Ask the Medicare Specialist
QUESTION:
Question from Donna: Aaron, I’m glad you clarified the misunderstanding from last week’s column regarding medical underwriting for Medicare Supplement Plan N. Also, plan N allows for the billing of Excess Charges (limited to 15%) by those providers who don’t accept Medicare Assignment. Pennsylvania is one of several states that prohibit Excess Charges. However, neighboring states where some residents may receive medical care do not have these same prohibitions. Cleveland Clinic comes to mind as well as Johns Hopkins and West Virginia University Medical Center (Ruby Memorial) as facilities where local residents could go for medical care. While it’s highly unlikely that medical providers in these states and facilities don’t accept Medicare assignment, anyone from SW PA considering plan N who does receive medical care from out of state providers should do their due diligence to ensure their providers accept Medicare Assignment.
ANSWER:
I realize this isn’t in question form, however, it’s so important for me to address the issues Donna mentions, define Excess Charges, and eliminate the fear of not having coverage for Excess Charges. That shouldn’t discourage anyone from enrolling in or making a move from Plans C, F, or G to Plan N. It simply won’t happen, not in Pennsylvania or another state.
Excess Charges can happen when you receive health care treatment from a provider who does not accept the Medicare-approved amount (Medicare Assignment) as full payment. Like Donna said, it’s not legal in Pennsylvania to bill for Excess Charges, nor is it in six other states. It is in 42 others. But I just wrote, it won’t happen in any of the 50 US states or territories. Here’s why. Every full-service hospital in the United States accepts Medicare Assignment and all doctors who are employee of a health care system also accept Medicare Assignment. For example, any doctor who has a UPMC, AHN, or Excela sign on their building or door is in network with any insurance company that the health system signed a contract with. It’s not up to each individual doctor to decide what company’s insurance they want to accept, that is up to their employer.
As the independent doctor disappears, and most are now employees of a hospital or health care system, Excess Charges simply aren’t an issue. It’s almost impossible to be treated by a specialist or a surgeon in a full-service hospital who doesn’t accept Medicare Assignment. Every surgeon or doctor practicing, making rounds, performing surgery, or giving Anesthesia at UPMC, AHN, Excela Heatlh, Cleveland Clinic, Mayo Clinic, John’s Hopkins, MD Anderson Cancer Center, etc., would be an employee of those facilities and accept Medicare Assignment. We have helped close to 10,000 clients enroll in Plan N since 2010. Not once have we heard from someone who was billed Excess Charges. There is absolutely no fear that you will ever be blindsided by large bills on Plan N, or any other that didn’t cover Excess Charges. Generally, the only specialists who don’t accept Medicare Assignment are those who treat the uber rich such as Wall Street CEO’s, movies stars, and Arab Oil Emirates. Those patients pay exorbitant prices to see their physicians. And these doctors won’t see Medicare beneficiaries because they’re not interested in working for pennies on the dollar compared to what Medicare reimburses, even after adding the maximum 15% Excess Charge. Now, on occasion, it’s possible for a chiropractor or mental health therapist not to accept Medicare Assignment. But the costs are minimal for their services.
There’s also is a slowly growing trend of Primary Care Physicians opening private practices and not taking any insurance, including Medicare. They charge a flat fee or offer a subscription style service. My former PCP just did that, and his costs are between $30 and $50. But again, one knows going in what they will pay. I’m actually happy with $50 compared to the $20 copay I have with my insurance plan because he spends a full 30 minutes with me if I need it.
Donna has great intentions and advocates for seniors, but her concerns and warning are unfounded. When getting services at well-known, large hospitals or health care systems and doctors, there needn’t be any concern about getting billed Excess Charges in any state. I want to make this very clear because I know the fear of Excess Charges can be what keeps some people from moving to Supplement Plan N from the ultra-expensive C or F. And in the last month or so, I’ve really been encouraging people to make a change from G, which is the most popular Supplement plan currently, but also one that is seeing significant across the board rate increases each and every year. Plan G is well on its way to being double the cost of Plan N. We’re already meeting people as young as 70 who are paying twice what N costs. And the only difference in out-ofpocket expenses are the small co-pays for those with N, $20 for a physician’s office visit and $50 at the emergency room. So, there’s no need for people to pay $800 to $1,200 per year or more to get rid of those co-pays. And if you’re not currently paying that much more for G than N, it won’t take more than a few years before that’s reality.
It’s not just the fear of Excess Charges that keeps people from changing from Supplement G to N, or from one Advantage Plan to another. It’s fear of change in general, as I’ve written 100 times, that keeps people overpaying for premiums and out of pocket costs. It’s also misinformation that can be spread by other seniors or people who simply don’t know all the ins and outs, regulations, and exceptions of Medicare Supplements, Advantage Plans, and Part D. Never take the word of a family member, friend, colleague, neighbor, or others, no matter how good their intentions are. Contact myself or another agent for the facts.
And if you would like to make an appointment for a no cost consultation regarding Medicare, individual, or employer group, or Life insurance, give one of our offices a call or email me. Aaron@getyourbestplan.com.