Something New to Me, That I Need Your Help On:

[Josh]

You're a whack job!

She knows better than to cancel his plan.

Did you read her post? She's talking about him dropping his plan and trying to get him a sup.

Jessica Durphy "PSERS and everyone else he has talked to swore up and down that he would be a fool if he opted not to take that coverage! I tend to disagree... He does get a $100.00 benefit towards his coverage monthly... the premium for his MAPD plan is $125.00.. normally would be $225.00.... I feel he should have gone with the supplement and forgotten the $100.00, but I just am curious as to what you guys think?"

Doesn't look like she does know better.

 

[Jessica Durphy]

Did you read her post? She's talking about him dropping his plan and trying to get him a sup.

Jessica Durphy "PSERS and everyone else he has talked to swore up and down that he would be a fool if he opted not to take that coverage! I tend to disagree... He does get a $100.00 benefit towards his coverage monthly... the premium for his MAPD plan is $125.00.. normally would be $225.00.... I feel he should have gone with the supplement and forgotten the $100.00, but I just am curious as to what you guys think?"

Doesn't look like she does know better.

WOW!! I got on here for some advice! I didn't term it wrong! It is a MAPD (Medicare Advantage Prescription Drug Plan) I told you all that I knew!!! He does have health issues! There is NOT any coverage in the gap (you're wrong) and I am telling the truth when I say he pays $125.00 a month with a $100 benefit... therefore the total would be $225.00!! Why would I lie on an issue like that! I have nothing to gain or lose with anyone, except some good information!!

He's already been paying a ton of money out of pocket for his copays on the surgery and the therapist visits! He's absolutely NOT happy!!! I wouldn't change or do anything to HURT this man in no way!! I'm fairly new, almost 2 years, but I'M NOT STUPID!!!
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You're a whack job!

She knows better than to cancel his plan.

THANK YOU for defending me!!

 

[Josh]

WOW!! I got on here for some advice! I didn't term it wrong! It is a MAPD (Medicare Advantage Prescription Drug Plan) I told you all that I knew!!! He does have health issues! There is NOT any coverage in the gap (you're wrong) and I am telling the truth when I say he pays $125.00 a month with a $100 benefit... therefore the total would be $225.00!! Why would I lie on an issue like that! I have nothing to gain or lose with anyone, except some good information!!

He's already been paying a ton of money out of pocket for his copays on the surgery and the therapist visits! He's absolutely NOT happy!!! I wouldn't change or do anything to HURT this man in no way!! I'm fairly new, almost 2 years, but I'M NOT STUPID!!!

Jessica, please let me make this as clear as possible, I in no way, shape or form meant to make this a personal attack. Please read the rest of this post through that lens.

I don't believe that you would lie about any of that, but there are some flags. The only MA-PD plans I've seen that high are retiree plans that have been designed for the employer specifically and the reason the premiums are higher is because of better benefits, like a $500 out of pocket max and/or coverage through the donut hole. You really should look at an SOB (summary of benefits) and make sure you're 100% on this. Based off of the way you presented everything it sounds like you're not 100% sure what he has. What is a zip code in the county he is in? I think it'd make a lot of sense to verify the plan is a non-group plan before making any assumptions unless you have the SOB for the plane which it sounds like you don't have. Just to be clear, I said I assumed there would be coverage through the donut hole on a plan that expensive, but I admitted I did not know. I have a significant amount of experience working not only in the sales arena of Medicare Advantage plans, but also on the plan side where the nuts and bolts of the plans are designed and put into action. If you really want help then feel free to respond here or PM me with more information and I'll gladly help you, but based off of what you said it didn't sound at all like a traditional MA-PD. Again, I could be wrong, but you haven't given much to go on and the price and benefits LOOK like an employer sponsored plan, especially with it being part of a retiree group.

 

[arnguy]

It's OK, Jessica. BTW I know you are not a witch!

 

[jsanchez001]

Jessica, please let me make this as clear as possible, I in no way, shape or form meant to make this a personal attack. Please read the rest of this post through that lens.

I don't believe that you would lie about any of that, but there are some flags. The only MA-PD plans I've seen that high are retiree plans that have been designed for the employer specifically and the reason the premiums are higher is because of better benefits, like a $500 out of pocket max and/or coverage through the donut hole. You really should look at an SOB (summary of benefits) and make sure you're 100% on this. Based off of the way you presented everything it sounds like you're not 100% sure what he has. What is a zip code in the county he is in? I think it'd make a lot of sense to verify the plan is a non-group plan before making any assumptions unless you have the SOB for the plane which it sounds like you don't have. Just to be clear, I said I assumed there would be coverage through the donut hole on a plan that expensive, but I admitted I did not know. I have a significant amount of experience working not only in the sales arena of Medicare Advantage plans, but also on the plan side where the nuts and bolts of the plans are designed and put into action. If you really want help then feel free to respond here or PM me with more information and I'll gladly help you, but based off of what you said it didn't sound at all like a traditional MA-PD. Again, I could be wrong, but you haven't given much to go on and the price and benefits LOOK like an employer sponsored plan, especially with it being part of a retiree group.

Hello Jessica,
I believe that you should take a look at the SOB, don't rely on your client to know the ins-out of the plan. An employer sponsored MAPD, in my experience, is almost ALWAYS better than an MAPD that they could get on their own (otherwise why offer them?) Either they have a very low OOP or offer coverage thru the donut hole.
Good luck.

 

[Josh]

Talked to Jessica on the phone today and we got all squared away

For the record, Jessica Durphy is awesome!

 

[GreenSky]

Talked to Jessica on the phone today and we got all squared away

For the record, Jessica Durphy is awesome!

By the way, I agree. Spoke with her awhile back and she is a lady that puts her clients first.

Not like the rest of us (except me).

Rick

 

[Jessica Durphy]

Awww, ya'll are going to make me blush!!

I have a "cheat sheet" of the summary of benefits~ a scaled down copy... and some of the speculations are right.. there is coverage in the donut hole (that gentleman's cost sharing is only 50% on the preferred and non-preferred brands) which is where he needs the most help!

I think I'll still, take the advice of MedicarePlanSolutions, jsanchez001, and really everyone else and do a little more homework with the ACTUAL summary of benefits!

Thanks for everyone's input and help..

Arnguy, you're funny!! I'm not a witch.. just bi-polar according to my husband!

 

[arnguy]

I believe all women are bi-polar, Jessica, so he must be correct!

 

[Jessica Durphy]

After much research for this guy, we have deducted that it's in his best interest to just stay where he is!

The max out of pocket for the med portion of his plan is $3400.00 but the coverage in the gap (donut hole) is where his biggest concern was~ right now as it is, he's got 50% coverage, so we both felt that his best option is to stay where he's at!

The copay's won't break him, the drug costs will!