Plan N Copays

[somarco]

Some of us drew a high lottery number.

Mine was 276.

The only way they were getting my butt was if the VC crossed the Mississippi.

 

[yorkriver1]

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

Rick

In Chico, lol, but, great tacos, no doubt! Have to "go back to Cali"….

Thanks for % of docs taking Medicare assignment. Still have carriers telling some stories about excess charges. One was so large, I was trying to imagine a $300k specialist bill that could possibly result in $30k excess charges for extended hospital and surgery situation. Then, too, maybe that was the "raw" bill before Medicare excess charge rates were applied.

There was a recent article in NYT about physicians deliberately bringing in pals not in network to consult during surgery, then bill patients in 6 figures. That could be Medicare fraud and abuse, so maybe not doing it with Medicare patients.

 

[somarco]

trying to imagine a $300k specialist bill that could possibly result in $30k excess charges

Xs only applies to OV, not professional services.

 

[yorkriver1]

OK, I was talking about Medicare Excess charges, which are not covered on Plan N. Are you talking about the Plan N out of pockets for Part B charges? Sounds like it. Thanks for the clarification, it is helpful for Plan N OOP charges, which are confusing. Not clear on most Plan N charts as to what services exactly get charged OOP and which are paid 100%.

 

[somarco]

Xs charges only come into play with docs that do not accept assignment, and only apply to the office visit. Professional services such as outpatient surgery, radiology, etc are not subject to xs charges.

These links provide excellent explanations of xs.

Participating vs. Non-Participating | Cahaba Government Benefit Administrators

Medicare Options -- Regulatory -- AAFP

Medicare Patients

 

[yorkriver1]

Thanks for the docs, helpful. So then why would we even remotely worry about excess charges not being covered on Plan N? Not even close to the possibilities on MAPD's, and the savings from Plan F. Wow, I coulda had a V-8 for all the sad clown songs in my head worrying if I was doing the right thing.

https://www.youtube.com/watch?v=pn_eS2XFZ5g

 

[somarco]

There is no comparison in N vs MAPD.

Xs charges are essentially a non-issue.

I just ran a comparison of N + PDP vs MAPD for a guy with type II diabetes. Among other things takes Metformin and Victoza.

I found some PDP plans with low annual Rx costs for around $100/mo + $3000 OOP for Rx.

Highest OOP on PDP was $10K.

Checked MAPD plans.

The one he said he wanted were $0 premium but had Rx costs of $9500.

He is not real happy with his Rx costs but now that he knows his $0 premium plan is going to cost him $9500/yr for Rx.

He is not looking at MAPD any more.

 

[yorkriver1]

When you consider the constant need to check who is in and out of network, that's another argument for Med/Supp. My under 65's on SSDI would jump for something like Plan N, and yes, I have found a couple RX plans that were much better for clients with certain drugs. This reminds me to help the spouse of one of my clients get a Med/Supp right away when T65 in the spring. Many health concerns.