Silver script $63 a month in 2024 with $525 deductible. Best silver script $116 a month

[Midlevel]

You're right, the under 65 market doesn't have a choice, a ppo option at best. But when you T65, most don't realize they have a better option to escape the managed care programs they are accustomed to, until an agent introduces OM to them.

I work the obamacare market, I and they, don't have this option, and when they hit 65, I am done playing doctor roulette.

As far as cost containment, most who are in dire need of help, and can't wait for a PA because the pain is so intense, just go to the ER room for instant treatment in a higher cost facility. There go the savings.

I will guess you've never had a life threatening illness, and been subject to insurance company delays and BS as your body or brain deteriorates. I have, not a place I would wish on anyone.

If mapd is so good, they should get rid of the 1 year free look period. Why does it exist in the first place?

Not sure why it exists, I’ve never had anyone use it. They would laugh at me if I said you can go back to your Med Sup at this price but lose all the dental, vision, etc and we have to put you back on a crappy PDP. No takers so far.

 

[somarco]

You're right, the under 65 market doesn't have a choice, a ppo option at best. But when you T65, most don't realize they have a better option to escape the managed care programs they are accustomed to, until an agent introduces OM to them.

Most of the T65 folks I get are coming off group insurance plans with very little premium cost sharing (employer pays the lions share but most have no idea how much that is). They are also accustomed to extras like dental, vision, STD, LTD, etc.

Those who tried to use their dental & vision with their current provider quickly learned most those providers are not in network. A few switched providers but many paid out of pocket at point of service, filed their own claims and waited on whatever reimbursement came back.

And most enjoyed good health during those years. The ones that were hospitalized for other than maternity, soon found out the problem with hidden providers and higher OOP. The EGH health care provider network is much larger and more fluid vs the 65+ Medicare market.

And almost everyone 65+ will one day have a drastic change in their health . . . the wrong time to have buyers remorse.

Because I wrote EGH cover on thousands of lives I had more exposure to the pitfalls of managed care than I would have writing only IFP coverage.

Of course that all changed with Obamacare, the plan brought to us by the hope & change guy who promised it would not add one dime to the deficit, and if you liked your doctor/plan you could keep them. All this was possible because of the ignorance of the American voter as vocalized by Jonathon Gruber.

I still write almost all of those T65 prospects coming off EGH and I don't think I have missed a single one coming off Obamacare. Took an app yesterday on a guy with the BX HMO version of Obamacare. He is paying $1200 per month as a single, has a $5k deductible and limited provider options. Two years ago he had to reschedule an MRI because BX changed his PCP without telling him and the specialist would not run the MRI without a referral from his new PCP.

SMH

EDIT - all of the above is based on personal experience, direct personal experiences or via client dealings. I did not have to "Google" anything other than Gruber's name. Had I not done that I would have spelled it Goober.

 

[rmhaire]

Not sure why it exists, I’ve never had anyone use it. They would laugh at me if I said you can go back to your Med Sup at this price but lose all the dental, vision, etc and we have to put you back on a crappy PDP. No takers so far.

Have you stopped to think that a lot of this has to do with politics?

Since I don't know anything about you, I'll make a guess based on some of your posts.

You live and work in a larger metropolitan area where people are more liberal and probably vote democrat. (Am I close)

@somarco and I work in a different area. We're both in Georgia and our market is more conservative and tend to vote republican. They don't like government control.

In my market I've noticed two types of people that choose MA over a supplement:

The ones that can't afford the premium.
The ones that can afford the premium but simply don't want to pay it.

 

[somarco]

In my market I've noticed two types of people that choose MA over a supplement:

The ones that can't afford the premium.
The ones that can afford the premium but simply don't want to pay it.

If they can't afford the premium they can't afford to get sick.

A possible exception would be dual's who, by my understanding, don't need any kind of insurance because what isn't paid by Medicare spills over to Medicaid. The result is almost $0 OOP for health care and Rx.

And those "extra benefits" are not worth a damn if you can't find quality providers who participate in the plans.

 

[yorkriver1]

Just to chime in on the penalty, a couple in their later 80's just happened to never get PDP's. No Rx until one had to get a $500 Rx. Smaller house, fancy neighborhood where 3500 Sq ft and up the norm, but living on SS only. Lucky their % of federal poverty level was ok for the manufacturer to provide the Rx free of charge. This is not my everyday habit, but I went to the doc office with the client to get them to sign the form to the manufacturer. A busy office so used my Jedi "you will get this signed now" move. The monthly penalty from 2006 onward, pretty high. They had found me, & after the Rx help, was able to get them lower cost MedSupps, no medical history that would cause decline, so both passed underwriting. The point is like was said, some Rx in the future could be astronomical. Another one, $5000 a month. That couple just happened to squeak under 500% of FPL to get that one no cost, and they have prescription coverage. The cancer maintenance prescription, $10,000 plus a month.

 

[yorkriver1]

My go to . . .
https://www.mapleleafmeds.com/

fallback . . .
[EXTERNAL LINK] - Canadian Pharmacy Service - Certified Canada Pharmacy Online



That will be a dumpster fire, not just PDP, but any Part D

I got a report of generic for Eliquis being $100-150/for 3 months. Thanks!

 

[yorkriver1]

Not sure why it exists, I’ve never had anyone use it. They would laugh at me if I said you can go back to your Med Sup at this price but lose all the dental, vision, etc and we have to put you back on a crappy PDP. No takers so far.

I have had 3 people use Trial Rights within the 1st year of T65. Cancer, cancer and severe gastrointestinal issues. That's not a lot for my years in the business, but they were glad to be able to change.
Folks on the forum (thanks!) helped me with trial rights details when I was new to Medicare plan sales, since no local insurance company sales reps had the answer to where could I find them listed. PS if you are new, it's p.23 in the Medicare publication: Choosing a Medigap Policy.

 

[Midlevel]

Have you stopped to think that a lot of this has to do with politics?

Since I don't know anything about you, I'll make a guess based on some of your posts.



You live and work in a larger metropolitan area where people are more liberal and probably vote democrat. (Am I close)

@somarco and I work in a different area. We're both in Georgia and our market is more conservative and tend to vote republican. They don't like government control.

In my market I've noticed two types of people that choose MA over a supplement:

The ones that can't afford the premium.
The ones that can afford the premium but simply don't want to pay it.

No, you aren’t close. I live in a very rural part of the Midwest. It is a 2 hour drive to find a city larger then 100000 people. We just have no issues with network providers. MA has become so popular that every Dr, hospital etc is in network. Guess I am just fortunate to live where I do and sell Medicare. Have only been to Atlanta airport so don’t know much about Georgia except Herschel Walker was a stud.

And no, you would have to go many miles from me to find many Democrats at all.

 

[Midlevel]

If they can't afford the premium they can't afford to get sick.

A possible exception would be dual's who, by my understanding, don't need any kind of insurance because what isn't paid by Medicare spills over to Medicaid. The result is almost $0 OOP for health care and Rx.

And those "extra benefits" are not worth a damn if you can't find quality providers who participate in the plans.

All my MA plans are reimbursement for dental, vision so providers in network means nothing. They just get a certain amount reimbursed no matter where they get work done as long as they are a licensed dentist.

 

[Midlevel]

Have you stopped to think that a lot of this has to do with politics?

Since I don't know anything about you, I'll make a guess based on some of your posts.

You live and work in a larger metropolitan area where people are more liberal and probably vote democrat. (Am I close)

@somarco and I work in a different area. We're both in Georgia and our market is more conservative and tend to vote republican. They don't like government control.

In my market I've noticed two types of people that choose MA over a supplement:

The ones that can't afford the premium.
The ones that can afford the premium but simply don't want to pay it.

One could argue that Original Medicare is under more Government control then a private insurance company taking care of a clients insurance. I hate politics and do not talk about them with anyone, all a bunch of crooks so what’s the difference.