Medicare Supplement Plan N

[somarco]

.Physician owned hospitals, who are allowed to turn away patients based on need. They don't have to take assignment.

I should have been more explicit when I tagged hospitals that do not accept federal funds as being exempt from Medicare assignment. Yes, privately owned hospitals that do not receive any federal monies, including from Medicaid patients, are not required to accept assignment.

Hospital inpatient charges do not fall under excess charges but their outpatient services, such as ER could bill for excesses subject to the cap.

Aren't "physician's services" billed to Part B, even as an inpatient?

Yes, but that has nothing to do with hospitals that do or do not take assignment.

 

[midwestbroker]

The only major hospital / clinics I know of that do not accept Medicare assignment are some Mayo clinics (I know some don't take it, but not sure about all of them).

Not taking assignment, providers are paid at 95%, and they can choose on a case by case basis to charge excess charges, which factor to 9.25% over the Medicare approved amount that they patient will have to pay.

Limiting charges = 115% (there is your 15% above the 100% approved Medicare amount)
Non-Participating providers = 95% reimbursement
1.15 x .95 = 1.0925 (9.25%)

Roughly 4% of doctors in the Medicare system are non-participating.

I do agree that it is possible as reimbursement changes happen, some providers can change to non-participating which will give them the ability to charge more. It is also possible that doctors may just run more tests or other services to charge Medicare more money.

Note - Connecticut, Mass, Minnesota, New York, Ohio, Penn, Rhode Island and Vermont do not allow Medicare excess billing.

 

[cladams]

Of course none of us know exactly what to expect in years to come, we can only look ahead and give our best personal assessments. I would imagine that other states will follow suit and not allow excess billing also, but which ones?

Personally, If I were turning 65, I would chose the Plan G in order to eliminate the hassel of confirming whether the provider is participating or not (4% non-par now - got it). It is worth the peace of mind, knowing the current state of flux in the healthcare market, and the inevitable continuous change. Those changes could reach assignment, which could affect participation, which could prompt providers to charge excess. I just assume to pay to take away that variable.


Valid point about the likelihood of providers simply billing Medicare for more procedures, as opposed to trying to collect excess charges from patients. Easier for providers to get it from uncle sam, than to get it from "uncle Bob's" SS check.