Question form Jim :
Question from Jim: In several recent columns and since I’ve been following them, you’ve recommended people who have Medicare Supplements G or F change to N. I’m afraid to do that because N has “Excess Charges.” I know in Pennsylvania the practice is illegal. But what about when I travel or wanted to get care at a hospital like the Cleveland Clinic or Johns Hopkins? Can you fully explain what Excess Charges are and how they work?
Answer
Answer: I wish I could put a dollar figure on how much money fear and misinformation cost seniors each year. Let me make this clear once again. You don’t need to be afraid to switch to Supplement Plan N due to Excess Charges for several reasons.
1) Excess Charges are an additional amount up to 15% more than the Medicare is contracted to pay a provider that can be billed. This is illegal in Pennsylvania and seven other states.
2) Only providers who don’t accept “Medicare Assignment” can bill Excess Charges. Accepting Medicare Assignment means agreeing to take what Medicare and the portion of the bill a Supplement pays, generally 20%, as payment in full. It’s illegal to charge more. It’s estimated that only 7% of doctors don’t accept Medicare Assignment and they generally fall into two categories: Primary care or family doctors who’ve decided they just don’t want to deal with taking insurance, work for cash only and aren’t interested in making claims to Medicare or private insurers, and those who treat the uber rich such as movie stars, Wall Street CEO’s, foreign dignitaries, etc. Even after charging the maximum 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. There isn’t a hospital in the country who has an Emergency Department that doesn’t accept Medicare Assignment. Any physician who is an employee of one of these hospitals or health care systems, the vast majority today, can’t charge more than what Medicare and any Supplement plan letter pays. For example, John’s Hopkins, Cleveland Clinic, Mayo Clinic, and MD Anderson Cancer Center accept Medicare Assignment. Therefore, their employees who supply medical services do as well. If you visit a doctor who has a sign in their parking lot or on their door, whose card has the emblem of any hospital or health care system, accepts Medicare Assignment. When a health care system or hospital signs a contract to take private insurance from Blue Cross Blue Shield, United, Aetna, UPMC, Medicare, etc., it’s a blanket contract for all their employees. Each doctor in that system does not get to pick and choose what insurance they want to take or not. They do not get to choose not to take Medicare Assignment.
4) Never. Not one single time in the 15-year history of The Health Insurance Store have we heard from a client who has been billed Excess Charges. Plan N was introduced in 2010 and I recognized the value immediately. It’s been the most popular plan among our clients since. We’ve advised well over 5,000 to choose Plan N and rarely recommend G. F is a rip-off and as such has been eliminated for sale by Medicare. What’s covered on G and N is identical except for two small bills: a $20 co-pay at a primary care doctor or specialist, and $50 for an Emergency Room visit. Just like Plan G, those on N pay $0 after their $226 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.
The average annual premium savings for someone age 70 or older who moves from Plan G to N is $1,000. That means for G to be of equal value, one would have to see a physician 50 times annually, almost an impossibility because the $20 co-pay does not apply to physical therapy, blood work, X-Rays, scans, biopsies, other tests. There is no reason whatsoever those who can pass medical underwriting should be on Plan G. None. YOU DON’T NEED TO FEAR EXCESS CHARGES. Let me repeat: It’s not possible or legal for a full-service hospital or doctors employed by them anywhere in the country to employ that practice.
A quick reminder; The agents at The Health Insurance Store are brokers, appointed to provide Medicare Supplements, Part D prescription, and Advantage HMO and PPO plans from every competitive company in the market ensuring all current and prospective clients unbiased advice. Consultations in person, over the phone, or via the internet are always no cost.
Contact us if you want to schedule an appointment or have questions about this or any other Medicare topic. Feel free to reach out to me via email at aaron@getyourbestplan.com.
Get Your Part D Reviewed
Another mistake those on Supplements make is remaining on their Part D prescription plan without having it reviewed professionally, which should be done every year. Two of the most popular plans are almost doubling their premiums while not offering better coverage. It’s also common for drug tiers on plans to be moved from 1 to 2, 2 to 3, and so on. Failure to change Part D plans can be extremely costly. Even if you didn’t buy your Supplement from The Health Insurance Store, we can review and recommend a plan for 2023, just like we do for all our active clients. If you’re interested, please contact us as soon as possible so we can get you the necessary form.
There aren’t many significant changes to Advantage Plans, but indeed some items worth mentioning. Probably the biggest news is the reduction of the MOOP by one of our three major companies. In 2021 they raised it significantly across the board on all their plans to the maximum allowable by Medicare. It stayed the same in 2022 and many members chose other carriers due to the increase. However, on a select number of plans, including what we feel is their best for 2023, it has been reduced by $3,000 and is now the lowest in the market for those that supply prescription coverage.
If you weren’t aware, there are no preexisting condition clauses with Advantage Plans. Anyone who has Medicare Parts A and B can change plans or companies regardless of their current or prior health, even those who have End Stage Renal Disease. All Advantage Plan companies must accept you and begin to pay claims the 1st day the policy goes into effect. In addition, all Advantage Plans must cover the same categories of benefits. As I’ve written on so many occasions, paying more in premium doesn’t get you any additional coverage for medical services! In fact, we will not be advising our current or potential clients to choose any Advantage Plan that will have a premium above $40 per month in 2023. If you are paying over $40 for your HMO or PPO, you should call or email us to set up an appointment and see side by side why paying more doesn’t equal more.
How will Inflation Affect AEP?
Lastly, due to inflation, we’re expecting this AEP, which begins on October 15th, to be the busiest we’ve ever had in terms of moving people from Supplements to Advantage Plans out of financial necessity. If there was ever a good time to do that, now is it because the most competitive plans have never been better in the 15 years I’ve been in the Medicare industry. For those who don’t like the thought of leaving a Supplement, there is some good news. You may not have to as it appears one of the biggest increases in the Social Security Cost of Living Adjustment (COLA) is going to be announced soon. It’s estimated to be from 8.5% to almost 10%. And for once, the raise will not be eaten up by a large Part B premium increase. In fact, many people believe it’s going to remain $170.10.
Thank you!
If you have any questions or concerns regarding this column topic, or would like to make an appointment for a no-cost consultation, please feel free to give us a call – we would be happy to help. I’d like to remind everyone that I do a live call-in talk show called Medicare A to Z every 1st and 3rd Monday of the month on WMBS Uniontown, 590AM and 101.1FM, from 1 to 3 PM. You can listen in on their website, wmbs590.com.
Erie County Area
1105 West 12th Street, Suite – A
Erie, PA 16501
Phone: 814-920-5275
Fax: 814-920-5276
Fayette/Westmoreland County Area
121 North Pittsburgh Street
Connellsville, PA. 15425
Phone: 724-603-3403
Fax: 724-603-3402
Pittsburgh Area
21 Yost Blvd., Forest Hills, PA 15221
Mailing Address: 128 Forest Hills Plaza, Pittsburgh, PA 15221
Phone: 412-349-8818
Fax: 878-302-3149
Albuquerque/Santa Fe, New Mexico Area
821 Coors Blvd. NW
Albuquerque, NM 87121
Phone: 505-200-0069
Fax: 505-200-0073
Serving These Areas
We proudly serve the health insurance and Medicare needs of the following Pennsylvania areas: Connellsville, Uniontown, Greensburg, Mt. Pleasant, Scottdale, Irwin, N. Huntingdon, Murrysville, Monroeville, Plum, Lower Burrell, New Kensington, Pittsburgh, Plum, Oakmont, Penn Hills, Forest Hills, Wilkinsburg, East Liberty, Lawrenceville, Bloomfield, Natrona Heights, Leechburg, Washington, Morgantown WV, Latrobe, Monnessen, Jeanette, Erie, Edinboro, Northeast, Girard, Fairview, Union City, Harborcreek, Corey, Meadville, Waterford, Ligonier, Kittaning, Somerset, Waynesburg, Fayette County, Westmoreland County, Armstrong County, Butler County, Somerset County, Erie County, Crawford County, Venango County, Allegheny Valley, Pennsylvania
We proudly serve the following New Mexico areas: Albuquerque, Rio Rancho, Sante Fe, Bernalillo, Belen, Los Lunas, Espanola, Moriarty, Corales, Tijeras, Cedar Crest, Edgewood, Soccoro, Sandoval County, Sante Fe County, Bernalillo County, Rio Arriba County, Valencia County, Soccoro County, New Mexico
Not affiliated with the U. S. government or federal Medicare program.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.