Medicare: Plan N now suggested ipo popular Plans F and G

[NoMoreJob]

Originally Posted by REWahoo View Post
Most who don't accept assignment will agree to take the Medicare amount once they learn your insurance will not pay the additional charge.

I'm curious if you have any evidence to back that statement up? Relying on the kindness of strangers doesn't give me a warm & fuzzy feeling when it comes to medical bills.

I agree with ncbill. For a modestly higher premium in Plan G, I like the secure knowledge that I'm covered for excess charges. The co-pay avoidance is also nice to have.

Last year, my Bronze ACA plan had a $6,550 annual deductible with a monthly premium for a 64 year old nearly $1,400. So far, I'm loving Medicare!

All I can say is that in my case the provider (a high profile national clinic) did not accept assignment in my state and DID charge the additional allowed amounts to many of my bills. Just FYI, there is 2% of the excess charge amount that the patient is often still responsible for.

I never added up all the charges but my out-of-pocket with Plan F was minimal, maybe a couple of hundred bucks on tens of thousands of dollars of charges and thousands of excess charges.

If nothing else it was a great stress reliever, at a time that neither my wife nor I needed any additional stress, to know that nearly everything was paid for by Medicare plus my supplement. I think that as we age and our mental capacities decline it will be even more valuable in this respect.

 

[REWahoo]

All I can say is that in my case the provider (a high profile national clinic) did not accept assignment in my state and DID charge the additional allowed amounts to many of my bills. Just FYI, there is 2% of the excess charge amount that the patient is often still responsible for.

Since your Plan F covers excess charges there is no reason for any provider who does not accept Medicare assignment to waive those charges.

What I stated was "...once they learn your insurance will not pay the additional charge" providers may waive these charges. I don't plan on testing this but it is nice to know the possibility exists should I ever find myself in that situation.

If nothing else it was a great stress reliever, at a time that neither my wife nor I needed any additional stress, to know that nearly everything was paid for by Medicare plus my supplement.

NMJ, I understand your logic for choosing Plan F and see that it is something you value and chose to do, just as I chose to do something different.

As I have explained many times, I understand what I perceive to be a very small risk that I am assuming by selecting a plan without excess charge coverage. In the unlikely event we do get hit with excess charges at some point, I anticipate the more than $500 each year DW and I will save in premiums will offset all or at least most of those charges.

Only time will tell.

 

[MichaelB]

In the unlikely event we do get hit with excess charges at some point, I anticipate the more than $500 each year DW and I will save in premiums will offset all or at least most of those charges.

Over 20 years, that’s $10K. To reach that amount in excess charges at 15%, the gross billing would need to be $66.7k. Given most providers, especially hospitals, accept assignment, that points to a unusual and unlikely situation. It’s a good bet to make.

Premiums are not the same around the country, so others may not see the same advantage as REWahoo. [-]Likewise, MediGap N does not include emergency coverage outside the US and Plan G does. That might make a difference for some.[/-]

We chose G after seeing REWahoo’s math, because international coverage is important to us, but also because the price advantage of N vs G was less compelling. They both are very good plans and most people are pretty well off with either one.

 

[Peter]

Likewise, MediGap N does not include emergency coverage outside the US and Plan G does.

Plan N does cover emergency treatment during overseas travel:
https://www.medicare.gov/supplements-other-insurance/medigap-travel

 

[MichaelB]

Plan N does cover emergency treatment during overseas travel:
https://www.medicare.gov/supplements-other-insurance/medigap-travel

You’re right.

 

[Peter]

Yes, you had me worried for a moment there!

 

[REWahoo]

Over 20 years, that’s $10K. To reach that amount in excess charges at 15%, the gross billing would need to be $66.7k. Given most providers, especially hospitals, accept assignment, that points to a unusual and unlikely situation. It’s a good bet to make.

It is an even better bet since, according to the video explanation in post #13 above, the 15% additional charge actually works out to be only 9.25%. That means DW and I would have to run up $108.1k in gross billing with providers not accepting assignment before our $10k in premium savings was depleted.

As you say, I think that's a good bet to make.

 

[MBSC]

Over 20 years, that’s $10K. To reach that amount in excess charges at 15%, the gross billing would need to be $66.7k. Given most providers, especially hospitals, accept assignment, that points to a unusual and unlikely situation. It’s a good bet to make.

It is an even better bet since, according to the video explanation in post #13 above, the 15% additional charge actually works out to be only 9.25%. That means DW and I would have to run up $108.1k in gross billing with providers not accepting assignment before our $10k in premium savings was depleted.

Try $76,670. While the non-participating provider only receives 9.25% more than a participating provider, the excess charge remains 15% of the non-participating approved amount.

$70,179 -- Participating provider approved amount.
$66,670 -- Non-participating provider approved amount (95% of above).
$76,670 -- Limiting charge. The maximum amount a non-participating provider can bill by law. (115% of the 95% amount). This is 9.25% more than the participating provider.

Original Medicare pays 80% of $66,670 (before the 2% sequestration calculation), Plan N pays the remaining 20% coinsurance on $66,670 leaving $10,000 in excess charges.

 

[REWahoo]

Try $76,670. While the non-participating provider only receives 9.25% more than a participating provider, the excess charge remains 15% of the non-participating approved amount.

$70,179 -- Participating provider approved amount.
$66,670 -- Non-participating provider approved amount (95% of above).
$76,670 -- Limiting charge. The maximum amount a non-participating provider can bill by law. (115% of the 95% amount). This is 9.25% more than the participating provider.

Original Medicare pays 80% of $66,670 (before the 2% sequestration calculation), Plan N pays the remaining 20% coinsurance on $66,670 leaving $10,000 in excess charges.

Thanks for the clarification.

This calculation once again reinforces the accuracy of my sig line.

 

[omni550]

Interested to learn what you decide.

I have decided to switch to Plan N with Aetna. I initiated the change process this morning.

It turns out that the Plan N premium on Aetna's site is even a few dollars less than what I had been quoted, so my 2019-20 annual savings will be $737.76 vs staying with Aetna's Plan G.

I have to pass underwriting to make the switch. I do not anticipate an issue.

omni

 

[Animorph]

I just signed up for a Plan G and a Part D plan.

Would have been pretty easy, but the pricing for the G's was pretty opaque. We only have Community Rated (same price for everyone) and Issue Age Rated (price is based on age when first bought) plans in my state. While no plans can price vs. attained age, some do give "discounts" for signing up "early". And of course the discount is in the very fine print. Two cheap plans had roughly 36% discounts included in the comparison price. Kind of like airline and resort fees.

So I had to create a spreadsheet (twisted my arm...). I looked at payments over 30 years. Two plans with discounts (AARP, BCBS), one with a fixed price (as far as I could tell, Cigna). I finally found a fourth plan that was both cheap and fixed price. At least I never found the fine print describing a discount. I signed up for that one, Mutual of Omaha. Not sure I'll be able to tell the difference between a discount slowly disappearing and normal cost and inflation adjustment, so we'll see how this works out. Kind of important since my issue age will go up if I change plans in the future (or the discount will be smaller), increasing the base price I'd be paying.

For the Part D the Medicare comparison tool was also a little opaque, listing "cost for the rest of the year", which is only two months for me. The costs displayed can also be dependent on which pharmacy you select. Most of the plans have preferred pharmacies and might not show the lowest cost if you just pick your favorite pharmacy. Looking at the cost details provided a little more clarity, for a bit more work. I was able to find an insurer that had all my meds in a generic tier at an average price. And costs while still on the deductible were lower than I was getting at Costco. Of course, who knows what any new drugs I may need will cost? At least I can change plans anytime.

That was a good few days wasted gathering information from multiple companies. And now I'm getting calls from those whose online "quote" turned out to be "we'll call you with our price". They'll be blocked eventually.

 

[omni550]

I have decided to switch to Plan N with Aetna. I initiated the change process this morning.

It turns out that the Plan N premium on Aetna's site is even a few dollars less than what I had been quoted, so my 2019-20 annual savings will be $737.76 vs staying with Aetna's Plan G.

I have to pass underwriting to make the switch. I do not anticipate an issue.

omni

The SeniorSavingsNetwork.org agent called me on Friday to say I passed underwriting and my new Aetna Plan N policy will become effective on Oct. 1.

omni

 

[REWahoo]

The SeniorSavingsNetwork.org agent called me on Friday to say I passed underwriting and my new Aetna Plan N policy will become effective on Oct. 1.

omni

Congratulations, and welcome to the N crowd.