Ask the Medicare Specialist

QUESTION:

From Diane: The one thing that has kept my husband and I from moving to Supplement Plan N is the prospect of Excess Charges. You did address it a bit in last week’s column, but I’m hoping you can get into more detail and explain why you say people don’t need to be concerned?

ANSWER:

Excess Charges have been a hot topic and I’ve received several questions regarding this the last couple of weeks. It’s one of many sources of misinformation, or lack thereof, when it comes to Medicare.

Let me say this again. Those on or considering Plan N don’t need to worry about being billed Excess Charges. I, nor the other licensed agents at The Health Insurance Store would ever write a policy that would put a client at financial risk or leave them hung out to dry if in need of expensive medical care or access to the best doctors and hospitals. There is zero financial incentive for us to recommend Plan N. In fact, the opposite is true as we’re paid smaller commissions when clients choose N rather than G or F. In the 13 years the Health Insurance Store has been in business, we’ve enrolled over 4,500 clients on Plan N. We’ve never heard from and single one who was billed Excess Charges.

Here’s why. Although irrelevant, it’s illegal to bill Excess Charges in Pennsylvania. Why is it irrelevant? Because there are very few doctors who don’t accept Medicare Assignment in the United States and they’re the only physicians who can charge more than the Medicare approved amount. In today’s health care environment, for better or worse, more and more doctors are employed by hospitals and health systems and accept all insurance their employer does. Every full-service hospital in the country accepts Medicare Assignment, meaning all their employees do as well.

And Let me be clear again. You will not end up in an Emergency Room, operating room, or be admitted to a hospital in the United States where you would have to pay more than Medicare’s maximum billable amount.

As the US population ages (18% of Americans were on Medicare in 2019), doctors, mainly specialists, must accept Medicare if they want to remain in the medical field. As I mentioned in the last column, the only doctors I’ve ever come across who don’t take Medicare are your rare PCP who’s decided not to accept any insurance at all, and possibly a mental health therapist or two. But otherwise, you won’t find doctors who don’t accept Medicare. Those who don’t generally treat the wealthiest and most powerful people in the country, or the world for that matter, not you or me. They get paid as much as ten times or more than what Medicare reimburses. Even if they added on Excess Charges, which has a 15 % limit on top of Medicare’s billable amount, they would still be working for pennies on the dollar.

Do you remember when he died Michael Jackson had a personal physician, Conrad Murry? He was getting paid $150,000/month by the singer. Dr. Murray didn’t see Medicare patients. Nor do others who treat movie stars, entertainers, Wall Street CEO’s, and those flying into the US, paying cash to get their medical care. They have private practices in places like New York City, Washington DC, Beverly Hills, and Palm Springs.

It’s can be an expensive mistake for people who don’t choose N when they initially go on Medicare B or fail switch from another plan while their health allows out of fear that Excess Charges or other Medicare covered services could cost thousands of dollars as opposed to G or F. IT CAN’T HAPPEN! IT WON’T HAPPEN! Not at UPMC, AHN, Excela, John’s Hopkins, Cleveland Clinic, Mayo Clinic, MD Anderson Cancer Center, or any other hospital you might choose to have a surgery, other procedure performed, or wind up in an emergency.

Plan N is a great way to save money on premiums while giving up next to nothing in terms of benefits. The only difference between Plan F (or C) and N is the Part B deductible of $203, a $20 physician’s office co-pay and $50 Emergency Room co-pay (waived if admitted). That’s it. The average savings for those who switch from Plans C and F is now close $1,500 per year.

G and N both have the same deductible, $203. The only difference are the co-pays on Plan N. The average savings for those moving from G to N is around $500 per year, or the equivalent of 25 doctor office visits. And remember, physical therapy, blood work, allergy or other injections, scans, surgical procedures, etc., are not subject to a co-pay. It’s also important to remember that the savings on Plan N will only increase as time passes. F is going up at almost five times the rate as N. G is also rising faster. I predict the savings over the next 10 years for those who have N today, compared to those on G and F, will be as much as $7,000 to $20,000!

Please be advised that those who have been on a Supplement more than six months must go through Medical Underwriting to change plan letters, even within the same company. Medical Underwriting is the process where insurance companies consider one’s current and previous health issues when determining who they accept into their plans. There are no physicals, however.

If you would like to see if you can pass underwriting or get a quote on a Supplement, please call one of our offices or email me personally. You can also request an appointment for a no-cost consultation as well. We’re once again scheduling in person meetings for those who are comfortable doing so. We also appreciate and respect those who wish to take a more cautious approach and will continue to offer phone and Zoom appointments.

I would like to apologize for many of the columns being temporarily removed from our website. They are once again being uploaded a day or two after they run in the paper. Look for a return of our webcasts and podcasts very soon as well.