Is Medicare Advantage the Future?

[AugustaMi]

Well, the MAPD market is 28 million strong and growing each year. That's a very large voting block to piss off. While ACA really destroyed the health insurance market, it was really marketed more to the individual purchaser and not the group insurance market (although it greatly impacted that market as well).

My point is, I believe MAPD is here to stay unless we go completely nuts and move to single-payer with a max out-of-pocket cap on Medicare. It certainly could happen, but I believe MAPD is here for a long, long time.

To me, ACA was completely nuts...but it still happened.

I hope you're right...But that seemingly minor detail you mention about single-payer. That is the red flag. I cannot do politics online. So I'll refrain. LOL. I just know that convos that seem to be just chatter at the water cooler can turn out to be great big problems down the road. And when the people at the water cooler are actually big-brained professor and lawmaker types that I have the good fortune to talk to (I'm small-brained by comparison, even though I do have a little U of M Honors degree).... well, those same people have made very real predictions regarding the ACA years before the reality of it smacked us all... at first, I refused to believe those types (denial). I've since learned to listen more and talk less.

The ride is enjoyable for now. Eggs/Basket analogy is the way I run these days.

I'm still trying to get out the med supp info...no one is biting....I know my demos/leads have something to do with it...right? You know, lower-income, less educated, rural area, etc...Idk, I definitely talk about the supp and stress the differences. As, a Medicare Newb, I was beginning to think of MAPD as democrat plans and Med supps as republican plans, but that's not quite right either. LOL Ok, sorry, I digress....

I have some time finally today...gonna go back and read a bit more on this...peace out.

 

[UKTX]

As long as we are on the "expense" side of the equation, we will always need to be wary. Its absolutley a necessary strategy now to "not have all your eggs in one basket"

I was amazed at how quickly ACA/the Feds destroyed U65......

Thats left a sour taste in my mouth and my thought is if they have done it before, they can do it again....and they probably will....at some point.

But for now, its business as usual

 

[AugustaMi]

UKTX, oh yes, once it started it was fast, but the talk of it coming was for years prior.

Yep, biz as usual. It was a good choice to jump back in when I did I think. wasnt into the commish side of medicare when ACA first imploded the landscape but it's too enticing now to walk away.

 

[selfgen]

Some are peddlers and tin men, some are not.

I never said ALL agents who offer MAPD plans are uninformed, or fail to fully explain and present the complexities of managed care plans.

Learn to read with comprehension.

However, if the shoe fits . . .

You often insuate that an MAPD is a greedy insurance carrier that will deny care , etc .

Yet most carriers nowadays, such as Humana, BCBS, Aetna, UHC for instance will offer BOTH types of plan , MAPD or Medigap.

Agent: “Oh no, you enrolled in an Aetna MAPD??? Oh, they’re going to restrict your care, they won’t want to pay for anything, They’re evil and greedy, they just want to make money off of you and they’ll not want to approve your doctor’s requests for care!!

Client: No, actually I signed up for an Aetna Plan G supplement.

Agent: Oh, you’re fine.

Same thing with agents. You and your ilk, like YouTube’s Chris Westfall, think that ANY agent that sold someone an MAPD plan didn’t explain the benefits, didn’t tell them about network restrictions, didn’t thoroughly go over the benefits, but rather just talked about all the additional benefits, and was just looking to make a quick buck and get out the door. Such gross generalizations nauseate me. Anytime I’m in front of a prospect, I consider myself their agent “for life “ when they sign up with me, so that kind of fast talking sales pitch ain’t gonna happen. EVER. Yeah, there’s agents like that out there. But I would tend to believe that most Medicare agents are like the people on this board. I can’t stand the way Westphall caricatures MAPD agents. It’s a fear mongering tactic by him. So he’s the sleazy agent in my opinion.

 

[somarco]

The low information crowd that is always looking for something free is why we have Obamacare.

The idea was Obamacare + Medicaid expansion would lead to single payer. Hasn't happened yet but that doesn't mean it won't happen.

Providers, especially hospitals, lose $$$ on Medicaid patients. Unless the hospital is privately owned it is compelled to accept Medicaid patients. Even in states that did not expand Medicaid, small, rural hospitals closed and many metro hospitals closed the ER plus L&D floors.

Low Medicaid reimbursement + higher deductible Obamacare plans = hospitals (especially ER) getting stiffed on the high deductible plans. Uncompensated care shot way up, DC reimbursement for DSH facilities also contributed to losses and closures.

Now we have carriers and CMS pushing low/no premium MAPD . . . it's deja view all over again.

Those that buy no premium MAPD and lack the funds to pay big bills are once again stiffing providers.

 

[adjusterjack]

Those that buy no premium MAPD and lack the funds to pay big bills are once again stiffing providers.

Who's doing the stiffing?

Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care" (OEI-09-18-00260) (hhs.gov)

 

[Travis Price]

Who's doing the stiffing?

Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care" (OEI-09-18-00260) (hhs.gov)

Reread the comment.. geez.. you really do need a hug.

He's saying that MAPD plans AND low income people that can't afford to pay are stifling providers.

MAPD doesn't pay claim. No one appeals. Provider doesn't get paid for services. Bills poor client. Sells debt for pennies on the dollar to collection agency.

As I've noted multiple times, and you're literally reposting the study that I already discussed two days ago, most people don't appeal MAO denial, which are often wrong and internally overturned.

As much as MAPD guys run their mouth about fraud in OM, and there definitely is, it's always the provider overbilling Medicare.

It's never Medicare refused to pay a claim that was appropriate.

 

[goillini52]

You often insuate that an MAPD is a greedy insurance carrier that will deny care , etc .

Yet most carriers nowadays, such as Humana, BCBS, Aetna, UHC for instance will offer BOTH types of plan , MAPD or Medigap.

Agent: “Oh no, you enrolled in an Aetna MAPD??? Oh, they’re going to restrict your care, they won’t want to pay for anything, They’re evil and greedy, they just want to make money off of you and they’ll not want to approve your doctor’s requests for care!!

Client: No, actually I signed up for an Aetna Plan G supplement.

Agent: Oh, you’re fine.

Same thing with agents. You and your ilk, like YouTube’s Chris Westfall, think that ANY agent that sold someone an MAPD plan didn’t explain the benefits, didn’t tell them about network restrictions, didn’t thoroughly go over the benefits, but rather just talked about all the additional benefits, and was just looking to make a quick buck and get out the door. Such gross generalizations nauseate me. Anytime I’m in front of a prospect, I consider myself their agent “for life “ when they sign up with me, so that kind of fast talking sales pitch ain’t gonna happen. EVER. Yeah, there’s agents like that out there. But I would tend to believe that most Medicare agents are like the people on this board. I can’t stand the way Westphall caricatures MAPD agents. It’s a fear mongering tactic by him. So he’s the sleazy agent in my opinion.

Yes, CW is sleazy in several ways..

 

[goillini52]

Who's doing the stiffing?

Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care" (OEI-09-18-00260) (hhs.gov)

It's a double stiff.

 

[somarco]

It's a double stiff.

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