A very disappointing report came out recently about Medicare Advantage plans in May, issued by the OIG (Office of the Inspector General) "How Medicare Advantage plans wrongly deny prior authorization requests". Meaning that while an Advantage Plan member waited to get approval for a procedure on your Advantage Plan, like surgery, the companies wrongly denied the procedure one out of 8 times! That's a lot of waiting and a lot of frustration!
My source / The AMA Published on their website 5/11/22.
"OIG found that 13% of the prior-authorization requests that were denied by Medicare Advantage plans met the clinical coverage rules of traditional Medicare. And of the claim-payment denials in the study sample, 18% met Medicare coverage rules and Medicare Advantage plan billing rules." So, give an insurance co. a chance to deny you, what do think happens! Better to avoid such censure? Yah think? Traditional Medicare has no such prior approvals. Now, that's the Cliff Notes for today!
Yeah dull to read and hard to understand if you look up the whole document, it's a 600 level report saying that "Traditional Medicare" does not have the same issues in getting approval for surgeries, etc. No pre approval is required under "Traditional Medicare." What's TM? Medicare A&B! Most clients that have TM have Medicare A & B & a Supplement and a Part D drug card for drugs out of hospital.
If I have an Advantage plan, don't I have TM?
No, Medicare approves of your Advantage plan, contributes around 10K a year to the company that makes you the plan offer (where did you think the free monthly and freebies come from?) but the Adv. Plan's own rules take over from Traditional Medicare relieving the Govt. from any financial responsibility. That's why you no longer show your Medicare card for treatment or for drugs, it's all on one card now. Think of a billboard that just got painted. First there was Traditional Medicare up there. Then your Adv. plan was pasted over A&B. That's how it works! Once that happens, all your new coverage is explained in your plan booklet and all billing goes to your new company. (You've just changed Daddies!")
From a business perspective Medicare plans are working well for the insurance industry and the government. How do we know? Because of the published nos. and the no. of companies that keep joining that market place. Banzai!! Few companies pull out, more come in. And the benefits (the distractions, the FREEBIES, increase.) And that's great. Times are getting harder and the sound of "free Medicare" is almost irresistible. (It's really "free monthly plus some stuff, and some large traps to fall in!") The profit margins are there. But who understands their new plan? I think few clients ever even read the booklet, which clearly explains what they will call upon you to pay. And yes, again, the devil is in the details.
My concern as a client first focused agent is how does it work for you! If I write it for you, will it perform well? Will I be glad I recommended it to you 10 years later?
Did you know agents that sell you your first Advantage plan get paid double for it over a traditional plan's commission, like a supplement. Make it a couples write up. Think the agent will wrestle with all the details of the supplement or just leave it out, "cause you know you want the FREE ONE." I'll not tell you what I think about that!
If I could only be sure I would never have a major hospitalization, kidney disease, cancer, major trauma, etc., I might buy one. But having sold well over 1500 Medicare plans and heard from those folks later, lost a wife to Stage 4 cancer, read all the fine print in the leave behind booklets, attended hundreds of product meetings, etc., I'll just say they are not for me. Do know If you are healthy enough to move, back to the Traditional side, you can do so any year starting on January the 1st. Many folks a few years into Medicare after developing conditions then start trying to change plans, hoping to then move to a supplement. Sorry! Like life insurance, when they wanted to sell it to you, you didn't need it. Now you need it, and they don't want to sell it!
Worst case scenario for an Advantage plan, anything that puts you in the hospital for awhile or reoccurs. Most Adv. Plans make you pay 20% of all Part B charges. $300 for the ambulance, $200 to $250 MRI, etc. 20% of Part B means for drugs in hospital (chemotherapy is one example). One of the most popular plans in my area charges you $350 a day for 6 days just for the stay.
By contrast, a supplement pays for that visit and all treatment for your monthly fee, plus a $233 annual deductible and you check out at zero. I know because I have experienced it, unfortunately. I have seen 50 plus day hospital stays with zero billing, due to the nature of supplements. Pick your doctor in all 50 states (as long as they take Medicare and want to see you). Kind of a giant PPO, as far as doctors. Yes, there's no freebies that come with it. But it may be a much better plan for your circumstances, and I can get you some Cracker Jacks. If you have serious illnesses as you approach 65 or travel a lot, that's just more encouragement to go in that direction.
Traditional Medicare (A&B) and usually also has a supplement and drug card // Non Traditional Medicare - Advantage plan with Maximum Out of Pocket ranging from $3400 to $7500, and OON (out of network) being $13,200 a year. (Does that sound like FREE MEDICARE to you?)
For a person of average to above average means, I always cover both paths and once we cover some of the issues of Adv. plans not shown on TV or discussed by most of the sales force that usually presents Adv. plans without even mentioning supplements, they usually go with Traditional Medicare and a supplement (starting price $103 to $150, depending on multiple issues) and a stand alone drug card starting at $6.90 a month.
Lots of folks are turning 65 (10K a day or more). Call me or email me for help in the process, ideally at least 4 months before your birthday. I do not have a fee to help and I have some clients who have been with me 15 years now. I can also get you a new quote on your current group plan, if you have one. Got a friend who writes U65 plans.
Gary / 713-376-5608 / former 9 year OB site sponsor / BC Top 30 Agency in TX Award / 400 plus current Medicare clients / Independent agency owner for 18 years
My source / The AMA Published on their website 5/11/22.
"OIG found that 13% of the prior-authorization requests that were denied by Medicare Advantage plans met the clinical coverage rules of traditional Medicare. And of the claim-payment denials in the study sample, 18% met Medicare coverage rules and Medicare Advantage plan billing rules." So, give an insurance co. a chance to deny you, what do think happens! Better to avoid such censure? Yah think? Traditional Medicare has no such prior approvals. Now, that's the Cliff Notes for today!
Yeah dull to read and hard to understand if you look up the whole document, it's a 600 level report saying that "Traditional Medicare" does not have the same issues in getting approval for surgeries, etc. No pre approval is required under "Traditional Medicare." What's TM? Medicare A&B! Most clients that have TM have Medicare A & B & a Supplement and a Part D drug card for drugs out of hospital.
If I have an Advantage plan, don't I have TM?
No, Medicare approves of your Advantage plan, contributes around 10K a year to the company that makes you the plan offer (where did you think the free monthly and freebies come from?) but the Adv. Plan's own rules take over from Traditional Medicare relieving the Govt. from any financial responsibility. That's why you no longer show your Medicare card for treatment or for drugs, it's all on one card now. Think of a billboard that just got painted. First there was Traditional Medicare up there. Then your Adv. plan was pasted over A&B. That's how it works! Once that happens, all your new coverage is explained in your plan booklet and all billing goes to your new company. (You've just changed Daddies!")
From a business perspective Medicare plans are working well for the insurance industry and the government. How do we know? Because of the published nos. and the no. of companies that keep joining that market place. Banzai!! Few companies pull out, more come in. And the benefits (the distractions, the FREEBIES, increase.) And that's great. Times are getting harder and the sound of "free Medicare" is almost irresistible. (It's really "free monthly plus some stuff, and some large traps to fall in!") The profit margins are there. But who understands their new plan? I think few clients ever even read the booklet, which clearly explains what they will call upon you to pay. And yes, again, the devil is in the details.
My concern as a client first focused agent is how does it work for you! If I write it for you, will it perform well? Will I be glad I recommended it to you 10 years later?
Did you know agents that sell you your first Advantage plan get paid double for it over a traditional plan's commission, like a supplement. Make it a couples write up. Think the agent will wrestle with all the details of the supplement or just leave it out, "cause you know you want the FREE ONE." I'll not tell you what I think about that!
If I could only be sure I would never have a major hospitalization, kidney disease, cancer, major trauma, etc., I might buy one. But having sold well over 1500 Medicare plans and heard from those folks later, lost a wife to Stage 4 cancer, read all the fine print in the leave behind booklets, attended hundreds of product meetings, etc., I'll just say they are not for me. Do know If you are healthy enough to move, back to the Traditional side, you can do so any year starting on January the 1st. Many folks a few years into Medicare after developing conditions then start trying to change plans, hoping to then move to a supplement. Sorry! Like life insurance, when they wanted to sell it to you, you didn't need it. Now you need it, and they don't want to sell it!
Worst case scenario for an Advantage plan, anything that puts you in the hospital for awhile or reoccurs. Most Adv. Plans make you pay 20% of all Part B charges. $300 for the ambulance, $200 to $250 MRI, etc. 20% of Part B means for drugs in hospital (chemotherapy is one example). One of the most popular plans in my area charges you $350 a day for 6 days just for the stay.
By contrast, a supplement pays for that visit and all treatment for your monthly fee, plus a $233 annual deductible and you check out at zero. I know because I have experienced it, unfortunately. I have seen 50 plus day hospital stays with zero billing, due to the nature of supplements. Pick your doctor in all 50 states (as long as they take Medicare and want to see you). Kind of a giant PPO, as far as doctors. Yes, there's no freebies that come with it. But it may be a much better plan for your circumstances, and I can get you some Cracker Jacks. If you have serious illnesses as you approach 65 or travel a lot, that's just more encouragement to go in that direction.
Traditional Medicare (A&B) and usually also has a supplement and drug card // Non Traditional Medicare - Advantage plan with Maximum Out of Pocket ranging from $3400 to $7500, and OON (out of network) being $13,200 a year. (Does that sound like FREE MEDICARE to you?)
For a person of average to above average means, I always cover both paths and once we cover some of the issues of Adv. plans not shown on TV or discussed by most of the sales force that usually presents Adv. plans without even mentioning supplements, they usually go with Traditional Medicare and a supplement (starting price $103 to $150, depending on multiple issues) and a stand alone drug card starting at $6.90 a month.
Lots of folks are turning 65 (10K a day or more). Call me or email me for help in the process, ideally at least 4 months before your birthday. I do not have a fee to help and I have some clients who have been with me 15 years now. I can also get you a new quote on your current group plan, if you have one. Got a friend who writes U65 plans.
Gary / 713-376-5608 / former 9 year OB site sponsor / BC Top 30 Agency in TX Award / 400 plus current Medicare clients / Independent agency owner for 18 years
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