Plan N Copays

[liorselamb]

How often have you seen these charged?

I'm not on medicare yet so it doesn't count.

Just because you haven't seen it doesn't mean it never happened.

If it never happens, why plan G and F even has it covered?

 

[somarco]

Aren't you guys forgetting about no excess charge coverage with plan N?

No. If you understand the way Medicare works, it's a non-issue.

 

[midwestbroker]

Only providers who are non participating can charge excess charges, which amounts to less than 5% of the providers who accept Medicare.

Not that it never happens, it is just highly unlikely it will.

Plus, Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont have banned excess charges.

 

[NYBernie]

Only providers who are non participating can charge excess charges, which amounts to less than 5% of the providers who accept Medicare.

Not that it never happens, it is just highly unlikely it will.

Plus, Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont have banned excess charges.

I've seen the NY ban and MOM law referenced a few times on the forum. When I questioned the NYS DOI regarding the law they pointed me to a NYS Public Health law that appears to set the limit at 105%, with certain codes being exempt. Some supplies and medical equipment are also exempt (in the Federal law?).

Does this 105% limit essentially "ban" the excess charges since 105% x 95% (non-PAR providers are paid 95% of the fee schedule amount?) = 99.8% allowed charge?

Even with a 105% limit, I am still a proponent of Plan N, especially in NY where Plan G is not competitive.

Although, I'm not even sure if you can give away Med Supps in NY as I haven't yet started my insurance career. Seems like MAPDs are the big winner in this state.

 

[jvancleve]

I've seen the NY ban and MOM law referenced a few times on the forum. When I questioned the NYS DOI regarding the law they pointed me to a NYS Public Health law that appears to set the limit at 105%, with certain codes being exempt. Some supplies and medical equipment are also exempt (in the Federal law?).

Does this 105% limit essentially "ban" the excess charges since 105% x 95% (non-PAR providers are paid 95% of the fee schedule amount?) = 99.8% allowed charge?

Even with a 105% limit, I am still a proponent of Plan N, especially in NY where Plan G is not competitive.

Although, I'm not even sure if you can give away Med Supps in NY as I haven't yet started my insurance career. Seems like MAPDs are the big winner in this state.

I agree that Plan N is a great plan for many Medicare beneficiaries. Attached is CMS guidance on how the Plan N copays work; good idea to understand the details for factual presentation to clients. Office visit copays under Plan N will normally be less that $20 under proper coding. Also, Part B excess charges are indeed very rarely billed - see write up attached to understand how these work. I personally do not see Part B excess charge coverage as a tangible benefit for Medicare beneficiaries. Hope this helps....

 

[liorselamb]

I agree that Plan N is a great plan for many Medicare beneficiaries. Attached is CMS guidance on how the Plan N copays work; good idea to understand the details for factual presentation to clients. Office visit copays under Plan N will normally be less that $20 under proper coding. Also, Part B excess charges are indeed very rarely billed - see write up attached to understand how these work. I personally do not see Part B excess charge coverage as a tangible benefit for Medicare beneficiaries. Hope this helps....

Here is some good info about Excess Charges and the formula for max charges doctors can charge.

http://www.cahabagba.com/part-b/enrollment-2/participating-vs-non-participating-part-b/

 

[DS4]

Prior to OBRA in 1990, it was the wild wild west for selling med supps.
Does 60% first year commission get your attention?
OBRA did several things,
1) Standardized med supps sold after 1992
2) Established the 6 month window were you can be declined
3) Established the 2 to 1 ratio requiring second year commission to be 50% of first. (That killed 60% first year)
4) No pre ex moving from one med sup to another , and,
5) The physician limiting charge. The first year it was 140%. Over the next few year, down to 115%.

Plan F was a big seller all throughout the 90's. If a Medicare bene had surgery, the odds were the surgeon & anesth were not par providers with Medicare.

Today, most all providers except Medicare assignment.

 

[Dave020]

Prior to OBRA in 1990, it was the wild wild west for selling med supps.
Does 60% first year commission get your attention?
OBRA did several things,
1) Standardized med supps sold after 1992
2) Established the 6 month window were you can be declined
3) Established the 2 to 1 ratio requiring second year commission to be 50% of first. (That killed 60% first year)
4) No pre ex moving from one med sup to another , and,
5) The physician limiting charge. The first year it was 140%. Over the next few year, down to 115%.

Plan F was a big seller all throughout the 90's. If a Medicare bene had surgery, the odds were the surgeon & anesth were not par providers with Medicare.

Today, most all providers except Medicare assignment.

 

[GreenSky]

Today, most all providers except Medicare assignment.

And even better, most (98%) ACCEPT Medicare assignment. (Although in Chico they probably do except assignment).

Rick

 

[DS4]

And even better, most (98%) ACCEPT Medicare assignment.

Thanks for the correction.
Don't forget, I dropped out of college my last semester, two months from graduation, lacking 12 units.
Nixon ended the Vietnam war and I was basically going to college for the student deferment.
I'm not a college grad like you.