Medicare Plan N copays

[Dash man]

We’re considering changing from our AARP Plan G to Plan N. We feel long term that Plan G premiums will increase faster than a Plan N. Our concern are the copays of up to $20 per office visit. We aren’t worried about the once or twice per month visits, but the possibility of multiple visits per week if we should need care for something requiring that, such as dialysis or radiation. Are the copays charged each time or only for the initial visits?
I’m interested in hearing from someone with experience with Plan N.
We are still in our 6 month initial enrollment period, so there is no problem making the change.

 

[RetMD21]

Copays are per cpt code charged so there can be multiple. I agree that the office visits are not a big concern. For most folks plan N will be fine but I didn't like the uncertainty, so I went with G

 

[ShokWaveRider]

I have plan G. It has been good, no coverage issues at all. $3,950 a year for Plan G and Standard Pert B and Part D premiums is cheap Max OOP health insurance these days.

Considering the average Max OOP for Advantage plans with all their restrictions is ~$7,800. I do not like to cut corners on my HI.

 

[REWahoo]

DW and I have had Plan N for 3+ years. The copay of up to $20 applies to office visits to our doctors, not to treatment appointments for physical therapy, radiation, dialysis, etc.

Here is a link to everything you'd wish to know (and more) regarding Plan N copays: https://www.cms.gov/Medicare/Health-Plans/Medigap/downloads/Plan_N_Guidance2.pdf

 

[REWahoo]

Considering the average Max OOP for Advantage plans with all their restrictions is ~$7,800. I do not like to cut corners on my HI.

Plan N the OP is asking about is a Medicare Supplement, not Medicare Advantage.

 

[Dash man]

DW and I have had Plan N for 3+ years. The copay of up to $20 applies to office visits to our doctors, not to treatment appointments for physical therapy, radiation, dialysis, etc.

Here is a link to everything you'd wish to know (and more) regarding Plan N copays: https://www.cms.gov/Medicare/Health-Plans/Medigap/downloads/Plan_N_Guidance2.pdf

Great! Thank you!! That’s what I was hoping to hear! Thank you for the link!

 

[ShokWaveRider]

Plan N the OP is asking about is a Medicare Supplement, not Medicare Advantage.

I know that, my point is G is a good deal for the most coverage and offers more advantages that N. I was just using Part C as an example of a high MOOP.

 

[grayv]

Shok, thanks for describing the difference like that. I was teaching a couple friends about their choices recently (they just turned 65), and that comparison would have helped.

 

[Telly]

I have Plan N. So far, once I have met the Part B deductible, the only place that has charged the Plan N copay is my Ophthalmologist. And the way that has worked is: Ophth submits claim to Medicare. Medicare pays their part, passes it on to my Plan N insurer, they subtract $20 or less from what they would have paid the Ophth. The Ophth bills me the $20 or less that is missing, and then I pay the Ophth for the missing $.

 

[ncbill]

Was it here that a poster on plan N claimed their doctors didn't bother with charging co-pays?

Also, I don't understand why people would pick G over G-HD since here the add'l premiums for G exceed the deductible for G-HD...is G really cheaper elsewhere?

 

[Dash man]

Was it here that a poster on plan N claimed their doctors didn't bother with charging co-pays?

Also, I don't understand why people would pick G over G-HD since here the add'l premiums for G exceed the deductible for G-HD...is G really cheaper elsewhere?

G-HD is not available where I am.

 

[REWahoo]

Was it here that a poster on plan N claimed their doctors didn't bother with charging co-pays?

We've had office visits with two doctors over the past couple of years who didn't charge the N copay. Not sure if it was lack of understanding of how Plan N works or they felt the administrative cost wasn't worth the potential revenue.

Note that the N copay is "up to" $20. You are billed for 20% of the approved Medicare charge, up to a maximum of $20. IOW, if the Medicare amount is less than $100, your copay will be less than $20.