Plan N Question

Jul 10, 2019

  1. goillini52
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    goillini52 MAGA...Eat More Bacon & BUILD THAT WALL!!!

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    Tell them to file with Medicare and find out. :yes:
     
  2. jbage007
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    jbage007 Guru

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    Based on Medicare allowed max for Dr. visit fees? Whatever that is?
    If it's say, $70, then 20% is $14.
    I've never read it that way. Are you sure? That's the equivalent of paying 20%. Why have a co-pay?
     
  3. goillini52
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    goillini52 MAGA...Eat More Bacon & BUILD THAT WALL!!!

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    Look at any Outline of Coverage that you leave your new client and under Plan N under You Pay it says, "Up to $20 per Office Visit". :yes:
     
  4. vic120
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    vic120 Guru

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    Because it is a Medicare supplement, not a PPO or HMO.

    With a supplement they only pay out, If Medicare pays 20% They client pays the leftover

    If the leftover is over $20 the insurance kicks in and pays

    However, if the leftover is only $10 there is nothing more for the client to pay beyond $10 and the INsurance does not take money from the client to put it elsewhere like with a managed plan
     
    vic120, Jul 10, 2019
    #24
  5. Chazm
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    Chazm Guru

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    Most Clients tell me that their co-pay for an office visit is about $14-$16 For a plan N
     
    Chazm, Jul 10, 2019
    #25
  6. Travis Price
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    Travis Price Guru

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    I think it's just easier to say up to $20. Undersell, over-deliver.
     
  7. somarco
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    somarco GA Medicare Expert

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    As others have pointed out, the N copay is not $20, it is the remaining 20% (above the B deductible) up to $20.

    Anyone with plan N should NEVER pay a dime until Medicare has adjudicated the claim and sent to the Medigap carrier.

    The Medicare MSN will tell if the claim is even payable; the carrier EOB will tell what (if anything) they owe.

    There are specific codes (as Travis pointed out) where a copay MAY be required. If someone presses me on this issue I will find and give them the codes.

    I NEVER say if a claim is paid or not.

    The only sure way is to follow my advice at the top. Wait until AFTER Medicare has adjudicated and approved the claim PLUS the claim has gone to the carrier.

    Medical provider staff would know a plan N from a plan T. I never take what they say as gospel.
     
    somarco, Jul 10, 2019
    #27
  8. Travis Price
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    Travis Price Guru

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    I would agree that's the smartest way to do it. At least you have appeal rights at that point.
     
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