This document written by Medicare to guide insurance companies and physicians on
when a plan and copay can be charged It clearly states that telehealth visits and urgent
care are exempt from that copay.
So how is it that we're now seeing people charge the
twenty dollar co pay for telehealth and urgent care?
What else has changed So you've decided on a Medicare supplement plan.
Good decision. But which one? Which supplement
plan will be right for you both today and as you age.
There are a number of videos with headlines like what is the best supplement plan for two
thousand twenty four or whatever year.
I find this odd because one of the benefits of a Medicare supplement is that the benefits never change.
They are literally written into Social Security Law.
It takes an act of Congress to change a Medicare supplement plan benefit Even then they can only
change benefits for people who have not yet enrolled.
Grandfathering in those already with a plan.
Unless of course, Medicare as a
bureaucracy simply changes some rules.
Well, we're gonna get into that in a minute. Still, how
can there be a different best plans from one year to the next?
The simple truth is that the right supplement plan for you is the one that will fit your
personality and remain within your budget.
In this video I will help you identify which Medicare
supplement plan that you'll most likely to be happiest with.
And I'm going to accomplish this without showing you a a table of benefits and pointing out
the deductible and the gaps and all that stuff It's just not necessary.
So why do people choose a Medicare supplement anyway?
It's very simple. People who choose the Medicare Supplement route instead of a Medicare
Advantage Plan do so because they want to keep the two most important benefits of original
Medicare What are those benefits?
First you're not limited by a network With a Medicare supplement, you can see any doctor go to
any medical facility in the US or US territory as long as they accept original Medicare.
That is almost every doctor and medical facility in the country.
Second, no insurance company has a say in your health care.
Now Medicare's intent is to cover everything that's medically necessary.
And they lean on your doctor to determine medical necessity.
Your health care decisions are between you and your doctor.
No pre authorizations required.
Keeping those two benefits of original Medicare are overwhelmingly the deciding factor for those
who choose a Medicare supplement plan over a Medicare Advantage Plan.
You get to keep the benefits of original Medicare regardless of which supplement plan you choose
or even which insurance company you decide to go with.
You can be in the worst Medicare supplement plan or the best Medicare supplement plan, they all
maintain original Medicare as your primary insurance with all of its benefits.
Now if you've seen my other videos on Medicare supplement plans you know that the three plans
with a cost to benefit ratio that should be considered are the plan g, the plan
n, and in some areas of the country, the plan g or F high deductible.
So let's start with this simple, but very important assertion The debate
between Medicare supplement Plan G versus Medicare Supplement Plan N is not one of benefits and
costs, but of personality Your personality.
Let me show you. Medicare supplement plan g offers the most health coverage of any Medicare
supplement that's available to those who are new to Medicare.
With a Plan G you can spend a year in the hospital as an
inpatient and inpatient services will not cost you a dime.
Your inpatient services are covered at one hundred percent.
With a plan g your only expense for inpatient and outpatient
Medicare bills is the annual Medicare Part B deductible.
Part B is Medicare's outpatient and physician's services insurance.
When you see a doctor for the first time during the calendar year you will pay the Medicare Part B deductible.
Once you've paid that deductible, you have a hundred percent coverage for the rest of the calendar year.
As I make this video the two thousand twenty four Medicare Part B deductible is just two hundred
and forty dollars You pay that once during the calendar year if and when you see the doctor.
That's it. After that you have a hundred percent inpatient and outpatient coverage.
And by the way have you seen my video showing the official estimates of the part b deductible
and monthly premiums going all the way out to two thousand thirty two.
So check the link above my left shoulder for that Alright So where were we?
Oh yeah Plan g is what I referred to almost a decade ago in one of my first videos
as the peace of mind plan People who choose a Medicare supplement plan g just want great
coverage They don't wanna have to think about their health care or medical bills.
It's just paid for It offers complete peace of mind.
Think of it this way. To the person who chooses a Medicare supplement plan g that peace of mind
coverage is more important than the extra money it costs For
plan g people peace of mind is more important than the extra premium.
It's that simple. So let's compare that to the Medicare Supplement Plan N.
Medicare Supplement Plan N has less insurance coverage than the Plan G And with the right
insurance company, Plan N will cost less over your lifetime.
But there's a catch beyond just the lower premium. We need to look at this closely to understand.
A Medicare supplement plan n is just like plan g and that you can spend a year in the hospital
as an inpatient your inpatient care won't cost you a dime You
have a hundred percent inpatient coverage.
Also just like plan g you must pay the annual Medicare Part B deductible if and when you see a
doctor for the first time during a calendar year.
But here's where this plan is different. With a plan n whenever you see a doctor for a
diagnosis or evaluation you will pay up to a twenty dollar co pay.
It doesn't matter if it's a primary care doctor or a specialist.
It's no more than twenty dollars. Technically, it's twenty percent of the medical bill up to a
maximum of twenty dollars If you go into an emergency room there is up to a fifty dollar co pay
And that's waived if you end up staying as an inpatient in the hospital.
Now this is important and it's often misunderstood.
The twenty dollar co pay is for diagnosis and evaluation visits only.
There's no co pay for go therapy There's no co pay for when you get a flu shot And there's no co
pay if you end up with chemotherapy infusions once a week.
What is a diagnosis or evaluation? When you go to the doctor's office to find out what's ailing
you, that's a meeting for a diagnosis.
When the doctor has you trying a new prescription or other treatment and you meet with your
doctor to see if that treatment is working.
That's an evaluation. When PlanN was
new, Medicare published this document.
About when to apply the co pay. That's titled revised questions and answers
regarding the implementation of Medicare Supplement plan n
co payment deductible and coinsurance.
Who'd have thought? Now this document was written by Center for Medicare Medicaid services,
Medicare to guide insurance companies and physicians
on when a plan and co pay can be charged.
And you can find this by the way It's going to be linked below in the show notes.
And it clearly states that telehealth visits
and urgent care are exempt from the deductible.
So how is it that we now see people charge the twenty dollar co pay for telehealth and urgent care.
So this guidance specifically refers
to medical billing codes that are used for off visits.
However, during the pandemic, telehealth became popular for obvious reasons.
In fact telehealth medical visits get this
increased thirty fold according to Medicare.
That's a lot. So telehealth has evolved from a single billing code category to
nine different categories and dozens of separate billing codes.
In addition, more and more people are ditching their primary care
doctor and just using urgent care instead.
And there are several reasons for this that we're not going to get into in this video So
Medicare was very cognizant of these changes and allowed for urgent care and some telehealth
to use the same billing codes that trigger the Medicare plan and co payment of up to twenty dollars.
That way Medicare is not overcharged in the case of using urgent care like a primary care
provider, or the doctor underpaid, as was the case with telehealth
Medicare though has not yet updated this memo It's still the only memo on
CMS dot gov providing guidance to the plan and co pay Hopefully it'll be updated.
Someday. For now, plan end policy holders should assume that any doctor's visits
intended to diagnose evaluate a medical condition will be eligible for that up to twenty
dollars plan n copay And this now includes urgent care, and some telehealth meetings.
The other difference between Plan N and Plan G is Part B
XS PlanN has no insurance to pay excess charges.
Are excess charges a big deal? No.
There are some YouTube videos that suggest that ten percent of Medicare doctors charge and
excess charge And if you end up in surgery, you can be surprised build by your doctor or
anesthesiologist or anyone else who visits you while you're in the hospital.
And of course they also suggest that more and more
doctors will charge excess charges in the future.
That's simply not true. None of it.
I did a video recently called Medicare excess charges are dead linked above my left shoulder,
and in the show notes below In that video I show using Medicare's own statistics on excess
charges showing that only two percent of doctors have a contract that allows them to charge an
excess charge, half of whom are in the mental health industry.
Only zero point three percent of Medicare bills include an excess charge.
There are also no excess charges allowed for emergency urgent care services, and doctors must
notify you in advance before charging an excess charge There's no surprise billing allowed And
Medicare has had that rule for more than a decade.
In the video excess charges are dead. I point out how you can tell if a doctor charges an
excess charge before you see them because they'll end up asking you to pay up front And I talk
about why that is the case in that video.
As far as trend, the number of doctors charging excess charges has been in a steady decline
every year since twenty ten.
In twenty sixteen, there was four percent of doctors could
charge an excess charge In twenty twenty it was down to three percent.
And now it's two percent. And I suspect that it's going to reach one percent in the next two years.
I go over why there is a declining trend in that video as well.
The bottom line is although excess charges are your responsibility if you have a plan n
supplement, most people will go through their entire Medicare experience without ever coming
across a doctor that has a contract that allows them to charge an excess charge.
So getting back on track about plan n as a choice People who choose a Medicare
supplement plan n do so because they like saving money.
They don't mind being responsible for knowing if their doctor charges an excess charge because
they know that that small task saves money.
So the person who best fits a Medicare supplement plan n is the person who wants to save money
and enjoys participating or doesn't mind participating, taking on a small responsibility
to save that money It's the same person who might enjoy using coupons for example, or wait for
a sale to buy something that they want, or maybe drive a few blocks out of the way to save some
money on gas The plan in person values being in control of their
health care, But also values being budget conscious.
They decide on plan n because they see it as a better value than Plan G.
So tell me, which personality are you Are you a piece of mind personality that prefer a
Medicare supplement Plan G or are you more interested in
saving money with a Medicare supplement plan in?
And by the way if you're not one hundred percent sure which plan fits you I'd like to add one other thought here.
The Medicare Supplement Plan N can save a person between fifteen dollars and fifty dollars a
month in premiums It depends on where you live So what I like to do to compare the cost versus
value of a Medicare supplement plan g and plan n is to
measure the price difference in office visit co pays.
Remember the twenty dollar office visit copay? How many office visits per month Each month
would it take for plan N not to be a better value relative to Plan G.
Again both are good plans. They're just for people with different personalities People that
want peace of mind coverage value that peace of mind over the higher premium costs, people that
want to save money are bothered more by the higher premiums than by the simple act of looking up
their doctor to make sure they don't charge an excess charge So please let me know which
personality are you in the comments below Just write plan g person or plan n person.
What I wanna do is tally them up over time and see which personality is more common.
And I'm going to put the result in a pinned comment in the section after we've gotten enough replies.
Now the last time I did this and this was years ago, we had thirty
three percent plan in votes versus fifty nine percent plan g.
So let's see if that changed. So please give me a moment of your time and let me know in the
comments below which personality are you.
And when we have enough votes Italian together, and we can all see who wins In the meantime,
please press the like button below and share this video with your friends And if you want to see
more videos like this, please subscribe because there's a lot more coming.
I'm Matthew Claassen with Medigapseminars dot org.
Thank you for watching