MA HMO or PPO??

@LostDollar -- My Medicare and You book (Kansas) shows a UHC choice plan. Under OOP it says $3,900/$10,000. What does that mean? The Choice plan is a PPO, and it means if you stay in-network, your OOP is $3900. It's $10K for in- and out-of-network combined.

For those of us that have moved on beyond T65, what does the cheap GTL Hospital Indemnity Plan cost when you get up to the 78-80 age range? (I happen to be of an age with Rousemark.) For KS, to cover the $250/day five-day inpatient copay, $250 outpatient surgery benefit, and $300 ambulance, looks like $44.05/mo for a 78-year-old. I'm paying something like $26 since I started at 65. (Side note: Air ambulance rides incur the same copay as a trip across town on the ground. That's cool.)

GTL Hospital Indemnity Plan again, how long does it take for the benefit to reset after use? Say I go to the hospital 4 times in a row with spacings of 30-45 days between admittances--how much coverage do I have for my 4 visits under the GTL plan you are talking about? The benefit matches up with Medicare benefit periods. From the Definitions section of my policy, it states:

One Period of Confinement: Relative to the Hospital Confinement Indemnity Benefit, with respect to the Hospital Confinement Maximum Benefit Period, One Period of Confinement begins when You become Hospital Confined. One Period of Confinement ends when there has been no additional Hospital Confinement for sixty (60) Days in a row whether or not the number of Days in the Hospital Confinement Maximum Benefit Period have been paid.

With UHC Dental, it is important to note that the degree of benefit one might obtain from a $2,000 policy will depend on the network. In my area, (my quadrant of my metropolitan area), dental professionals accepting the UHC standalone plans are quite limited. Also, the UHC allowed amounts are less than allowed amounts for BCBS (and likely for Delta). The net effect being that the real life benefit provided by a $2K UHC MAPD dental coverage may not be what someone expects when they hear $2K of dental coverage. That would be true of any MA plan's dental coverage that uses a network. I can say that in my part of TN, there is a decent group of dentists who are par. Also, don't forget that network negotiated prices are lower than street. For example, an extraction that would be $95 for someone with no insurance might be $50 for a participating dentist. So that $2K dental benefit may well be worth something like $3K-$4K in walk-in-off-the-street fees.

MAPDs are not for everyone, but are growing hugely in popularity. When I started doing Medicare stuff 15 years back, probably 75% of my book was Med supps plus PDPs. I recently checked my database and now it's 83% MA. More and more providers are signing on since to refuse is peeing against a tidal wave.


You said it correctly . If an agent refuses to embrace mapd in 5 yrs his book will be shredded and his pool of new clients small . With the Gtl plan from my understanding if you have 5 days and use 2 then you have 3 days left in your 60 day period . It resets every 60 days . I'm selling 5 new to Medicare in next 8 days and I'm pushing mapd with a Stacked hospital rider including cancer rider . We all had ppo's out entire lives . All of a sudden it's not good enough for over age 65 . I believe in the product .
 
Yes. three out of the last four were in Knoxville. How do six people convert from an MA plan to a sup plan? How are they going to pass underwriting?

Trial right is one way . . . (5th one down, can't copy the "You dropped a Medigap plan . . _)

You have the right to buy:

The Medigap policy you had before you joined the Medicare Advantage Plan or Medicare SELECT policy, if the same insurance company you had before still sells it.

If your former Medigap policy isn't available, you can buy a Medigap Plan A, B, C*, D*, F*, G*, K, or L that's sold by any insurance company in your state.

Guaranteed issue rights | Medicare

I think you bought from Equitable which sold the block to SILAC. Equitable is not selling Medigap, and I don't think SILAC is an issuing carrier.


Another way is if your current carrier goes out of business (6th one down on the list)

In the U65 major med market, managed care was the only product available in the last 30 years or so. My switch away from major med & group insurance was prompted by Obamacare, but it was also a welcome relief to offer something that is NOT managed care.

The trial right can allow you to switch to MA and then back the next month. The rules can be challenging and carriers look for ways to scuttle the process . . . be careful if you go this route.
 
Last edited:
You said it correctly . If an agent refuses to embrace mapd in 5 yrs his book will be shredded and his pool of new clients small . With the Gtl plan from my understanding if you have 5 days and use 2 then you have 3 days left in your 60 day period . It resets every 60 days . I'm selling 5 new to Medicare in next 8 days and I'm pushing mapd with a Stacked hospital rider including cancer rider . We all had ppo's out entire lives . All of a sudden it's not good enough for over age 65 . I believe in the product .

"Pushing and stacking"? Interesting

Under 65 people don't have the option of "any doctor" like medicare. PPO is the best and only option available and to those mostly under employer group only, and ACA is all shitty HMO's.

When they T65, its the first time they get that "any doctor" option, and that's what they get from me. They are getting older and sicker, not the reverse.
 
"Any doctor" . . .

I prefer the line "If you like your doctor, you can keep your doctor. This is not a campaign promise, it's the way original Medicare works".

When you explain options, you don't have to PUSH or STACK anything . . . people hate to be sold but they love to buy

Why does one who "believes in the product" have to PUSH or stack anything unless they are doing it strictly to pad commissions? Or perhaps it is because they PUSH an inferior product?

Some folks have a real need to validate their position by boasting about their pitch and production.
 
Last edited:
"Pushing and stacking"? Interesting

Under 65 people don't have the option of "any doctor" like medicare. PPO is the best and only option available and to those mostly under employer group only, and ACA is all shitty HMO's.

When they T65, its the first time they get that "any doctor" option, and that's what they get from me. They are getting older and sicker, not the reverse.

Do you or Somarco give the client a choice of mapd ? I would say 100% no . The only time I show a client a med sup turning 65 is if he's in very poor health . I believe in mapd just like you believe in med sups . Mapd a run away freight train . I expect big movement from med sup to mapd this aep .
 
The only time I show a client a med sup turning 65 is if he's in very poor health .

So you're literally doing the same thing. People usually DON'T know options because you're not presenting them.

One of my first qualifying questions is "Do you want to pay more up front and less on the back end or less up front and more when you use it?"

That's the risk tolerance test. My opinion, and just mine, is if you're not understanding their risk tolerance you're doing a disservice.

That causes book instability.

Ultimately though, it's your book and your business. So ymmv.
 
Do you or Somarco give the client a choice of mapd ? I would say 100% no . The only time I show a client a med sup turning 65 is if he's in very poor health .

I mention mapd but very few of my clients want it, or after years of being their agent, they ask me to make the decision. I also work a high end market, the few lower income clients get referred to an mapd agent.

But your above quote nails it. "You will only sell a med supp if in poor health".

So those not in good health, should not be on mapd. Therefore, you are assuming all of those in good health will remain in good health.

That's pretty bold playing roulette with people's future. If they can afford a med supp, they should be on med supp. Good or bad health.
 
I mention mapd but very few of my clients want it, or after years of being their agent, they ask me to make the decision. I also work a high end market, the few lower income clients get referred to an mapd agent.

I rarely bring it up but will address the MAPD option if they ask. Years of working with managed care (since that was the ONLY option), and working closely with clients NEEDS, allows me a unique insight into what happens in a client's life when their health changes.

I don't initiate the MAPD vs Medigap discussion but my lead in starts with "do you want to keep your current doctors?" which is always yes. The follow up is a general question about their health and medications . . . even though T65 is not underwritten. Health information is not required but it gives me insight into their current and previous health concerns. Same for their Rx . . . but that information also gives me an idea of what kind of PDP they might need.

EVERYTHING revolves around building a package that addresses all of their NEEDS and most of their wants.

If someone asks about those "no premium" plans I explain the differences. If they still want a MAPD I refer them to an agent I trust who takes care of them. He gets the commission and I avoid the headache of explaining why their claim was denied or never pre-approved.

While most of my clients U65 were healthy sometimes their health would change. I also had one high risk pregnancy where claims in the last trimester were in the $500k range and the carrier did not want to cover round the clock care and infusion therapy.

Healthy people may not care who treats them but the story changes with their health. Chronic conditions, such as diabetes, can require very specialized care including (sometimes) multiple surgeries.

Anyone who PUSHES a managed care plan without discussing how a health change can impact the level and quality of care is failing their clients. The fact that many MAPD agents are pushing HI and cancer plans shows an acknowledgement that health changes can precipitate large bills is one thing . . . but it also shows that the agent acknowledges there are financial holes in managed care plans. "Patching" those holes with an inferior indemnity product where the carrier is a secondary payer with a great deal of latitude in approving/paying claims is a crap shoot.

There is a reason why so many carriers offer ancillary lines and that reason is profit. There is an expression about casinos that also applies to carriers that target ancillary lines . . .

Casinos are built on the wallets of losers. Carriers that only write HI, accident, dental, cancer, etc build their home offices on the wallets of people who will rarely collect on those policies that produce predictable low loss ratios. That is how carriers can pay 30%, 40%, 50% or more FYC and high renewals. There is so much fat in those plans the carrier can pay claims and have tons left over for comp and fancy buildings.

Ancillary lines can produce a nice cash flow for the agent but delivers very little value to the policyholder.

My career has been built on never offering something I would not personally own. I have never paid for dental, HI, accident or cancer insurance and no reason to start now.

I don't PUSH or STACK anything and I don't have to but still have a very comfortable income that is relatively hassle free except during AEP. My closing ratio and client retention numbers are consistently in the 90th percentile. Carriers love that and so do I. My clients understand what they have and don't get distracted by shiny baubles.

My only concession is when someone wants SilverSneakers. Even though I don't see the value I offer them a carrier that includes SS and both of us are happy. I get paid on the Medigap and never have to handle complaints about why their "free" gym membership does not include chair yoga classes.

This approach is completely foreign to PUSH and STACK agents who simply want to make as much as possible from a policyholder and move on to the next fish.
 
Last edited:
I mention mapd but very few of my clients want it, or after years of being their agent, they ask me to make the decision. I also work a high end market, the few lower income clients get referred to an mapd agent.

But your above quote nails it. "You will only sell a med supp if in poor health".

So those not in good health, should not be on mapd. Therefore, you are assuming all of those in good health will remain in good health.

That's pretty bold playing roulette with people's future. If they can afford a med supp, they should be on med supp. Good or bad health.

You mention mapd ? You don't sell mapd so you only mention it to discredit it . If they want it you won't sell it as your not certified. When I say " stack " I'm talking full coverage . $3 k moop . I'm putting $200 a day hospital rider on it with , $5 k cancer Rider and $250 ambulance rider . Costs around $48 a month . He's $0/$0 at the dr . With the bigger mapd coverages most every dr is in network now .He's got much better and cheaper part d coverage also . Last aep I moved about 15 people from sup to mapd(They called me ). I've not gotten 1 call complaining about their coverage . Yagent isn't most of your business off aca clients turning 65 ? I'm assuming a great many of these had big subsidy's ? I'm now 21 months into selling Medicare were I'm getting 5-7 referral sales a month . Mostly T-65 . I don't chase any sale now . Even the dm o work . I show them a potential better product and why . If they want it fine and if not I walk . I will say with mapd you'll get 5 times the calls of med sups . You'll get a lot of calls about dental , part d drugs and dental . Dental is the most .
 
Last edited:
Back
Top