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Old 10-11-2015, 07:33 PM
 
Location: Wisconsin
25,591 posts, read 56,363,195 times
Reputation: 23297

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Quote:
Originally Posted by Weichert View Post
That is a very interesting plan. I read more on MSAs this afternoon, it looks good, don't see how you could lose on it especially with Froedtert getting in this (so I just read).
Where, specifically, did you read this?? I wish Froedert had its own MA, but, for now, it doesn't.

MSA plan will pay for any Medicare provider anywhere - won't pay excess charges but, as I understand it, will pay 80% of the Medicare-allowed fees for nonparticipating providers. Froedtert, however, does take assignment, so excess is not an issue with them.

I'm in the process now of selecting a new PCP through Froedtert which is less than two miles down the road from me. Only Q is whether they (and other providers) will demand payment upfront. $$ amount of deductible appears on the face of the insurance card, so the large deductible might require them to do that.

MSA company I'll be going with is NetworkPrime out of Menasha, WI - the $2k/yr. deposit. They've had a number of MA's for decades servicing the middle and northern parts of the state, but the MSA is a statewide plan. The other MSA is an offshoot of the Marshfield Clinic dba Security Health for it's MA's. It, too, has been offering MA's, competing with Network Prime. Both companies are better rated by CMS than UHC, BCBS, Humana. No surprise, there.

Quote:
Originally Posted by Weichert View Post
Do you get earnings on the cash deposits?
Minimal earnings on cash deposits. Medicare deposits (for both plans) go to Mellon Bank. Plan says money can be transferred to another bank (or institution??). Not sure how that can be done w/o triggering a taxable event. I have to talk to their rep about that. Some form of a rollover, I assume.

Quote:
Originally Posted by Weichert View Post
I wonder why Medicare isn't pushing it more, could be a real demand for it.
MSA's have been mentioned on the Medicare website for a few years - but maybe before the current crunch in capitation rate, the private insurers were more profitable offering regular MA's???

Also, guessing it would a whole lot harder for them to deny payment for any Medicare-allowed service under an MSA. There are NO PREAPPROVALS necessary. So, opportunities for ill-gotten profit (aka denials) are considerably curtailed.

Last edited by Ariadne22; 10-11-2015 at 07:48 PM..
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Old 10-11-2015, 08:56 PM
 
Location: Chesapeake Bay
6,046 posts, read 4,804,524 times
Reputation: 3544
Quote:
Originally Posted by Ariadne22 View Post
Where, specifically, did you read this?? I wish Froedert had its own MA, but, for now, it doesn't.

MSA plan will pay for any Medicare provider anywhere - won't pay excess charges but, as I understand it, will pay 80% of the Medicare-allowed fees for nonparticipating providers. Froedtert, however, does take assignment, so excess is not an issue with them.

I'm in the process now of selecting a new PCP through Froedtert which is less than two miles down the road from me. Only Q is whether they (and other providers) will demand payment upfront. $$ amount of deductible appears on the face of the insurance card, so the large deductible might require them to do that.

MSA company I'll be going with is NetworkPrime out of Menasha, WI - the $2k/yr. deposit. They've had a number of MA's for decades servicing the middle and northern parts of the state, but the MSA is a statewide plan. The other MSA is an offshoot of the Marshfield Clinic dba Security Health for it's MA's. It, too, has been offering MA's, competing with Network Prime. Both companies are better rated by CMS than UHC, BCBS, Humana. No surprise, there.

Minimal earnings on cash deposits. Medicare deposits (for both plans) go to Mellon Bank. Plan says money can be transferred to another bank (or institution??). Not sure how that can be done w/o triggering a taxable event. I have to talk to their rep about that. Some form of a rollover, I assume.

MSA's have been mentioned on the Medicare website for a few years - but maybe before the current crunch in capitation rate, the private insurers were more profitable offering regular MA's???

Also, guessing it would a whole lot harder for them to deny payment for any Medicare-allowed service under an MSA. There are NO PREAPPROVALS necessary. So, opportunities for ill-gotten profit (aka denials) are considerably curtailed.
You are right. Its NetworkPrime for MSAa But Froedtert is now co-owner of NetworkHealth which offers Advantage plans. From the blurb that I read the implication is/was for them to coordinate future healthcare activities. I wasn't reading very carefully re the MSAs, got the names mixed (they are kinda similar), although I did look at HealthPrime MSA evidence of coverage. But not that carefully, I'll look at it again.

Is the no preapproval a characteristic of MSAs and mandated by CMS? If so, these plans are as good as Medigaps. In fact, they'd be a much better deal for most people. If in relatively good health, you'd get the equivalent guarantee of Medigap without paying a dime and accumulate should you need it later. Interesting.

Last edited by Weichert; 10-11-2015 at 09:20 PM..
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Old 10-11-2015, 10:11 PM
 
Location: Wisconsin
25,591 posts, read 56,363,195 times
Reputation: 23297
Quote:
Originally Posted by Weichert View Post
From the blurb that I read the implication is/was for them to coordinate future healthcare activities. I wasn't reading very carefully re the MSAs, got the names mixed (they are kinda similar), although I did look at HealthPrime MSA evidence of coverage. But not that carefully, I'll look at it again.
Whoa.............ask and ye shall receive!

You are absolutely correct - just looked at the literature, again. NetworkPrime (MSA) is offered by Network Health.

Froedtert is now co-owner of Network Health:


Froedtert Health completes purchase of Network Health stake

Froedtert Health and Ministry Health complete agreement to co-own insurance plan | News | Froedtert & the Medical College of Wisconsin

Explains why, when I called for the brochure, girl immediately mentioned Froedtert when I gave her my zipcode.

Well, that makes it doubly attractive.

Thank you. I did not know this.

Quote:
Originally Posted by Weichert View Post
Is the no preapproval a characteristic of MSAs and mandated by CMS? If so, these plans are as good as Medigaps.
Don't know if no preapproval is characteristic of MSAs, but Security Health mentions nothing about preauthorizations, etc., either. Just says:
Quote:
You can go to any doctor, hospital, or other providers that accepts Medicare payment, the plan's terms and conditions for payment [no idea how they would know what that is unless they are talking about deductible], and agrees to treat you.
As a matter of fact, literature for both organizations appears identical in many places - word for word.

Here is Evidence of Coverage from Network Health/NetworkPrime - it's long, but a quick and easy read:

https://networkhealthmedicare.com/_f...OC_MSA_001.pdf

Quote:
Originally Posted by Weichert View Post
In fact, they'd be a much better deal for most people. If in relatively good health, you'd get the equivalent guarantee of Medigap without paying a dime and accumulate should you need it later.
Well, that's what I'm thinking. I'm still young enough and healthy enough that I should be able to build up a balance in this account - and over the next five-ten years save myself a fair chunk of premium dollars, as well. By then - Froedtert may have even become the "Kaiser" of our area - in addition to the MSA, offering its own MA w/teeny copays and no payment hassles because it owns its own facilities and employs its own doctors.

****

Thanks again for that Froedtert info. It isn't mentioned anywhere in any of the Network Prime sales material - a very well put together, spiral bound, tabbed booklet, btw.

Guess I can now stop wondering if Froedtert will "accept" the plan.

Last edited by Ariadne22; 10-11-2015 at 10:28 PM..
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Old 10-12-2015, 01:54 PM
 
484 posts, read 558,516 times
Reputation: 903
Default Can't speak to MSAs vs. MA

Kefir King, a few issues to check out before erolling in the new Empire Medicare Advantage plan:

a. Do all your providers accept it? No out of network coverage for Medicare Advantage plans.
b. Does the hospital you'd be going to if you were to be hospitalized accept it? Same issue, no out of network coverage if hospital doesn't accept Advantage plan.
c. Get the Schedule of Benefits for the new Medicare Advantage plan and read through it to see if there are other changes from your further Empire coverage.
d. Give a call to the Medicare Rights Center. They are a national non-profit not controlled by or funded by Medicare. They may have some guidance for you on picking plans.
e. If you think you were the only one who lost coverage, give a call to the NYS Department of Financial Services and ask about the ending of your former Medicare Advantage plan. They would certainly know how many insureds had to switch, because BC had to notify them that it was withdrawing that product.

On a final note, Empire Blue Cross and Blue Shield is not the only New York outpost of Blue Cross/Blue Shield. They are the southeastern New York franchise. Also operating in New York are Blue Cross of Western New York, Excellus Blue Cross Blue Shield (Central NY) and Northeastern Blue Cross and Blue Shield.

Last edited by Inquring81; 10-12-2015 at 02:04 PM..
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Old 10-14-2015, 09:07 AM
 
Location: Manhattan
25,368 posts, read 36,956,293 times
Reputation: 12767
Quote:
$0 to $23 - or $23 to $0 - premium changes. There must be some basic coverage
change in the new policy other than the premium - and, too, BCBS probably
doesn't want to sell a $0 premium policy.
In 2014, monthly premium for Manhattan residents was $0, in $2015 it was $23/mo. It is being advertised for 2016 as back to $0 per month. <I guess the response to their $23 per month was less than stellar.>

Well, tomorrow begins the new enrollment period, so I will try to enroll in the zero monthly plan and see what happens.

Last edited by Kefir King; 10-14-2015 at 09:15 AM..
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Old 10-14-2015, 09:32 AM
 
Location: Manhattan
25,368 posts, read 36,956,293 times
Reputation: 12767
Quote:
Originally Posted by Inquring81 View Post
Kefir King, a few issues to check out before erolling in the new Empire Medicare Advantage plan:

a. Do all your providers accept it? No out of network coverage for Medicare Advantage plans.
b. Does the hospital you'd be going to if you were to be hospitalized accept it? Same issue, no out of network coverage if hospital doesn't accept Advantage plan.
c. Get the Schedule of Benefits for the new Medicare Advantage plan and read through it to see if there are other changes from your further Empire coverage.
d. Give a call to the Medicare Rights Center. They are a national non-profit not controlled by or funded by Medicare. They may have some guidance for you on picking plans.
e. If you think you were the only one who lost coverage, give a call to the NYS Department of Financial Services and ask about the ending of your former Medicare Advantage plan. They would certainly know how many insureds had to switch, because BC had to notify them that it was withdrawing that product.

On a final note, Empire Blue Cross and Blue Shield is not the only New York outpost of Blue Cross/Blue Shield. They are the southeastern New York franchise. Also operating in New York are Blue Cross of Western New York, Excellus Blue Cross Blue Shield (Central NY) and Northeastern Blue Cross and Blue Shield.

a. All my providers accept it.
b. All New York City hospitals take it
c. Oh, I am certain there are many other changes involving increased prices.
d. Very good advice thank you.
e. I'll try that.

In the final note, everything is county by county and NYC is made up of 5 counties so there are differences in plans offered even by borough. Manhattan is specifically New York County and has two Med Advantage plans from Blue Cross, an HMO and a PPO.

All good advice, thank you, Inquiring.
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