Medicare Cost Sharing Vs Specific Co-pmts

[timeflies]

More and more MAPD plans are charging $0 to 20% for certain diagnostic test, xrays, MRI's and outpatient procedures instead of charging a specified cost share of say $250-300. Although it is good to know exactly what a member pays for a test or a procedure, it seems to me that based on some of the claim notices from Medicare, the 20% could often be less expensive than the specific cost sharing. What have other agents experienced?

 

[somarco]

the 20% could often be less expensive than the specific cost sharing.

You can probably bet that is not the case.

Some higher tier drugs are also switching to coinsurance vs copay and it isn't because the copay was too high.

 

[vic120]

You can add outpatient surgery to that list as well. I have had a few that signed up with great copay & $0 when I first started in 2012. Now plan has 20% and premium, Only they are no longer able to get their GI or OE back and are just stuck. Also some have even lost their beloved Doc's

 

[kstein]

More and more MAPD plans are charging $0 to 20% for certain diagnostic test, xrays, MRI's and outpatient procedures instead of charging a specified cost share of say $250-300. Although it is good to know exactly what a member pays for a test or a procedure, it seems to me that based on some of the claim notices from Medicare, the 20% could often be less expensive than the specific cost sharing. What have other agents experienced?

I've seen this also. Coventry had a $350 CO pay for MRIs when the 20% was only $60!

It's a sneaky way to pass more of the cost onto the consumer.

 

[WCMason]

It is true that MA members may pay more than their coinsurance would have been under Original Medicare. However, they get an MOOP that they would not otherwise have. That's the trade off.