Sunday, February 10, 2013

MEDICARE M.O.O.P. & Your Healthcare Financial Risk


MEDICARE MOOP is the most important factor for seniors . MOOP determines how much of your money you must pull from checking, savings and retirement accounts for your health services. We at the SENIOR FAMILY believe MOOP is as seriously, important as you seeing your own Family-PCP, favorite, closest Hospital, and your Specialists. As we focus on MOOP, we are speaking of possible financial risk and your costs. A MOOP statement of RISK by law should be applied to all Medicare Health Plans !

MOOP is always (by: Medicare Law) a cost factor in the Medicare Advantage (Plan-C) Plans. However, the risks apply to: Original Medicare A&B, and/or when combining A&B with a traditional insurance Supplement (Medigap) policy; they have their associated risks that are rarely spoken of. Keep in mind all health plans have their own possible out of pocket risks (OOP), even the Medicare Drug Plan-D has an annual non-fixed risk. THE BOTTOM LINE is how much do/could you have to pay from your wallet or pocket-book!

Your MOOP & RISK of popular types of Medicare Plans:

Original Medicare Parts A&B: By only using A&B, your financial risk and potential loss is virtually unlimited because your co-insurance, cost-share payment is 20%. Medicare pays 80% and you pay 20%. We know that 20% of the cost of a chronic illness, catastrophic event, or an accident can possibly place many seniors in heavy debt. Remember: the 20% of $300 thousand dollar hospital bill is $60 thousand "out-of-your-pocket"!!.The multiplier is .2 (the 20%) of all bills/costs. THIS IS A HIGH RISK SITUATION GET HELP SOON. PLEASE CONSIDER A MEDIGAP-SUPPLEMENT with a PART D PLAN or PART-C ADVANTAGE MAPD (one's w/DRUG PLAN).  SEE-ABOUT-MORE

Original Medicare Parts A&B with a Medigap Supplement (Med-Sup): Generally. depending on the Standardized Plan-type, most of the costs are paid, sometimes all. The hospital deductibles, the Part B (other 20%) co-insurance, and other costs are paid. There are 10 Medigap standardized supplements, each slightly different in what they pay. Check with us regarding your plan-type's risk. We at the SENIOR FAMILY will always recommend the Medigap supplement types F and G, because they do cover MEDICARE EXCESS CHARGES, which are near unlimited "out-of-your-pocket" risks. F & G are safest. ASK YOUR ADVISOR WHAT MEDIGAP-TYPE YOU HAVE & WHAT ARE YOUR RISKS. Beware of "low-ball" Medigap-Supplement quotes.. SEE-ABOUT-MORE

Medicare Advantage C-Plans (MA or MAPD): This is where MOOP statement disclosure laws are applied. By law, all Advantage Plans have an annual MOOP that is published in the Benefits Summary, it's the "out-of-your-pocket" yearly risk limit. This yearly amount is always $3400 to $6700. (Some plans can be as high as $10,000.) So with an Advantage Plan your risk limit is an annual fixed amount ranging from 34hundred to 10thousand dollars. The total risk for your A, B, and D are in that amout. The MOOP re-sets each Jan 1st, with your loss limit restored. Generally, the higher monthly premium costs on the Advantage will have the lowest, safest MOOP. ASK WHAT ARE MY TOTAL ANNUAL RISKS?  SEE-ABOUT-MORE

Medicare Part-D Drug Plans (PDP):  These plans have risk, however, the financial risks of these plans are rarely spoken of unless it's the "DONUT-HOLE" coverage gap. The risk is the cost of your medications and how long you are in the "DONUT." A new brand name drug or specialty new drug can place you in the DONUT in Feburary, having you paying $4970 plus any co-insurance costs out of pocket easily. As Medicare laws of 2011, the D-Hole coverage-gap has been slightly closed. The pharmaceutical companies now pay for 50% of the higher cost BRAND NAME drugs. Your cost-share, "out-of-your-pocket" risk during the GAP is 79% for your generics and 47% for brand name drugs. This means you pay $3.17 for a 4 dollar generic and for a $300 brand name you pay $141. Remember: your gap-costs are approx. 20% off and 50% off retail price. Will the "Donut" go away by 2018? ASK YOUR DOCTOR WAYS YOU CAN SAVE & AVOID A DONUT-HOLE. USE MEDICARE.GOV TO PLAN YOUR GAP. SEE-ABOUT-MORE

Remember: A Medigap-Supplement is a traditional insurance product. The Advantage Part-C and Drug Plan Part-D's are Medicare Approved Provider plans. A Medicare C Advantage Plan is never considered or referred to as a Medigap or Supplement.  


For any other plan types please call or write.  

(If your Medicare Advisor doesn't explain MOOP & RISK, dump them, it's the law.)

To further understand Medicare Plan types: PLEASE CLICK HERE

Al Warren
Senior Family Alliance/RX                 
2809 Kirby Pkwy, Suites 116-125
Memphis, TN 38119 

855.SENIOR6 toll-free
901.217.1805 office

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Anonymous said...

You really make it seem so easy with your presentation but
I find this matter to be really something that I think I would never understand.
It seems too complicated and extremely broad for me. I am looking forward for your next post, I'll try to get the hang of it!

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WOW. The "cash your annuity in" guys are in here. LOL...hummmmm? Bet it's the same person with all the above comments.


I'm Alan, the owner and moderator here.

Darren Sanford said...

Wow! What a comprehensive review on Medicare and out of pocket expenses. Everyone should be thoroughly familiar with this, especially the elderly who are on Medicare.

Thanks for sharing and make it an awesome day.


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I work for Seniors with all the Medicare Plans & Sr.Financial Planning... I saw what was happening in the homes of senior families and sacrifices seniors made for their prescriptions & health coverage. So I built a Saving & Educational place for my Seniors & their Families. I had my 1st Medicare Plan job in 1979. I worked for some large Wall Street firms years ago, there I was educated in senior's finance/safe investing, finished my CFP educational requirement in 01'. Now, I am a Plan Broker representing more 172 Medigap-Sups, Plan C Advantage, & Drug Plans. Now, I just apply my education & skills to benefit "Senior Families".. From Federal Housing to Assisted Living to Golf Course Patios, it's the same mission: Education & Healthcare; bringing SAVINGS-SECURITY-DIGNITY. We welcome comments on any posts. Remember, this is a WWW platform so protect your identity, you can post anonymously. Call us Toll-Free 855-SENIOR6 for private help. THE SENIOR FAMILY ALLIANCE IS NOT AFFILIATED WITH THE U.S.GOVERNMENT, STATE DHS, OR MEDICARE. ONLY COMPENSATED BY THE PROVIDER COMPANIES OF THE PLANS. PLAN DETAILS PRESENTED UNDER MEDICARE SOA RULES.