Medicare Supplements Vs. Medicare Advantage

[Chazm]

The situations with the SLMB, Q-1 etc. Those who are not QMB. That is the toughest situation. As I'm sure you know these people may receive "share of cost" from the state.

If someones share of cost is below the Part A Deductible $1068 in 2009. I was told that they are better of with original Medicare_"share of cost".

For example, if a prospects share of cost is $800, and God forbid they are hospitalized, they pay $0 because the medical bill, Part A Deductible, is above their share of cost $800.

From what I read, and what more experienced agents told me, if the share of cost is below the part A deductible--don't touch them. they may end up paying more with an MA (hospital co-pays, surgery etc).

If the share of cost is above the Part A deductible, then enroll them.
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I agree, save the premium money they would have spent for a rainy day.

I haven't been doing SNP very long, only a few apps so far but I know if I have a client who is QMB and has a share of cost they are eligible for evercare's SNP which has zero's across the board on deductibles and co pays. But, I still am fuzzy on the whole thing so maybe I could learn a thing or two from you.

Yoda~ I can understand where you are coming from but their has been numerous times where I have met with a client, did a needs analysis and medicare presentation and realized that for his/her situation a med. supp. would not be the best and write a MA. Afterwards, I get a referral and then do a med supp on the referral. If I wasn't able to help her out I might have not received the referral.

Actually, this happened today. I met a lady, her SS was $1150, had about $50k in a IRA and a couple of small cd's. Currently doesn't have health insurance (is turning 65) and only had a small amount left over every month after paying bills. There is no way she could afford part B ($96.40) plus the D plan ($140) and part D ($35) every month. She was very happy that I also offered the MAPD and at the end she handed me a friends phone number and name, I didn't even ask for a referral. Now, this referral may not be a med supp but I'm willing to find out.

 

[AJAX]

I agree with you about a PPO but that wasn't the question nor did you state earlier that you were addressing PPO's and not HMO's or PFFS plans .

The question dealt with those plans that fall under Medicare Part C, all of them. If you are going to discuss PPO's then you should also add comments about HMO' and PFFS plans.

A needs analysis is something I think in terms of financial planning not health insurance for a senior.

What seniors really need to insure the best quality of life, is the best available health care that they can afford regardless of what their past, current or future health care needs may have been or may be in the future.

My wife also works in the health care field. And yes, to a medical professional medical history is extremely important. This has nothing to do with the quality of health care they should have available. Or, are you saying that people who are "healthy" today do not need the best health care available?

The concluding statement in my post said,

"I believe the decision on which one a senior should take boils down to two things. Cost and the importance of being totally in charge of their health care." Does that not sufficiently cover everything?

Maybe I should have said "Cost/Affordability" instead of just cost.

I agree with you on: "Cost/Affordability" of Supplements being a major factor.

I also agree with you that Supplements are better, in terms of access to health care (any Medicare certified Medical provider should accept a supplement).

You seem to have a lot of experience in Med Supps. I respect that. I am not trying to argue with you.

However we disagree on a needs analysis. When it comes to Med Supps, you don't necessarily need a thorough "needs analysis."

Do you travel? Where? How often/long?............fill in the blank........etc

(If a prospect states they cannot afford a Med Supp, and they are only interested in an MA. I use a more thurough needs analysis)

Do you currently have Medicaid (state program)?

Are you receiving any financial assistance through the State or Social Security?

Who is your current healthcare provider?

What type of coverage do you have now? MA-HMO, PFFS, SNP, PPO (I may ask to see their card)

Why are you interested in making a change from your current coverage? What do you like most/least about your current coverage?

What's most important to you in a health plan?

If they are interested in an MA, after a presentation
Who is your current primary care physician?

Are you seeing any specialists?

What medications are you currently taking?

These are natural conversational questions that puts the prospects needs first.

I don't recommend HMO's because of network limitations, authorization requirements, and the need for referrals to see specialists on most HMO's.

I don't recommend PFFS plans, because a medical provider can decide at any time to refuse Medical service if they disagree with the terms/payments (unless it's an Emergency/Urgent care situation).

I recommend PPO's, for the reasons of no referrals required, the company will pay or reimburse for medical services provided regardless of seeing medical providers in or out of network. Members cost sharing may be higher ofcourse.

I state this because of my market area.

All of this written, it depends on your market. Some markets offer PPO's with $0 additional premiums, some don't. Some Markets have HMO's with an open Acces network, Some have a point of service option. Some plans have premiums, some don't.

All of that the original poster can get training on. There is no need for me to explain the details of PFFS, HMO, and so on. that would depend on her market, and the specific carriers she choose to be appointed with.

Medical history is important, to emphasize the importance of access to care. If someone tells me they have diabetes, I would emphasize the importance of a Supp or PPO--access to a specialist/Podiatrist.

I've known people who have HMO's who never get to see a specialist, the gatekeeper/PCP tries to handle everything.

A needs analysis draws out the prospects concerns/needs. What is important to them. It helps us to forget about selling, and focus on educating the prospect on the benefits/disadvantages of different Medicare plan options . Etc.

I guess we can agree to disagree on a needs analysis.

I always introduce a Med Supp first and its benefits. Again, if a prospect truly can't afford a Med Supp. And if the prospect is interested (Scope documented in advance..... etc) I explain the advantages/disadvantages of an MA.

 

[Cenla Agent]

I agree with AJAX on the needs analysis, discovery or whatever you want to call it. It's a basic part of sales in any industry--establish a need and meet that need. As both he and Frank note, there often isn't a lot of that required when selling Med Sups.

If you are going to market MA plans at all you need to do that. If you are attempting to replace MA with a Med Supp you need to do it, at least to find out what kind of plan they have--MA or MAPD to know if they are locked in or to know if they already have a standalone PDP or if they will have to enroll in one. As Frank has stated here many times, he asks questions too i.e. "what company do you have now," "how much are you paying" etc.

How many and what kinds of questions you ask depends on what you are marketing--FE, LTC, Annuities, DI, MA, etc. Obviously it will be much more detailed if you are a financial planner or if you are looking at a high face value life ins. case
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I also tend to agree with AJAX's approach in general. As he noted, you have to know your local market. Some HMO plans have self referral to a specialist, for example.

 

[apptdepot]

I have worked in both markets and the long and short of it is and this is just like any other type of insurance: You have to assess the needs and benefits of all products you have for the clients. For instance, If your client visits the doctor 5 times a month and their copay on a Medadv is $20, it may make sense to put them into a $120 Med supp. But if a client barely ever visits the Dr. tell them to save the money they are paying every month and take a med advantage. More than likely they aren's going to visit the hospital on any normal occasion so why waste the money? Tell them to save that amount of money they would pay and keep for if they do go to the hospital. They can pay their deductable with it. Or better yet tell them to take a vacation! Hope this helps.

 

[AJAX]

Not quite sure why its a dis-service. The ppo has no premium and includes PDP, how is that bad?

Now if they do qualify for low income then sure, I'll enroll them in evercare

The situations with the SLMB, Q-1 etc. Those who are not QMB. That is the toughest situation. As I'm sure you know these people may receive "share of cost" from the state.

If someones share of cost is below the Part A Deductible $1068 in 2009. I was told that they are better of with original Medicare_"share of cost".

For example, if a prospects share of cost is $800, and God forbid they are hospitalized, they pay $0 because the medical bill, Part A Deductible, is above their share of cost $800.

From what I read, and what more experienced agents told me, if the share of cost is below the part A deductible--don't touch them. they may end up paying more with an MA (hospital co-pays, surgery etc).

If the share of cost is above the Part A deductible, then enroll them.
- - - - - - - - - - - - - - - - - -
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I have worked in both markets and the long and short of it is and this is just like any other type of insurance: You have to assess the needs and benefits of all products you have for the clients. For instance, If your client visits the doctor 5 times a month and their copay on a Medadv is $20, it may make sense to put them into a $120 Med supp. But if a client barely ever visits the Dr. tell them to save the money they are paying every month and take a med advantage. More than likely they aren's going to visit the hospital on any normal occasion so why waste the money? Tell them to save that amount of money they would pay and keep for if they do go to the hospital. They can pay their deductable with it. Or better yet tell them to take a vacation! Hope this helps.

I agree, save the premium money they would have spent for a rainy day.

 

[Yoda]

When you run into a person who says they have a MA plan or says they want a MA plan it means only one thing. Get out of there fast! It means you are either dealing with a tight ass or a poor person and neither one of these are the kind of people that it is going to be pleasurable or profitable to deal with. In fact if you are dealing with poor people and those MA plans you better have you errors and omissions paid up because those people are trouble. But dont listen to me keep on dealing with those poor people and the tight asses and let me know how much life insurance and Long term care you ever sell them.

 

[Frank Stastny]

I agree with you on: "Cost/Affordability" of Supplements being a major factor.

I also agree with you that Supplements are better, in terms of access to health care (any Medicare certified Medical provider should accept a supplement).

You seem to have a lot of experience in Med Supps. I respect that. I am not trying to argue with you.

However we disagree on a needs analysis. When it comes to Med Supps, you don't necessarily need a thorough "needs analysis."

Do you travel? Where? How often/long?............fill in the blank........etc

(If a prospect states they cannot afford a Med Supp, and they are only interested in an MA. I use a more thurough needs analysis)

Do you currently have Medicaid (state program)?

Are you receiving any financial assistance through the State or Social Security?

Who is your current healthcare provider?

What type of coverage do you have now? MA-HMO, PFFS, SNP, PPO (I may ask to see their card)

Why are you interested in making a change from your current coverage? What do you like most/least about your current coverage?

What's most important to you in a health plan?

If they are interested in an MA, after a presentation
Who is your current primary care physician?

Are you seeing any specialists?

What medications are you currently taking?

These are natural conversational questions that puts the prospects needs first.

I don't recommend HMO's because of network limitations, authorization requirements, and the need for referrals to see specialists on most HMO's.

I don't recommend PFFS plans, because a medical provider can decide at any time to refuse Medical service if they disagree with the terms/payments (unless it's an Emergency/Urgent care situation).

I recommend PPO's, for the reasons of no referrals required, the company will pay or reimburse for medical services provided regardless of seeing medical providers in or out of network. Members cost sharing may be higher ofcourse.

I state this because of my market area.

All of this written, it depends on your market. Some markets offer PPO's with $0 additional premiums, some don't. Some Markets have HMO's with an open Acces network, Some have a point of service option. Some plans have premiums, some don't.

All of that the original poster can get training on. There is no need for me to explain the details of PFFS, HMO, and so on. that would depend on her market, and the specific carriers she choose to be appointed with.

Medical history is important, to emphasize the importance of access to care. If someone tells me they have diabetes, I would emphasize the importance of a Supp or PPO--access to a specialist/Podiatrist.

I've known people who have HMO's who never get to see a specialist, the gatekeeper/PCP tries to handle everything.

A needs analysis draws out the prospects concerns/needs. What is important to them. It helps us to forget about selling, and focus on educating the prospect on the benefits/disadvantages of different Medicare plan options . Etc.

I guess we can agree to disagree on a needs analysis.

I always introduce a Med Supp first and its benefits. Again, if a prospect truly can't afford a Med Supp. And if the prospect is interested (Scope documented in advance..... etc) I explain the advantages/disadvantages of an MA.

I better understand what you are calling a needs analysis. I also accumulate much the same information when I think it is appropriate.

I can better see, since you also sell Part C Plans, the importance of what you are talking about. If I offered them then I would also do an in depth needs analysis.

However, I do not sell any of the Part C Plans. If I have a prospect who either insists on one or is in a financial position where it is a good fit, I pass that prospect on to another agent. I make sure the agent is one I can trust to genuinely help my prospect, not one just interested in making a commission.

I guess I could have saved us both a lot of typing had I initially said I do not sell Part C Plans so the approach you take, by necessity, is substantially different than mine. You sound like an agent who is very concerned about finding a "perfect fit" for your prospect. Things that a professional insurance should do.

Your clients are lucky to have an agent like you.

 

[Jessica Durphy]

QMB, SLMB, Q-1, sorry guys I don't understand the abbriviations ?

I'm enjoying reading all these posts, very interesting and lots of information.

Trailhiker= yes that's right they do term this as "God's country".... it is a very beautiful area up this way!

 

[Tom Highway]

QMB, SLMB, Q-1, sorry guys I don't understand the abbriviations ?

I'm enjoying reading all these posts, very interesting and lots of information.

Trailhiker= yes that's right they do term this as "God's country".... it is a very beautiful area up this way!

QMB is Queen Mary's Brigade - they get a special election for MAPD.
SLMB is Started Late Mary's Brigade. They also get a special election, but they have to go through a waiting period.
Q-1 is Quote 1 time only - you can only make one visit to a Q-1 person's home, if they don't sign up that day you get no other home visits....
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Actually, these are different levels of medicaid, which is a STATE benefit vs LIS (low income subsidy), which is qualified through social security (a federal benefit).
The different abbreviations are the different levels of medicaid, and each state has different income cutoff points for each level.

QMB stands for Qualified Medicare Beneficiary, and it's usually the lowest of the low income folks. SLMB is Specified Low Income Medicare Beneficiary, and Q-1 (also known as QI-1) is Qualified Individual. The Q1 category sometimes the state medicaid agency will not coordinate benefits with plans.

People who have these classifications will have their Part B premium paid by the state, and depending on the state and the level of medicaid, have a cost sharing where the state will pick up their coinsurance if they're on straight medicare. Therefore, a lot of the plans have medicaid dual eligible plans where they have $0 copays; the plans must have a contract with each state medicaid agency, and they will coordinate billing.

Medicaid folks are DEEMED eligible for LIS, so they will always (unless there's some sort of a problem) get the low copays on their prescriptions.

You should hit each carrier you're appointed with for training about LIS and medicaid to see what it means to their specific plans in PA, or any other states you may sell in.

You said you're right on the OH border, I think? It may behoove you to see if OH has a reciprocal agreement for your license, and get a non-resident producer license in OH. They may have better rates on supps, better demographics for supps, or a better situation for MAPD plans, if it would be worth the drive.

 

[policy doctor]

Jessica...the quickest way for you to learn the Medicare niche is to understand and read 2 books.

The first, Medicare and You...2009 ..(changes yearly). Understand the definitions, the coverage details of Part A and B, and read the medicaid/state programs.

The second...Choosing a medigap policy. That is furnished by your ins companies whose med supps you rep.

I usually underline and have stickys' in pages I reference frequently. Plus you have a tool to show the senior that is truly "from the horse's mouth."

Third....do a spread sheet with Part A and Part B. Compare Med Advantage and Med supp per benefit. YOu will be very conversant and knowledgeable. I guarantee it.