Plan N Copay Question...

[sman]

Yes, I know that. I guess you have more faith in doctor's offices than I do.

OK.... it is NOT a $20 copay. It is 20% up to $20. Therefore they can't just ask for $20 since that may be more than 20% of the medicare approved charges for the DOV.

 

[Medicareguy]

Don't need opinions here... need facts. If I wanted opinions I'd use my own that sounds more in line with what is currently happening.

The client goes to the doc, doc files with medicare, medicare kicks it over to secondary after adjusting charges and paying thier 80% (if after the $155 is met). Secondary gets claim, client is on Plan N, secondary kicks the client an EOB showing that they owe 20% up to $20 on that visit.

Talked to a lady yesterday about this. She had an EOB from the doc visit last month.. medicare approved $65 for the visit.. she'd have to pay $13... when... my opinion says she'll get billed for the $13 after it's been processed.

Again... assuming the $155 ded is met. If not she'd get billed for the $65.

Anyone with facts?

Just like group coverage, I would just tell the lady to bill me so I know what I'm paying. It will save the clinic money not to have to refund or bill again. Clinic's don't have cash registers...just whip out a $100 bill and see what they say.

 

[retread]

You're correct. It is 20%, up to $20.

Really, it shouldn't be talked about as a $20 co-pay.

Probably best to say...you'll pay 20% of your Medicare approved doctor charge, up to $20.

Almost every carrier I am contracted with, when speaking of plan "N", describe it as a $20 copay plan. That's the problem.

 

[insurance0707]

I work with mostly turning 65. If you're showing Plan N you might want to mention that the welcome to Medicare Physical is not subject to the $155 dedutible and the $20 copay. Also, starting January 1st 2011 Preventative care benefits/annual wellness checkup is no subject to the $155 deductible or $20 copay. I have a lot of healthly clients and they only go to the doctor once or twice a year, usually for preventative care, the plan N could be a good option for them.

Here's the link that lists the 2011 preventative care benefit....

Key Provisions That Take Effect Immediately

 

[Yoda]

A very possible scenario would be someone on that "N' plan gets sick in November or Dec and has to pay the $155 dollar part B deductible and then gets sick again in January or Feb and has to pay the part b deductible again. And about then they are wondering if switching to that "N" plan was such a great idea.

 

[insurance0707]

With that 24% rate increase UO took, I've been switching clients that have Plans G or F and on average their saving about $1,400 - $1,500 in premium. Singles are seeing about a $700 savings. Yes, there could be a worst case senioro of them having to meet the ded in Nov and then again in Jan. Plan N would be much more popular if they just had to pay the $20 copays without having to meet the $155 deductible.