MAPD PPO vs Medigap?

[PattyBurgers]

I think I’ve let two clients in almost 11 years switch from a med supp to a MAPD. Out of 100% necessity.
If I met someone on Plan F and SS the only thing I would say is have a nice day

I appreciate your opinion. Before I left the appointment I tried talking the wife with some positive points to stay on her Med Supp. They actually came to one of my seminars last year wanting to switch and in front of a room full of prospects I told her to stay with her Med Supp if she was only wanting to change for the Dental and Gym membership which to me aren’t worth a darn thing compared to what the Med Supp costs and provides.

Just trying to provide them with the info they request before they run into a sneaky rep from a competitor. She already told me that the FL Blue Agent she met with said her original agent that has her on her Med Supp won’t change her because he makes more money on Med Supps. Sadly, as a new agent last year I didn’t even fully understand how I got paid so I’d tell people “ honestly the commission I get from either MAPD or Med Supp is NOT what decides for me”.

And of course my agent manager wants EVERYONE on a MAPD so last year when I had questions about Med Supps I never got the full story and am still learning about them on my own.

 

[somarco]

For starters, your agency manager doesn't care about what is good for the client. Or you for that matter.

They only care about what is good for THEM. No altruism here.

Second, you can't change a prospects mind. You can try to educate them about options, but eventually they will do what THEY want to do.

You can be a part of that decision or not.

If you try to SELL them something they don't want, even if it is what (in your mind) they NEED, it will blow up on you.

I don't SELL.

I inform, educate and let the prospect decide.

A few months ago a guy called. Referral from a long term client. He and wife were 68. Wife still working (for KP). Planned on retiring late in the year. Both had A but not B. She had worked for KP for 20 years. The only thing they knew was the HMO model.

He wanted to know how to enroll in B and wanted advice on what to do when she retires.

I agreed to share information on how to enroll in B and avoid penalties or delays. Also told him if they wanted the KP retiree plan I would not be able to help them.

Earlier this week my referring client called to ask about shingles vaccine. I addressed his questions then he asked how things were working out with Phil (the referral). I told him I had not heard from them in months and assumed the wife had retired and then took the KP plan.

But I promised to follow up and see.

So an email went out to Phil and wife, letting them know that Larry (my client) had asked about them. I took the opportunity to remind them of how much information had been shared in June and how I had not heard from them. If they still wanted my help they should contact me, otherwise I wished them well.

No pressure.

Next day Phil emailed and updated me on the pending retirement. He also said they were leaning toward the KP plan but still wanted to hear what I had to offer.

Figured this was a nice way of blowing me off but I responded and sent one of my video's that discusses things about MA plans that no one ever talks about. In the video I state up front that I don't have any MA clients and never will. Also tell them I don't have an MA plan and never will.

At the same time the video makes it clear that Medicare is not one-size-fits-all. Each person needs to decide what is right for them. There are not right or wrong choices.

An hour later Phil emailed back. He and his wife had watched the video plus several others on my YT channel. He said MA plans are no longer a consideration.

I called them at the agreed upon time. Spent about 20 minutes on the phone answering other questions.

Then I took 2 Plan G Medigap apps.

 

[Todd King]

And of course my agent manager wants EVERYONE on a MAPD so last year when I had questions about Med Supps I never got the full story and am still learning about them on my own.

I hate agents like that! So ignorant and uninformed. Either that, or just greedy. Either way, not good!

 

[Newby]

Do any of you take the extra step once you look up doctors on the PPO Plans to call the doctor’s office if they are out of network to see if they accept the plan at all?

We have a problem in my area where some doctors refuse to take some of the Advantage Plans regardless if they are HMO or PPO.

 

[Midlevel]

I have called billing offices and successfully gotten several of them to contract with the PPO that is in our County. A lot of times its just an oversight or they thought they were in the network. 1 group has taken me 13 months but they are now all in network. When I do seminars I get asked about certain Drs. and want to be able to tell them if they are in network or not without having to go searching.

 

[somarco]

When a provider opts out of participating it is usually with good reason. With MA plans it often has more to do with pre-authorization hassles than anything. Docs like to treat patients without a carrier second-guessing their decisions.

Office staff could be reduced considerably if they did not accept insurance.

But because patients don't pay their bills, even when it is just a copay, they are mostly forced to accept insurance.

So they pick and choose which plans (if any) to accept and which to pass on.

 

[Newby]

When a provider opts out of participating it is usually with good reason. With MA plans it often has more to do with pre-authorization hassles than anything. Docs like to treat patients without a carrier second-guessing their decisions.

Office staff could be reduced considerably if they did not accept insurance.

But because patients don't pay their bills, even when it is just a copay, they are mostly forced to accept insurance.

So they pick and choose which plans (if any) to accept and which to pass on.

My own general practitioner and my own dermatologist (totally unrelated offices) both have signs hanging in their patient treatment rooms saying they no longer accept Humana Medicare plans of any type. These signs have been hanging up there for at least 5-years.

Each time I go there I tell them that they need to clarify that they DO accept Humana Medicare Supplements. But they never seem to change the signs.

I’ve seen a different GP run a newspaper ad in the newspaper during annual enrollment stating that as of January 1st he will no longer accept any United Healthcare Medicare Advantage Plans. He was warning his patients that if they want him as their doctor this is the time to choose a different health plan.

You have to follow through when signing people up for PPO Plans that their doctor will accept the plan at all if he is not in network. IF they are married to certain doctors.

Now on the other hand some people are NOT as married to specific doctors as agents assume them to be. I’ve had some people that I just ask them if you can save on your overall cost by letting the Insurance plan choose your doctors would you prefer to do that? And quite a few will respond that yes they would be fine with that. Then I just sign them up on an HMO and help them select a doctor in the HMO network and tell them Do not ever go to any doctor that your primary physician does not refer you to.

I’ve had no problem with the HMOs at all by doing this. You just have to make sure that they are the type of person who is not married to certain doctors. You match the plans to the personality type of the applicant.

 

[somarco]

My business is all OM and Medigap. No networks.

My PCP has a sign similar to your @Newby. A laundry list of plans they do not take. Most are Medicaid, "sharing" plans, indemnity or other junk plans. But they also have a few MA plans.

When clients/prospects say they hear docs don't take carrier X I tell them they are talking about MA not OM and Medigap.

No one has argued yet and no one has come back and said their doc did not take their Medigap plan.

 

[Newby]

My business is all OM and Medigap. No networks.

My PCP has a sign similar to your @Newby. A laundry list of plans they do not take. Most are Medicaid, "sharing" plans, indemnity or other junk plans. But they also have a few MA plans.

When clients/prospects say they hear docs don't take carrier X I tell them they are talking about MA not OM and Medigap.

No one has argued yet and no one has come back and said their doc did not take their Medigap plan.

That’s right. But those doctors never seem to correct their signs clarifying that they take ALL Medigap plans. Which of course they do.

 

[Yagents]

Doctors dont "accept" any medigap plan. They accept OM and medigap just pays the rest (if plan F)