Basic Medicare Part B 2020 Premium $144.30 ??

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dm200
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Basic Medicare Part B 2020 Premium $144.30 ??

Post by dm200 » Fri Nov 08, 2019 10:33 am

I recently saw several online sites quoting a 2020 medicare part B - basic premium - increase to $144.30 per month, or $8.80 increase from 2019.

Is that the correct amount?

rivercrosser
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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by rivercrosser » Fri Nov 08, 2019 11:23 am

dm200 wrote:
Fri Nov 08, 2019 10:33 am
I recently saw several online sites quoting a 2020 medicare part B - basic premium - increase to $144.30 per month, or $8.80 increase from 2019.

Is that the correct amount?
Yes, everything I've seen and read says 144.30. Also the part a and part b deductibles are changing some in 2020.

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dm200
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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by dm200 » Fri Nov 08, 2019 12:19 pm

rivercrosser wrote:
Fri Nov 08, 2019 11:23 am
dm200 wrote:
Fri Nov 08, 2019 10:33 am
I recently saw several online sites quoting a 2020 medicare part B - basic premium - increase to $144.30 per month, or $8.80 increase from 2019.
Is that the correct amount?
Yes, everything I've seen and read says 144.30. Also the part a and part b deductibles are changing some in 2020.
Fortunately for us, our Kaiser medicare plan in 2020 will have lower monthly premiums, as well as many lower copays and charges for many services :)

FactualFran
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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by FactualFran » Fri Nov 08, 2019 3:00 pm

dm200 wrote:
Fri Nov 08, 2019 10:33 am
I recently saw several online sites quoting a 2020 medicare part B - basic premium - increase to $144.30 per month, or $8.80 increase from 2019.

Is that the correct amount?
That was an estimate published in April of 2019 on page 83 of a 2019 Annual Report of the Boards of Trustees of the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund.

The official basic premium has not yet been published.

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Eagle33
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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by Eagle33 » Fri Nov 08, 2019 8:25 pm

The medicare.gov site has $144.60 for 2020 Part B standard premium.
2020 Part B premiums

Part B deductible is $198 in 2020.
Rocket science is not “rocket science” to a rocket scientist, just as personal finance is not “rocket science” to a Boglehead.

kjsammy
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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by kjsammy » Sat Nov 09, 2019 7:41 am

[Deleted -- mod oldcomputerguy]

Medicare advantage is not heavily marketed, it is relentlessly marketed. That can only be good for industry, not me.
The podcast below is (as someone else wrote) extraordinary. It is a much broader discussion than just medicare advantage (discussed at the top).
Listen to podcast here:
https://ralphnaderradiohour.com/medicar ... advantage/
Transcript here:
https://ralphnaderradiohour.com/wp-cont ... script.pdf

Of note: "
Dr. Fred Hyde: There are three things, Ralph, that are very important to the individual. First is that in Medicare Advantage, there is an out-of-pocket, an annual out-of-pocket limitation on expenses, but there is no such limit in traditional Medicare and that’s the government rule, if you will. So, in a sense, if you look at the government as an employer, the employer is putting more and more expense on the traditional Medicare beneficiary with regard to out-of-pocket limitations. Medicare Advantage, the capitation payments which the plans receive are sufficiently generous that they can say, we’re gonna have an out-of-pocket limitation every year. A second piece of the information is that the Medicare Advantage people may have narrow networks. They, on average, only have about half the hospitals in a given area signed up because they like to have contracts with the hospitals that guarantee a higher volume, for perhaps incrementally lower cost. In traditional Medicare, people enter whenever they want because almost every doctor, almost every hospital takes traditional Medicare. But the narrow network is another technique for trying to squeeze profit out of the Medicare Advantage programs. And then finally there’s a new trick this year; there’s something called prior authorization, which drives physicians nuts. It amounts to having your office staff spend endless amounts of time on an 800 number talking to somebody who’s probably not clinically trained to try to get approval for something the doctor has already prescribed. Prior authorization is not allowed in traditional Medicare, but they are now allowed in the Medicare Advantage program. And one other new trick this year is called step therapy. Step therapy also drives doctors’ nuts. It basically says, this is the drug your doctor thinks you need, but before we pay for that, we want you to try a bunch of other drugs that we don’t think are gonna work as well, which are less expensive. Step therapy for pharmaceuticals, prior authorization for everything, narrow networks to constrain the choices the that the Medicare beneficiary has--these are all tools which the Medicare Advantage program has. And you’ll recognize they’re traditional HMO tools—the kind of things that we threw out in the beginning of the early 1990’s—but here they are back again in the Medicare program.

Ralph Nader: Well when the insurance companies at these lunches or seminars try to tempt older people, they say, well, you get more services under Medicare Advantage than you do under traditional Medicare. Once you told me, it’s not what you pay, it’s what you get when you need payment for your health care. Can you explain that? And what happened when Aetna didn’t like certain services under Medicare Advantage? "

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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by drawpoker » Sat Nov 09, 2019 12:44 pm

kjsammy wrote:
Sat Nov 09, 2019 7:41 am

......Medicare advantage is not heavily marketed, it is relentlessly marketed........
Dr. Fred Hyde: ....... in Medicare Advantage, there is an out-of-pocket, an annual out-of-pocket limitation on expenses, but there is no such limit in traditional Medicare and that’s the government rule, if you will.......
Relentless is putting it mildly. Judging by the endless barrage of TV commercials that started last month.

I have never ever understood how people can use such a misleading argument about no OOP limit on traditional Medicare.
This would only be true for the small minority of people who did not buy supplement C, F, or G.

For people who bought supplement plan N (presumably trying to save money on the monthly premiums) what did they expect to happen? When their health went south? Or the ones who bought bare-bones Plans L or M? Didn't it occur to them why the premiums were so cheap?

I suppose it is technically true to say "Traditional Medicare does not have any limit, or maximum, on out-of-pocket" without further explanation. But it is grossly misleading and unfair to seniors not to add "however you can insure yourself accordingly and secure that OOP limit very easily".

But, of course, I guess there are sr. citizens out there with televisions who believe Joe Namath actually needs those free rides to his medical appointments. Ya know, that certain M.A. plan out there that offers them. :P :P :P

prd1982
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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by prd1982 » Sat Nov 09, 2019 1:17 pm

drawpoker wrote:
Sat Nov 09, 2019 12:44 pm

For people who bought supplement plan N (presumably trying to save money on the monthly premiums) what did they expect to happen?
I think the tradeoff for Plan-N depends on the state. For CT, balance billing is not allowed. So there should not be any surprises, at least in-state. At least that is what I believe (I have Plan-N). Now, if you live in FL, you really want to cover balance billing. Please let me know if I have a false sense of security.

sport
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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by sport » Sat Nov 09, 2019 1:24 pm

kjsammy wrote:
Sat Nov 09, 2019 7:41 am
[Deleted -- mod oldcomputerguy]
Medicare advantage is not heavily marketed, it is relentlessly marketed. That can only be good for industry, not me.
The podcast below is (as someone else wrote) extraordinary. It is a much broader discussion than just medicare advantage (discussed at the top).
Listen to podcast here:
https://ralphnaderradiohour.com/medicar ... advantage/
Transcript here:
https://ralphnaderradiohour.com/wp-cont ... script.pdf

Of note: "
Dr. Fred Hyde: There are three things, Ralph, that are very important to the individual. First is that in Medicare Advantage, there is an out-of-pocket, an annual out-of-pocket limitation on expenses, but there is no such limit in traditional Medicare and that’s the government rule, if you will. So, in a sense, if you look at the government as an employer, the employer is putting more and more expense on the traditional Medicare beneficiary with regard to out-of-pocket limitations. Medicare Advantage, the capitation payments which the plans receive are sufficiently generous that they can say, we’re gonna have an out-of-pocket limitation every year. A second piece of the information is that the Medicare Advantage people may have narrow networks. They, on average, only have about half the hospitals in a given area signed up because they like to have contracts with the hospitals that guarantee a higher volume, for perhaps incrementally lower cost. In traditional Medicare, people enter whenever they want because almost every doctor, almost every hospital takes traditional Medicare. But the narrow network is another technique for trying to squeeze profit out of the Medicare Advantage programs. And then finally there’s a new trick this year; there’s something called prior authorization, which drives physicians nuts. It amounts to having your office staff spend endless amounts of time on an 800 number talking to somebody who’s probably not clinically trained to try to get approval for something the doctor has already prescribed. Prior authorization is not allowed in traditional Medicare, but they are now allowed in the Medicare Advantage program. And one other new trick this year is called step therapy. Step therapy also drives doctors’ nuts. It basically says, this is the drug your doctor thinks you need, but before we pay for that, we want you to try a bunch of other drugs that we don’t think are gonna work as well, which are less expensive. Step therapy for pharmaceuticals, prior authorization for everything, narrow networks to constrain the choices the that the Medicare beneficiary has--these are all tools which the Medicare Advantage program has. And you’ll recognize they’re traditional HMO tools—the kind of things that we threw out in the beginning of the early 1990’s—but here they are back again in the Medicare program.

Ralph Nader: Well when the insurance companies at these lunches or seminars try to tempt older people, they say, well, you get more services under Medicare Advantage than you do under traditional Medicare. Once you told me, it’s not what you pay, it’s what you get when you need payment for your health care. Can you explain that? And what happened when Aetna didn’t like certain services under Medicare Advantage? "
We have an MA plan. We pay an additional premium for that over the part B premium. However, the network is very wide and there is no cap on coverage. Our copays are $15 for the primary care doc and $25 for all other in-network docs. Our annual in-network deductible is $150. Our annual OOP in-network maximum is $1500. Rx's are $10 (or less) for 30 day generics and $30 for brand name. We get full coverage over the "donut hole" Part D gap. For the medical items that are not paid in full, such as well checks, colonoscopies, and blood tests, we pay 4% of the medicare rate. We have some medical needs that have very high "list prices". Our costs are very low. We are very happy with our MA plan. The out-of-network numbers are higher, but not prohibitive. We have never needed to pay these.

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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by drawpoker » Sat Nov 09, 2019 1:42 pm

prd1982 wrote:
Sat Nov 09, 2019 1:17 pm
drawpoker wrote:
Sat Nov 09, 2019 12:44 pm

For people who bought supplement plan N (presumably trying to save money on the monthly premiums) what did they expect to happen?
I think the tradeoff for Plan-N depends on the state. For CT, balance billing is not allowed. So there should not be any surprises, at least in-state. At least that is what I believe (I have Plan-N). Now, if you live in FL, you really want to cover balance billing. Please let me know if I have a false sense of security.
I wasn't referring to balance billing (excess charges allowed in some states)

I was referring to the fact that people with Plan N have no OOP max. No matter how often they go the doc, specialist, or E.R., they have to cough up a co-pay. Even if you reach $5,000, or $10,000, it never stops. Unlike with Plan G, once you have met the yearly deductible, or C or F (no deductible) you never pay another dime for anything that Medicare covers. Your OOP is whatever the monthly premiums cost, nothing more.

Please let me know if that is wrong under your Plan N.

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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by drawpoker » Sat Nov 09, 2019 1:54 pm

dm200 wrote:
Fri Nov 08, 2019 10:33 am
.....2020 medicare part B - basic premium - increase to $144.30 per month, or $8.80 increase from 2019.
Is that the correct amount?
I think I know what is eating at you - this $8.80 increase is a big jump from 2018 to 2019, isn't it. When it went up by only $1.50. :happy

Now, if you really want to cry in your beer :beer :annoyed consider this : All the years (2013-2016) when there was No Increase at all :shock:
The 2013 premium of $104.90 stayed that way until the 2017 increase.

https://www.thebalance.com/current-and- ... ms-2388483

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HueyLD
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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by HueyLD » Sat Nov 09, 2019 2:02 pm

$144.60 per Medicare.gov. What a bargain!!!

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dm200
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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by dm200 » Sat Nov 09, 2019 2:03 pm

drawpoker wrote:
Sat Nov 09, 2019 1:54 pm
dm200 wrote:
Fri Nov 08, 2019 10:33 am
.....2020 medicare part B - basic premium - increase to $144.30 per month, or $8.80 increase from 2019.
Is that the correct amount?

I think I know what is eating at you - this $8.80 increase is a big jump from 2018 to 2019, isn't it.
When it went up by only $1.50. :happy
Now, if you really want to cry in your beer :beer :annoyed consider this : All the years (2013-2016) when there was No Increase at all :shock:
The 2013 premium of $104.90 stayed that way until the 2017 increase.
https://www.thebalance.com/current-and- ... ms-2388483
No, not at all. I am not upset at all - just stating and understanding "the facts".

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dm200
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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by dm200 » Sat Nov 09, 2019 2:07 pm

Medicare advantage is not heavily marketed, it is relentlessly marketed.
Yes - I agree 100%.

In my opinion, some of the marketing of MA plans is very truthful and accurate, while some can be misleading (or very misleading) to some folks.

I have also concluded, from various friends and acquaintances, that many are very happy and satisfied with their MA plans (Humana and Kaiser, for example).

I also agree that, for some, MA plans are not a good fit, for various reasons. I also believe that MA plans vary greatly - and there are big differences from one area to another.

In the specific cases where I have encountered friends and acquaintances who are, or have been, very unhappy with Kaiser locally - I am always very puzzled about their reasons - based on our long experience.

One friend was very, very unhappy with her Kaiser PCP (the same one I have) because the Kaiser PCP told the friend that she was very overweight and should lost weight. Although I have no medical credentials - the friend is obviously well into the "obese" range!

Another friend told me she was very unhappy with Kaiser because, when her late husband was enrolled in Kaiser, his Kaiser physicians could not make him quit drinking (her husband was an long time alcoholic). I think that was a very unreasonable expectation.

One (of several) reasons my wife and I are happy with Kaiser is that we take advantage of all of the features and benefits of Kaiser membership - from after hours urgent care to telephone appointments, to email consultations with our various Physicians, to online mail order prescription refills, and so on.
Last edited by dm200 on Sat Nov 09, 2019 2:26 pm, edited 1 time in total.

montanagirl
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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by montanagirl » Sat Nov 09, 2019 2:20 pm

kjsammy wrote:
Sat Nov 09, 2019 7:41 am
[Deleted -- mod oldcomputerguy]

Of note: "
Dr. Fred Hyde: There are three things, Ralph, that are very important to the individual. First is that in Medicare Advantage, there is an out-of-pocket, an annual out-of-pocket limitation on expenses, but there is no such limit in traditional Medicare and that’s the government rule, if you will. So, in a sense, if you look at the government as an employer, the employer is putting more and more expense on the traditional Medicare beneficiary with regard to out-of-pocket limitations. Medicare Advantage, the capitation payments which the plans receive are sufficiently generous that they can say, we’re gonna have an out-of-pocket limitation every year. A second piece of the information is that the Medicare Advantage people may have narrow networks. They, on average, only have about half the hospitals in a given area signed up because they like to have contracts with the hospitals that guarantee a higher volume, for perhaps incrementally lower cost. In traditional Medicare, people enter whenever they want because almost every doctor, almost every hospital takes traditional Medicare. But the narrow network is another technique for trying to squeeze profit out of the Medicare Advantage programs. And then finally there’s a new trick this year; there’s something called prior authorization, which drives physicians nuts. It amounts to having your office staff spend endless amounts of time on an 800 number talking to somebody who’s probably not clinically trained to try to get approval for something the doctor has already prescribed. Prior authorization is not allowed in traditional Medicare, but they are now allowed in the Medicare Advantage program. And one other new trick this year is called step therapy. Step therapy also drives doctors’ nuts. It basically says, this is the drug your doctor thinks you need, but before we pay for that, we want you to try a bunch of other drugs that we don’t think are gonna work as well, which are less expensive. Step therapy for pharmaceuticals, prior authorization for everything, narrow networks to constrain the choices the that the Medicare beneficiary has--these are all tools which the Medicare Advantage program has. And you’ll recognize they’re traditional HMO tools—the kind of things that we threw out in the beginning of the early 1990’s—but here they are back again in the Medicare program.

Ralph Nader: Well when the insurance companies at these lunches or seminars try to tempt older people, they say, well, you get more services under Medicare Advantage than you do under traditional Medicare. Once you told me, it’s not what you pay, it’s what you get when you need payment for your health care. Can you explain that? And what happened when Aetna didn’t like certain services under Medicare Advantage? "
That was good, thanks! :beer

diy60
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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by diy60 » Sat Nov 09, 2019 2:44 pm

drawpoker wrote:
Sat Nov 09, 2019 1:42 pm
prd1982 wrote:
Sat Nov 09, 2019 1:17 pm
drawpoker wrote:
Sat Nov 09, 2019 12:44 pm

For people who bought supplement plan N (presumably trying to save money on the monthly premiums) what did they expect to happen?
I think the tradeoff for Plan-N depends on the state. For CT, balance billing is not allowed. So there should not be any surprises, at least in-state. At least that is what I believe (I have Plan-N). Now, if you live in FL, you really want to cover balance billing. Please let me know if I have a false sense of security.
I wasn't referring to balance billing (excess charges allowed in some states)

I was referring to the fact that people with Plan N have no OOP max. No matter how often they go the doc, specialist, or E.R., they have to cough up a co-pay. Even if you reach $5,000, or $10,000, it never stops. Unlike with Plan G, once you have met the yearly deductible, or C or F (no deductible) you never pay another dime for anything that Medicare covers. Your OOP is whatever the monthly premiums cost, nothing more.

Please let me know if that is wrong under your Plan N.
I'm not prd1982, but I wanted to respond to your reply. I generally agree with most of the info you post on BH. While technically true Plan N does not have a maximum OOP, the numbers you state in this response are unrealistic and grossly overstated. I consider Plan N nearly identical to Plan G, especially in states that prohibit balance billing. In my neck of the woods balance billing is prohibited and Plan N is about $20/month cheaper. This would mean it would take 10 trips to the doctor or 4 trips to the ER, or some combination, for Plan N to break even with Plan G. To get to your unlimited OOP of $5,000 to $10,000 one would have to make 500 doc visits in one year ($20/visit x 500 visits = $10,000), logistically impossible.

It's possible I don't understand other differences between Plan G and Plan N that negatively impact OOP, please advise if so.

In my view, the biggest problem is the fear mongering the insurance companies engage in causing seniors to make poor choices.

drawpoker
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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by drawpoker » Sat Nov 09, 2019 3:02 pm

diy60 wrote:
Sat Nov 09, 2019 2:44 pm
....While technically true Plan N does not have a maximum OOP, the numbers you state in this response are unrealistic and grossly overstated. I consider Plan N nearly identical to Plan G........it would take 10 trips to the doctor or 4 trips to the ER, or some combination, for Plan N to break even with Plan G. To get to your unlimited OOP of $5,000 to $10,000 one would have to make 500 doc visits in one year ($20/visit x 500 visits = $10,000), logistically impossible.
Obviously, you haven't had any recent hospital stays or surgeries since going on Plan N, have you.

Forget the ordinary visits to the doc or ER trips. Do you have any idea at all the number of Part B claims that all of the other physicians and providers (separate and apart from the actual hospital) are going to bill for an inpatient? From personal (and very recent) experience, I can tell you the list is staggering. At $50 per, 20 of them is $1,000 OOP

$5,000 to $10,000 could actually be rather conservative for a Plan N enrollee. Who has the bad luck to end up in the hospital 2 or 3 times in the span of a year, along with the routine visits to PCP and specialists.

You're right about this, though. Maybe I don't understand the subject very well. As I cannot for the life of me see how if the difference in price is only 20 bucks a month between G and N - why would anyone gamble, take chances, for such a petty sum? Please explain the reasoning at work here. Seriously I just don't get it. :?
Last edited by drawpoker on Sat Nov 09, 2019 3:15 pm, edited 1 time in total.

Broken Man 1999
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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by Broken Man 1999 » Sat Nov 09, 2019 3:14 pm

Medicare Advantage plans seem pretty popular. DW and I have one courtesy of Mega Corp.

Interesting info at this link from Kaiser Family Foundation:

https://www.kff.org/medicare/issue-brie ... e-in-2019/


A couple of takeaways...(my bold)

"....In 2019, one-third (34%) of all Medicare beneficiaries – 22 million people – are enrolled in Medicare Advantage plans, similar to the rate in 2017 and 2018. Between 2018 and 2019, total Medicare Advantage enrollment grew by about 1.6 million beneficiaries, or 8 percent – nearly the same growth rate as the prior year. The Congressional Budget Office (CBO) projects that the share of beneficiaries enrolled in Medicare Advantage plans will rise to about 47 percent by 2029...."

AND

".....The share of Medicare beneficiaries in Medicare Advantage plans (including Medicare cost plans), varies across the country. In 28 states and Puerto Rico, at least 31 percent of Medicare beneficiaries are enrolled in Medicare Advantage plans, with more than 40 percent of enrollees in six states (HI, FL, MN, OR, WI, PA) and Puerto Rico. The majority of the Medicare private health plan enrollment in Minnesota has historically been in cost plans, rather than Medicare Advantage plans, but as of 2019, most cost plans in Minnesota are no longer offered and have been replaced with risk-based HMOs and PPOs. Medicare Advantage enrollment is relatively low (20 percent or lower) in 14 states and the District of Columbia, including two mostly rural states where it is virtually non-existent (AK and WY)..."

Makes total sense to me. You have to have a population to build a network. A MA plan just isn't feasible for an insurer where people (and providers) are scarce. Traditional Medicare would serve them well, and I think they would have to do some traveling to find specific specialists/providers. The good news is when they can find a specialist/provider, they don't have to worry about the network issue.

My state (Florida) has 43% of Medicare eligible folks choosing enrolled in a Medicare Advantage plan. And, in Miami-Dade county, FL, the Medicare Advantage plans cover a whopping 66% of seniors on Medicare. :shock:

Broken Man 1999

Edited to change wording from choosing to enrolled.

No idea who is doing the choosing, but the ones making the choices certainly are choosing MA plans. Might be individuals, HR departments, someone is choosing, and to your point, it might not be at the individual level, that is the Medicare eligible insured.
Last edited by Broken Man 1999 on Sat Nov 09, 2019 5:05 pm, edited 2 times in total.
“If I cannot drink Bourbon and smoke cigars in Heaven than I shall not go. " -Mark Twain

diy60
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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by diy60 » Sat Nov 09, 2019 3:18 pm

drawpoker wrote:
Sat Nov 09, 2019 3:02 pm
Obviously, you haven't had any recent hospital stays or surgeries since going on Plan N, have you.

Forget the ordinary visits to the doc or ER trips. Do you have any idea at all the number of Part B claims that all of the other physicians and providers (separate and apart from the actual hospital) are going to bill for an inpatient? From personal (and very recent) experience, I can tell you the list is staggering. At $50 per, 20 of them is $1,000 OOP

$5,000 to $10,000 could actually be rather conservative for a Plan N enrollee. Who has the bad luck to end up in the hospital 2 or 3 times in the span of a year, along with the routine visits to PCP and specialists.

You're right about this, though. Maybe I don't understand the subject very well. As I cannot for the life of me see how if the difference in price is only 20 bucks a month between G and N - why would anyone gamble, take chances, for such a petty sum? Please explain the reasoning at work here. Seriously I just don't get it. :?
Not on supplemental yet, still in the 6 month decision window. Thanks for sharing a real work data point on Plan N potential costs.

drawpoker
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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by drawpoker » Sat Nov 09, 2019 3:27 pm

diy60 wrote:
Sat Nov 09, 2019 3:18 pm


.....Thanks for sharing a real work data point on Plan N potential costs.
Double-check this on co-pay amounts for specialists, my memory is a little hazy. I know PCP visits are $20, maybe some specialists, not all, are higher. And, unless you live in PA, CT, or some other state that prohibits the extra 15% billing, most of the excess billing allowed by Medicare is done by specialists, not PCP's.

Point is - it's not just Plan N. Anything other than C, F and G are potential time-bombs for OOP.

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FrugalInvestor
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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by FrugalInvestor » Sat Nov 09, 2019 3:39 pm

diy60 wrote:
Sat Nov 09, 2019 3:18 pm
drawpoker wrote:
Sat Nov 09, 2019 3:02 pm
Obviously, you haven't had any recent hospital stays or surgeries since going on Plan N, have you.

Forget the ordinary visits to the doc or ER trips. Do you have any idea at all the number of Part B claims that all of the other physicians and providers (separate and apart from the actual hospital) are going to bill for an inpatient? From personal (and very recent) experience, I can tell you the list is staggering. At $50 per, 20 of them is $1,000 OOP

$5,000 to $10,000 could actually be rather conservative for a Plan N enrollee. Who has the bad luck to end up in the hospital 2 or 3 times in the span of a year, along with the routine visits to PCP and specialists.

You're right about this, though. Maybe I don't understand the subject very well. As I cannot for the life of me see how if the difference in price is only 20 bucks a month between G and N - why would anyone gamble, take chances, for such a petty sum? Please explain the reasoning at work here. Seriously I just don't get it. :?
Not on supplemental yet, still in the 6 month decision window. Thanks for sharing a real work data point on Plan N potential costs.
Also remember that Plan N does not pay 'excess charges' (Plan G does). Providers not accepting Medicare assignment and therefore charging excess charges are not terribly common but if you end up using one those charges can add up over time especially for something like cancer treatment. I happened to use an elite national provider who does not accept assignment and was relieved that all of these charges were paid by my 'G' supplement plan.
IGNORE the noise! | Our life is frittered away by detail... simplify, simplify. - Henry David Thoreau

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dm200
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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by dm200 » Sat Nov 09, 2019 3:49 pm

In my opinion, it is very, very difficult to evaluate various Medicare Plans (Advantage or Medigap) just from the plan documents. For our Kaiser Medicare Plan (currently 'Cost' moving to 'Advantage' next year) - I note here some of the benefits that are not (or may not be) apparent from reading the plan documents. Note that this may also be very true of many other plans and types of plans.

- All Kaiser facilities in this area offer free parking, while most of our prior Physicians had offices where we had to pay about $5 every time we saw any of the Physicians.

- While the plan documents state that nearly all specialist visits must have a referral from your PCP, in actual practice, when you get that first referral, you almost never need to get another referral for the same condition. Also, in many cases (about half in our cases) - the PCP referral can be done without an office visit to the PCP (done by email or telephone appointment - no charge for either)

- We have not been charged an office visit copay for our annual office PCP visit - even when we bring up new issues.

- About half of things I would normally need to see a Physician in person for - I can deal with satisfactorily by email or telephone appointment (no charge for either)

- In some cases (cardiology and hematology in my case), I have not needed to see specialists in person (and need to pay the specialist copay) because my PCP gets such specialists to look at my records, test results, etc.

- In several of my situations where I would normally need to see a specialist in person every year, I can safely see such specialists less frequently by email communication and having lab tests done (both no charge) between actual in person appointments

- The outpatient surgery fee (currently $250 - and going down next year to $175 for us) is all inclusive - no added charges for facility, anesthesiologist, etc. The only very small charge sometimes is a prescription for pain meds.

-

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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by drawpoker » Sat Nov 09, 2019 3:59 pm

Broken Man 1999 wrote:
Sat Nov 09, 2019 3:14 pm

Makes total sense to me. You have to have a population to build a network. A MA plan just isn't feasible for an insurer where people (and providers) are scarce........My state (Florida) has 43% of Medicare eligible folks choosing a Medicare Advantage plan...... And, in Miami-Dade county, FL, the Medicare Advantage plans cover a whopping 66% of seniors on Medicare.....
I think your use of the term "choosing a Medicare Advantage plan" is misplaced. What you are overlooking is this:

Of the approximate 34% of seniors on MA rather than Traditional you can attribute either 9.2%, or, 14.1%, depending on which source you use, of that 34% due to dual-eligibles who had no choice in the matter. Those who qualify as dual-eligibles for both Medicare and Medicaid are automatically put into special M.A. plans.

I used the figures of 9.2% and 14.1% since those are the percentages of those over 65 living in poverty, and, thus, presumably dual-eligibles. Since you seem to be a fan of KFF reports, here's this:

https://www.kff.org/medicare/issue-brie ... n-poverty/

Ergo, I think it is a bit misleading to say that a third of senior citizens have "chosen" M.A. plans over Traditional Medicare, wouldn't you? The "true" picture is more like 15% or 20%.

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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by dm200 » Sat Nov 09, 2019 4:07 pm

drawpoker wrote:
Sat Nov 09, 2019 3:59 pm
Broken Man 1999 wrote:
Sat Nov 09, 2019 3:14 pm
Makes total sense to me. You have to have a population to build a network. A MA plan just isn't feasible for an insurer where people (and providers) are scarce........My state (Florida) has 43% of Medicare eligible folks choosing a Medicare Advantage plan...... And, in Miami-Dade county, FL, the Medicare Advantage plans cover a whopping 66% of seniors on Medicare.....
I think your use of the term "choosing a Medicare Advantage plan" is misplaced. What you are overlooking is this:
Of the approximate 34% of seniors on MA rather than Traditional you can attribute either 9.2%, or, 14.1%, depending on which source you use, of that 34% due to dual-eligibles who had no choice in the matter. Those who qualify as dual-eligibles for both Medicare and Medicaid are automatically put into special M.A. plans.
I used the figures of 9.2% and 14.1% since those are the percentages of those over 65 living in poverty, and, thus, presumably dual-eligibles. Since you seem to be a fan of KFF reports, here's this:
https://www.kff.org/medicare/issue-brie ... n-poverty/
Ergo, I think it is a bit misleading to say that a third of senior citizens have "chosen" M.A. plans over Traditional Medicare, wouldn't you? The "true" picture is more like 15% or 20%.

Yes - very good point!


Also, while I do not know the numbers or percentages involved, there are some employer retiree health insurance plans that require enrollment in a specific Medicare Advantage Plan. I know several folks who are retirees from a very large nearby school system. Financially - it seems very good for them - since they pay nothing for this MA plan AND under this plan, the provider network is very large and wide - and they pay nothing for office visits, procedures, etc.

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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by drawpoker » Sat Nov 09, 2019 4:11 pm

dm200 wrote:
Sat Nov 09, 2019 4:07 pm

Also, while I do not know the numbers or percentages involved, there are some employer retiree health insurance plans that require enrollment in a specific Medicare Advantage Plan.....
Yes, very true. When you add in that factor, it skews the exalted 34% number being thrown around even more, making the true numbers even more distorted.

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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by prd1982 » Sat Nov 09, 2019 4:41 pm

drawpoker wrote:
Sat Nov 09, 2019 3:02 pm
diy60 wrote:
Sat Nov 09, 2019 2:44 pm
....While technically true Plan N does not have a maximum OOP, the numbers you state in this response are unrealistic and grossly overstated. I consider Plan N nearly identical to Plan G........it would take 10 trips to the doctor or 4 trips to the ER, or some combination, for Plan N to break even with Plan G. To get to your unlimited OOP of $5,000 to $10,000 one would have to make 500 doc visits in one year ($20/visit x 500 visits = $10,000), logistically impossible.
Obviously, you haven't had any recent hospital stays or surgeries since going on Plan N, have you.

Forget the ordinary visits to the doc or ER trips. Do you have any idea at all the number of Part B claims that all of the other physicians and providers (separate and apart from the actual hospital) are going to bill for an inpatient? From personal (and very recent) experience, I can tell you the list is staggering. At $50 per, 20 of them is $1,000 OOP

$5,000 to $10,000 could actually be rather conservative for a Plan N enrollee. Who has the bad luck to end up in the hospital 2 or 3 times in the span of a year, along with the routine visits to PCP and specialists.

You're right about this, though. Maybe I don't understand the subject very well. As I cannot for the life of me see how if the difference in price is only 20 bucks a month between G and N - why would anyone gamble, take chances, for such a petty sum? Please explain the reasoning at work here. Seriously I just don't get it. :?

I copied this from the Medicare web site for the CO-pays:

Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don't result in inpatient admission.

* The $20 is for an office visit. So I assume this does not include a doctor seeing you while in the hospital.

* The $50 is for emergency room visits, and only if not admitted as inpatient. I realize lots of hospital work is now done as out-patient.

So I really don't see $5,000 to $10,000.

I looked at my plan and it is $33/month difference, or approximately 20 office visits a year. Now if I get very sick, I might have more than 20 visits a year. But I don't see this as a major expense is this case. Not to mention that none of the doctors I have seen have charged me the $20 co-pay.

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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by drawpoker » Sat Nov 09, 2019 7:09 pm

prd1982 wrote:
Sat Nov 09, 2019 4:41 pm
......So I really don't see $5,000 to $10,000.....
......looked at my plan and it is $33/month difference, or approximately 20 office visits a year. Now if I get very sick, I might have more than 20 visits a year. But I don't see this as a major expense is this case. Not to mention that none of the doctors I have seen have charged me the $20 co-pay.
Thanks for clarifying. Since I don't have Plan N and you do, maybe you can explain which doctors, and which type coded office visits, qualify for the $20 rate, and which don't. For the benefit of folks who may be weighing buying N instead of the other choices. Not to mention that your experience of never being charged the $20 co-pay might give false hope to others. Do you think your experience is typical for Plan N people?

"Now if I get very sick,"

Aha, That is the key here. Getting very sick. Without getting into the fine points of medical procedures (and violating forum rules) - think I can safely say this:

With what I have been through in the past 10 months and 9 days If I was carrying Plan N instead of Plan F I estimate my OOP would approach $5,000 by the end of the year. (I am in one of the states that does not ban excess charges for Part B) But, looking it over more closely, I will concede you are likely right, me wrong. I was being a little too much of an alarmist by suggesting going upwards as far as $10,000. My bad.

Also, discovered something else I had wrong about the bare-bones Plans K, L, and M. According to the Medicare and You current book, K has a 2019 OOP limit of $5,560; L has OOP limit of $2,780. So the El Cheapo premium rates (at least for these two) are not as much a threat, risk, or ticket to the poorhouse after all. There is escape hatch(s) for those willing to take a gamble.

But, that just brings us back to how this thread veered off in this direction. All the yakkety-yak talk, the dire warnings, that - Traditional Medicare Does Not Have Any OOP Limits, Watch Out, Beware, et al

Apparently the OOP limits are even broader than realized. Not just buying C, F, or G will do it, but also K and L.

So, why, do even the so-called experts on the subject, keep trotting out this old argument :?: I don't get it. :?

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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by prd1982 » Sun Nov 10, 2019 8:36 am

drawpoker wrote:
Sat Nov 09, 2019 7:09 pm
Since I don't have Plan N and you do, maybe you can explain which doctors, and which type coded office visits, qualify for the $20 rate, and which don't.

...

With what I have been through in the past 10 months and 9 days If I was carrying Plan N instead of Plan F I estimate my OOP would approach $5,000 by the end of the year. (I am in one of the states that does not ban excess charges for Part B)
I assumed the $20 would be charged for all office visits except for the wellness checks, which I think are once a year. My thought is that some doctors don't charge the $20, even though they can, because they don't want folks to avoid the doctor office. This benefits the patient and the doc. But I assume I will pay $20 for all visits.

As for your costs, I too would have plan G vs N if balance billing was allowed in my state. I would also expect the cost difference between G and N to be more than $33/month. It would be interesting to hear from folks in states that allow balance billing to list G/N rate differences.

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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by retired early&luv it » Sun Nov 10, 2019 10:19 am

Eagle33 wrote:
Fri Nov 08, 2019 8:25 pm
The medicare.gov site has $144.60 for 2020 Part B standard premium.
2020 Part B premiums

Part B deductible is $198 in 2020.
Thanks for posting, have been wondering what the costs next year would be.

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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by FrugalInvestor » Sun Nov 10, 2019 10:34 am

prd1982 wrote:
Sun Nov 10, 2019 8:36 am
As for your costs, I too would have plan G vs N if balance billing was allowed in my state.
It sounds like you are equating 'balance billing' to 'excess charges.' Are Medicare excess charges covered under state balance billing laws?
Last edited by FrugalInvestor on Sun Nov 10, 2019 10:35 am, edited 1 time in total.
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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by dodecahedron » Sun Nov 10, 2019 10:35 am

drawpoker wrote:
Sat Nov 09, 2019 4:11 pm
dm200 wrote:
Sat Nov 09, 2019 4:07 pm

Also, while I do not know the numbers or percentages involved, there are some employer retiree health insurance plans that require enrollment in a specific Medicare Advantage Plan.....
Yes, very true. When you add in that factor, it skews the exalted 34% number being thrown around even more, making the true numbers even more distorted.
On the other hand, I know that at least one very large retiree plan (covering all state and local government retirees in NY) requires enrollment in a specific Medigap plan. MA is not an option for them unless they want to abandon their excellent retiree coverage. (Their retiree plan covers the supplemental premium costs AND even reimburses the retirees for their Part B and Part D premiums, including any applicable IRMAA part B surcharges!)

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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by prd1982 » Sun Nov 10, 2019 12:08 pm

FrugalInvestor wrote:
Sun Nov 10, 2019 10:34 am
prd1982 wrote:
Sun Nov 10, 2019 8:36 am
As for your costs, I too would have plan G vs N if balance billing was allowed in my state.
It sounds like you are equating 'balance billing' to 'excess charges.' Are Medicare excess charges covered under state balance billing laws?
CT does not prohibit all excess charges, but does prohibit the ones I think most of us worry about. It is really a "no surprise bill" law. Here is what is prohibited:

* A bill for health care services, other than emergency services, received by an insured for services rendered by an Out-of-Network health care provider, where such services were rendered by such Out-of-Network provider at an In-Network facility during a service or procedure performed by an In-Network provider or during a service or procedure previously approved or authorized by the health carrier and the insured did not knowingly elect to obtain such services from such Out-of-Network provider.

* In respect to emergency services, PA # 15-146 requires that when emergency services for a patient are provided by an Out-of-Network provider, the provider can only require a patient to pay the equivalent of what the patient would be charged at their In-Network rate.

So, it does not cover:

* The term "surprise bill" does not include emergency services or services that the patient knowingly elected to receive from an Out-of-Network provider and for which an In-Network provider was available.

* If I go to a doctor office, I need to ensure he/she accepts the Medicare rate. But I don't see this as a hardship.

This year, CT expanded the coverage to prohibit labs from surpise billing.

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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by dm200 » Sun Nov 10, 2019 1:26 pm

dodecahedron wrote:
Sun Nov 10, 2019 10:35 am
drawpoker wrote:
Sat Nov 09, 2019 4:11 pm
dm200 wrote:
Sat Nov 09, 2019 4:07 pm
Also, while I do not know the numbers or percentages involved, there are some employer retiree health insurance plans that require enrollment in a specific Medicare Advantage Plan.....
Yes, very true. When you add in that factor, it skews the exalted 34% number being thrown around even more, making the true numbers even more distorted.
On the other hand, I know that at least one very large retiree plan (covering all state and local government retirees in NY) requires enrollment in a specific Medigap plan. MA is not an option for them unless they want to abandon their excellent retiree coverage. (Their retiree plan covers the supplemental premium costs AND even reimburses the retirees for their Part B and Part D premiums, including any applicable IRMAA part B surcharges!)
Yes - retiree coverage can vary a lot!

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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by FrugalInvestor » Sun Nov 10, 2019 1:27 pm

prd1982 wrote:
Sun Nov 10, 2019 12:08 pm
FrugalInvestor wrote:
Sun Nov 10, 2019 10:34 am
prd1982 wrote:
Sun Nov 10, 2019 8:36 am
As for your costs, I too would have plan G vs N if balance billing was allowed in my state.
It sounds like you are equating 'balance billing' to 'excess charges.' Are Medicare excess charges covered under state balance billing laws?
CT does not prohibit all excess charges, but does prohibit the ones I think most of us worry about. It is really a "no surprise bill" law. Here is what is prohibited:

* A bill for health care services, other than emergency services, received by an insured for services rendered by an Out-of-Network health care provider, where such services were rendered by such Out-of-Network provider at an In-Network facility during a service or procedure performed by an In-Network provider or during a service or procedure previously approved or authorized by the health carrier and the insured did not knowingly elect to obtain such services from such Out-of-Network provider.

* In respect to emergency services, PA # 15-146 requires that when emergency services for a patient are provided by an Out-of-Network provider, the provider can only require a patient to pay the equivalent of what the patient would be charged at their In-Network rate.

So, it does not cover:

* The term "surprise bill" does not include emergency services or services that the patient knowingly elected to receive from an Out-of-Network provider and for which an In-Network provider was available.

* If I go to a doctor office, I need to ensure he/she accepts the Medicare rate. But I don't see this as a hardship.

This year, CT expanded the coverage to prohibit labs from surpise billing.
I gather from your response that the CT 'surprise billing' law has no impact on Medicare 'excess charges' billing. Assuming that's the case I don't believe it should have any impact on choosing between plans G or N.

As far as a provider accepting Medicare there are actually two pertinent questions. The first is "do you accept Medicare." If the answer to this is "yes" then your Traditional Medicare insurance and supplement will apply. The second is "do you accept Medicare assignment." If the answer is "yes" then the provider is obligated to accept the Medicare approved amount for the service as full payment for services provided. If it is "no" then the provider may charge up to 9.25% over the Medicare approved amount (.95 x Medicare approved amount x1.15). The 9.25% charged by providers not accepting assignment is what's covered by plan G (or F).
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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by drawpoker » Sun Nov 10, 2019 1:43 pm

I don't understand where you are getting the 9.25% figure :?

We have always been taught to prepare for up to 15%, but no higher, over the Medicare-approved amount.

Are you referring to some special law applicable just in your own state?

https://65medicare.org/medicare-part-b-excess-charges/

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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by FrugalInvestor » Sun Nov 10, 2019 2:35 pm

drawpoker wrote:
Sun Nov 10, 2019 1:43 pm
I don't understand where you are getting the 9.25% figure :?

We have always been taught to prepare for up to 15%, but no higher, over the Medicare-approved amount.

Are you referring to some special law applicable just in your own state?

https://65medicare.org/medicare-part-b-excess-charges/
No, not state specific.

If a provider doesn't accept assignment the amount Medicare will approve is limited to 95% of the normal Medicare approved fee schedule amount. The following is from the Medicare.gov site here.....
https://www.medicare.gov/your-medicare- ... assignment
They can charge you more than the Medicare-approved amount, but there's a limit called "the limiting charge ". The provider can only charge you up to 15% over the amount that non-participating providers are paid. Non-participating providers are paid 95% of the fee schedule amount.
1.15 x .95 = 1.0925

If that's not confusing enough there's another 2% "sequestration charge" that the patient still must pay (and that F or G will not pay). You'll have to ask the U.S. Congress to explain that one.
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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by prd1982 » Sun Nov 10, 2019 3:58 pm

FrugalInvestor wrote:
Sun Nov 10, 2019 1:27 pm
I gather from your response that the CT 'surprise billing' law has no impact on Medicare 'excess charges' billing. Assuming that's the case I don't believe it should have any impact on choosing between plans G or N.
Not true. What is the main time you cannot ask if the doctor takes medicare assignment? It is when you are in the hospital, esp the emergency room. The CT laws do prevent this extra charging. If I go to a non-emergency doctor visit, I am able to ask the doctor the 2 questions you mention, and act on the responses.

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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by FrugalInvestor » Sun Nov 10, 2019 4:14 pm

prd1982 wrote:
Sun Nov 10, 2019 3:58 pm
FrugalInvestor wrote:
Sun Nov 10, 2019 1:27 pm
I gather from your response that the CT 'surprise billing' law has no impact on Medicare 'excess charges' billing. Assuming that's the case I don't believe it should have any impact on choosing between plans G or N.
Not true. What is the main time you cannot ask if the doctor takes medicare assignment? It is when you are in the hospital, esp the emergency room. The CT laws do prevent this extra charging. If I go to a non-emergency doctor visit, I am able to ask the doctor the 2 questions you mention, and act on the responses.
I don't believe that a doctor who has opted out of Medicare can bill a Medicare patient for an amount in excess of what Medicare will allow for emergency care services but I could be wrong. See here....

https://www.aafp.org/practice-managemen ... icare.html

From article.....
Physicians who have opted-out of Medicare under the Medicare private contract provisions may continue to furnish emergency or urgent care services to a Medicare beneficiary with whom the physician has not previously entered into a private contract, provided the physician:

Submits a claim to Medicare in accordance with both 42 CFR part 424 (relating to conditions for Medicare payment) and Medicare instructions (including but not limited to complying with proper coding of emergency or urgent care services furnished by physicians and qualified health care professionals who have opted-out of Medicare).
Collects no more than the Medicare limiting charge, in the case of a physician (or the deductible and coinsurance, in the case of a qualified health care professional).
IGNORE the noise! | Our life is frittered away by detail... simplify, simplify. - Henry David Thoreau

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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by prd1982 » Sun Nov 10, 2019 5:20 pm

Well, I'm prepared to admit I don't understand medical billing. If I search Google for does ct allow medicare part b excess charges I see:

Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island and Vermont do NOT allow Part B excess charges

On many of the returned items. I had assumed that was related to the rules I previously described.

Added:

Elimination of Excess charges provided by the Medicare Overcharge Measure (MOM)

The law, referred to as the Medicare Overcharge Measure (MOM), was adopted by Pennsylvania, Connecticut, Massachusetts, Minnesota, New York, Ohio, Rhode Island and Vermont. In these states, doctors working with Medicare must take Medicare Assignment and cannot charge Part B excess charges.

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Re: Basic Medicare Part B 2020 Premium $144.30 ??

Post by Electron » Tue Nov 12, 2019 2:02 pm

Here is the latest information on 2020 Medicare costs including Part B Premium and IRMAA amounts.

The Income Related Monthly Adjustment Amount (IRMAA) income brackets have been adjusted for inflation starting in 2020.

IRMAA amounts for Medicare Part B increased in each tier while the IRMAA amounts for Medicare Part D decreased.

https://www.cms.gov/newsroom/fact-sheet ... eductibles

https://www.medicare.gov/drug-coverage- ... drug-plans
Electron

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