Plan G risks or lack thereof

[Winter_123]

Out in the real world, where the rubber meets the road, has anyone encountered any real problems or heard of any real problems from clients who signed up for say, Plan G, where the excess charges are not completely covered?

What's the best way to size the risk to the client here? Obviously you dont want to cheap out. On the other hand, you dont want seniors paying to cover something that is akin to getting hit by a meteorite.

Whats the prudent way of thinking about this?

Thanks,

Winter

 

[GreenSky]

Out in the real world, where the rubber meets the road, has anyone encountered any real problems or heard of any real problems from clients who signed up for say, Plan G, where the excess charges are not completely covered?

What's the best way to size the risk to the client here? Obviously you dont want to cheap out. On the other hand, you dont want seniors paying to cover something that is akin to getting hit by a meteorite.

Whats the prudent way of thinking about this?

Thanks,

Winter

I've yet to have a client whos doctor accepted Medicare but not assignment. But look at it from a risk-reward basis.

If a doctor wanted to charge the 9.25% more (15% of 95%) on a 100 procedurek, it's $9.25. Plan G pays 80% of that leaving about $1.80. Most people can afford that.

The premium difference between F and G is usually a great deal more than the risk even taking into account the payment of Medicare Part B.

I much prefer G to F because of the premium savings - sometimes $300-600. Plan D is even a better value however if the senior really wants excess charges covered, you can easily "convert" them to Plan G.

You can throw all that out the window if F or J is within $150 of G. Then the are decent values.

I know that Frank is concerned about future premium increases which are typically lower with D or G. In California that is not an issue due to the annual GI provision for Med Supps. Perhaps it would be an issue elsewhere.

Rick

 

[Winter_123]

I've yet to have a client whos doctor accepted Medicare but not assignment. But look at it from a risk-reward basis.

If a doctor wanted to charge the 9.25% more (15% of 95%) on a 100 procedurek, it's $9.25. Plan G pays 80% of that leaving about $1.80. Most people can afford that.

The premium difference between F and G is usually a great deal more than the risk even taking into account the payment of Medicare Part B.

I much prefer G to F because of the premium savings - sometimes $300-600. Plan D is even a better value however if the senior really wants excess charges covered, you can easily "convert" them to Plan G.

You can throw all that out the window if F or J is within $150 of G. Then the are decent values.

I know that Frank is concerned about future premium increases which are typically lower with D or G. In California that is not an issue due to the annual GI provision for Med Supps. Perhaps it would be an issue elsewhere.

Rick

How does that 15% of 95% piece work. I don't follow that.

As background let me ask this: How does the 15% apply? Say if a client has a 100 dollar precedure but with a doctor who does not take assignment. Does this just make it a 115 dollar prededure now and then both medicare pay their share of that, or how does that work?

Winter

 

[GreenSky]

How does that 15% of 95% piece work. I don't follow that.

As background let me ask this: How does the 15% apply? Say if a client has a 100 dollar precedure but with a doctor who does not take assignment. Does this just make it a 115 dollar prededure now and then both medicare pay their share of that, or how does that work?

Winter

If a doc does not take assignment, they can increase the cost by 15% of 95% of Medicare, not 15% of 100%.

Medicare still pays their share so using your calculations:

$100 procedure
Medicare pays $80
Doc charges 115% of $95 = $109.25
$109.25 minus $80 = $29.25
Supplement pays 20% of $100 = $20
Balance remaining $9.25
Plan G pays 80% of $9.25 or $7.40
Patient still owes $1.85

So the doctor must still do all the billiing but he/she will not be paid directly by either Medicare or the Supplement. The patient waits to receive payment and then the doc must hope the bill is then paid to him.

All of this to make an extra $9.25! If the procedure was $5,000 (almost impossible with Medicare), then the excess charge he could collect would be $462.50. How many docs take a chance that the patient doesn't pay $5,462.50?

That's why almost everyone accepts assignment with the exception of perhaps those in Beverly Hills and Al's neighborhood.

If you want to discuss this more, feel free to call Frank at his place or for correct answers, call me at 818-342-9200. (Had to bust Frank's balls a little).

Rick

 

[Winter_123]

If a doc does not take assignment, they can increase the cost by 15% of 95% of Medicare, not 15% of 100%.

Medicare still pays their share so using your calculations:

$100 procedure
Medicare pays $80
Doc charges 115% of $95 = $109.25
$109.25 minus $80 = $29.25
Supplement pays 20% of $100 = $20
Balance remaining $9.25
Plan G pays 80% of $9.25 or $7.40
Patient still owes $1.85

So the doctor must still do all the billiing but he/she will not be paid directly by either Medicare or the Supplement. The patient waits to receive payment and then the doc must hope the bill is then paid to him.

All of this to make an extra $9.25! If the procedure was $5,000 (almost impossible with Medicare), then the excess charge he could collect would be $462.50. How many docs take a chance that the patient doesn't pay $5,462.50?

That's why almost everyone accepts assignment with the exception of perhaps those in Beverly Hills and Al's neighborhood.

If you want to discuss this more, feel free to call Frank at his place or for correct answers, call me at 818-342-9200. (Had to bust Frank's balls a little).

Rick

Good stuff. Thanks

 

[retread]

Out in the real world, where the rubber meets the road, has anyone encountered any real problems or heard of any real problems from clients who signed up for say, Plan G, where the excess charges are not completely covered?

What's the best way to size the risk to the client here? Obviously you dont want to cheap out. On the other hand, you dont want seniors paying to cover something that is akin to getting hit by a meteorite.

Whats the prudent way of thinking about this?

Thanks,

Winter

Just to add another brick to the load, I have asked my brother-in-law, who is an M.D. if he ever refused "assignment" in order to charge more. He said "No, and I don't know any other doctors that do, either."

 

[GreenSky]

Just to add another brick to the load, I have asked my brother-in-law, who is an M.D. if he ever refused "assignment" in order to charge more. He said "No, and I don't know any other doctors that do, either."

Although I'm not a doctor, I did stay at a Holiday Inn Express, and I concur with your bro-in-law.

Rick

 

[insurance0707]

Most doctors and hospitals accept assignment, the Mayo clinic however does not. I have a client that just had a big rate increase, he has Plan F, I told him we could switch him to Plan C. He didn't want to do it because he has cancer and is going to the Mayo clinic. Also, I don't think medical equipment/supplies have that 15% cap.

I rarely see excess charges, but every once in awhile I'll come across it.

 

[patch36]

Most of my clients go with G. Some do not get or trust the math and go with F even though they will generally save at least $100 a year after they pay the $135 Part B deduct. Sometimes I just give up and sell the F when that is what they are used to and I can't make them comfortable with the Part B deduct issue. The excess charge issue seems easier to explain than the Part B deduct issue. The boomers who are aging in are much easier to explain this stuff to, but an average 77 year old doesn't always get it and will choose the convenience of never paying a deduct. At some point in the presentation I have to decide whether to give up on the math or not.

 

[G.Gordon]

95% of my clients are on D or G's with the majority on G. Never an issue.