What is your experience with Plan N

[Texas Proud]

So, not wanting to steal somebody else's thread I will start this one.


I am looking at the differences between Plan G and Plan N... the two differences is you 'might' have a copay and excess charges...


If you have plan N do you get charged on a regular basis for copay?


I read that about 5% of bills have excess charges, what is your experience?



I know IF you are good about it that you would not get them but on the videos that is one of the pitfalls talked about... that the patient does not ask up front all the time...

 

[REWahoo]

DW and I have had Plan N for the past four years.

We do get charged the copay whenever it applies - for doctor visits. Note the copay is $20 ($50 for ER visits) but since after Medicare pays their 80% the remaining amount owed is, at least for us, usually less than $20, we only owe that lesser amount. IOW, our copay amount is usually under $20. Note there is no copay for labs, x-rays, physical therapy, etc.

Never had an excess charge. The possibility of being billed an excess charge is remote, and you can easily avoid even that small possibility by making sure the provider accepts Medicare assignment.

One more plus for Plan N: I've been monitoring my insurance company rate adjustments for Plan N vs Plan G over the past four years and N has definitely seen smaller increases than G.

 

[Dash man]

I have plan N and agree with what ReWahoo says. Seven states don’t permit Excess Charges, and I’m in PA which is one of them, so it was a no brainer. However, we spend a lot of time in Florida, so I did look into it. Around 96% of doctors accept Medicare assignment, so it’s pretty rare. The excess charges are capped at 15%, so there is protection. And I understand a doctor that charges excess fees has to deal with the insurance carrier separately, raising their administrative costs.
Plan G is the guaranteed issue plan for older retirees that begin Medicare later than 65. So it’ll likely be an older crowd resulting in higher cost increases over time. An example is my brother-in-law. He is 66 and still on DSIL’s insurance. He’s diabetic, a smoker, over weight and has high blood pressure. When DSIL retires and they both go on Medicare, he will be guaranteed Plan G, but Plan N will not be available. That kind of patient drives up costs big time. His mother was the same except she was not overweight and lived until 99.
I think you’ll be happy with Plan N.

 

[zinger1457]

I'm also getting close to selecting a plan, started out leaning toward G put the more I look at it N might be a good fit. I did find a tool (link below) to search for healthcare providers who have opted out of Medicare in my area but that is a step beyond not accepting Medicare assignment. Wondering if anyone has found a similar tool listing healthcare providers that don't accept Medicare assignment? I can check individual healthcare providers by name but might be helpful to get a complete list in my area like the tool below. BTW, no healthcare providers opted out of Medicare in my area, had to go to a larger nearby city to find any and most of those listed were psychiatrist.

https://data.cms.gov/tools/provider-opt-out-affidavits-look-up-tool

 

[anethum]

When my mom fell and broke her pelvis and wrist and went to the ER late in the day, an orthopedist was brought in to look at the x-rays and set her wrist. It turned out that he didn't accept Medicare assignment and my mom had no ability to choose a different orthopedist in those circumstances. (My mom had a great retiree insurance plan that ended up paying her, and she in turn paid the orthopedist.)

Just become someone is losing their insurance doesn't mean they will necessarily be more expensive or less expensive to insure. In most states, most Medicare plans have premiums based on someone's age bracket. So I think "Guaranteed Issue" is a red herring. That guy Christopher Westfall ranted on and on about Guaranteed Issue in one of his videos whose purpose seemed to me to be to get people to switch to Plan N so he'd get new commissions.

 

[Rocket Man]

I went on Medicare two years ago and chose plan N. All of my doctors accept Medicare assignment. No issues and I am happy with it.

 

[REWahoo]

When my mom fell and broke her pelvis and wrist and went to the ER late in the day, an orthopedist was brought in to look at the x-rays and set her wrist. It turned out that he didn't accept Medicare assignment and my mom had no ability to choose a different orthopedist in those circumstances. (My mom had a great retiree insurance plan that ended up paying her, and she in turn paid the orthopedist.)

The orthopedist's maximum charge would have been 15% more than 20% of the allowed Medicare charge. Do you recall the dollar amount she ended up paying him?

 

[anethum]

I recall the orthopedist bill being about $2,000.

My point is that there are many circumstances when people are in no position to make choices about medical care.

 

[Dash man]

When my mom fell and broke her pelvis and wrist and went to the ER late in the day, an orthopedist was brought in to look at the x-rays and set her wrist. It turned out that he didn't accept Medicare assignment and my mom had no ability to choose a different orthopedist in those circumstances. (My mom had a great retiree insurance plan that ended up paying her, and she in turn paid the orthopedist.)

Just become someone is losing their insurance doesn't mean they will necessarily be more expensive or less expensive to insure. In most states, most Medicare plans have premiums based on someone's age bracket. So I think "Guaranteed Issue" is a red herring. That guy Christopher Westfall ranted on and on about Guaranteed Issue in one of his videos whose purpose seemed to me to be to get people to switch to Plan N so he'd get new commissions.

You have a misunderstanding I believe. The individual’s premium will not be any higher than normal for his age, but because the population of the G plan being somewhat less healthy than the Plan N population, Plan G premiums are likely to increase at a faster rate than Plan N.
As far as getting people to change plans for the commission, you obviously haven’t watched Chris Westfall much. The highest commission plans are the Medicare Advantage plans. He has many videos explaining why Medicare Advantage plans are so bad and the ads misleading. This year, the Medicare Supplement plans pay $80 to the agency that writes them up. I forget the exact number, but MA commissions are more than double that.

 

[MBSC]

The orthopedist's maximum charge would have been 15% more than [-]20%[/-] 95% of the allowed Medicare charge. Do you recall the dollar amount she ended up paying him?

FIFY. Also, be careful when asking how much was "paid". When a provider does not accept Medicare assignment, Medicare and the Medigap/retiree plan send payment to the bene. The bene pays the entire 109.25% (115% of 95%) but only a fraction of that is the excess charge.

 

[MBSC]

Wondering if anyone has found a similar tool listing healthcare providers that don't accept Medicare assignment?

See below.

I'm turning 65 soon and have been looking at the AARP/UHC G and N plans. The additional co-pays aren't an issue but I guess the scary part with the N plan is being hit with the 15% excess charge. Is it not as bad as it sounds? Seems like that could be a sizable bill for certain procedures if any doctor/hospital decided to add it.

Here is the Medicare provider finder.

https://www.medicare.gov/care-compare/

For doctors/clinicians, it tells you if they accept the Medicare approved amount (no excess). If it has a question mark followed by "may charge...", it means they can and usually do bill the excess charge. Try Clinical Social Worker in Phoenix and go to page 7 for examples. Other types of providers like hospitals, labs and ambulance cannot bill excess charges.

 

[REWahoo]

FIFY. Also, be careful when asking how much was "paid". When a provider does not accept Medicare assignment, Medicare and the Medigap/retiree plan send payment to the bene. The bene pays the entire 109.25% (115% of 95%) but only a fraction of that is the excess charge.

Thanks for the clarification.

Once again the devil is in [-]medical insurance[/-] the details!

 

[anethum]

You have a misunderstanding I believe. The individual’s premium will not be any higher than normal for his age, but because the population of the G plan being somewhat less healthy than the Plan N population, Plan G premiums are likely to increase at a faster rate than Plan N.
As far as getting people to change plans for the commission, you obviously haven’t watched Chris Westfall much. The highest commission plans are the Medicare Advantage plans. He has many videos explaining why Medicare Advantage plans are so bad and the ads misleading. This year, the Medicare Supplement plans pay $80 to the agency that writes them up. I forget the exact number, but MA commissions are more than double that.

Plenty of people select N because of lower premiums. That says nothing about their current or future healthcare costs. Plenty of folks like myself and others on this forum who are in apparent excellent health select G. I wanted the simplicity of just the one low annual deductible, and no worries about Excess Charges or annoying $20 co-payments. Everyone has their own priorities and reasons for their Medicare Supplemental choice.

We'll have to agree to disagree about Westfall. I felt that he was clearly trying to scare people into switching from G to N. I assume he knew they were unlikely to want to switch to an Advantage plan. And what he was saying was in conflict with one of his earlier videos when he was touting Plan G. The guy did not impress me. I'm glad that he at least tries to steer people away from Advantage plans. FWIW, in retrospect I wasn't happy with my first Boomer Benefits agent, but when I switched from Mut. of Omaha to AARP/UHC Plan G (by passing underwriting), I was quite happy with my 2nd BB agent.

 

[zinger1457]

Thanks, but I was looking for a search tool that would only list the providers in my area that don't accept Medicare assignment, that tool doesn't do that unless I'm missing something. To find that information I have to search through a 30+ page list of all the providers in my area.

See below. Originally Posted by MBSC View Post
Quote:

Here is the Medicare provider finder.

https://www.medicare.gov/care-compare/

For doctors/clinicians, it tells you if they accept the Medicare approved amount (no excess). If it has a question mark followed by "may charge...", it means they can and usually do bill the excess charge. Try Clinical Social Worker in Phoenix and go to page 7 for examples. Other types of providers like hospitals, labs and ambulance cannot bill excess charges.

 

[Dash man]

Thanks, but I was looking for a search tool that would only list the providers in my area that don't accept Medicare assignment, that tool doesn't do that unless I'm missing something. To find that information I have to search through a 30+ page list of all the providers in my area.

I’m not sure it exists. People are typically looking for doctors who do accept Medicare assignment. Those are easy to find on Medicare.gov by searching for providers and using the filter to only select Medicare providers.

 

[Bamaman]

Plenty of people select N because of lower premiums. That says nothing about their current or future healthcare costs. Plenty of folks like myself and others on this forum who are in apparent excellent health select G. I wanted the simplicity of just the one low annual deductible, and no worries about Excess Charges or annoying $20 co-payments. Everyone has their own priorities and reasons for their Medicare Supplemental choice.

We'll have to agree to disagree about Westfall. I felt that he was clearly trying to scare people into switching from G to N. I assume he knew they were unlikely to want to switch to an Advantage plan. And what he was saying was in conflict with one of his earlier videos when he was touting Plan G. The guy did not impress me. I'm glad that he at least tries to steer people away from Advantage plans. FWIW, in retrospect I wasn't happy with my first Boomer Benefits agent, but when I switched from Mut. of Omaha to AARP/UHC Plan G (by passing underwriting), I was quite happy with my 2nd BB agent.

We were on Plan G, but my wife was facing need of a $2500 electric wheelchair and I needed a new $$$$ insulin pump. I didn't realize you could switch plans at anytime, and I changed to Plan F that covers the Plan B 20% deductible/co-pay for hard goods. Had I not had Plan G, I don't believe we would have been eligible for Plan G--with pre-existing conditions.

My wife just returned from today after a most serious back surgery and later a broken leg in a fall. No telling what the bills will be for 7 weeks at three hospitals and two rehabilitation clinics--and 2 surgeries. You bet we're glad we chose Plan F.

 

[Texas Proud]

FIFY. Also, be careful when asking how much was "paid". When a provider does not accept Medicare assignment, Medicare and the Medigap/retiree plan send payment to the bene. The bene pays the entire 109.25% (115% of 95%) but only a fraction of that is the excess charge.

OK, thanks for this... it is not really 15% OOP but 9.25%...

 

[Texas Proud]

Plenty of people select N because of lower premiums. That says nothing about their current or future healthcare costs. Plenty of folks like myself and others on this forum who are in apparent excellent health select G. I wanted the simplicity of just the one low annual deductible, and no worries about Excess Charges or annoying $20 co-payments. Everyone has their own priorities and reasons for their Medicare Supplemental choice.

We'll have to agree to disagree about Westfall. I felt that he was clearly trying to scare people into switching from G to N. I assume he knew they were unlikely to want to switch to an Advantage plan. And what he was saying was in conflict with one of his earlier videos when he was touting Plan G. The guy did not impress me. I'm glad that he at least tries to steer people away from Advantage plans. FWIW, in retrospect I wasn't happy with my first Boomer Benefits agent, but when I switched from Mut. of Omaha to AARP/UHC Plan G (by passing underwriting), I was quite happy with my 2nd BB agent.

Do not know enough about any of these guys but one of Westfall's videos was talking about lazy insurance agents who push plan G... he showed the amount of higher premiums the agent would get selling G over N... he said it took more time to explain N to people but thought that the difference in premiums and premium increases would more than pay for the extra costs of plan N...


And he did say that if you are not in good health then plan G is a better plan for you....



I would think that most people would stick with their agent they used if they wanted to change...


I am still trying to determine if I go with him or BB... I just started contacting them so no data on my account...

 

[REWahoo]

he said it took more time to explain N to people but thought that the difference in premiums and premium increases would more than pay for the extra costs of plan N...

I mentioned earlier that I've been monitoring annual rate increases for Plan G vs N by my carrier, Mutual of Omaha. I just ran the numbers on the increases announced over the past several months, covering rates for 25 individual states. Their average announced increase for Plan G was 8.25% while Plan N was 5.2%.

Looks like Westfall might be accurate, at least with respect to premium increases.

 

[Texas Proud]

OK, looks like Ascendo, a CVS Aetna company is the lowest cost with the lowest rate of increase...


Does anybody have this plan? Any info on them?



As a side note... I am going with the Senior Savings Network over Boomer Benefits as they spent the time to discuss various drug plans with me. BB said they would not do anything on plan D unless I signed up with them for a supplement plan.