Offer Plan G and Plan F - Keep It Simple!

There is so much misunderstanding in the past few messages (not yours) it almost defies logic, some of you need to read about the simple basics, such as Medicare assignment, before posting anything in a public forum.


What gets me is how many agents that say they have 8-10 years experience with Medicare, come on here and ask the most basic questions.:laugh:
 
There is so much misunderstanding in the past few messages (not yours) it almost defies logic, some of you need to read about the simple basics, such as Medicare assignment, before posting anything in a public forum.

Sorry, I think I see at least one of the things you are referring to. Confusion and tunnel vision. I am going to be studying harder on this stuff after the first of the year.

I am a great one for leaping first and then looking around on the way down. One of these days there wont be a mattress at the bottom.
 
Sorry, I think I see at least one of the things you are referring to. Confusion and tunnel vision. I am going to be studying harder on this stuff after the first of the year.

I am a great one for leaping first and then looking around on the way down. One of these days there wont be a mattress at the bottom.

Nothing wrong with rookies asking questions. Some that aren't rookies ask questions rather than look it up(when they should already know the answers).
 
I think he was being facetious. I've seen an excess charge one time and it was for about $40.

If a dr doesn't accept assignment they only get paid 95% (top of my head no time to look up) of what Medicare would normally pay for a procedure. So the client would essentially pay 9.25% above their normal amount IIRC

Currently 96% of doctors accept assignment so it's typically not an issue.

You were generous, thank you.

I was so focused on thinking about Plan N that I did not recognize that I was making a comment that applied to all Medigap supplements.

I think the comment I was given before also talked about billing, maybe that if the Dr didn't accept assignment, they had to bill the patient for the rest which then left the Dr exposed to all the normal Accts Pay risks and collection problems.
 
I think he was being facetious. I've seen an excess charge one time and it was for about $40.

If a dr doesn't accept assignment they only get paid 95% (top of my head no time to look up) of what Medicare would normally pay for a procedure. So the client would essentially pay 9.25% above their normal amount IIRC

Currently 96% of doctors accept assignment so it's typically not an issue.

Actually the patient pays 15% of 95%. The doctor gets an additional 9.25%.

I have hundreds of clients and have never heard of a doctor legally charging excess.

The "excuse" of getting cancer and seeing a doctor who doesn't take assignment is a bogus argument. If the doctor wants to get paid directly by Medicare and a supplement he has to take assignment. Otherwise he still does all the billing but the patient gets paid.

I can't imaging a doctor hoping that the grieving widow pays him (or her) after the doctor kills the patient.

Rick

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I think the comment I was given before also talked about billing, maybe that if the Dr didn't accept assignment, they had to bill the patient for the rest which then left the Dr exposed to all the normal Accts Pay risks and collection problems.

Nope. The doctor doesn't just bill the patient for 15%. He must bill the patient for 100% (plus 9.25%). The reality is a doctor won't hire a biller and worry about getting paid for a few bucks.

It's a shame there isn't someplace, maybe online with webinars where someone can learn Medicare.

Rick
 
The thing that gave me pause about Plan N when I was considering it as a purchaser, was the open ended nature of the co-payment charges. In posts here I was given one scenario which suggested that there is some level of risk to a plan N participant of incurring out of pocket charges, due to co-pays, that could fall between the out of pocket maximums for HDF and Plan K. That was what bothered me most, at a personal level, about Plan N.

I have memory issues, so I cannot cite specific statements, but after the posts I was given here, I decided that there was a higher probability of having some medical condition which required treatment which would not be covered at all by Medicare; than there was of having treatments from a provider which involved excess charges of any significant amount.
 
So the client would essentially pay 9.25% above their normal amount IIRC.

Actually the patient pays 15% of 95%. The doctor gets an additional 9.25%.
Provider accepts assignment:

Billed Charge: $109.25
Medicare approved amount: $100
Medicare assignment allowed amount: $100
Medicare payment (80% of allowed amount): $80
Patient responsibility (20% of $100 allowed amount): $20

Provider does not accept assignment:

Billed Charge: $109.25
Medicare approved amount: $100
Medicare non-assignment allowed amount: $95
Medicare payment (80% of allowed amount): $76
Patient responsibility (20% of $95 allowed amount plus 15% of $95 allowed amount): $33.25
 
Provider accepts assignment:

Billed Charge: $109.25
Medicare approved amount: $100
Medicare assignment allowed amount: $100
Medicare payment (80% of allowed amount): $80
Patient responsibility (20% of $100 allowed amount): $20

Provider does not accept assignment:

Billed Charge: $109.25
Medicare approved amount: $100
Medicare non-assignment allowed amount: $95
Medicare payment (80% of allowed amount): $76
Patient responsibility (20% of $95 allowed amount plus 15% of $95 allowed amount): $33.25

Red above - the Med Sup would pay this on a F, G or N - correct? There is no Part B Excess here - correct?

Green above - the Med Sup pays the 20% or $19 and the 15% or $14.25 is the Part B Excess that Plan N doesn't pay and would be patient's responsibility?
 
The Part B excess charges could be $1000 and $1000 of dollars. Why expose a senior to financial ruin?
Thousands? Sorry, but I doubt that's ever happened and would challenge anyone who said it has. Ever compare the premium difference between Plans D and G or between C and F, where the ONLY difference is the excess charge? You'll find the premium difference mostly in the $5-10 per month range. A carrier exposed to thousands in additional risk would never charge so little for that additional financial exposure. Per one carrier, the average excess charge is $8.

I rarely sell N, but that's because my clients prefer the extra few dollars in premium for Plan G to have a clearly set out-of-pocket, meaning no unknown number of copays (which aren't really copays, but the 20% coinsurance not to exceed $20), and no unknown possibility of excess charges. But if they do want to consider N, I do reassure them that they will likely never see an excess charge, and if they do it will likely be small. Financial ruin? No way.
 

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