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I joined Medicare 1/1/23 so I have time to change plans. Currently I am on Plan G and expect to see the doctor say 4 times a year. I'm in Az.
Plan N will save me $30 a month or $360 a year. Subtract four visits t($20 each) to the doctor that's $80 or $280 a year I save swapping Plan G for Plan N.
But. who to say co-payments won't rise in the coming years or that more doctors will not accept the Medicare-approved amount sticking me with the 15%.
I joined Medicare 1/1/23 so I have time to change plans. Currently I am on Plan G and expect to see the doctor say 4 times a year. I'm in Az.
Plan N will save me $30 a month or $360 a year. Subtract four visits t($20 each) to the doctor that's $80 or $280 a year I save swapping Plan G for Plan N.
But. who to say co-payments won't rise in the coming years or that more doctors will not accept the Medicare-approved amount sticking me with the 15%.
So... stay with Plan G or switch to Plan N?
Plan N premium differential will increase with age. At age 81 in WI, for me, the differential between a G and N is over $80/mo. As long as you have no need of nonparticipating Medicare providers, N is a great choice. Many here have had N, experienced major medical events, with very minimal out-of-pocket.
Also consider a high-deductible G plan. Medicare pays its 80%, you pay the 80% copay until $2,700 deductible is reached. For the healthy, that may never happen. Premium in some states is one-third that of regular Medigap. For me, premium is $800 yr. v. over $2,400 year for a regular Medigap. I have a high-deductible G as do many others here. Over time, the premium savings can be substantial.
Plan N premium differential will increase with age. At age 81 in WI, for me, the differential between a G and N is over $80/mo. As long as you have no need of nonparticipating Medicare providers, N is a great choice. Many here have had N, experienced major medical events, with very minimal out-of-pocket.
Also consider a high-deductible G plan. Medicare pays its 80%, you pay the 80% copay until $2,700 deductible is reached. For the healthy, that may never happen. Premium in some states is one-third that of regular Medigap. For me, premium is $800 yr. v. over $2,400 year for a regular Medigap. I have a high-deductible G as do many others here. Over time, the premium savings can be substantial.
Is it possible copayment ($20) will see a jump in price or there might be an increase in nonparticipating Medicare providers?
Plan N seems the better deal but what are the drawbacks outside of having to pay the $20 per visit?
Plan N seems the better deal. So, what are the drawbacks outside of having to pay the $20 per visit?
It’s my understanding that 98% of doctors are participating in Medicare pricing.
Where I think you might see excess charges are from a hospital or other facility stay, where different providers provide services behind the scenes and may not accept all the different insurances on the market (radiologists, consulting specialists for the main doctor, labs, etc.).
In past years using employer insurance, I rec'd a bill or two from providers I'd never heard of but were used by my main provider, and which charged more than my ins. co. would pay. So I got the bill for the difference.
Is it possible copayment ($20) will see a jump in price or there might be an increase in nonparticipating Medicare providers?
Plan N seems the better deal but what are the drawbacks outside of having to pay the $20 per visit?
Quote:
Originally Posted by john3232
Plan N seems the better deal. So, what are the drawbacks outside of having to pay the $20 per visit?
It’s my understanding that 98% of doctors are participating in Medicare pricing.
Which is why Plan N should be fine - and has proven to be fine - for those who have them. Even Mayo Clinic which had once been a nonparticipating provider is now a participating provider.
A nonparticipating Medicare provider will accept Medicare patients but is allowed to charge a 15% excess fee over and above the Medicare-allowed charge which, for a nonparticipating provider, is 5% below that of regular Medicare reimbursement. In the end, factoring in the 5% reduction, the nonparticipating provider receives 10% more than it would as a participating provider. Plan N will not pay that extra 10%. Plans F and G and the hd-G will.
FYI - there are also doctors who are neither participating nor nonparticipating providers - which means you pay full market rates for their services, not Medicare rates.
And, yes, Plan N is the better deal - unless you expect numerous doctor visits in a year. Do a cost-benefit analysis - for me, $960 year premium differential = 48 doctor visits in a year. I rarely doctor. So, yes, Plan N is the better deal.
Again, consider the high-deductible G. If your health is good and chronic serious illness is not in your DNA or on your horizon, you will save substantial premium dollars.
Quote:
Originally Posted by bpollen
Where I think you might see excess charges are from a hospital or other facility stay, where different providers provide services behind the scenes and may not accept all the different insurances on the market (radiologists, consulting specialists for the main doctor, labs, etc.).
This could occur if the providers do not accept Medicare patients at all. Any provider who is either a participating or nonparticipating Medicare provider CANNOT bill or accept payment in excess of the Medicare-allowed charge for the service. Balance billing is not allowed - unless the service is not covered by Medicare. Most hospitals are participating Medicare providers. Some labs and possibly some doctors with privileges at these hospitals may not be.
Last edited by Ariadne22; 04-05-2023 at 05:08 PM..
I joined Medicare 1/1/23 so I have time to change plans. Currently I am on Plan G and expect to see the doctor say 4 times a year. I'm in Az.
Plan N will save me $30 a month or $360 a year. Subtract four visits t($20 each) to the doctor that's $80 or $280 a year I save swapping Plan G for Plan N.
But. who to say co-payments won't rise in the coming years or that more doctors will not accept the Medicare-approved amount sticking me with the 15%.
So... stay with Plan G or switch to Plan N?
This is a question only you can answer. Yes, save $360/year in premiums. Maybe in a good year see doctor 4x and save $280. Then in a "bad" year see doctor 8x or have other tests & costs.
So if you save $300/year what else could you do with that money?
Why I chose Plan G: Although I would save money with a Plan N, when I am old-old I might not have the mental acuity to keep track of bills and making payments to doctors and labs for balances due. With Plan G it is simpler because only responsible for the amount up to the Part B deductible ($226 in 2023), then the UHC supplement covers the rest. For me, the less paperwork to track when I'm old, the better.
Which is why Plan N should be fine - and has proven to be fine - for those who have them. Even Mayo Clinic which had once been a nonparticipating provider is now a participating provider.
A nonparticipating Medicare provider will accept Medicare patients but is allowed to charge a 15% excess fee over and above the Medicare-allowed charge which, for a nonparticipating provider, is 5% below that of regular Medicare reimbursement. In the end, factoring in the 5% reduction, the nonparticipating provider receives 10% more than it would as a participating provider. Plan N will not pay that extra 10%. Plans F and G and the hd-G will.
FYI - there are also doctors who are neither participating nor nonparticipating providers - which means you pay full market rates for their services, not Medicare rates.
And, yes, Plan N is the better deal - unless you expect numerous doctor visits in a year. Do a cost-benefit analysis - for me, $960 year premium differential = 48 doctor visits in a year. I rarely doctor. So, yes, Plan N is the better deal.
Again, consider the high-deductible G. If your health is good and chronic serious illness is not in your DNA or on your horizon, you will save substantial premium dollars.
This could occur if the providers do not accept Medicare patients at all. Any provider who is either a participating or nonparticipating Medicare provider CANNOT bill or accept payment in excess of the Medicare-allowed charge for the service. Balance billing is not allowed - unless the service is not covered by Medicare. Most hospitals are participating Medicare providers. Some labs and possibly some doctors with privileges at these hospitals may not be.
This is something to consider -- plan design affects selection. Those who "rarely" doctor will select the plan with co-payments; those who frequently doctor will select one that does not. In other words, people tend to select the plan that is in their financial best interests. This is called adverse selection. What that means is that Plan N will attract a healthier pool of members so it is expected to have lower premium costs over time.
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