Question:
In last week’s column you recommended that people who have Medicare Supplements G or F change to N. I’m afraid to do that because N has Excess Charges. Is my fear founded? Can you fully explain what Excess Charges are and how they work?
Answer:
You don’t need to be afraid to switch to N due to Excess Charges for several reasons.
1) It’s illegal to bill Excess Charges in Pennsylvania as well as seven other states.
2) Only Doctors who don’t accept “Medicare Assignment” can bill Excess Charges. It’s estimated that only 7% of doctors do not and they generally fall into two categories: Primary or family doctors who’ve decided they just don’t want to deal with taking insurance. They work for cash only and aren’t interested in making claims to Medicare or private insurers. The others are doctors who treat the Uber rich such as movie stars, Wall Street CEO’s, foreign dignitaries, etc. They work out of places like Manhattan, Miami Beach, Los Angeles, and Palm Springs. Even after charging the maximum Excess Charges, 15%, these doctors would be working for pennies on the dollar compared to what their clients pay. They aren’t interested in giving that kind of discount to people like you or me.
3) There isn’t a full-service medical hospital in the country that doesn’t accept Medicare Assignment. As the population continues to age and people live longer, they don’t have a choice. It wouldn’t take long for a hospital to become wildly unpopular if they decided to bill people more than their competitors, which would lead to treating fewer patients. I imagine it also would cause billing nightmares. By the time they had to hire more people to work in billing and pay agencies to collect unpaid bills, the Excess Charges probably wouldn’t generate any extra profit. You might now ask “Even if the hospital accepts Medicare Assignment, what if the surgeon or anesthesiologist doesn’t?” That would be extremely, extremely rare. First, the majority of physicians are employees of a hospital system in today’s healthcare environment.
There are very few independent doctors left, especially surgeons who need to perform procedures in hospitals and outside of their own facilities. Secondly, doctors must meet certain criteria to get hospital privileges. I assume taking Medicare Assignment would be one.
4) Never. Not one single time, have we gotten a call from a client who has been billed Excess Charges. Plan N was introduced in 2010. I recognized the value immediately, and it has been the most popular plan among our clients since. We have sold over 3,000 Plan N policies. We make sure our clients understand the bills they are responsible for no matter what plan letter they choose. With N, it’s three bills and three bills only; the Medicare Part B deductible ($198 in 2020), a $20 co-pay at a primary care doctor or specialist, and $50 at the Emergency Room. They are well aware they pay $0 after their deductible has been met for services such as blood tests, X-Rays, MRI’s, CT Scans, hospitalizations, surgical procedures, durable medical equipment, diabetic supplies, Chemo, radiation, outpatient rehab, Skilled Nursing, etc. We instruct them to contact us right away if they get a bill for any of these services or one in excess of $20 for an office visit or $50 at the Emergency Room. We would know if billing Excess Charges were even a rare occurrence.
Today’s topic is regarding Supplements. However, I want everyone to understand that Advantage Plan HMO’s and PPO’s work very differently in regards to what bills one is responsible for, what doctors and hospitals one can access, how medical services are approved or authorized, how they are regulated, and what they cost. It’s vital to understand the pros and cons of both types of plans when making a choice. This is especially important for those going on Medicare Part B for
the first time, as this is generally the one and only chance people have to get a Supplement without their medical history being considered. That’s not the case with Advantage Plans. They must accept everyone who has both Medicare Parts A and B, regardless of past or present health issues, with only one exception.
If you are turning 65 soon or thinking about retiring, give us a call to set up a no cost consultation. Our agents are brokers, appointed with virtually every competitive Advantage Plan, Supplement, and Part D plan available on the market. Do not make the common mistake of simply calling the company you currently have your insurance with and buying a plan. Many companies won’t explain Supplements or even mention them as an option.
And if you already have Medicare, feel free to contact us to get a second opinion on what plan you may have enrolled or renewed in during the Annual Election Period which ended December7th. I’d also like to remind those readers who don’t live within a convenient drive to one of our three Western PA locations in Forest Hills, Connellsville, or Erie, we can consult over the phone or via virtual appointment, which is almost like sitting across the desk from an agent. You can also call with any questions or email me personally at aaron@hisc-80ff94.ingress-daribow.easywp.com. And don’t forget to follow us on Facebook for information on the latest news regarding Medicare and prescription drugs, which is going to be a hot topic as the House of Representatives debate and introduce bills that will supposedly attempt to reduce the costs of brand name medications.
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