80% of what i sell are duals . 10% are people who already have Ma”s and I’m replacing . The other 10% are turning 65 and i show them medigap and med advantage with the pros and con’s and they make the decision . We access there present health and recent use of health care and go from there with different possible cost outcomes.On the above quote earlier i meant to say i don’t think a middle class to wealthy person should buy a ma not that i won’t sell them one . I show both and they make the decision[/QUOTE]
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Medicare Advantage health plans leave seniors scrambling for alternatives
- Thread starter Northeast Agent
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80% of what i sell are duals . 10% are people who already have Ma”s and I’m replacing . The other 10% are turning 65 and i show them medigap and med advantage with the pros and con’s and they make the decision . We access there present health and recent use of health care and go from there with different possible cost outcomes.On the above quote earlier i meant to say i don’t think a middle class to wealthy person should buy a ma not that i won’t sell them one . I show both and they make the decision[/QUOTE]
- 4,142
I have the opposite effect.
I show people Medicare Advantage and Medicare Supplements. I tell them the Pro's and Con's.
Most people select the MS plan.
I did write 4 MA's this year, but three of them were for people basically with their mind made up.
I mean, anyone can afford 39-60 a month for a HDG and get better overall care with freedom to boot with Original Medicare.
It's the damn Silver Sneakers and Dental that they love. What sucks is that I get more money on the MA plan. Especially when I can compound it with HI and better residuals. Stupid Michigan.
I can usually Commission $700 FYC.
I show people Medicare Advantage and Medicare Supplements. I tell them the Pro's and Con's.
Most people select the MS plan.
I did write 4 MA's this year, but three of them were for people basically with their mind made up.
I mean, anyone can afford 39-60 a month for a HDG and get better overall care with freedom to boot with Original Medicare.
It's the damn Silver Sneakers and Dental that they love. What sucks is that I get more money on the MA plan. Especially when I can compound it with HI and better residuals. Stupid Michigan.
I can usually Commission $700 FYC.
InsuranceGuy29
Guru
- 421
This is so incredibly spot on. That’s how 95% of my calls with my MAPD clients go. With My Supplement clients, they always badger me with wanting to run new RX’s or find new RX plans, etc. I can’t necessarily blame them. For whatever reason, stand-alone RX plans just have much more wild swings in formulary additions/subtractions and prices than MAPD plans. But it’s definitely a major pain in the @ss when you have to run tons of these plans, only to hear “Ok, let’s change plans.” Im not trying to sound like an @ss, but all that does is suck my time, and offers absolutely zero incentive. Renewals are what? About $36, or $3/month. Yea, not exactly a huge incentive to look into that. Might as well run a charity.
InsuranceGuy29
Guru
- 421
It isn’t so much about the extra benefits as it is saving a ton of extra money, monthly. My old man is great with money, has a lot of it, and he went with an MAPD when he turned 65. I ran a cost illustration, showing if he had went with a Supplement, from day one, along with a PDP, and a stand-alone dental policy. He would’ve spent about $33,000, to date. Granted, about $5,000 of this has went to his healthcare needs, and I understand this will vary if someone is really sick, right away, but that’s a TON of money. And he invested it all and has made a killing on the stock market. If I was a Senior (with or without money), who wasn’t immediately deathly ill at 65, I would choose an MAPD. It’s a no-brainer for me.
The OM + Medigap vs MA boils down to the agent's first hand experience where it matters. Point of claim.
How much or how little someone pays for their coverage doesn't matter when the claims roll in.
Will the individual have unfettered access to care or are they willing to let a carrier direct their care? Will claims be paid hassle free or is it up to the patient to fight for reimbursement? What about surprise billing?
I get calls all the time from clients who are anticipating extensive medical care and want to know if their claims will be paid and how much care will cost them.
The plan they have, the one they CHOSE, allows them to use any doctor anywhere and the most they will pay out of pocket is around $200 for the year.
Two of them are fighting cancer. One has been a client for years and was diagnosed with AML last year. Lot's of care, chemo, etc. Her bills have run over $300k so far. Everything covered. No hassles. Out of pocket was $200.
Another, new client, has battled adrenal cancer for about 5 years. The cancer metastasized to other organs over a year ago. Multiple surgeries, chemo, etc.
Until October she was on a managed care plan (Obamacare) that has drained her savings. In the last 2 months she has run up over $80k in claims. No hassles. She uses the doc's she knows and a few more for some new issues. Hospitalized here and in MD at NIH for more surgery. All the bills have not come in but her responsibility is $200.
I also have new clients needing cataract surgery. Gross billed charges run around $45k. Liability for Medicare covered claims $200.
Another client discharged from the hospital a couple of weeks ago after a 10 day stay for COVID. He is receiving care at home, including O2 therapy. Out of pocket $200.
None of them have complained about the monthly premium and they never will.
Saving money on premiums is irrelevant when it comes to care and paying the bills. They are glad they listened to me and not Joe Namath.
I deal in real life situations and "sell" peace of mind.
Having worked with managed care plans for over 30 years there is a reason why I will never have a client on those plans. I have no problem telling folks if they want an MA plan they need to go somewhere else. They almost never do that.
How much or how little someone pays for their coverage doesn't matter when the claims roll in.
Will the individual have unfettered access to care or are they willing to let a carrier direct their care? Will claims be paid hassle free or is it up to the patient to fight for reimbursement? What about surprise billing?
I get calls all the time from clients who are anticipating extensive medical care and want to know if their claims will be paid and how much care will cost them.
The plan they have, the one they CHOSE, allows them to use any doctor anywhere and the most they will pay out of pocket is around $200 for the year.
Two of them are fighting cancer. One has been a client for years and was diagnosed with AML last year. Lot's of care, chemo, etc. Her bills have run over $300k so far. Everything covered. No hassles. Out of pocket was $200.
Another, new client, has battled adrenal cancer for about 5 years. The cancer metastasized to other organs over a year ago. Multiple surgeries, chemo, etc.
Until October she was on a managed care plan (Obamacare) that has drained her savings. In the last 2 months she has run up over $80k in claims. No hassles. She uses the doc's she knows and a few more for some new issues. Hospitalized here and in MD at NIH for more surgery. All the bills have not come in but her responsibility is $200.
I also have new clients needing cataract surgery. Gross billed charges run around $45k. Liability for Medicare covered claims $200.
Another client discharged from the hospital a couple of weeks ago after a 10 day stay for COVID. He is receiving care at home, including O2 therapy. Out of pocket $200.
None of them have complained about the monthly premium and they never will.
Saving money on premiums is irrelevant when it comes to care and paying the bills. They are glad they listened to me and not Joe Namath.
I deal in real life situations and "sell" peace of mind.
Having worked with managed care plans for over 30 years there is a reason why I will never have a client on those plans. I have no problem telling folks if they want an MA plan they need to go somewhere else. They almost never do that.
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I could have sworn mapd networks and drug formularies change every year? Doctor drops out, client on new med, etc.
Doesn't a good agent verify their doctors and meds will still be covered next year on the mapd? To me, that is twice the work, vs just rx analysis on pdp.
Also, rumor says the most profitable product sold by carriers and by agents, are $0 premium mapd plans. I get the math, just wonder how they get there. Ah....dictate who you can see, maybe require referrals, pre auth, cost sharing, etc. Restrictions = profit.
Each year i am tempted to engage in mapd, but then my med supp discussions start, and the bad health year stories begin. Not one had any issues with choice, access, pre auth, claims, surprise bills and are still alive.
They are thankful they listened to my advice, and tell me horror stories of their neighbors on mapd.
I dont like playing doctor roulette with aging clients with growing health risks.
Doesn't a good agent verify their doctors and meds will still be covered next year on the mapd? To me, that is twice the work, vs just rx analysis on pdp.
Also, rumor says the most profitable product sold by carriers and by agents, are $0 premium mapd plans. I get the math, just wonder how they get there. Ah....dictate who you can see, maybe require referrals, pre auth, cost sharing, etc. Restrictions = profit.
Each year i am tempted to engage in mapd, but then my med supp discussions start, and the bad health year stories begin. Not one had any issues with choice, access, pre auth, claims, surprise bills and are still alive.
They are thankful they listened to my advice, and tell me horror stories of their neighbors on mapd.
I dont like playing doctor roulette with aging clients with growing health risks.
And thus is why almost all my Mapd business is either ppo duals ( I don’t sell hmo duals ) were they can go to any doctor in the nation that accepts Medicaid or people who already have a ma . But I also have first hand knowledge of tons of people who have would have saved $50k plus by having a mapd . I just pulled up a fact . From 2010-2019 mapd enrollment has gone from 11.1 million to 22 million or 34% of total People on Medicare . We all know this freight train will continue . To stay in business eventually every dr and hospital will have to accept most plans . Just like most hospitals must accept United’s plans or they’ll be in big trouble .
Dr.s can leave the network anytime during the year and the client would be notified if they are leaving the network. So no, I do not check their doctors or meds. They are notified as well if they have a brand name that will no longer be covered.
I’m not saying I put all or even most of my clients with a MAPD, I definitely push Med supps. But, MAPD is just easier work for me and year after year the MAPDs are getting better and better.
I’m having to fight harder and harder every AEP to convince my Med supp clients to keep their Med supp.
Med Sups are a dying breed I'm afraid. I've done 3 so far this year but we have a hell of a Cost Plan that blows Med Sups away and has dental, vision, hearing and gym also not to mention a ton of low premium MA plans with great networks. So thankful I don't have to sit and ask 14 health questions and write down all their prescriptions and then wait 2 weeks to see if they are accepted. I take the apps and file it away and onto the next one. The MAPD's have to have good drug plans and not mess with them because they know that can blow the whole sell if their drug plan sucks. 90% of my clients have the GTL Hospital plan along with their MA and are happy as hell.
A key challenge for states in ensuring access to care for the 85.3 million Medicaid beneficiaries is having a sufficient number of providers. The Medicaid and CHIP Payment and Access Commission (MACPAC) recently found that higher Medicaid fees are associated with higher rates of physicians accepting new Medicaid patients. Even so, acceptance of new Medicaid patients differs across specialties.
Medicaid beneficiaries may be receiving care from other clinicians (for example, physician assistants, nurse practitioners, and clinical social workers) and in settings other than physician offices, such as community health centers
https://www.healthaffairs.org/do/10.1377/hblog20190401.678690/full/
Many doctors accept poor patients as long as it’s financially sustainable. But the Medical Association of Georgia says the payment cuts are forcing more doctors to see fewer or no Medicaid patients. Donald J. Palmisano Jr. is executive director of the Association. He says, “The payment under Medicaid is less than the cost of providing the care…and so if a physician has a healthy mix of payers they’re able to see Medicaid patients, but if they happen to be in areas with a high Medicaid population it just makes it where the physicians are unable to take as many Medicaid patients as they would like.”
Georgia Medicaid Recipients Will Have A Harder Time Finding Doctors | 90.1 FM WABE
