AARP Medicare Supplement

[Frank Stastny]

Completely incorrect. Medicare pays exactly zero of the excess chargess. The 15% winds up being 9.25% but let's go with 15% to keep it simple. The following is not exactly correct, but it is the way I explain it to my prospects - again to keep it simple.

Medicare allowable is $100. Medicare pays $80, the supplement pays $20. If the doc doesn't accept assignment, and the client has Plan D, the client pays the 15%.

However, neither Medicare nor the supplement will pay the doctor. Why, because he wouldn't accept assignment of the claim. The money goes to the client.

So now the doctor has to hope he gets $115 from the client AFTER he does all the billing instead of knowing he'll receive $100.

By the way, the actual amount is not $15, it's really $9.25 but that's too much information to explain to my clients.

Let's assume the net premium difference between Plan F and Plan D is $275, after deducting the $135 Part B deductible that is not paid by Plan D. (It's more like $500-600 in Missouri). At 15%, that would mean that the client would have to incurr bills of almost $2,000 from doctors that don't accept assignment.

Since only 1% of the doctors won't accept assignment and knowing how much Medicare limits charges, it becomes almost impossible for Plan F to be a money saver for any client.

I'm tired of typing. I'm sure Frank will be along to correct my simplification.

Rick

Nope, ya done good.

The only thing you didn't specifically say is if the doctor accepts assignment then Medicare and the insurance company both send the checks directly to the doctor. The doctor receives 100% of their money without having to bill or worry about "late pays" or "no pays".

That was a huge incentive for doctors to begin accepting assignment.

 

[senior-advisor-indiana]

Frank,
You are virtually always on the money when it comes to supplements.

 

[jdeasy]

Completely incorrect. Medicare pays exactly zero of the excess chargess. The 15% winds up being 9.25% but let's go with 15% to keep it simple. The following is not exactly correct, but it is the way I explain it to my prospects - again to keep it simple.

Medicare allowable is $100. Medicare pays $80, the supplement pays $20. If the doc doesn't accept assignment, and the client has Plan D, the client pays the 15%.

However, neither Medicare nor the supplement will pay the doctor. Why, because he wouldn't accept assignment of the claim. The money goes to the client.

So now the doctor has to hope he gets $115 from the client AFTER he does all the billing instead of knowing he'll receive $100.

By the way, the actual amount is not $15, it's really $9.25 but that's too much information to explain to my clients.

Let's assume the net premium difference between Plan F and Plan D is $275, after deducting the $135 Part B deductible that is not paid by Plan D. (It's more like $500-600 in Missouri). At 15%, that would mean that the client would have to incurr bills of almost $2,000 from doctors that don't accept assignment.

Since only 1% of the doctors won't accept assignment and knowing how much Medicare limits charges, it becomes almost impossible for Plan F to be a money saver for any client.

I'm tired of typing. I'm sure Frank will be along to correct my simplification.

Rick

For now, I'll take your word for it as you are much more of an expert than I even pretend to be. What I posted was what I was taught. I still don't get the 9%? I assume you are correct and I was misinformed while I research further.

 

[senior-advisor-indiana]

It is because medicare lowers the approved amount if they do not accept assignment.

 

[maleman2045]

Let's assume the net premium difference between Plan F and Plan D is $275, after deducting the $135 Part B deductible that is not paid by Plan D. (It's more like $500-600 in Missouri). At 15%, that would mean that the client would have to incurr bills of almost $2,000 from doctors that don't accept assignment.

Since only 1% of the doctors won't accept assignment and knowing how much Medicare limits charges, it becomes almost impossible for Plan F to be a money saver for any client.

I'm tired of typing. I'm sure Frank will be along to correct my simplification.

Rick

I have had a few conversations on this topic with Frank and the most important part of the message is "to actually compute total costs for both plans, then compare."

In Florida (Volusia County), using MOO, a T65F Plan F will cost a whopping $21.48 annually over a Plan D, which for that cost, I would sell Plan F as there is virtually no "real" value in selling Plan D to save 1.79/month.

The concept is sound, but "do the math" just to be sure.
Mike

 

[Frank Stastny]

It is because medicare lowers the approved amount if they do not accept assignment.

Medicare states that if the doctor does not accept assignment the doctor can add 15% to the amount Medicare approves. However, Medicare reduces the amount they have proved by 5% is the doctor does not accept assignment.

Now the doctor can only add the 15% to the reduced amount.

If Medicare approves a total of $100 and the doctor does not accept assignment then Medicare reduces it by 5% so now the approved amount is $95. $95 x 1.15% = $109.25

The above shows that although the doctor can add an additional 15%, after Medicare reduces the amount by 5% the doctor is really only getting an additional $9.25 and not $15.

That really isn't enough additional money for the doctor to risk not getting paid or have to spend money billing.

 

[GreenSky]

Medicare states that if the doctor does not accept assignment the doctor can add 15% to the amount Medicare approves. However, Medicare reduces the amount they have proved by 5% is the doctor does not accept assignment.

Now the doctor can only add the 15% to the reduced amount.

If Medicare approves a total of $100 and the doctor does not accept assignment then Medicare reduces it by 5% so now the approved amount is $95. $95 x 1.15% = $109.25

The above shows that although the doctor can add an additional 15%, after Medicare reduces the amount by 5% the doctor is really only getting an additional $9.25 and not $15.

That really isn't enough additional money for the doctor to risk not getting paid or have to spend money billing.

I have a tear in my ear knowing how much I taught you.

Rick

 

[Frank Stastny]

I have a tear in my ear knowing how much I taught you.

Rick

Are you going to pass that around or smoke all of it yourself?

 

[yabadabadoo1026]

found this forum about a month ago------------the education I get from all you experienced experts is invaluable---thanks all for such great guidance

 

[senior-advisor-indiana]

found this forum about a month ago------------the education I get from all you experienced experts is invaluable---thanks all for such great guidance

I assume you are really just talking about me and did not want to hurt anyones feelings. Thank you.