- Thread starter
- #31
Plan G
MA HMO or PPO??
- Thread starter rousemark
- Start date
Helpico_Insure
Super Genius
- 145
MSA will give access to most providers. For the PDP you should search and see who's the most good for you. Do you have any meds not covered from your planb?
- 31,449
If you can find any that'll take them.
Helpico_Insure
Super Genius
- 145
I'll try it from February 2023.
- 7,436
(Caveat, not an agent but what I think I know about MSA)
@rousemark
1) Posts here on the forum indicate that provider access under the MSA may not be quite as easy as the MSA plan literature and helpico suggest. With current health conditions, OP does not need to place himself in a situation of having to do battle with providers to get them to take the plan.
2) MA Trial Right DOES NOT APPLY for MSA plans.
3) The big name L**** MSA is not available in TN (at least in 2022 according to their website).
4) Full MSA deductible is more than OP's Medigap premium. Full MSA deductible, less reimbursement, may, or may not, be more than OP's Medigap premium However, in my opinion, there is some tracking and bookkeeping there that OP does not need to subject himself to at this time in his life.
5) Under MSA, note that OP's liability will be THE FULL MEDICARE APPROVED AMOUNT, not just 20% of it. (Thank you, Thank you, @sshafran for pointing that out some years ago.)
6) MSA plan would not remove the need for dealing with meds under a PDP.
(Edit
Please note: The plan also does NOT pay excess charges from non-participating providers and those excess charges do not count toward the plan deductible.
End Edit)
regards
LD
Last edited:
Michael Sullivan
New Member
- 1
The rule of thumb is that HMO is more restrictive on doctors and you pay more for going out of network.
but it all depends on the plan. For Humana, at least where I sell it, that's roughly true. the HMO plans often offer no or very limited (Emergency only) out of network coverage, while the PPO plans usually have both larger networks, and in some plans, almost the same coverage out of network as in.
That said, some carriers are different. With one plan that I use a lot, you actually bet better OON coverage with their HMO-POS plans than with the PPO plan (or most other PPO plans). HMO and HMO-POS almost always offer lower copays and more benefits than equivalent PPO plans, so I find that HMO is a much more common selection for my clients. But this might not be the case if they were all hard HMOs like the plans Humana offers locally.
So the answer is -- you gotta read your summary of benefits, know your networks and look up your doctors. It's not anywhere near as simple as the rules of thumb might suggest.
but it all depends on the plan. For Humana, at least where I sell it, that's roughly true. the HMO plans often offer no or very limited (Emergency only) out of network coverage, while the PPO plans usually have both larger networks, and in some plans, almost the same coverage out of network as in.
That said, some carriers are different. With one plan that I use a lot, you actually bet better OON coverage with their HMO-POS plans than with the PPO plan (or most other PPO plans). HMO and HMO-POS almost always offer lower copays and more benefits than equivalent PPO plans, so I find that HMO is a much more common selection for my clients. But this might not be the case if they were all hard HMOs like the plans Humana offers locally.
So the answer is -- you gotta read your summary of benefits, know your networks and look up your doctors. It's not anywhere near as simple as the rules of thumb might suggest.
SamC3d
New Member
- 5
My take may be somewhat different. First, not everyone needs a Medicare Advantage Plan. Those that do I separate by need.
b. The Supplement has no network but the monthly premiums may
cause some concern.
2. Though the PPO will allow a beneficiary to go out of network at a higher cost, it should be remembered that a PPO provider who agrees to accept the plan's terms to see a patient today is not required to continue to see that patient in the future.
3. The Medicare Supplement typically has a lower out of maximum than a lot of Medicare Advantage Plans. Add to that the fact that a beneficiary can see any provider in the country without needing a referral.
My advice is to underwrite the beneficiaries' medical needs and concerns and not be a product pusher driven by commission.
I'm not saying that that is the case, but I do believe that a beneficiary's needs should be placed above our own interest.
- A person with more chronic care needs may be better served with either a Medicare Supplement if eligible or an HMO.
b. The Supplement has no network but the monthly premiums may
cause some concern.
2. Though the PPO will allow a beneficiary to go out of network at a higher cost, it should be remembered that a PPO provider who agrees to accept the plan's terms to see a patient today is not required to continue to see that patient in the future.
3. The Medicare Supplement typically has a lower out of maximum than a lot of Medicare Advantage Plans. Add to that the fact that a beneficiary can see any provider in the country without needing a referral.
My advice is to underwrite the beneficiaries' medical needs and concerns and not be a product pusher driven by commission.
I'm not saying that that is the case, but I do believe that a beneficiary's needs should be placed above our own interest.
- 7,436
So (realizing this may be FL advice not applicable in the rest of the country) how do you handle the financial side of the beneficiary's concerns?
Say the Medigap premium plus the PDP premium is considerably more than the MAPD OOP?
I would question how that approach would work in @rousemark area . . . east TN about 50 miles from two larger cities (about 180,000 population) . . . his town about 14,000 population.
You aren't moving from F or G (how old are you, anyway?) at $4450 a year to spend $3900 on an HMO OOP, which you are damn sure going to hit. If you go to the PPO, you'll be spending even more than your current premium, plus the drama.
Mom says "absolutely NOT"
Mom says "absolutely NOT"
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