and seniors started to complain in droves to Medicare. The rules came down and now, due to problems a number of years back, we cannot cold call or bring up MA plans.

I know of agents that use the Medicare and You book at their appointments and show them page 16 (2014 edition) where there is a graph on options for additional Medicare options. They point to the side of Medicare supplements. If they (the prospect) ask about the other side, they brought it up. HOWEVER, as it was mentioned, the true intent of an appointment that was generated by a cold contact (cold call, door knock, advertising that did not address Medicare Advantage,etc) has to be a Medicare supplement in this example or it is considered a CMS violation.

And of course once it goes to a MA appointment, there are protocols for agents to follow to remain compliant.

Hope this helps....

That's a good breakdown until you get to the part about saying the agents were the problem.

The companies and the IMO's pushed these plans on untrained agents. Or I should say, agents trained by them on how to push the plans.

I know I was sent into the field with training by a supposed expert and did several ride alongs with him and his top agent. When I was on my own I followed everything they taught me to the letter.

Only after I got well seasoned did I realize that the training was wrong.

The second year of writing MA plans for me I got in huge trouble with my management because I refused to go on appointments and take application before Nov 15. They were teaching agents to just not date the applications. I refused and was cut off the lead program.

Then Humana made the MIPPA regulation in 2008 along with the cut in commissions.

It's not the agents or the prospects that didn't want to have options explained to them.

All the problems with MA plans, PFFS, PPO or HMO come directly from the companies. They blame the agents and CMS for the restrictions but the problems and the rules come from the debil himself.

But, almost problem could be solved by doing away with lock in. But who do you think wants lock in? Not the clients, not the agents. Who is served by the restrictions on clients and agents?

Answer that and you now know where the problem is.

 

[Todd King]

Explain, please. Why are Advantage plans a threat to seniors? If it's such a threat, why is it an option in the first place? Where does all the Medicare Advantage hate come from? I understand Advantage plans cannot be solicited, but why does it instill the need for "protection"? Geez.

If, in fact, an agent only sells MA plans and not Medicare Supplements as well, then that tells me that the agent doesn't understand either of them in their entirety. If you don't understand Med Supps and how they are better for many clients, then you're doing a disservice to many of those clients by talking them into an MA plan where they shouldn't necessarily be.

 

[midwestbroker]

I agree 100% that agents were not the problem, but that is how CMS viewed it and based their opinions on the complaint calls to form MIPPA.

The national roll out of MA and was probably the worst launching of a product in history. Providers did not know what was going on, agents who never sold MA plans did not deceive proper training, and beneficiaries were lost in the mix. 1-800-MEDICARE had at minimal 45 minute hold times.

But, in the end the seniors complained they did not understand what they had bought. So, agents took it on the chin and here we are today. Of course there were some bad apples out there, but CMS punished us all.

I didn't want to go into a rant on my previous post, because I could go on but I will spare all who have braved my ramblings