Question from Monica:
I looked in my “Medicare & You 2024…The official U.S. government Medicare Handbook” on page 34 for what and if chiropractic services are covered. It says “You pay 20% of the Medicare-approved amount. The Part B deductible applies.” I’m not sure of what the “Medicare-approved amount” is. Can you shed some light on this?
Answer:
The “Medicare-approved amount” is what Medicare pays to a healthcare provider who has agreed to participate in the program, also known as “accepting Medicare Assignment.” All full-service hospitals, with the exception of VA facilities, and major health systems as well as every physician who is employed by them accept Medicare Assignment. A very important aspect of this concept for those on Original Medicare and a Supplement is any provider who accepts Medicare Assignment, by law, must take what Medicare and the Supplement reimburses as payment in full and cannot charge more than that amount unless otherwise stated in the Supplement policy. For example, those on Supplement Plan G have a $240 deductible that is not reimbursed by Medicare or their Supplement, and those on N have the same deductible along with two co-pays: $20 at a physician’s office visit and $50 at the ER. Otherwise, there are no other out of pocket costs for Medicare covered services. I’ve been asked too many times to count, “what about Excess Charges on Plan N?” That’s never an issue. As I explained in last week’s column and just wrote, zero hospitals outside the VA system and only doctors who treat the uber rich don’t accept Medicare Assignment. We’ve never had a Supplement client who was billed for Excess Charges, and it should not be a reason to avoid Plan N which can save thousands of dollars per year in premiums versus Plans C, F, and G. Anyone who has plans C or F, and almost everyone on G, who can change to Plan N should do so immediately. Moving Supplement letter Plans or companies can be done all year and isn’t limited to any enrollment period.
A similar concept as Original Medicare and a Supplement is in play when it comes to Medicare Advantage plan HMOs and PPOs. Any provider who has signed a contract to be “participating,” aka “in network,” with an Advantage Plan insurance company agrees to a set level of compensation from that carrier for each covered service. These network providers can’t charge a patient any more than the co-pays or coinsurance (cost sharing) that the insured has which are published in their Summary of Benefits or Evidence of Coverage. Some examples of co-pays and coinsurances with the Advantage Plans that we recommend to our clients are as follows: $0 for blood work, $20 for an X-ray, $90 for the ER, $200 for a CT scan, MRI, or outpatient surgery, $250 for a hospital stay, 20% chemotherapy or other injected and infused drugs, etc. It’s a violation of CMS regulations for a network provider to knowingly charge a patient any more than their co-pay or coinsurance in addition to what they were reimbursed by the insurance company. It’s extremely important for those on Advantage Plans to be familiar with what their cost sharing is because as I also addressed in last week’s column, it’s very common for those on Advantage Plans (and Supplements) to get overbilled due to any number of errors. Failure to be familiar with one’s co-pays can often result in wasting money on an erroneous bill.
I’d like to take advantage of the extra space I have in this column to once again let retired and active US Postal workers know there’s a very important development for current and future retirees. 2025 will see the introduction of a Postal Service Health Benefits initiative as a carve out of the Federal Employees Health Benefits (FEHB) program which will have new Medicare specific plan choices. Those who aren’t yet retired will not have the same non-Medicare options as current retirees do. Up until this point, those who retired from the Post Office could opt out of Part B when enrolling in the FEHB plans. However, this triggered the “clock to start” for a late enrollment penalty of 10% of the current Medicare Part B premium for each year one went without. Those who retire from the Post Office after 2025 won’t have the option to opt out of Part B and will either need to go on a new Medicare USPS retiree plan or choose a Supplement or Advantage Plan on the open market. USPS retirees who previously opted out of Part B won’t be forced to enroll in Part B or pay the penalty and will not be forced to choose from the new plans. They will have the choice to remain in the FEHB program.
However, what the Feds are doing is giving those who opted out of Part B an amnesty period to enroll without the late enrollment penalty. It starts April 1st and runs through September 30th. The first correspondences regarding this matter have already been sent out to those who it affects. Announcements will be ongoing with instructions on how to apply. I’m highly recommending any USPS retiree who has opted out of Part B to take advantage of what is being touted as a one-time opportunity. I’m anticipating the Feds attempting to price those who don’t have Part B out of the FEHB plans with the goal of getting them into the new Medicare plans. If that indeed happens, you don’t want to be stuck with the choice of paying $300 to $500 per month for a FEHB plan or $300 or more for Part B plus the cost of the new Postal Medicare plan or one on the open market that the majority of Medicare beneficiaries choose from.
There is much uncertainty at this point unfortunately, but I will be sharing more as information emerges. I will also be posting about the new USPS benefits that will appear exclusively on our Facebook Group that has the same name as the columns. To join, simply go to our website and click the sky-blue banner at the top of the page.
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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.
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