- 7,066
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.