Original Medicare

[theinuranceguy]

Quick question to all the agents marketing Med supps and MAs.

Other than network issue... is there any reason why someone would want to be on original medicare and a part d?

I say that because just last week, I met with a lady turning 65... she was told by someone to not pick up anything and just pay the copays and deductibles of original Medicare...

I laughed for a second because I thought she was joking... but she was serious... why you ask... Because her hospital will write off any expenses that she might rack up while there.

Lol, so we wrote her up on a stand alone part D.. and I was on my way...

Thats the first time I have ever heard someone say that to me.

 

[Frank Stastny]

For prospects who's doctors accept assignment I have suggested to a lot of them that if they don't want to take a Med Supp that just having Medicare will be a good option for them especially if the only other option they have is a PFFS plan.

At least they will not be limited to the doctors and hospitals they can go to. They will still be able to make choices and receive quality health care when needed.

If they are even reasonably in good health they will end up money ahead. PFFS plans are not premium free in all counties in Missouri.

I can't speak about HMO's or PPO's because they are not available for me to sell in the areas I work in.

 

[retread]

Quick question to all the agents marketing Med supps and MAs.

Other than network issue... is there any reason why someone would want to be on original medicare and a part d?

I say that because just last week, I met with a lady turning 65... she was told by someone to not pick up anything and just pay the copays and deductibles of original Medicare...

I laughed for a second because I thought she was joking... but she was serious... why you ask... Because her hospital will write off any expenses that she might rack up while there.

Lol, so we wrote her up on a stand alone part D.. and I was on my way...

Thats the first time I have ever heard someone say that to me.

It is absolutely amazing what people will believe from friends and relatives that have no idea what they are talking about.

You have to be firm with these hard-heads. Let them know they are WRONG, but be gracious, and leave them with your card. Check back with them from time to time. Sooner or later they will learn their friends' advice is moronic and will be eager for your help.

You can always tell a nim-wit, ...but you can't tell him much.

 

[jdeasy]

Quick question to all the agents marketing Med supps and MAs.

Other than network issue... is there any reason why someone would want to be on original medicare and a part d?

I say that because just last week, I met with a lady turning 65... she was told by someone to not pick up anything and just pay the copays and deductibles of original Medicare...

I laughed for a second because I thought she was joking... but she was serious... why you ask... Because her hospital will write off any expenses that she might rack up while there.

Lol, so we wrote her up on a stand alone part D.. and I was on my way...

Thats the first time I have ever heard someone say that to me.

Reminds me of a couple of my MA clients I just dealt with. They were on a $0/premium MA PFFS and have been since Jan. It's a husband and wife and they both just dropped their MA and went back to original Medicare. They are both duals, so, they can drop it anytime they want.

They called this week asking if they could get it back. I told them they could and asked why they dropped it. They said they dropped it because they had to pay the $15 when ever tey saw the doctor. I told them that they would pay more than that sinc ethey had to pay the $135 deductable and then 20%. They said, "yeah, but we had to pay the $15 up front, when you don't have the card and just Medicare, they will bill you for the part Medicare doesn't pay and, if you don't have the money, you just don't pay the bill". You just can't argue with that mindset.

I asked why they wanted to pick it back up then and she said that she had heard that the doctor will now bill for the co pay instead of requiring it upfront.

 

[theinuranceguy]

Ya thats the first Ive heard that.

But, if they are DE why would they have a copay anyways?

Do they have a spend down or some kind of cost share?

If so, many SNP MAPDs regardless of monthly cost share have a zero copay for primary dr.

Just wondering.

 

[Joe Moore]

You have got to remember, every Social Worker, Preacher, neighbor, and relative knows more about these plans than trained agents do.

We have had many persons drop, or have intentions of dropping a MAPD plan with the advice of one of the above. Some have horrendous outcomes. One got out June 30, and could not get back in a MAPD until August 1. Went through the month of July with no coverage except Original Medicare. No drugs available for July. All from the expert advice of a neighbor.

Joe Moore
Tennessee Senior Beneifts
Asurco Insurance Marketing
PO Box 1954
Morristown, TN 37816
1-800-226-1004

 

[theinuranceguy]

You have got to remember, every Social Worker, Preacher, neighbor, and relative knows more about these plans than trained agents do.

We have had many persons drop, or have intentions of dropping a MAPD plan with the advice of one of the above. Some have horrendous outcomes. One got out June 30, and could not get back in a MAPD until August 1. Went through the month of July with no coverage except Original Medicare. No drugs available for July. All from the expert advice of a neighbor.

I understand that, Ive been doing this for a while, but can you think of any reason (other than network issues) why someone would only be on original medicare?

 

[Joe Moore]

I understand that, Ive been doing this for a while, but can you think of any reason (other than network issues) why someone would only be on original medicare?

There is a possibility of provider issues; doctors or hospitals not being in the network, or they have got one on for a certain insurance company. Pain Clinics are a pain for us in TN. Don't know if it is the clinics not wanting the insurance, or the insurance having found a way to avoid having people going to pain clinics.

Also, politics gets involved as to why a certain hospital may not want to take a certain plan. I remember when the Democrats took over Congress, I talked to one Hospital CEO that had just announced that his hospital would not accept a lot of PFFS plans that our agents were marketing. His reason: it was just a matter of time until Democrats were going to cut his profits. It did not happen, and he stayed out of the plans for only about a month. I think he realized he had just shot himself in the proverbial foot. Or, the hospital may threaten to stop taking a plan to renegotiate reimbursement rates.

We have had doctors suggest and sometimes demand to patients that they go back to original medicare. When you have this, it is very hard to hold the business on the books. We have agents, GA's, MGA's and sub-IMO's scattered all over the country. Seems each area has its own unique set of problems. And a new one comes up about every 2 weeks.

Joe Moore
National Senior Benefits
Asurco Insurance Marketing
PO Box 1954
Morristown, TN 37816
1-800-226-1004

 

[patch36]

The only reasons I can think of are;

1. If they were wealthy and could easily pay the 20pct and were willing to self insure that portion, or if they are poor, have no attachable assets and do not plan on ever paying the 20pct.

2. Uninformed or Misinformed.

 

[patch36]

Hospitals generally do not just settle for the Medicare approved amount when it comes to MA's. They sign contracts with the MA insurance companies that negotiate a higher rate than Medicare pays.

With MA's that are PFFS plans the hospitals do not have contracts making them part of a network, but rather they have Memorandums of Agreement that give them the 'extra' money they negotiate from the insurance companies.

Doctors don't have this option, they either accept Medicare assignment or not when it comes to MA's. So this puts PFFS in a precarious position with hospitals due to the nature of the plans.

Neither hospitals or doctors are not contractually bound to accept PFFS, but hospitals have an additional advantage of being able to negotiate rates above approved Medicare Rates.

Excuse my misuse of terminology, but the essence of my description is accurate.