Plan N Part B Excess Charges
- Thread starter jdgilbys5
- Start date
Depends on where you live. Here in FL I think the statistic is that approx 5% of doctors do not accept assignment. Which means they charge excess charges. The ones I've come across have all been for office visits. CMS limits the excess charges to 15% over what was approved. So, if the doctor billed $200 and Medicare approved $100, then Medicare would pay $80 and the client would pay the other $20 + $15 for excess charges. Me, I'm a Plan F guy. There's only a $30-$40 difference in premium. After they pay the $155 part B deductible $155/12=$13/mo. that only leaves a premium difference of $17-$27. If they go to the doctor once, that's taken care of in the co-pay. The emergency room co-pay takes up 2 mos premium savings. If you add any excess charges at all, then, the client would have been better off with the F. Not to mention that seniors (most of the time) love to give the doctor the supplement card and not have to pay anything. A lot will, over time, question why am I paying a premium and then having to pay the doctor bills? I think if you write these N Plans you're just asking for an agent who sells MA plans for $0 or very low premiums to replace your business.
All of the second part is just my opinion, and, I'm sure others will have an opposite one. Good Luck.
All of the second part is just my opinion, and, I'm sure others will have an opposite one. Good Luck.
- 1,240
Most doctors and hospitals accept assignment and won't overcharge. like lflashman posted above, the government has put a cap on the amount a doctor can overcharge...15% of Medicare's approved amount.
You might want to show your clients both plans and let them decide.
You might want to show your clients both plans and let them decide.
- 4,707
The math on whether plan F or plan N is better varies by state. In California, I have always sold F and all my clients are happy.
- 7,066
Everyone's clients will be "happy" with Plan F unless they talk to me. 
In states where Plan F is substantially more expensive than Plan D I can always walk away with an app and my new clients have never, in sixteen years, ever ended up getting "screwed" financially because they didn't have a Plan F.
I have been selling Med Supps for over sixteen years and I neither sell Plan F nor recommend it. I have clients throughout the US. Excess charges are not an issue regardless of where one is. I only sell either Plan D or Plan G if the company doesn't offer a Plan D.
ALL hospitals Accept Assignment so that is NEVER an issue.
The "cap" on Excess charges really isn't a true 15%. Medicare reduces the amount they would normally approve by 5% then the doctor can add the 15%. If one does the math, the doctor only receives an extra 9.25%. That is why virtually all doctors Accept Assignment.
Plus, if the doctor Accepts Assignment the checks from Medicare and the Insurance company go directly to the doctor. If the doctor does not accept assignment then the checks from Medicare and the Insurance company go to your client. Now the doctor has to worry about late pays and no pays.
It is not financially advantageous for the doctors not to Accept Assignment.
In states where Plan F is substantially more expensive than Plan D I can always walk away with an app and my new clients have never, in sixteen years, ever ended up getting "screwed" financially because they didn't have a Plan F.
I have been selling Med Supps for over sixteen years and I neither sell Plan F nor recommend it. I have clients throughout the US. Excess charges are not an issue regardless of where one is. I only sell either Plan D or Plan G if the company doesn't offer a Plan D.
ALL hospitals Accept Assignment so that is NEVER an issue.
The "cap" on Excess charges really isn't a true 15%. Medicare reduces the amount they would normally approve by 5% then the doctor can add the 15%. If one does the math, the doctor only receives an extra 9.25%. That is why virtually all doctors Accept Assignment.
Plus, if the doctor Accepts Assignment the checks from Medicare and the Insurance company go directly to the doctor. If the doctor does not accept assignment then the checks from Medicare and the Insurance company go to your client. Now the doctor has to worry about late pays and no pays.
It is not financially advantageous for the doctors not to Accept Assignment.
- 4,707
- 7,066
You would be the rookie in my office
I understand. I'm still "wet behind the ears" but I'm working on "catching up" though.
- 18,988
I understand. I'm still "wet behind the ears" but I'm working on "catching up" though.
Would you still reccomend D over F if the annual premium difference is only $125 to $175?
I'm looking at now where there is $12/mo difference between D and F. Why would anyone go for D in that situation?
- 7,066
I think we have had this discussion before and you should know that I am referring to states where Plan F is substantially more than a Plan D.
What I said in the above post is "In states where Plan F is substantially more expensive than Plan D". I have seen Plan F priced $600 more than a Plan D. Would you still sell a Plan F? I would hope you wouldn't, then why ask me a similar question where Plan D is priced very close to a Plan F? Unless you just want to argue.
It should be obvious to anyone that if the difference is equal to or less than the Medicare Part B deductible that no one would recommend a Plan D or G.
There are states where Plan F is actually less expensive.
- - - - - - - - - - - - - - - - - -
Thank you for that enlightening comment. Is it possible that you didn't read what I posted?
Last edited:
