The Great Big Medicare Rip-Off [Medicare Advantage]

[LostDollar]

Just so long as you mandate availability of a Medical Savings Account option in all counties....

I won't vote for that unless there is also provision for a Senior HSA type account so people can save some of their Social Security benefits (or other income) towards medical expenses. The need to save for medical expenses does not miraculously stop on a person's 65th birthday.

 

[kgmom219]

Going back to the guy who freaked at the Part D Deductible...

Just run the damn numbers, use 5 pharmacies and play. Here's your annual cost on X plan, Y and Z. You pick.

And Midlevel...I may not like MAPD, but if you think I am hiding information from my clients, you are way wrong. When there is a significant difference, they know about it. Then I say referral or HMO and get shot down. And the Part D cost savings vs MAPD comes on the HMO plans, not the PPO plans.

I also have a responsibility to the Financial Planners who feed me clients all year long. They hate MAPD. But it obviously leads me to higher income client, 80% of whom either pay IRMAA or appeal IRMAA.

 

[sshafran]

Going back to the guy who freaked at the Part D Deductible...

Just run the damn numbers, use 5 pharmacies and play. Here's your annual cost on X plan, Y and Z. You pick.

And Midlevel...I may not like MAPD, but if you think I am hiding information from my clients, you are way wrong. When there is a significant difference, they know about it. Then I say referral or HMO and get shot down. And the Part D cost savings vs MAPD comes on the HMO plans, not the PPO plans.

I also have a responsibility to the Financial Planners who feed me clients all year long. They hate MAPD. But it obviously leads me to higher income client, 80% of whom either pay IRMAA or appeal IRMAA.

I agree - this is what it it is - I'm not wasting more time on it - just pick - is often my procedure.

The problem with this (and I hate to sound repetitive and I'm not trying to be annoying) is that I don't trust the annual cost estimates, so I no longer even mention annual cost estimates.

I'm a big believer in telling them what the summary of benefits says - if it says 25% - that's all I say: 25%.

Told a guy that today. He takes a COPD med. On SilverScript. Called me - he had to pay several hundred today at the pharmacy because of the deductible. Wanted to know what it would be later this year. I said: 25% because it's Tier 3 w/ SS. He asked for a dollar figure. I answered: I don't know - it's 25%, you can ask the pharmacist for the dollar figure.

 

[Midlevel]

And the Part D cost savings vs MAPD comes on the HMO plans, not the PPO plans

100% incorrect. I only use PPO Plans and all the ones I write have $0.00 premium, $0.00 deductible and $0.00 copay on Tier 1 & 2 generics. If anyone ever argues the stand alone pdp’s are better then the ones built into the MAPD’s they are not the sharpest tool in the shed. These plans know they have to have a kick ass PDP bc it’s built right into the plan so don’t want to persuade clients to go with another Company that may have a better PDP built in.

 

[goillini52]

And the Part D cost savings vs MAPD comes on the HMO plans, not the PPO plans

100% incorrect. I only use PPO Plans and all the ones I write have $0.00 premium, $0.00 deductible and $0.00 copay on Tier 1 & 2 generics. If anyone ever argues the stand alone pdp’s are better then the ones built into the MAPD’s they are not the sharpest tool in the shed. These plans know they have to have a kick ass PDP bc it’s built right into the plan so don’t want to persuade clients to go with another Company that may have a better PDP built in.

4 of the 9 Free PPO's in my area have RX deductibles of $150(AARP), $250(Humana), $505(BCBS) and $505(BCBS). Except for Humana, which has no deductible on Tiers 1-3, the others have no deductible on Tiers 1 and 2. I prefer the Free Aetna MAPD($0 deductible)..

As far as the MAPD RX being better than a PDP plan, I guess I'm not the sharpest tool in the shed. My wife and I have the SilverScript Plus PDP. She just started a new Cholesterol drug that's covered and retail is $561 a month. Aetna's Free MAPD PPO doesn't cover it and shows a $624 retail a month. On mine the RX is the same on both.

 

[Midlevel]

4 of the 9 Free PPO's in my area have RX deductibles of $150(AARP), $250(Humana), $505(BCBS) and $505(BCBS). Except for Humana, which has no deductible on Tiers 1-3, the others have no deductible on Tiers 1 and 2. I prefer the Free Aetna MAPD($0 deductible)..

As far as the MAPD RX being better than a PDP plan, I guess I'm not the sharpest tool in the shed. My wife and I have the SilverScript Plus PDP. She just started a new Cholesterol drug that's covered and retail is $561 a month. Aetna's Free MAPD PPO doesn't cover it and shows a $624 retail a month. On mine the RX is the same on both.

Sounds like you need to move.

 

[Truce]

I guess it varies by state. When I'm running a NJ quote my sunfire tool defaults to MAPD (ka-ching!) for drug pricing after I put in drugs, and when I toggle back to Part D stand alone the annual cost is higher...sometimes a lot higher....I honestly can't recall it ever going lower. I think it's because the MAPD tiers are more generous for generics, and a lot of popular MAPD plans (HMO and PPO) are no or lower drug deductible. Formularies seem pretty similar. A blanket statement that MAPD Part D benefits are better than stand alone Part D passes the smell test here for 2023.

 

[kgmom219]

I agree - this is what it it is - I'm not wasting more time on it - just pick - is often my procedure.

The problem with this (and I hate to sound repetitive and I'm not trying to be annoying) is that I don't trust the annual cost estimates, so I no longer even mention annual cost estimates.

I'm a big believer in telling them what the summary of benefits says - if it says 25% - that's all I say: 25%.

Told a guy that today. He takes a COPD med. On SilverScript. Called me - he had to pay several hundred today at the pharmacy because of the deductible. Wanted to know what it would be later this year. I said: 25% because it's Tier 3 w/ SS. He asked for a dollar figure. I answered: I don't know - it's 25%, you can ask the pharmacist for the dollar figure.

I am now sending the damn screen prints from Medicare.gov. Total
PITA but it works.

And it’s CYA. If Medicare was wrong and you can prove it, they’ll switch the plan.

 

[InsuranceGuy29]

I guess it varies by state. When I'm running a NJ quote my sunfire tool defaults to MAPD (ka-ching!) for drug pricing after I put in drugs, and when I toggle back to Part D stand alone the annual cost is higher...sometimes a lot higher....I honestly can't recall it ever going lower. I think it's because the MAPD tiers are more generous for generics, and a lot of popular MAPD plans (HMO and PPO) are no or lower drug deductible. Formularies seem pretty similar. A blanket statement that MAPD Part D benefits are better than stand alone Part D passes the smell test here for 2023.

Same experience here in Chicago. It's smart business. With MAPD's, the companies would be foolish to massively jerk the prices around year-to-year, because they'd be losing tons of money from people switching plans. With drug plans, I doubt they care much. I don't even think most of them even want to offer drug plans, because they probably lose money or don't make much....it's just a required part of offering MAPD's. As an agent, I know I don't even want to write stand-alone PDP's anymore. Too many headaches, too little pay, and way too many dramatic price fluctuations from year-to-year. I'm down to about 30 PDP clients, and I hope it eventually goes to zero. Just not worth the effort.

 

[LostDollar]

Same experience here in Chicago. It's smart business. With MAPD's, the companies would be foolish to massively jerk the prices around year-to-year, because they'd be losing tons of money from people switching plans. With drug plans, I doubt they care much. I don't even think most of them even want to offer drug plans, because they probably lose money or don't make much....it's just a required part of offering MAPD's. As an agent, I know I don't even want to write stand-alone PDP's anymore. Too many headaches, too little pay, and way too many dramatic price fluctuations from year-to-year. I'm down to about 30 PDP clients, and I hope it eventually goes to zero. Just not worth the effort.

That's a piece of information I was not aware of.

If a carrier wants to offer MAPD's in a market, they also have to offer a PDP option?