Why Pay More?

[renee15]

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!

I have NEVER sold an indemnity plan. Your insured is better off putting $75/month in a savings account if they are concerned about a hospital copay. In one year they would have enough saved for 2 hospital days. Most Seniors are never admitted to a hospital, everything is OP

 

[renee15]

That will definitely kill the Medigap market.

Unlike MA plans which are give away plans, Medigap is sold, not bought. If that mess ever comes to Georgia I will probably hang up my spurs and ride off into the sunset.

Currently there are only 9 states with a birthday or anniversary rule and 4 more that are year round GI.

I wrote a GI plan after the client "returned" to OM after a year with a MAPD. I get paid 98 cents a month. (UHC)

 

[renee15]

It's wrong to compare MA to Med Sups. MA is supposed to be compared to Medicare A&B. That is what it is replacing. And it stacks up well against A&B mainly because you can add in Part D at no cost. Plus have the dental and gym memberships too. AND have a max out of pocket. What you are giving up is the great network and your doctor being the final decision-maker on expensive treatments.

When you compare a Medicare supplement, you should really be comparing to Medicare advantage plus the add on plans that help pay the co-pays.

My spouse had 6 CT scans, 1 MRI, 3 hospital stays, 30 chemo treatments,(OM paid over 5K for each treatment) and home health in one calendar year. Those anti nausea shots were covered by OM at $800+ (2x/month). A MAPD plan would have restricted so much of this.....

 

[Newby]

My spouse had 6 CT scans, 1 MRI, 3 hospital stays, 30 chemo treatments,(OM paid over 5K for each treatment) and home health in one calendar year. Those anti nausea shots were covered by OM at $800+ (2x/month). A MAPD plan would have restricted so much of this.....

I'm pretty sure that with either original Medicare or most Medicare advantage plans you would have owed 20% and they would've covered 80%.
But when you add in the Medicare supplement that picks up the 20% so you owe zero.

 

[somarco]

Medicare supplement that picks up the 20%

This is a HUGE advantage over the Medicare replacement plans. Most folks, and especially seniors, are much more likely to incur 20% claims than hospital inpatient (Part A) claims.

 

[gregj]

much more likely

kinda-sorta. In any given year, about 1% of the population accounts for about 22% of total health spending; half the population incurs under 3% of total spending. That 3% averages about $/yr, but about 15% of the population incurs no health treatment spending. These figures include everyone, but the same 'usage curve' essentially applies to Medicare beneficiaries (yes, us olds are disproportionately represented in the top 1%, and underrepresented in the bottom 50%). Dollar cut-point for the bottom 50%? $ 1,360 in 2022. Most in that under 50% were well under that figure. $1,360 is real money, but to paraphrase something you said elsewhere, If someone can't afford $500/day for 3 days in the hospital they probably have bigger problems that HIP, or any Medicare coverage option, can't solve.

Everyone knows of high-health-treatment examples, but almost everyone also overestimates their odds of being one of those unfortunates. Sure, buy insurance that fits your comfort level with underestimating your health treatment bills for the coming year. That makes sense. Irrationally exaggerating your health spending risk is, well, irrational.