Plan N Co-payment

billyg

Guru
100+ Post Club
I finally saw a MoO Plan N policy the other day and read through the coverage. Up until now, I have been advising that with a Plan N, after the patient pays the Part B deductible, he has to pay a $20 per visit copayment. However, the way that I understand the actual policy language, the patient would pay the lesser of the 20% copayment, or $20. Considering that many office visits subjected to the 20% copayment are less than $100, there will be many times that the patient will pay less than $20.
 
That is exactly correct. If the charge is $50 then the copay would only be $10. That is extremely important to explain that to each prospect.
 
So very true....but if the clients not to good with math don't forget to remind them the max is a $20 co-pay.
 
I finally saw a MoO Plan N policy the other day and read through the coverage. Up until now, I have been advising that with a Plan N, after the patient pays the Part B deductible, he has to pay a $20 per visit copayment. However, the way that I understand the actual policy language, the patient would pay the lesser of the 20% copayment, or $20. Considering that many office visits subjected to the 20% copayment are less than $100, there will be many times that the patient will pay less than $20.

It is rare to find a doctor that charges less than $100 for a office visit these days.
 
So very true....but if the clients not to good with math don't forget to remind them the max is a $20 co-pay.

Maybe we should develop something like a "tip chart" that would break it down in $5 increments for them. :)

Actually that might just work. Be sure to use the phrase "now that you are on a fixed income" when you explain it. Seniors love to talk about being on a "fixed income". In my experience the more money they have the more often they use that term.
 
That's right, so the payment is 20% of the medicare approved amount not what the doctor charges. If the DR. charges $100.00 but the medicare approved amount is $75.00, the client will pay 20% of the $75.00 which would be $15. But we also need to remember about the $155.00 deductible. The other question is when does the client pay it. To me it makes sense to let the Dr. bill them since they really won't know what their payment due is.
 
Just sell plan F and the consumer doesn't have to fuss with all those pesty deductibles and copays.:)

Agreed but if the difference between F and N is $250-350 a year, it may be in the client's best interest to go for the lower priced plan. Especially if you wrote the Plan F and I can "steal" it by moving them to Plan N. (Most of my clients are Plan F).

Rick
 
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