Modernized Plan N Questions

I'm looking at new rates for Blue Cross of California. At age 70, the difference between F and N is $58 per month. Knock off $15 for Part B deductible (using $180 a year in the future) and the client still saves $43 per month. Rarely does anyone go to the doctor for a visit more than 24 times a year.

If someone goes 25 times, it's a break even against Plan F.

It doesn't matter in this case if someone is diabetic or has COPD, Plan N is by far the best choice. The fact that someone sees doctors on a regular basis does not "disqualify" him from Plan N.

One really needs to do the math to see if N is a better deal than F. In the case of a 70 year old in Los Anglees, F really makes no sense.

Many times a blanket statement about which plan is good and which plan is bad is simply based upon ignorance rather than facts.

Rick

Thank you for the correction, but ignorance also keeps people from reading an entire post that stated "depending on which state you live" which was included in my post. Didn't mean to get your panties in a knot by suggesting you buddy may be wrong. You saw a chance to pounce and you didn't read what I wrote. By the way, is he right???
 
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The $20 copay does not apply to outpatient surgery, ambulance, MRI's, X-rays, Medical supplies, diabetic supplies, etc. The $20 copay would be for office calls, which would include specialists, chiropractic care, and I'm guessing physical therapy. Starting 1-1-11, preventative care is supposed to be covered at 100% with no $155 deductible or copay


If the $20 does not apply to the above procedures are you saying that medicare will cover them at a 100%
 
The $20 copay does not apply to outpatient surgery, ambulance, MRI's, X-rays, Medical supplies, diabetic supplies, etc. The $20 copay would be for office calls, which would include specialists, chiropractic care, and I'm guessing physical therapy. Starting 1-1-11, preventative care is supposed to be covered at 100% with no $155 deductible or copay


If the $20 does not apply to the above procedures are you saying that medicare will cover them at a 100%

Yes, that is exactly what the healthcare reform bill states is going to happen to preventitive care on Jan. 1,2011.
 
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The $20 copay does not apply to outpatient surgery, ambulance, MRI's, X-rays, Medical supplies, diabetic supplies, etc. The $20 copay would be for office calls, which would include specialists, chiropractic care, and I'm guessing physical therapy. Starting 1-1-11, preventative care is supposed to be covered at 100% with no $155 deductible or copay


If the $20 does not apply to the above procedures are you saying that medicare will cover them at a 100%

Medicare covers the above procedures at 80% and Plan N would pick up the other 20%. Except on office calls, you'd have the $20 copay and $50 for emergency room visit. The modernized plan N also improves the hospice care benefit. The client would no longer have the small copay for pain medication or respite care.
 
Medicare covers the above procedures at 80% and Plan N would pick up the other 20%. Except on office calls, you'd have the $20 copay and $50 for emergency room visit. The modernized plan N also improves the hospice care benefit. The client would no longer have the small copay for pain medication or respite care.


Thank you , that is what I was looking for. When I spoke with Mutual Of Omaha yesterday I gave the example of a $4000 surgeons fee and she said as long as the doctor billed it as a doctors office visit they would only pay $20, I said ok what if he doesn't bill it as a doctors office visit, and she said again, as long as he bills it as a doctors office visit it is $20 , we went around and around for 15 minutes and she never budged!
 
MOO is taking the approach that Part B Copay is either 20% or $20.00, which ever is less. I haven't seen any other company take that approach.

ALL companies will take that approach since it is the language set forth by CMS and the NAIC when this plan was designed. MOO isn't doing anything special...

Read a few outlines of coverage (where the language is pretty standard from company to company)...

All plan N's have a copay of "20% up to $20" on the office visit charge. That said, there is no copay on doctors services in the hospital, etc.

There is a billing "code" for an office visit... that code is what triggers the copay. No code... no copay.
 
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You said- we went around and around for 15 minutes and she never budged![/quote]

The reason that you went round and round is because she probably didn't know the answer either. I have found out that you can't take the word of folks working for the carrier because it is likely they don't know anymore than you do.
 
Yes, you are correct she didn't know, I pressed her because I want to make sure I communicate the benefits correctly to my customers.

If what is said about surgeons fees and tests are true then Plan F is a extinct or useless plan.
 
If what is said about surgeons fees and tests are true then Plan F is a extinct or useless plan.

I wouldn't call Plan F "extinct" just no longer necessary since Medicare made the changes in the mid 90's. If you will look at the outline of coverage for both Plan F and Plan D you will see that the coverage provided for Part A is exactly the same.

You will see the following differences in the Part B coverage: Plan F pays the Medicare Part B Deductible, Plan D doesn't. Plan F pays 100% of Excess Charges, Plan D doesn't. The rest of the benefits are identical. If their doctor Accepts Assignment then the benefits paid by Plan D are exactly the same as the benefits paid by Plan F.

Plan N is exactly the same as Plan D with the exception of the co-pays. "Clinical Laboratory Services-Test for Diagnostic Services" are paid 100% buy Medicare for all Plans, even by Plan A.

Plan F still has its place when Plan F is priced very close to either a Plan D or G. Plan N should be carefully explained to the prospect to make sure they understand the copay for doctor visits and emergency room treatment.
 
Urgent Care is not considered Emergency room care. Urgent Care under Plan N would be paid at 80% by Medicare and 20% by Plan N. I saw that in a Q & A that Mutual of Omaha/United of Omaha had on their website
 
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