When is the Plan N Copay Applied?

[BeeSelective]

Don’t think the treatment itself is an office visit copay, although the provider may charge for an ov and the copay might apply.

Seem to me I had a similar situation about 2-3 yrs ago, and the co pay did not apply. It depends on whether the provider charges an office visit.

 

[somarco]

The Plan N copay has been discussed in several threads. Use the advanced search function for "plan N copay".

Here is a recent thread that provides quite a bit of information, especially post #15 by #mbsc

https://insurance-forums.com/community/threads/plan-n-copay-for-chemo.92590/page-2

 

[yorkriver1]

I am interested in the outcome here, since cancer treatment is a concern of many Medicare beneficiaries. I have seen the budget minded, if not absolutely finance limited, opt for Plan G instead of N, when presented with both options, to avoid just this potential multi office visit charge scenario. I don't try to persuade them otherwise. What makes them feel secure is their decision. It will make me more comfortable in being able to back up whatever statements are made about Plan N to state that there is no absolute guarantee that some outpatient treatments won't have a charge for office visit, if they do happen. I am also doing a mental calculation of the possible out of pocket. If there were, say, 2 visits a week for a year, at the maximum of $20, that's $1,040, or about $86.67/month. It would be attractive to have that be zero, as on Plan G, but also the accumulated premiums over the years for G Vs. N, I don't know that it's a complete financial disaster, other than the client's expectations as laid out by an agent. We are all doing our best to give realistic expectations to clients.

 

[somarco]

My default presentation is for G. I rarely roll out N unless they bring it up.

I don't get into the weeds that much. I do tell them if they anticipate going to the doctor more than a dozen times a year N is probably not a good choice.

And I don't explain the nuances of when a copay will be billed and when it isn't. Clients have short term, selective memories. They will completely forget you told them the specifics of when a copay will be billed but will absolutely remember you saying there would not be a copay for chemo or rad.

Any time you try and predict what will happen on a claim you have a greater chance of being wrong even when you gave the right answer.

 

[yorkriver1]

My default presentation is for G. I rarely roll out N unless they bring it up.

I don't get into the weeds that much. I do tell them if they anticipate going to the doctor more than a dozen times a year N is probably not a good choice.

And I don't explain the nuances of when a copay will be billed and when it isn't. Clients have short term, selective memories. They will completely forget you told them the specifics of when a copay will be billed but will absolutely remember you saying there would not be a copay for chemo or rad.

Any time you try and predict what will happen on a claim you have a greater chance of being wrong even when you gave the right answer.

Good point! Even if that isn't thousands more than on G, an extra $120+ or so a month they weren't expecting, not happy.

 

[somarco]

Money surprises are never fun.

Took an app this week on a lady that had signed up for a $40 MA plan without realizing her OOP was $6700. She is T65 and still undergoing treatment for cancer.

Her husband was the one who read the material, figured they really could not afford the plan, then found me online.

Her G plan comes in at $97.

Big shock was her Part D.

The agent that sold her the MA plan either never ran her drugs through the formulary or just lied when he said "they are all covered".

I ran a PDP and compared to her drug costs for the MA plan.

Of the 19 drugs she is taking, 18 are on the plan I suggested, 17 on the MA plan.

But that is only part of the story.

The PDP has a projected annual cost of $7,000 vs $24,000 for the MA plan.

I worked with her to get her Rx bill down to less than $3,000.

Had she stayed with the MA plan she never could have afforded it.

 

[TampaHound]

Money surprises are never fun.

Took an app this week on a lady that had signed up for a $40 MA plan without realizing her OOP was $6700. She is T65 and still undergoing treatment for cancer.

Her husband was the one who read the material, figured they really could not afford the plan, then found me online.

Her G plan comes in at $97.

Big shock was her Part D.

The agent that sold her the MA plan either never ran her drugs through the formulary or just lied when he said "they are all covered".

I ran a PDP and compared to her drug costs for the MA plan.

Of the 19 drugs she is taking, 18 are on the plan I suggested, 17 on the MA plan.

But that is only part of the story.

The PDP has a projected annual cost of $7,000 vs $24,000 for the MA plan.

I worked with her to get her Rx bill down to less than $3,000.

Had she stayed with the MA plan she never could have afforded it.

I haven't really done Medicare but was thinking about getting into it some. This is good to know and I may steal your story. It's to easy for the old folks to just get caught up in price and not understand exactly what it is they are buying.

 

[kgmom219]

Money surprises are never fun.

Took an app this week on a lady that had signed up for a $40 MA plan without realizing her OOP was $6700. She is T65 and still undergoing treatment for cancer.

Her husband was the one who read the material, figured they really could not afford the plan, then found me online.

Her G plan comes in at $97.

Big shock was her Part D.

The agent that sold her the MA plan either never ran her drugs through the formulary or just lied when he said "they are all covered".

I ran a PDP and compared to her drug costs for the MA plan.

Of the 19 drugs she is taking, 18 are on the plan I suggested, 17 on the MA plan.

But that is only part of the story.

The PDP has a projected annual cost of $7,000 vs $24,000 for the MA plan.

I worked with her to get her Rx bill down to less than $3,000.

Had she stayed with the MA plan she never could have afforded it.

Nice job, Bob.

 

[somarco]

I may steal your story

I take PayPal donations.

 

[TampaHound]

I take PayPal donations.

Funny thing is that I had someone ask me for advice about Medicare the other day, they are still a good 3 months outside their IEP. As we were talking your story come up.

So where do I send the check?