2022 Plan G vs Plan N Supplement

[wmc1000]

With the prohibition of balance billing effective 1-1-22 will it make more sense to choose plan n over plan g?

 

[REWahoo]

It is my understanding the "No Surprises Act" applies to commercial insurance only. From the Brookings Institution: Understanding the No Surprises Act

The new surprise billing protections apply to all commercially insured patients (since public insurance programs like Medicare, including Medicare Advantage, and Medicaid already include protections from surprise bills)...

Based on this it appears nothing will change regarding the G vs N decision question.

 

[MichaelB]

With the prohibition of balance billing effective 1-1-22 will it make more sense to choose plan n over plan g?

The balance billing prohibition won’t affect that choice. The primary difference between N and G is coverage of excess charges. Some providers accept Medicare assignment, which is the approved Medicare payment rate. Other providers accept Medicare but not assignment, and they can charge an additional 15%. This is called “excess charges”, and Supplement G covers that charge, while Supplement N does not.

Balance billing is where the provider is out of network, charges more than what the patient’s insurance usually pays, takes the insurance payment and then bills the patient directly for charges not covered by the insurer. Medicare doesn’t allow this.

If a provider doesn’t accept Medicare it can bill you for the entire amount, which you are responsible for, and neither supplement will cover the charge. If they do take Medicare, they cannot bill more than the Medicare rate plus excess charges.

 

[RetMD21]

If a provider doesn’t accept Medicare it can bill you for the entire amount, which you are responsible for, and neither supplement will cover the charge. If they do take Medicare, they cannot bill more than the Medicare rate plus excess charges.

Is this just physician services or all part B charges? I am thinking of something like chemotherapy

 

[MichaelB]

Is this just physician services or all part B charges? I am thinking of something like chemotherapy

Our forum expert, MBSC, would enlighten us more, but hasn’t been around lately (hope he’s all right). All the literature I’ve read alternates between provider and physician. No mention of lab, hospital, etc.

A few states don’t allow Medicare excess charges. This article at Boomer Benefits provides a bit of detail and names the states https://boomerbenefits.com/part-b-excess-charges/

 

[MBSC]

Is this just physician services or all part B charges? I am thinking of something like chemotherapy

Our forum expert, MBSC, would enlighten us more, but hasn’t been around lately (hope he’s all right). All the literature I’ve read alternates between provider and physician. No mention of lab, hospital, etc.

Medicare providers must accept assignment on Part B drug claims so expensive chemo drugs are exempt from excess charges (aka the Limiting Charge). Hospital claims (facility charges), labs, and ambulance are always assigned.

Also, all Mayo Clinic locations are now Medicare participating. I appreciate the concern. I'm fine now.

Does Mayo Clinic accept Medicare? Yes, Mayo Clinic is a participating Medicare facility in Arizona, in Florida, in Rochester, Minn. and at all Mayo Clinic Health System locations.

https://www.mayoclinic.org/patient-visitor-guide/billing-insurance/insurance/faq

Medicare Claims Processing Manual
Chapter 1 - General Billing Requirements
Section 30.3.12.3 - Carrier Rules for Limiting Charge

The limiting charge applies to all of the following services/supplies, regardless of who provides or bills for them, if the services/supplies are covered by the Medicare program and are provided:

-Physicians’ services;
-Outpatient physical therapy services furnished by an independently practicing physical therapist;
-Outpatient occupational therapy services furnished by an independently practicing occupational therapist;
-Diagnostic tests [edit: this is EKG testing, not lab]; and
-Radiation therapy services (including x-ray, radium, and radioactive isotope therapy, and materials and services of technicians).

Physicians, non-physician practitioners, and suppliers must take assignment on claims for drugs and biologicals furnished on or after February 1, 2001, under §114 of the Benefits Improvement and Protection Act (BIPA).

Reference: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c01.pdf