Medicare Supplement Plan N

steveadlman

Guru
100+ Post Club
When a person is in the hospital as an inpatient does the $20 copay apply when a doctor sees them at the hospital whether it be their doctor or a staff doctor assigned to them by the hospital? Or does the $20 copay only apply when they see their doctor at his office?
 
When a person is in the hospital as an inpatient does the $20 copay apply when a doctor sees them at the hospital whether it be their doctor or a staff doctor assigned to them by the hospital? Or does the $20 copay only apply when they see their doctor at his office?

At the office..................
 
When a person is in the hospital as an inpatient does the $20 copay apply when a doctor sees them at the hospital whether it be their doctor or a staff doctor assigned to them by the hospital? Or does the $20 copay only apply when they see their doctor at his office?
No copay at hospital. The copay (really a 20% coinsurance with a $20 cap) applies only to a small number of CPT codes, all for traditional doctor office visits.
 
When a person is in the hospital as an inpatient does the $20 copay apply when a doctor sees them at the hospital whether it be their doctor or a staff doctor assigned to them by the hospital? Or does the $20 copay only apply when they see their doctor at his office?

the most they might have to pay is $147 deductible
 
I recently signed up a guy under plan N from plan G this last summer, he was healthy, went to the doctors a couple of times a year. Well he switched out of the plan N, he had a whole bunch of things go wrong and the doctor copays (all were $20) was beginning to eat up all the profit from the plan change, so back to F he goes....I guess I am somewhat partial to plan N, I have seen quite a few rate increases for plan N's around the country and it just puts me on guard.
 
I recently signed up a guy under plan N from plan G this last summer, he was healthy, went to the doctors a couple of times a year. Well he switched out of the plan N, he had a whole bunch of things go wrong and the doctor copays (all were $20) was beginning to eat up all the profit from the plan change, so back to F he goes....I guess I am somewhat partial to plan N, I have seen quite a few rate increases for plan N's around the country and it just puts me on guard.

In my area its around 22 visits a year to eat up the savings from a plan N if the bill was indeed $20. Most clients tell me it's around $13 which equates to about 34 visits. That's a lot of visits but I'm sure some could hit it. Luckily here in FL United healthcare lets people switch to plan F at any time with no health questions.
 
When a person is in the hospital as an inpatient does the $20 copay apply when a doctor sees them at the hospital whether it be their doctor or a staff doctor assigned to them by the hospital? Or does the $20 copay only apply when they see their doctor at his office?

the most they might have to pay is $147 deductible

There is no $147 deductible for hospital inpatient.
 
There is no $147 deductible for hospital inpatient.
True, but the part B deductible will be involved with any hospital stay--if not already met--due to related medical services. That's what I took him to mean, anyway.
 
I recently signed up a guy under plan N from plan G this last summer, he was healthy, went to the doctors a couple of times a year. Well he switched out of the plan N, he had a whole bunch of things go wrong and the doctor copays (all were $20) was beginning to eat up all the profit from the plan change, so back to F he goes....I guess I am somewhat partial to plan N, I have seen quite a few rate increases for plan N's around the country and it just puts me on guard.

It may be more of an emotional reaction to paying bills rather than a straight up $ to $ lack of savings. No question, F is a crowd pleaser when it comes to "it just pays". Then when the rates keep going up, not so happy.

N is so far ahead of Medicare Advantage plans for MOOP, if anyone can afford it, I try to get them there.

I have a family member on N, and the office visits vary from about $10 to about $16. It's still a pretty amazing plan when you consider all of the outpatient services that won't have coinsurance to pay.
 
If they are going to the Dr every other week, clearly the Plan N may not be a good fit. For me though, the Dr's office coins/$20 cap is not so much the main concern, as is the future potential of "part B excess charges."


I know that "part B excess charges" have not been a regular issue with the Plan N to date. In the years to come however, if Medicare assignment is scaled back, I can see more providers elect to be non-participating, and charge the additional 15%. Obviously, the 15% would not be that significant for lesser charges, but could potentially be significant with more expensive services. I explain this to clients, and recommend the Plan G for this reason, as it removes the possibility of 15% surprises down the road, while still being in a plan with a more stable premium (more stable than "F" anyway).

I realize this is based on my speculation about Medicare assignment being scaled back as the under 65 moves toward a single payer system. Does anyone else share this same concern?
 
Back
Top