Medicare Part B "Excess Charges"--Have You Had Them?

[Qs Laptop]

Trying to decide between a Plan G and a Plan N. Besides the copay, one of the main differences that I can see is Plan G covers "Excess Charges" on Part B of Medicare, whereas Plan N does not. I understand that excess charges are charges that doctors bill you above and beyond Medicare rates because they do not participate in Medicare billing rates.

I also understand as the insured it's up to me to be sure any provider I select participates in Medicare when I make the appointment to see them.

It seems to me that Part B Excess Charges should be quite rare. That said, has anybody encountered excess charges in their Medicare Part N coverage?

(It's kind of a non-issue for me since I'm in Minnesota and such excess charges are prohibited, but it could happen if I go out of state.)

 

[REWahoo]

It seems to me that Part B Excess Charges should be quite rare.

Yes.

That said, has anybody encountered excess charges in their Medicare Part N coverage?

DW and I have been on Plan N for 4+ years. She's seen a number of specialists and neither she nor I have seen any excess Part B charges.

 

[Telly]

None in 3 years on Plan N.

 

[ncbill]

I'm curious about if those saying "none" live in a state that prohibits excess charges?

And outside those states, how much is the difference between Plan G & Plan N per month?

And why not just pick Plan G-HD for the lower monthly premium instead?

 

[camfused]

^^^ I believe the concern with plan G is that it may be more susceptible to increases in the future than a plan N.

 

[REWahoo]

I'm curious about if those saying "none" live in a state that prohibits excess charges?

I answered none and live in a state where excess charges are allowed.

And outside those states, how much is the difference between Plan G & Plan N per month?

In my case, roughly $25/mo.

And why not just pick Plan G-HD for the lower monthly premium instead?

Two reasons:

As mentioned above, there is a concern that Plan G may be susceptible to higher future rate increases when compared to Plan N. For an example of why this might be a valid concern, MoO announced increases this year for Plan G by an average of 8.25% while Plan N averaged 5.2%. This comparison was as of the end of August and included rate announcements for 25 states.

Regarding Plan G-HD, I have concerns about my and DWs ability to accurately track and verify the validity of the ever increasing $2K+ HD deductible each year. Trying to keep up with whether or not I owe or have met the deductible amount is not something I want to deal with now, much less as my mental acuity continues to decline. Plan N is far simpler in that we should never see a bill greater than $20 after the Medicare deductible amount is met.

 

[ncbill]

"Plan N is far simpler in that we should never see a bill greater than $20 after the Medicare deductible amount is met."

Even for something like ongoing cancer treatments?

 

[REWahoo]

"Plan N is far simpler in that we should never see a bill greater than $20 after the Medicare deductible amount is met."

Even for something like ongoing cancer treatments?

Yes.

 

[Qs Laptop]

"Plan N is far simpler in that we should never see a bill greater than $20 after the Medicare deductible amount is met."

Even for something like ongoing cancer treatments?

Yes, it's true. And I was told by BoomerBenefits that even if you have something chronic, like you need kidney dialysis or weekly chemo treatments most doctors will not charge you for each visit so that you don't rack up $20 copays every week.

 

[REWahoo]

... even if you have something chronic, like you need kidney dialysis or weekly chemo treatments most doctors will not charge you for each visit so that you don't rack up $20 copays every week.

^ This. The Plan N copay applies to "services coded as office visits or evaluation and management visits" to a physician. No copay is charged for lab work, x-rays, physical therapy, etc.

You can read the gory details here: https://www.cms.gov/Medicare/Health-Plans/Medigap/downloads/Plan_N_Guidance2.pdf

 

[teej1985]

"Plan N is far simpler in that we should never see a bill greater than $20 after the Medicare deductible amount is met."

Even for something like ongoing cancer treatments?

Well, if you go to the Emergency Room, you'll pay $50, so there's that. But Still likely still a bargain.


For a 65 year old in California, The cheapest N is State Farm which is $1155 annually. The cheapest G, also State Farm, is $1522, so it is a solid savings - although this doesn't consider the various discounts that insurers might offer. if I change it to age 85, State Farm is still the cheapest for both, but the G is $2907 while the N is $2296.

 

[ncbill]

^^^^^

And how much is Plan G-HD?

So to sum up, the reason to pick Plan N is that it won't be as popular as Plan G & so should see much lower premium increases?

 

[Dash man]

^^^^^

And how much is Plan G-HD?

So to sum up, the reason to pick Plan N is that it won't be as popular as Plan G & so should see much lower premium increases?

Plan G is a Guarantee issue plan for those who sign up for Medicare Part B later than age 65. So this will allow older and potentially sicker people get Plan G, resulting in higher costs and higher premium increases. Plan N is not Guarantee issue, so only younger people can join the plan keeping premiums lower than Plan G.

 

[frank]

Plan G is a Guarantee issue plan for those who sign up for Medicare Part B later than age 65. So this will allow older and potentially sicker people get Plan G, resulting in higher costs and higher premium increases. Plan N is not Guarantee issue, so only younger people can join the plan keeping premiums lower than Plan G.

when you say guarantee issue, does that mean if I change companies on plan g there will be no preexisting conditions or health exams?

 

[Dash man]

when you say guarantee issue, does that mean if I change companies on plan g there will be no preexisting conditions or health exams?

No, read this from Medicare.gov:

“Guaranteed issue rights

Guaranteed Issue Rights (Also Called "Medigap Protections")
are rights you have in certain situations when insurance companies must offer you certain Medigap policies. In these situations, an insurance company:

Must sell you a Medigap policy
Must cover all your pre-existing health conditions
Can't charge you more for a Medigap policy because of past or present health problems
In most cases, you have a guaranteed issue right when you have other health coverage that changes in some way, like when you lose the other health coverage. In other cases, you have a "trial right" to try a

Medicare Advantage Plan (Part C)
and still buy a Medigap policy if you change your mind.

You have a guaranteed issue right (which means an insurance company can’t refuse to sell you a Medigap policy) in these situations:

You’re in a Medicare Advantage Plan, and your plan is leaving Medicare or stops giving care in your area, or you move out of the plan's service area.
You have the right to buy

Medigap Plan A, B, C*, D*, F*, G*, K, or L that’s sold by any insurance company in your state.”

 

[anethum]

I am dubious that "guarantee issue" rules have an appreciable effect on rates. It's a relatively small number of people who become eligible to sign up for Medigap plans thanks to guarantee issue circumstances, and I don't see any reason why these people are any more likely to be more expensive to insure than existing policy holders of the same age. In most states, Medigap policy rates can and do increase based on age. Even "community rated" UHC plans have decreasing discounts based on age.

 

[Dash man]

A lot of people work past 65 and sign up for Part B and supplements when they retire. The numbers may be more than you think.

 

[Telly]

None in 3 years on Plan N.

I'm curious about if those saying "none" live in a state that prohibits excess charges?

State allows Excess Charges, never seen one.

 

[teej1985]

^^^^^

And how much is Plan G-HD?

So to sum up, the reason to pick Plan N is that it won't be as popular as Plan G & so should see much lower premium increases?

State Farm doesn't have a Plan G HD but cheapest Plan G HD in California, United American, for a 65 year old is $376/year. For the 85 year old, also United American is $778.