Posted on 12/14/2014 7:25:12 AM PST by CGASMIA68
I need to pick something by 12/31.ATT is dumping us retired types to a BS type Exchange.The reps are minimum wagers and don't know squat.
Been looking at plans and need, if possible some input on Plan F's "Excess charges"? Its a $70 month dif for me for a plan with it or without which is plan "N" Any one up to speed on this stuff your input would be appreciated. Last year went to the DR one time and the ER 1 time(i am not a roofer) Thanks
Generally speaking there are two types of plan F coverage. One plan F is a high deductible which has a lower premium than the standard plan F. You’ve got to shop around.
In my experience AARP seems to have the best plan F around.
My concern is I cant find any one that can explain just what and how “Excess Charges” comes into play. MY Dr is one of them?
That 70 buck dif will pay for dental for the year but don’t want to get hit with some unforeseen thousand dollar charge
“Excess Charges” payments are defined by the company offering the product. So, narrow your choices from what’s offered and call the insurance company’s support line to determine the definition of payment of excess charges.
Did you get more detailed info on plan “N”, from either the doc or medicare reps?
Plan N is $70/month more?
“F” is 70 more than “N” because of “Excess Charge” coverage
So I guess I need to ask all providers if they accept medicare assignment aka payment?
according to the on hand info from AARP it says that plan N is a 20 dollar co-pay for doctor visits.
The term used “excessive charges” applies to a situation where a doctor would charge over and above the medicare eligible amount allowed.
As I recall from a meeting with a rep it depends on which state you receive the care. For example, it could happen in the state of Florida. Medical providers in other states (OH is one) that do not allow providers to charge above the medicare eligible amount.
I have Aetna Plan F and as I need injections for wet macular degeneration I am very grateful for this outstanding coverage. I have never made a co-pay so far.
By the way, I did not know I would have wet macular degeneration but it happened the same month my coverage started.
A full plan “F” if you can get it is that way to go if you know of any medical problems you might have. A quadruple bypass would be about $0 out of pocket. Doctors treat you like royalty.
Plan F is the only way to go. All plan F policies are identical no matter who the carrier is.
If you have an HMO, it will usually cover the Medicare gap. But if you have medical insurance, it usually won’t be sufficient and you will need to buy an extra policy to cover the Medicare gap.
As the other posters say, if you have the latter, Policy F is all you need.
Check out the Medicare Advantage plans for your state. They are sometimes better, because they cost you less and offer a bit more services.
Note that the online (Medicare) list of plans may vary from what is in the Medicare & You 2015 booklet. Also check with your main doctor and hospital to make sure they are on the plan you might choose.
Some MAs have little or no plan premiums, depending on your state, and many include the prescription drug requirment with and without deductibles.
I have and Medicare advantage is simply Medicare administered by a private company vs CMS and that is why there may be zero premiums,its the same thing,no more no less other than a few added but extremely basic dental and vision.Most medicare adv dental plans are quite poor from what I have researched and vision is about the same and amounts to reading an eye chart once a year
Medicare Excess Charges relate to Medicare “Part B” coverage—which is for Medical services. If you are on Medicare, and happen to go to a doctor who does not accept Medicare assignment (accept full payment by Medicare), he is allowed to have an “excess charge”. This excess charge would be an amount above and beyond what Medicare approves for a specific procedure / doctor office visit.
Medicare basically has a big book of each and every imaginable procedure, and what it should cost to perform. They might say a specific test will cost $400. If you were to go to a doctor, and have that specific test performed, Medicare will pay a maximum of $400, because that is what they deem reasonable and customary.
If the doctor decided the $400 payment is not enough—he is able to charge more—and this “additional” amount would be called the excess. However, the doctor is limited to charging an additional 15% over an above what Medicare approves. In our example, you went to the doctor for a test, and Medicare approved $400. The doctor would be able to charge 15% higher, in this case roughly $60 additional to the original $400 already approved by Medicare. The total allowable charges in this case would be $460. ($400 X 15% excess = $60 + original $400 = $460 total).
If you purchase Medicare Supplemental Insurance, you can shield against the cost of any “excess charges” that you may be faced with. However, not all Medicare Supplement Plans will provide Medicare excess charge coverage. Currently, only Medicare Supplement Plans F & Plan G will provide excess charge coverage. Both Plan F & G will pay 100% of any excess charges you may incur.
If you purchase a Medicare Supplement Plan that does not provide excess charge coverage, you can still shield against ever paying any excess charges as long as you simply ask your doctor before you go to him “Do you accept Medicare assignment?”. As long as they say YES, and they DO accept Medicare assignment, you will never have a Medicare excess charge.
Minimum plan coverage is the same between carriers by law but premiums might vary.
I highly recommend Plan F or Plan G. As a previous poster stated, by law all plans have to be the same, regardless of provider. I.E. All plans F have the same coverage, all plans G have the same coverage. It is simply a matter of what you are being charged.
The reason for the differences in cost? Advertising costs are a huge factor. A company called SelectQuoteSenior will do the legwork for you, comparison shopping the costs. (No charge to you.) They were terrific and patient explaining everything to me, and their followup customer service is superb. They don’t search every company, however. Just the ones with strong credit ratings. Regardless, I have done my comparison shopping, and nobody can come close to what I am paying now for Plan G. (about $110.00/month.)
I had major surgery 2 months ago, performed by a specialist, and spent 9 days in a physical therapy in-patient place. Every invoice I have received shows Patient Responsibility: $0.00. Just the paperwork reduction is a Godsend.
You choose your Doctor according to the specialty you require, with no referrals required. No restrictions regarding hospital the surgeon prefers, nor the rehab place you choose. The policy is portable if you travel. I couldn’t ask for a better supplemental policy.
Good luck!
Thanks to all that chimed in.
I learned a lot and found out what I needed to know.
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