Should You Ditch Your Medicare Advantage Plan?

[rmhaire]

Florida's in a world of it's own.

You ain't kidding either.

@axeman462 rides to work every day on a unicorn.

 

[sman]

@sman there is no doubt in my mind you did the right thing for your client. The MSA/HSA concept worked well for the under 65 market . . . individuals and group.

But is seemed like there was reluctance on the part of providers in getting their head wrapped around it for the Medicare market.

Agree or not?

Definitely agree. In my experience, albeit limited, the biggest obstacle was the providers.

 

[sman]

Where have you seen me say that I INSIST on everyone buying a Medigap plan?

@MedicareWAA i will defend Bob here. I get several referrals from him every year for MAPD's. When the prospect can't qualify for a Med Supp or simply prefers MAPD, he sends them my way. His primary goal is to take care of the prospective client. If they aren't a fit for a Med Supp, he isn't just leaving them high and dry.

 

[Medicare bro]

I am a type I diabetic who wears an insulin pump and CGM and I meet a $6000 out-of-pocket maximum every year. A $0 premium MAPD in my state does NOT make sense for me, as premiums would be less than copays/coinsurance on MA plans every year. Your 3 scenarios are a good start to discussions but it isn't about what's happening today, it's about what risk someone is willing to take on. Insurance is all about risk transfer and we choose what we feel like is best for our situation based on how averse we are to risk.

That's fair, tbh, and this is weird, but I can't think of any clients of mine who use insulin pumps. I know the insulin isn't the problem.

 

[somarco]

I can't think of any clients of mine who use insulin pumps

Unless you broach the subject, they probably won't bring it up.

Most of my diabetic clients are T2 and the few T1 I have that use insulin are usually not on a pump. When I meet someone new who is T1 I ask if they have a CGM and pump. If they do I let them know their insulin should be a Part B claim. Most of the time they are pleasantly surprised especially if they are T65 and are accustomed to running it through their EGH drug plan.

 

[MedicareWAA]

I'm 72 and I pay $156 a month for Plan F.

Where do you see anybody new to Medicare Part B paying $225 a month for N or G?

For a 66 year old man who wants a plan G, count on $200+ for your plan in Florida, New York, Missouri, Connecticut, parts of California, etc. Every market is unique but there are many, many places where $200ish is the prevailing rate. Then add a drug plan and a dental plan.

 

[MedicareWAA]

@MedicareWAA i will defend Bob here. I get several referrals from him every year for MAPD's. When the prospect can't qualify for a Med Supp or simply prefers MAPD, he sends them my way. His primary goal is to take care of the prospective client. If they aren't a fit for a Med Supp, he isn't just leaving them high and dry.

He doesn't sound like an insurance advisor. He sounds like a Medigap salesman.

 

[Medicare bro]

@MedicareWAA i will defend Bob here. I get several referrals from him every year for MAPD's. When the prospect can't qualify for a Med Supp or simply prefers MAPD, he sends them my way. His primary goal is to take care of the prospective client. If they aren't a fit for a Med Supp, he isn't just leaving them high and dry.

I am so curious about this! So he could potentially help them with an Advantage but refers them out? Why?

 

[MedicareWAA]

That way when they need to have their leg amputated 4 years later and are wondering why their out of pocket is so high you can remind them that you went over in detail the supplement options but they chose the cheaper chicken.

Once again, this is not accurate in all parts of the country. There are tons of densely populated areas with MAPDs having $2,500 - $3,200 MOOPs. Sometimes lower.

Whether or not an Advantage plan makes sense for someone depends on their individual needs and preferences, but it is a myth that MA out of pocket costs are meaningfully higher than a supplement. That's true in some markets, but it's not true in many other markets. In many markets, it's the opposite. What a supplement gives you is maximum freedom and very predictable costs.

Out of pocket costs = plan premium plus cost share

 

[somarco]

Every market is unique but there are many, many places where $200ish is the prevailing rate. Then add a drug plan and a dental plan.

And your point is . . .?