Why Pay More?

[annon123]

It's sort of misleading them though to present it that way. A lot of people think that their MAPD coverage has to be equal or greater to the Medicare with the sup when you explain it that way. It's just equal or greater than A&B. When you add in the sup, that's obviously much higher level of coverage.

Like a client called me this morning that was very upset because she recently found out she has breast cancer and her oncologist told her that she better check with her insurance agent what she's gonna be running into as the treatments are very expensive and she has to come in weekly. She was on a supplement so that was great news. She won't owe anything. If she was on an advantage plan, she would owe 20% of the cost of the treatments until she reaches her max out-of-pocket. Plus, of course we would need to verify the network.

If they are looking for complete coverage to the extent possible then why shouldn't their MA be comparable to OM+supp and D? I don't know what you do but I talk about costs up front vs as they need care (including MOOP's if they were to need care or what the supp and D have as MOOP), networks, GI issues later if the healthy ones get sick and give them some idea what is a deal breaker for passing medical underwriting and do they have a family history of that stuff, etc.

Again how is this misleading them? MA's cover more than A&B and most people have a supp and D to make up, or mostly make up, for that. Only around 5% (if the bot is to be believed) have A&B only. So if you want to compare coverage in a more apples to apples way, including coverage, over all costs when filling the gaps A&B alone create, MOOP, etc. you compare the various C's out there with A and B along with the various D and supps out there. C will have more than most supps with vision, dental, hearing, etc. and if income wise they qualify for a cash card then that too.

The people I talk with either are dual eligible and healthy (and have no idea how they will pay the copays but decide not to worry about it since they are healthy "now" or use the one system here that won't sue and fire you if you don't pay) so look at the cash cards, etc. that the MA's offer or have enough money that paying the premiums for supps and D's is at least marginally affordable. Locally the network issue isn't all that relevant as the 4 systems accept just about anything. The issue, for some, is the overall poor health care here and they want to be able to go out of state if need be. Those folks mostly opt for a OM and supp and D although sometimes an MA PPO or HMO works for them (at least when they sign up) depending on where they want to go.

If you neglect to inform them about OM plus Supp and D (if they don't already know about that) then of course a MA will sound better to most. If you educate them about the kinds of choices first before asking them what they are more likely interested in based on their needs I don't think that is even remotely misleading.

 

[somarco]

MA's cover more than A&B

Kind of . . .

If you don't factor in access to the full range of providers . . . denial of services . . . delays due to prior authorization . . . non-par dental providers . . . non-par vision providers . . . essentially any number of places where your "extra coverage" doesn't work.

Saying MA covers more is like saying Diners Club is better than the other cards . . . except MC & VISA are accepted at more places than Diners.

 

[goillini52]

Kind of . . .

If you don't factor in access to the full range of providers . . . denial of services . . . delays due to prior authorization . . . non-par dental providers . . . non-par vision providers . . . essentially any number of places where your "extra coverage" doesn't work.

Don't forget the copays.

 

[annon123]

Kind of . . .

If you don't factor in access to the full range of providers . . . denial of services . . . delays due to prior authorization . . . non-par dental providers . . . non-par vision providers . . . essentially any number of places where your "extra coverage" doesn't work.

Saying MA covers more is like saying Diners Club is better than the other cards . . . except MC & VISA are accepted at more places than Diners.

I agree with you. I was addressing the specific comment that you need to compare MA to OM without a supp or D which I don't think is the correct comparison. If you compare them with the most each covers then OM + Supp (and for apples to apples a supp with "extras" + D wins in my opinion. You need to look at MOOP (and factor in premiums), networks, referrals, copays, etc. - all of that stuff.

 

[somarco]

Don't forget the copays.

When you have a serious medical condition, coinsurance will eat through your savings quicker than copays.

 

[goillini52]

When you have a serious medical condition, oinsurance will eat through your savings quicker than copays.

I should've said copays and coinsurance, since MAPD's have both.

 

[annon123]

I should've said copays and coinsurance, since MAPD's have both.

And that is where I think we don't think about health insurance the same way we think about car insurance, renters or home owners insurance, etc. With those 3 we buy it just in case something bad happens and if it doesn't we are glad to be a profit center for the insurance company. If we didn't and waited until after something bad happened it would be too late. With health insurance the argument is "well you are healthy now" so go with coverage that is cheap with a lot of limitations and will often totally trash your budget when "things go wrong" and "you aren't". We don't think that way with the other kinds of insurance.

 

[Newby]

If you could buy a true supplement to the MA, that would be a step in the right direction. But t he add one you can buy only give piecemeal coverage to the gaps. And, none address them problems with preauthorizations and networks.

I've never understood why each MA company doest offer matching plans to fill the co-pays on their MA plan. They would sell like hotcakes.

 

[somarco]

I've never understood why each MA company doest offer matching plans to fill the co-pays on their MA plan

CMS does not allow beneficiaries to have a supplement and MA.

 

[Newby]

CMS does not allow beneficiaries to have a supplement and MA.

I'm not talking about a supplement. I'm talking about the indemnity plans that pay like $400 per day in the hospital, etc.

Each carrier should make one that perfectly matches the co-pays in their advantage plans they offer. They would sell the shit out of those. Here's the Humana Medicare advantage plan and here's the matching Humana co-pay plan for an additional $75 a month. Bam!