Plan N excessive charges 15%

[Steve s]

Supplement shopping. Cannot find much first hand experience for plan N on line. No problem with the up to $20 copay but wondering about the excess charges. Know what it means,15% over approved amount. But never read about any personal experience from an owner. Did he get nailed really hard one year. Did he ever have to pay the %15 several times in a year. My neighboring state Mn do not allow these charges but Iowa does.
Would appreciate any imput from a Plan N owner and if they have been happy with it. Not sure it is worth the concern for a few dollars savings.

Funny I use to pay $1600 a month now Im bargain shopping to say a few hundred for the whole year. Thanks you.

 

[CRLLS]

Same caveat about the 15% for Plan F. If the provider "accepts Medicare assignment" there is no extra 15%. If the Provider accepts medicare patients but not "assignment", he can bill no more than 15% over the Medicare approved rates. After all deductibles are met, Medicare pays their 80% of their approved rate. The Supplement pays the other 20% and you are on the hook for the 15%. Generally, if the Provider does not accept any Medicare at all, you are out of luck. You pay the full bill. No Medicare payment, no Supplement payment.

I cannot express enough, the point about making sure they "Accept Medicare Assignment"

 

[REWahoo]

Same caveat about the 15% for Plan F. If the provider "accepts Medicare assignment" there is no extra 15%. If the Provider accepts medicare patients but not "assignment", he can bill no more than 15% over the Medicare approved rates. After all deductibles are met, Medicare pays their 80% of their approved rate. The Supplement pays the other 20% and you are on the hook for the 15%.

Plan F pays for the 15% "excess charge", as does Plan G. Other Medigap plans do not.

 

[saydiver]

From everything I've read excess charges are rare as far as Medicare is concerned. About 96% of drs accept Medicare assignment, but some well known places, like the Mayo Clinic, do not accept Medicare assignment. The services you'll likely see excess charges on are what are know as PARE services; Pathology, Anesthesia, Radiology and Emergency. In some states excess charges are illegal. In the remaining states the allowable limit is 15% above the Medicare allowable charge, but effectively it's really only 9.25% above, because non-participating drs only get 95% of the Medicare allowable charge.

 

[REWahoo]

From everything I've read excess charges are rare as far as Medicare is concerned. About 96% of drs accept Medicare assignment, but some well known places, like the Mayo Clinic, do not accept Medicare assignment. The services you'll likely see excess charges on are what are know as PARE services; Pathology, Anesthesia, Radiology and Emergency. In some states excess charges are illegal. In the remaining states the allowable limit is 15% above the Medicare allowable charge, but effectively it's really only 9.25% above, because non-participating drs only get 95% of the Medicare allowable charge.

^ This is also what I learned when I was making the decision on what Medigap plan to choose. The highly unlikely chance I will ever encounter an excess charge is why I decided to go with Plan N and take advantage of the lower monthly premiums.

 

[savory]

We had plan N last year and can't remember being charged extra. My wife had a significant procedure and I had follow up from one last year.

We moved our residence and decided to go to an HMO, Kaiser since we heard good things. I did not move away from N due to anything about the plan.

 

[MichaelB]

One thing to look at is the price difference between Plans N and G. In my case I went with G because N was only $10 per month less and I felt that was not enough.

 

[CRLLS]

Plan F pays for the 15% "excess charge", as does Plan G. Other Medigap plans do not.

Correct. Maybe I misspoke (mis wrote). I didn't mean to imply that Plan F did not cover it, I meant to describe what "excess charges" are.

As you say, Plan F and G do cover that 15% excess charge. None of the other do. At least that is how it is in Illinois.

 

[REWahoo]

One thing to look at is the price difference between Plans N and G. In my case I went with G because N was only $10 per month less and I felt that was not enough.

Good point, the premium savings has to be worth it.

In our case the difference between N and G was closer to $20 per month for each of us. I figured if even one of us was exceedingly unlucky and got hit with an excess charge, the fact that we were saving a combined ~$450 per year would likely offset that potential cost.

 

[MBSC]

Chris Westfall at Senior Savings Network has a new video touting Plan N (link). He believes future rate increases will continue to be low and stable since it is not part of the 2020 Medigap changes.

Medicare.gov has a physician lookup tool. If the physician has a green check mark, they accept assignment.

As you say, Plan F and G do cover that 15% excess charge. None of the other do.

HD-F also covers excess charges after the $2300 MOOP has been met.

About 96% of drs accept Medicare assignment, but some well known places, like the Mayo Clinic, do not accept Medicare assignment.

The main campus in MN accepts assignment but ones in AZ and FL do not. The excess charge only applies to certain medical services.

Although Mayo Clinic doesn't participate with Medicare Part B in Arizona and Florida, Medicare will help pay for services provided at all Mayo Clinic sites regardless of whether they participate with Medicare Part B.

Reference: https://www.mayoclinic.org/patient-.../accepted-insurance/medicare/more-on-medicare

 

[Steve s]

Thanks for the replies. Leaning toward G. Only little over $10 more a month and we are close to Mayo so if they don't take assignment might be worth the $10. I did think Minnesota does not allow excess charges but again not that much more for G.
My wife was medicare disability so the only plan she could get at the time was Plan A for $328 a month. Her turning 65 will save us enough to both get the G plus some left over.
Thanks again.

 

[REWahoo]

I did think Minnesota does not allow excess charges but again not that much more for G.

Yes, Minnesota is one of the handful of states that prohibits part B excess charges. That means the only value you will get from the extra $10/month premium for G vs N is the potential of saving a $20 copay for an office visit ($50 for an emergency room visit if you aren't hospitalized).

Regarding the $20 copay, DW had office visits to four different doctors this year and only one billed her for the copay. My guess is the administrative cost to bill and process the payment may not be worth $20.

 

[ncbill]

IMHO Plan N is only worthwhile for residents in those states which prohibit the upcharges, for everyone else Plan F or Plan G.