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CMS has recently put out additional guidance on Plan N co-pays and deductibles. There have been a lot of questions recently on when co-pays apply for certain services.
The biggest question seems to be if a client pays their $20 or $50 co-pay, before the $155 Pat B deductible is met. CMS's definition says:
"1. Will payment of the Medicare Part B deductible by the beneficiary when the beneficiary has a Plan N policy operate the same way as fee-for-service Medicare, in that the beneficiary pays coinsurance or a copayment for the Medicare-approved amount for services only after meeting the Part B deductible?
Yes, the Plan N subscriber is responsible for meeting the deductible before any coinsurance or copayment is collected. Once the deductible is met, the subscriber is responsible for up to $20 per office visit and up to $50 for an emergency room visit."
You can view the full PDF here.
The biggest question seems to be if a client pays their $20 or $50 co-pay, before the $155 Pat B deductible is met. CMS's definition says:
"1. Will payment of the Medicare Part B deductible by the beneficiary when the beneficiary has a Plan N policy operate the same way as fee-for-service Medicare, in that the beneficiary pays coinsurance or a copayment for the Medicare-approved amount for services only after meeting the Part B deductible?
Yes, the Plan N subscriber is responsible for meeting the deductible before any coinsurance or copayment is collected. Once the deductible is met, the subscriber is responsible for up to $20 per office visit and up to $50 for an emergency room visit."
You can view the full PDF here.
