"Would you sell your mom this plan?"

[aufan]

My mom is 72 and has a mutual of omaha plan F. Her premium just went up to 168.00/mo. She really doesn't want to pay that much for her supplement.

She has had some health problems before (light heart attack, irregular heart beat) but she works every day and is in pretty good shape overall.

I am considering looking at a Coventry med advantage plan for her. I'm going to make sure her primary physician accepts part c and also the major hospitals in the area.

I would appreciate thoughts and advice about this. She is my mom, but if I can't feel good about putting my own mom on this plan I sure won't be able to sell it to anyone else.

 

[Cenla Agent]

My mom is 72 and has a mutual of omaha plan F. Her premium just went up to 168.00/mo. She really doesn't want to pay that much for her supplement.

She has had some health problems before (light heart attack, irregular heart beat) but she works every day and is in pretty good shape overall.

I am considering looking at a Coventry med advantage plan for her. I'm going to make sure her primary physician accepts part c and also the major hospitals in the area.

I would appreciate thoughts and advice about this. She is my mom, but if I can't feel good about putting my own mom on this plan I sure won't be able to sell it to anyone else.

Given what Mutual of Omaha has done with those plans with shutting them down and going to United World everywhere I know of, you can only expect the rate increases to keep coming.

How far in the past were her problems? If it has been more than 2 years it's possible another supplement that is cheaper might accept her.

Is the Coventry a 0 premium plan? I would also check the specialists in the area, like her cardiologist assuming she has seen one in the past given her history. Don't just check one doctor but try to find out its acceptance overall as much as you can. I'm sure she'd rather pay for a supp she can use anywhere that takes Medicare vs. $0 prem plan that is a crap shoot with acceptance if you get mixed results with surveying the providers.

Look at the copayments and figure up what it would cost for a hospital visit, tests, office visits, etc and see how much she would save both in a routine year and in one that is a little worse than that. If it's a lot it might be worth switching. If it's not that much, better off sticking with what she has. Also, does the plan have a maximum out of pocket limit?

Make sure she fully understands and is comfortable with having to pay copays out of pocket before switching to an MA since sometimes it takes a while for that concept to sink in if they have never had a PPO or something similar in the past.

 

[Cenla Agent]

Also, it's not as simple as her physician "accepting Part C". With Private Fee For Service plans there is no contract and they are free to accept some plans and not others so you want to investigate acceptance of that particular plan. With PFFS, providers can decide to accept it today and to not accept it tomorrow.

 

[aufan]

That's great advice Cenla and I very much appreciate it. You know as a son first and an agent second, I first have to consider her welfare and you addressed that very succinctly.

This is really a dilemna I am having by representing these plans. As it stands right now, I just don't like the "ifs" and "buts" with these part C plans. My gut says for her to keep her med sup for now based on her history. In other words, if she has continued medical issues and especially extended care, I fear the part C plan is going to be more costly in the long run.

I think as senior marketers we ought to treat ALL our clients like they were or own parent or grandparent. If we did, there would probably be a lot more satisfied clients out there.

 

[senior-advisor-indiana]

I dont sell alot of MA plans but I have a client that had a pacemaker put in and it only cost him $250 for the whole thing. I think he sadi the bill was well over 50k for everything but he only paid $250 copay. So they do what they are suppose to. I would much rather sell a med supp though.

I have heard of people paying alot in bills, I guess it just deends on the plan. I only sell the best.

 

[Cenla Agent]

I dont sell alot of MA plans but I have a client that had a pacemaker put in and it only cost him $250 for the whole thing. I think he sadi the bill was well over 50k for everything but he only paid $250 copay. So they do what they are suppose to. I would much rather sell a med supp though.

I have heard of people paying alot in bills, I guess it just deends on the plan. I only sell the best.

Most of them pay quite well for inpatient hospital visits, whether its open heart surgery, ICU or whatever.

Where the costs can run up is if they are doing something repeatedly, like being in and out of the hospital several times in a year, going for radiation, chemo, dialysis or some other kind of treatment many times in a year. Inpatient skilled nursing care is something to watch too since every plan I've ever seen has them paying out of pocket sooner than they would under Medicare Part A. I've also seen plans that will have them paying something out of pocket for Medicare home health and/or paying up to 50% for durable medical equipment.

 

[Frank Stastny]

No I would not sell it to my mother! I think a better question is would you sell yourself one? I would never take one.

Why would you want to take her out of a Med Supp? If my mother couldn't afford to pay the premium then I would pay it for her. I would never let her drop her Med Supp.

I understand the concept of looking for places to save money but not when it comes to health care. My mother travels extensively. Just because her doctor may take one and the local hospital does also what would happen if she was out of the area and got sick?

During a medical emergency is no time pick up the yellow pages and have to get on the phone and start looking for a doctor or hospital that will accept an Advantage Plan. I am not impressed by them at all.

Why does she have a Plan F? Move her into a Plan D, that's what my mother has. In Missouri when premiums go up Plan F usually has the greatest increase, Plan D one of the smallest.

Sorry for the rant but this is a subject I really feel very strongly about. I don't understand the concept of bargain hunting for health care, especially with there being so many uncertainties as I believe there are with an MA.

They are still too new. No one knows what they are even going to be like next year let alone five years from now. Everyone thought HMO's were so great when they started and look at them now.

If my mother gets sick I want her to have the availability of going to the best doctor and hospital in the country regardless of where she is.

 

[Frank Stastny]

Also, it's not as simple as her physician "accepting Part C". With Private Fee For Service plans there is no contract and they are free to accept some plans and not others so you want to investigate acceptance of that particular plan. With PFFS, providers can decide to accept it today and to not accept it tomorrow.

An excellent point and a major consideration. Probably the biggest in my opinion.

I should have started my "ranting post" by quoting you. This is probably my biggest concern about Part C plans. That in itself is reason enough not to take an MA.

 

[sman]

That's great advice Cenla and I very much appreciate it. You know as a son first and an agent second, I first have to consider her welfare and you addressed that very succinctly.

This is really a dilemna I am having by representing these plans. As it stands right now, I just don't like the "ifs" and "buts" with these part C plans. My gut says for her to keep her med sup for now based on her history. In other words, if she has continued medical issues and especially extended care, I fear the part C plan is going to be more costly in the long run.

I think as senior marketers we ought to treat ALL our clients like they were or own parent or grandparent. If we did, there would probably be a lot more satisfied clients out there.

I always tell my potential clients that if they can afford a Med Supp, they should get one. The MA plans will change from year to year and as soon as Congress decides to reduce funding, they will change dramatically.

I am not a huge fan of the Coventry plan. Too much potential out of pocket unless it's the AF1 plan (look at outpatient surgery - 20% on the other plans). Are there not any other plans available in your area? In my area, the Today's Options Premier is a pretty good plan. It does have a $35 premium, but the out of pocket exposure is limited (and I'm not talking about the maximum out of pocket - I'm talking about the copays for everything).

Another thing to consider, if your mother did switch to an MA plan, she could go back to a guarantee issue Med Supp within 12 months. So that could be a way to get her a lower cost Med Supp.

Just a thought.

 

[senior-advisor-indiana]

Another thing to consider, if your mother did switch to an MA plan, she could go back to a guarantee issue Med Supp within 12 months. So that could be a way to get her a lower cost Med Supp.

You really need to look into this subject a little deeper. She can only go back to her original med supp. NOt anyone she wants. She can go to united world or unicare. Those are the only ones that I know of exceptng GI from a MA. Read the medicare book, call medicare, call the companies you write for. They CANT do it. Its up to the company if they want to.