Med Supp Vs Medicare Advantage

[VaDwayne]

My Bad, ESRP(Employer Sponsored Retirement Plan). Thank you for listening. The example was real, but I just posted to jump start the thread. I knew that an argument between at least a couple of agents would ensue. I know that I should out grow this, but the Senior Forum is just to easy.

THANK YOU!!!! This thread brought a lot of humor to my soul as I sit here in my recliner sick as a freakin dog ( a sick dog). I needed a good laugh.

 

[GreenSky]

My Bad, ESRP(Employer Sponsored Retirement Plan). Thank you for listening. The example was real, but I just posted to jump start the thread. I knew that an argument between at least a couple of agents would ensue. I know that I should out grow this, but the Senior Forum is just to easy.

I appreciate it. I was bored last night and was hoping someone would post something stupid. Glad there is a Luke Jr on this forum.

Rick

 

[VaDwayne]

You would be much better advised to seek out Frank Stasny. (877.633.0808) You might also want to contract with him and take advantage of his many years of experience and his excellent method of helping agents. He will tutor you without a "tude." I've spoken to him and I have no doubt that he is the best in the senior healthcare business. There is no one better.

Yes, you can contact Rick instead... you can see his postings here. You decide who will be best for your needs. No wrong answer... just a difference in style, attitude, and personality between the two. I recommend Frank because he is a genuinely nice man... and I also like his goats!!! YMMV. (I once had a goat when I lived/worked on a farm in Raphine, Virginia in 1969 right after college graduation. Nice animals.)

Al, did you work at Cyrus McCormick's historic farm when you lived here, or did you work on a private farm?

 

[Norwayguy]

"Members typically also pay a monthly premium in addition to the Medicare Part B premium to cover items not covered by traditional Medicare (Parts A & B), such as prescription drugs, dental care, vision care and gym or health club membership."

I never said the member wouldnt have to pay anything else as in co pays...ded..etc. i said the part b premium covers benefits under the MA plan, which they do.

Nevermind you are totally missing what your saying or you truely believe that the fixed cost each month that Medicare provides to an MA plan is ONLY the members Part B Premium and that is not true...Medicare provides to the MA plan a fixed amount each month of between 800-1200 per month or more now.

 

[Norwayguy]

I spoke to a CMS representative to get the correct answer. How does Medicare determine what they pay to a MA plan and where does the money come from?

1) How does Medicare determine what they pay to a MA plan?
ANSWER: "CMS bases the Medicare payment on a private plan between its bid and its benchmark. The benchmark is a bidding target which has several factors."

_
2 How and where does Medicare get the funding to pay a MA Plan?
ANSWER: "The amount determined by Medicare to the MA plan is what i just went over. But to answer your question, the money paid by Medicare to a MA plan is a portion of the enrolled members Part B premium. Medicare retains the remaining amount should the MA plan offers rebates back to the Part B premium for lower premiums or supplementary benefits."

CALL 1-800-MEDICARE and ask for yourself since you guys know it all!! IDIOTS!!

Funny and wrong.

I suggest you call Medicare back, and ask about Capitation Rates and Medicare Advantage programs. Capitation is a formula that Medicare computes and becomes the FIXED amount that Medicare pays to an MA plan. Capitation has nothing to do with Part B Premiums. Part B premiums that a member pays through SS deduction goes into the Medicare trust fund then co-mingles with everyone elses contributions.

I am a licensed agent, I do not post behind a cloak my license info can be obtained from the State. I do not fear any claims of error or ommission in regards to Medicare Advantage and how it is funded....Can you say the same if you advise a client in error that the only money an MA carrier receives in that members Part B premiums plus any direct premium for the MA plan.

I'm done with you because you are either not an agent or someone that just wants to screw with us.

 

[GreenSky]

I'm done with you because you are either not an agent or someone that just wants to screw with us.

I don't think he has the brains to screw with us. But we are all idiots - he's the only one that knows the "truth".

Wouldn't you just love to follow petrinoknowsnothing after each appointment and provide the correct information to his prospects? T'would be a gold mine.

Unfortunately, he and his "kind" are the reason I'm sure that the feds will take over all Medicare sales in the future.

Rick

 

[Norwayguy]

you r right but when a member goes to a MA plan...money is removed from medicare and paid to the MA plan.

Your right money does come from Medicare to the MA plan but it has nothing to do with Part B premiums and is not even close to the same amount of money.

 

[Todd King]

Petrino, This has nothing to do with what Medicare pays the insurance companies but refers to what the client is actually paying for his Part C plan. I've been reading your posts as debating what Medicare actually pays the insurance company, not the client.

Please confirm which one you are trying to prove.

 

[jdeasy]

You disagree with the information below??

http://www.oregon.gov/DCBS/SHIBA/docs/section4.pdf?ga=t

(refer to page 4)


What Does a Medicare Advantage Plan Cover?

For example: George C. lives in Massachusetts and has a Medicare Advantage Plan through Fallon Community Health, one of the highest-rated health plans in the country. He has an HMO plan with drug coverage. His monthly premium cost for the plan is $208.40 (the Medicare Part B premium of $96.40 plus $112 charged by Fallon). Also, his out-of-pocket expenses include a $15 copay for each PCP visit, $20 for each specialist visit, 10% coinsurance for durable medical equipment, and an annual deductible of $310 for prescription medications.​

If you join a Medicare Advantage Plan, the plan must provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) benefits, including emergency and urgent care. The only major benefit not covered by these plans is hospice care – this benefit is covered by Original Medicare even if you choose a Medicare Advantage Plan.
Many Medicare Advantage Plans offer extra coverage, such as vision, hearing, dental, and general checkups and other health and wellness programs. Most advantage plans include Medicare prescription drug coverage (Medicare Part D).
Most Medicare Advantage Plans are managed care plans, usually a health maintenance organization (HMO) or a preferred provider organization (PPO). These plans may require that you choose a primary care physician (PCP), get a referral from your PCP to see a specialist, and use only doctors, hospitals, and other medical facilities and services that are part of that health plan’s provider network.
Some private health insurance companies offer a Medicare Advantage Plan known as a Private Fee-for-Service (PFFS) Plan that may allow you to see any doctor or use any Medicare-approved hospital. However, unlike Original Medicare, you may have a copayment for doctor visits and not all providers may be willing to treat you. However, in a PFFS Plan you do not have to choose a PCP and you do not need a referral to see a specialist.
What Does a Medicare Advantage Plan Cost?

Each month, Medicare pays your advantage plan a fixed amount of money to provide your care. The advantage plan is then responsible for paying your doctor, hospital, and other providers of care.
Although your advantage plan must follow Medicare’s rules, it can charge you a premium and additional out-of-pocket expenses, such as a copayment for a doctor visit, coinsurance for durable medical equipment (such as a wheelchair), and an annual deductible for prescription medications.

You also are responsible for your Medicare Part B monthly premium, which is taken out of your social security check.

For example: George C. lives in Massachusetts and has a Medicare Advantage Plan through Fallon Community Health, one of the highest-rated health plans in the country. He has an HMO plan with drug coverage. His monthly premium cost for the plan is $208.40 (the Medicare Part B premium of $96.40 plus $112 charged by Fallon). Also, his out-of-pocket expenses include a $15 copay for each PCP visit, $20 for each specialist visit, 10% coinsurance for durable medical equipment, and an annual deductible of $310 for prescription medications.​

This does not prove your point. What this show is much it costs the beneficiary.

What it does prove is that you are completely clueless about the workings of Medicare and Medicare Advantage and that you should not be talking to seniors about either.

 

[IMO101]

Konsultint, I appreciate your Motto, and I agree with you 100%. It is a complex market, but a very rewarding one. As long as you are driven by a passion to help the client, this is a great career path. I don't find the regulations to be a major issue. There is just a certain way to do things, and as long as you do things that way, and don't get creative, it's really pretty simple. We have a new MGA who was the top producer in our state, with over 200 MA enrollments during AEP alone, and a whole lot more over the past 12 months. She loves what she does, she networks, she helps seniors, and all of her marketing at this point is from referrals, after just a few years in the business. Now she is helping new agents get started in this field, and I can tell you, she is driven by a passion to help the senior. She has told me that most of her clients can't afford a med supp plan, so that's really not even an option for them. A good MA plan helps them in many ways, and proof of the benefits they experience is her excellent retention. Anyway, I think it is important to understand all available options, and if you want to specialize on this niche, it is a great thing to do for seniors, and is financially rewarding as well.