Med Supp Vs Medicare Advantage

[mkd1204]

After reading through the forums, I see that many of you either don't or won't sell the Medicare Advantage plans and I was hoping you could spell out the big negatives.

I've been looking over the information on the Medicare Advantage from BCBS NJ and it doesn't look that bad so I must be missing something. It is probably because i'm more accustomed to our small group plans which are crap and extremely expensive so any improvement doesn't seem all that bad.

I guess what I'm looking for is how to properly explain why a client should or shouldn't consider an advantage plan.

Thanks.

 

[Norwayguy]

After reading through the forums, I see that many of you either don't or won't sell the Medicare Advantage plans and I was hoping you could spell out the big negatives.

I've been looking over the information on the Medicare Advantage from BCBS NJ and it doesn't look that bad so I must be missing something. It is probably because i'm more accustomed to our small group plans which are crap and extremely expensive so any improvement doesn't seem all that bad.

I guess what I'm looking for is how to properly explain why a client should or shouldn't consider an advantage plan.

Thanks.

MA plans are a good alternative for people who can not afford a Medicare Supplement. The value of these plans (in my area) has been declining ie higher co-pays, higher oop max etc..

But the reason some agents and I count myself among those want nothing to do with Part C (MA Plans) & Part D plans is CMS and its marketing rules, and compensation structure something you will not find on the retail side of a website...Take $100 dollars maybe its a little more now and do the AHIP course if you decide to sell MAs you'll probably need to take it anyway and you'll start to see how wacked out CMS and the insurance companies are on MA plans...The rules are the same pretty much for Part D plans and take just as long to explain but unless the person is new to Part D you comp is $25 or so a year. And whenever a problem occurs its not with the Med Supp its with the Part C or D plan.

 

[billyg]

MA plans are a good alternative for people who can not afford a Medicare Supplement. The value of these plans (in my area) has been declining ie higher co-pays, higher oop max etc..

To emphasize your point, in our area, most of the lower cost MAs ($0 - $100) will actually cost the insured more money out of pocket for common hospital claims than if they were on just basic Medicare. It's hard for me to see the value in that, though there are salespeople that specialize in them and think they're great anyway.

 

[IMO101]

My two cents. Medicare Supplement plans are great, but they are expensive for those on a fixed income, who are in great health. Why pay over a thousand a year for a Med Supp plan, then purchase a Part D Rx plan for another 360 a year (so you are at around $1500 or more per year on average), if you are in good health, and only go to the doctor maybe 5-6 times per year? You could have an MA plan with a 0 copay, pay $10 to go to a doctor appointment, and spend $50-$60 per year on copays. Also the MAPD plan would include the Part D at no extra cost, and with no deductible (that saves you around $360/year on Part D Premium. and around $310/year on Part D Deductible). What if you go to the doctor 3 times per month? Well, that is still just $30/month in copays. Maybe $45/month depending on the plan. Still less than the Med Supp. What if you go to the ER? Probably a $50 copay for a MA plan. Not bad. Also, MA Plans have out of pocket maximum's, so worst case, you are protected by that limit, which may be around $3750/year. However, you wouldn't hit that every year most likely. Med Supp's are great also, and the more you go to the doctor, the ER, the OR, etc., the better a deal they become. However for the average healthy senior who goes to the doctor 5-6 times or less per year, maybe one or two ER visits per year, they are paying a lot of money for something that they really may not need, if they choose to go with a Med Supp. There is more to the story, since MA plans are intensely regulated, so they are best for those who really specialize in them. Just selling a few here and there is dangerous in my opinion. Those I know who do this year round, and sell an average of 20+ per month, make great income, great renewals, and really enjoy it (selling MA plans). Med Supp's are nice because the regulations are more reasonable, also there is a guaranteed issue window, when you are within 6 months of your 65th birthday (or within 6 months of obtaining Medicare Part B), so if you miss that window, and have an MA plan instead, you may not qualify for the med supp again in the future, depending in your health (or you may qualify at a higher rate). To conclude this excessively long post (sorry), it really depends on the circumstance, what is best for the client, and what makes sense to the agent as far as the primary focus, etc. My advice is to only do MA if you are going to really spend considerable time mastering it. If you are into that, it is a great career path. If not, I would stay away, and leave it for those who do. Med Supp's are great, and thanks to the new Modernized plans (Plan N for example), they are relatively affordable, and you can count on them (the benefits don't change every year, as they tend to do for MA plans). However, the rates do increase. So it's a bit of a mixed bag. I hope that helps. Best of luck.

 

[Norwayguy]

To the previous poster the value of MA plans will vary widely based on where you and your clients are located...When you mention OOP maxs of $3750 I would love to see those in my area...OOP maxes are $6K plus. Also if a senior only goes to a Dr 5-6 times per year they would probably be better off with just original Medicare and no MA plan...But if you look at this like you would for under 65 health plans you are insuring for the large expenses....I notice you did not talk about co-pays for hospital admissions for 3-4 days etc also once your health has gone down your ability to return to Original Medicare and a Medsupp is reduced.

 

[mkd1204]

Thanks for the answers. As far specializing in the advantage plans, my situation is unique in that, my area, southern new jersey only has one Medicare Advantage plan which is Horizon BCBS. I'll get certified in it just to have it, but I'll take your suggestions in recommending it with reservations. What I don't want to happen, is to have people think I'm pushing only one particular plan. If I can explain the downsides to the advantage plans then I'll be better off. If they want it anyway, then it is easy, they have one choice in their carrier.

 

[redkee]

I wonder how many people on a MA plan who really get sick and reach their max oop of maybe $6700 end up on Medicaid.I also notice that most agents do not talk about selling a high deductible plan F.I guess the cheapest way to beat high medical costs is: to just drop dead when your time is up.

 

[IMO101]

Why would they be better off with original Medicare? Then they would have a deductible for the doctor visits, have to pay a part D premium, and probably have a part D deductible also. That means around 360 part d premium and 310 deductible, so around 670/year out of pocket exposure just for part D. Why not have a 0 premium MAPD Plan, that includes part D, and has 0 drug deductible? Instead of paying 20% for doctors (and having a deductible) with original Medicare, the client would have copays, no deductible. Also usually additional benefits like vision, possibly preventative dental, and worldwide ER coverage. All for 0 premium. For hospital, many plans run around $275/day for the first 5 days, then 0 thereafter. Not bad, considering you are paying 0, and saving $670 potentially on the part D factor, picking up extra benefits, and not everyone is hospitalized all that often. Still, you do make good points, and I understand what you are saying. What area are you in with such a high OOP Max? I've personally sold over 1000 MA plans, and have great retention. My clients are happy, and send me referrals consistently. I've stopped selling them due to overall priorities in helping our agent partners, but I still help clients who send referrals. It has been a positive experience, I just want to mention that. I realize not all areas are the same, and we do sell a lot of med supp plans as well, depending in the situation.

 

[konsultint]

If you truly want to help seniors, learn them both and sell them both. Seniors need to be educated and assisted based on their personal situations. My motto: Help enough people get what they want and you will get what you want. Learn the ins an outs of the plans so you can crunch the numbers like IMO101's great example and the senior will choose one or the other and thank you. Crunching the numbers for their particular situation is the key, to do that you will need to know physical ailments, meds, transportation issues, income issues, etc. Helping seniors is a great contribution and the payout is not bad either.

 

[wehotex]

After reading through the forums, I see that many of you either don't or won't sell the Medicare Advantage plans and I was hoping you could spell out the big negatives.

I've been looking over the information on the Medicare Advantage from BCBS NJ and it doesn't look that bad so I must be missing something. It is probably because i'm more accustomed to our small group plans which are crap and extremely expensive so any improvement doesn't seem all that bad.

I guess what I'm looking for is how to properly explain why a client should or shouldn't consider an advantage plan.

Thanks.

It's really all relative to the area that you sell in. In a blue collar city like San Antonio, MAs are very popular, Med supps not so much(because they can't afford them). The quality and quantity of MA provider networks also contribute to the popularity of MAs in an area.