What Does a Medicare Only Pt Pay for Specialist Visit?

[wehotex]

One of my Aetna HMO mbs recently cancelled recently because she swears that she pays about $25-30 for visit yo a doctor (ANY OF THEM). This is LESS than the Aetna specialist copayment of $45. What would a typical specialist charge for a visit with Original Medicare?

 

[policy doctor]

I had one lead say he pd $12 to PCP and about 21-22/specialist w just original medicare.

Even his meds were lower with AARP RX pdp preferred instead of an MAPD with anybody.....esp since his drs were not all in any zero premium network...LOL...kinda hard to overcome that one.

 

[WCMason]

One of my Aetna HMO mbs recently cancelled recently because she swears that she pays about $25-30 for visit yo a doctor (ANY OF THEM). This is LESS than the Aetna specialist copayment of $45. What would a typical specialist charge for a visit with Original Medicare?

Same as any other doctor: 20% after Part B deductible. And the fee schedule is not tied to specialty. For a doctor visit the fee is based on three factors: new patient or returning, length of appointment in time, and severity of condition being treated. Most correctly coded doctor visits would not exceed the $25-30 range she claims to be paying, often much lower. One should not choose an MA plan over Original Medicare to lower doctor visit costs; its value is its cap on the OOP, which Original Medicare does not have.

 

[yogooglethis]

One of my Aetna HMO mbs recently cancelled recently because she swears that she pays about $25-30 for visit yo a doctor (ANY OF THEM). This is LESS than the Aetna specialist copayment of $45. What would a typical specialist charge for a visit with Original Medicare?

25-30 sounds accurate and she probably likes the fact that she doesn't have to pay the 25-30 at time of service - or ever for that matter. If she is like a lot of people with Medicare only that tell me they don't pay anything for doctor visits and if it it's true it's usually because they just don't pay their bills.. It's funny how clients will fixate on the doctor co pay but aren't concerned about the cost containment for IP and a MOOP that MA offers vs. just Medicare.

 

[policy doctor]

ok but some people judge product based on their current expenses not what the future may bring.

Glad they're all different.

 

[WCMason]

ok but some people judge product based on their current expenses not what the future may bring. Glad they're all different.

That's where we come in and serve the clients, helping them understand that "what the future may bring" is where the value of insurance is greatest.

 

[policy doctor]

I don't argue with people...just consider the source and go with that.

 

[wehotex]

25-30 sounds accurate and she probably likes the fact that she doesn't have to pay the 25-30 at time of service - or ever for that matter. If she is like a lot of people with Medicare only that tell me they don't pay anything for doctor visits and if it it's true it's usually because they just don't pay their bills.. It's funny how clients will fixate on the doctor co pay but aren't concerned about the cost containment for IP and a MOOP that MA offers vs. just Medicare.

Sure, but if you're proposing an overpriced turkey Aetna plan with $6,700 MOOP, it's somewhat of a struggle.

 

[WCMason]

Sure, but if you're proposing an overpriced turkey Aetna plan with $6,700 MOOP, it's somewhat of a struggle.

Don't propose that. Propose a better MAPD or a med supp. Less struggle for you. Better coverage than Original Medicare alone for them. Everyone's a winner.

This AEP I had nearly 150 people in a $0 MAPD going to $90, high OOP. Moved every one. None went to Original Medicare except those who also got a med supp from me. No struggle.

 

[yogooglethis]

Sure, but if you're proposing an overpriced turkey Aetna plan with $6,700 MOOP, it's somewhat of a struggle.

This client sees no value in the imminent benefit of not having to pay 147.00 part b deductible and also a free part D plan worth about $600.00?That right there will buy her about 25 visits to the specialist vs having Medicare only - not to mention the most important benefit of having the MOOP financial safety net.