One of your recent articles says “The only difference between Supplement Plans G and N are two small co-pays those on N pay, $20 at a physician office visit, be that a PCP or a Specialist, and $50 at the Emergency Room. Services like Physical Therapy (PT) or allergy injections are not subject to the co-pay.” I’ve been struggling for months trying to decide whether to shift to plan N from F and held off because i have a lot of PT visits. Everything I read in the past just mentioned “office visits”. I’ve called Medicare and was passed around to a number of people. The final gal who answered told me PT visits were considered office visits and were subject to co-pays. Who does one contact at Medicare to get correct answers?
The representative who told you that PT is subject to the copay was wrong
It’s not. We have thousands of clients on Plan N. The only co-pays are at “physician office visits” as you mentioned. Physician and office being the two key words. As far as PT or allergy injections are concerned, a doctor isn’t providing the service. Those and others such as CT scans, MRI’s, X-Rays, blood work, etc., where a doctor isn’t involved also don’t include a co-pay. Nor do other procedures that physicians perform such as surgeries, or when they visit patients who are admitted to the hospital. Co-pays are only applicable when one visits a physician in his or her office. Period.
As far as who one contact at Medicare to get correct answers
Sadly, Madeline’s experience is not uncommon at all. Medicare’s website, medicare.gov, can be helpful to some extent if one can find the page where you type a couple words or phrases in a search bar that can confirm if a treatment or service is covered. Google can also be helpful just by asking a question such as, “does Medicare cover XYZ?”
Our clients don’t have to worry about calling Medicare or surfing the internet because they can simply ask one of our staff members these types of questions. We almost always know the answer, eliminating the frustration of being transferred back and forth, or getting conflicting, or in Madeline’s case, wrong information. One of the best pieces of advice I’ve ever received in my 25-year career in sales was, “never guess when someone asks you a questions you don’t know the answer to without 100% certainty. Say you don’t know, go find the answer, and give it to the customer after your research is complete.” That’s exactly what we do on the occasions we get stumped.
I want to address what Madeline said about being torn on moving from Plan F to N.
No one who can pass medical underwriting should give leaving Plan F or C a second thought. If nothing else, move to Plan G, which works exactly the same as F once the small Part B deductible of $203 has been met. Once it has, like F, there are no bills for any Medicare covered services. I guarantee Madeline is paying at least $300 to $400, probably more, per year for F than what G would cost. In 5 years, that will be closer to $1,000. It makes no sense to spend $300 to $1,000 to eliminate $200 in bills.
So many people are fearful of moving from Plans F and C because they’ve never received a bill for Medicare covered services. They worry that changing plan letters could lead to being responsible for thousands of dollars. It simply can’t happen with either Plan G or N. Unfortunately, this line of thinking is still an extremely common and expensive mistake.
When calculating if N is a better value than G, it’s simple. For someone like Madeline, N, at a minimum of around $40/month or $480/year less than G. At $20 per doctor visit, she would have to visit a PCP or specialist 24 times to get equal value from Plan G as N. All those who have G are doing is pre-paying for doctor visits they aren’t likely to use. And as I tell all my clients, if you’re going to the doctor that many times in a year, you probably have a lot more to worry about than if Plan N is costing you $100 or $200 more per year than G would. For the most part, we recommend G only to those who consistently utilize a therapist or counselor for mental health purposes two to four times a month.
As we also discussed in a recent column, those wanting to move to a Supplement from an Advantage Plan must pass medical underwriting. That also holds true for those who want to move from one Supplement letter plan to another, even within the same company. So, while debating on changing plans, one could be diagnosed with a condition that would prevent a move to a less expensive plan. Unlike Advantage Plans, however, those on Supplements can change any time during the year and don’t need to wait until 2022 to do so.
If you have any questions on this topic, want a quote on a different Supplement Plan letter of company, or would like to set up an appointment for a no-cost consultation, please call one of our offices or visit our website. You can also email me if you would like to submit a question for a future column.
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