Medicare - just A + B?

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DetroitRick
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Re: Medicare - just A + B?

Post by DetroitRick »

The simple unpredictability of medical costs in old age was the main factor in my wanting either a supplement policy or an Advantage plan. Chemo, multiple hospital stays, skilled nursing - who knows? Tough to predict at 65, impossible to predict at 90. The insurance alternatives just aren't that expensive, so I'd rather have the protection. Like all insurance, I hope to not need it. When I got done analyzing my needs, I found either G, G-High Deductible, or N sufficient to make me comfortable against all these rare, but potentially catastrophic, possibilities. Should future premiums get ridiculous, I'll reconsider an Advantage program. For now, I hope to remain on the losing end of the premium/benefit equation.

Be aware in buying supplements how very large premium differences can be between identical coverage policies. Even among policies that using identical rating methods. Compare 2 attained-age based policies at various ages - you quickly see how different premiums can become based on age (and, as I found, location). But still, in absolute terms, not that costly except at the extremes.

As far as Part D, it was an even easier choice for me. With the added advantage of being able to change every year, selection via the Medicare.gov tool made the choice easy. Even at a healthy 65, my prescription benefit far exceeds my meager $23/month premium. I don't take much, or anything exotic, but my prescriptions are cheaper now than they were under my good ACA plan. Formulary is virtually identical too for the plan I chose - so no compromise and lower cost. At that is true now, and I'll shop yearly since differences between plans (premiums, formulary, benefits) are significant. But given pharma costs in general, I would not entertain skipping Part D.
tj
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Re: Medicare - just A + B?

Post by tj »

DetroitRick wrote: Mon May 10, 2021 12:13 pm The simple unpredictability of medical costs in old age was the main factor in my wanting either a supplement policy or an Advantage plan. Chemo, multiple hospital stays, skilled nursing - who knows? Tough to predict at 65, impossible to predict at 90. The insurance alternatives just aren't that expensive, so I'd rather have the protection. Like all insurance, I hope to not need it. When I got done analyzing my needs, I found either G, G-High Deductible, or N sufficient to make me comfortable against all these rare, but potentially catastrophic, possibilities. Should future premiums get ridiculous, I'll reconsider an Advantage program. For now, I hope to remain on the losing end of the premium/benefit equation.

Be aware in buying supplements how very large premium differences can be between identical coverage policies. Even among policies that using identical rating methods. Compare 2 attained-age based policies at various ages - you quickly see how different premiums can become based on age (and, as I found, location). But still, in absolute terms, not that costly except at the extremes.

As far as Part D, it was an even easier choice for me. With the added advantage of being able to change every year, selection via the Medicare.gov tool made the choice easy. Even at a healthy 65, my prescription benefit far exceeds my meager $23/month premium. I don't take much, or anything exotic, but my prescriptions are cheaper now than they were under my good ACA plan. Formulary is virtually identical too for the plan I chose - so no compromise and lower cost. At that is true now, and I'll shop yearly since differences between plans (premiums, formulary, benefits) are significant. But given pharma costs in general, I would not entertain skipping Part D.
I'm not sure why N would even be considered. G HD vs G seems like better options. N isn't that much cheaper than G but has no out of pocket max on the co-pays, if I recall correctly.
ModifiedDuration
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Re: Medicare - just A + B?

Post by ModifiedDuration »

tj wrote: Mon May 10, 2021 2:43 pm
I'm not sure why N would even be considered. G HD vs G seems like better options. N isn't that much cheaper than G but has no out of pocket max on the co-pays, if I recall correctly.
I guess it might depend on where you live and what the price difference between G and N is.

Someone just told me that he decided to go with N because it was $40 a month less than G and he figured as long as he averages less than 24 doctors visits a year, which he considered to be very likely, he was coming out ahead (we live in a state where Excess Charges are not allowed).
DetroitRick
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Re: Medicare - just A + B?

Post by DetroitRick »

tj wrote: Mon May 10, 2021 2:43 pm
I'm not sure why N would even be considered. G HD vs G seems like better options. N isn't that much cheaper than G but has no out of pocket max on the co-pays, if I recall correctly.
I didn't find the decision to be black and white at all. The copays involved are only up to $20 for a doctor visit and $50 for a non-admission hospital visit. Nothing else. So it's a pretty definable worst case and I wouldn't personally worry about the aggregate out of pocket for these charges anyway. The other difference is Part B excess charges, which I wasn't overly concerned about in terms of $ risk (although there is no consensus here on that).

When I looked at G vs. N among the carriers in my market, some gave a clear advantage to one or the other and some did not. For example, under the largest carrier in my area age 65, G for me was about $130 per month, while N was $120 per month. Only a little bit greater spread at age 80. So not enough savings for me, although it's close (about 6 doctor visits to breakeven). Other insurers had greater spread and I would have selected N. But this is only one factor - when you look at the variance in premium increases over time, there are bigger issues that will drive long-term premium costs. Bottom line, all three were still worthy of my consideration.
PowderDay9
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Re: Medicare - just A + B?

Post by PowderDay9 »

Chip Munk wrote: Mon May 10, 2021 10:29 am
PowderDay9 wrote: Sun May 09, 2021 7:47 pm Typically the really large claims are for Part A and the amount you have to pay is only $1,484.
The thing that surprised me about this when I was preparing to sign up for Medicare is that the Part A deductible is per "benefit period", not per year. You could end up paying this deductible more than once in one year. Here's how Medicare describes "Benefit Period" in the "Medicare and You" handbook:

Benefit Period
The way that Original Medicare measures your use of hospital and skilled nursing facility services. A benefit period begins the day you’re admitted as an inpatient in a hospital or skilled nursing facility. The benefit period ends when you haven’t gotten any inpatient hospital care (or skilled care in a skilled nursing facility) for 60 days in a row. If you go into a hospital or a skilled nursing facility after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There’s no limit to the number of benefit periods.
This is a very good point to make sure people are aware of this. The limit would be 6 of these periods in a 1 year time frame since you have to be admitted, then 60 days later a new period could begin.

I'm more concerned about large claims over $10-20k and so far I haven't heard of any people on only Part A + B or somebody who had this much paid out by their Medigap plan. If I saw somebody have a $50k Medigap claim, I'd be much more likely to recommend Medigap.
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danielrhall
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Re: Medicare - just A + B?

Post by danielrhall »

ModifiedDuration wrote: Mon May 10, 2021 3:00 pm
tj wrote: Mon May 10, 2021 2:43 pm
I'm not sure why N would even be considered. G HD vs G seems like better options. N isn't that much cheaper than G but has no out of pocket max on the co-pays, if I recall correctly.
I guess it might depend on where you live and what the price difference between G and N is.

Someone just told me that he decided to go with N because it was $40 a month less than G and he figured as long as he averages less than 24 doctors visits a year, which he considered to be very likely, he was coming out ahead (we live in a state where Excess Charges are not allowed).
No brainer for me. The monthly premium for Plan G from my preferred carriers is less expensive than Plan N.

I just reached Medicare age and did a lot of reading. Now several of my friends are also getting Medicare coverage and are coming to me with questions and for recommendations. I always share these two observations: Medicare is absurdly and needlessly complicated, and often makes no logical sense.

Fortunately, it's good insurance.
ModifiedDuration
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Re: Medicare - just A + B?

Post by ModifiedDuration »

PowderDay9 wrote: Mon May 10, 2021 6:32 pm
I'm more concerned about large claims over $10-20k and so far I haven't heard of any people on only Part A + B or somebody who had this much paid out by their Medigap plan. If I saw somebody have a $50k Medigap claim, I'd be much more likely to recommend Medigap.
This 2010 report to Congress on page 54 states that in 2008 2% of Traditional Medicare beneficiaries incurred “cost sharing” of over $10,000, with the average in that group being $15,400.

In addition, there was a 4% chance to be in the $5,000 to $9,999 group, with an average cost sharing of $6,900.

If the chance in 2008 was 2% that you would incur cost sharing of over $10,000 in one particular year and maybe you were on Medicare for 20 years and your spouse was on Medicare for 20 years, well, you can do the math, but you probably would want to plan on at least one year with very high cost sharing for a couple.

(The note to the table does state that most Medicare beneficiaries have secondary insurance that covers some or all of this Medicare cost sharing.)

These figures are from 2008 and presumably would be much higher now.

http://medpac.gov/docs/default-source/r ... Report.pdf
PowderDay9
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Re: Medicare - just A + B?

Post by PowderDay9 »

ModifiedDuration wrote: Mon May 10, 2021 7:19 pm
This 2010 report to Congress on page 54 states that in 2008 2% of Traditional Medicare beneficiaries incurred “cost sharing” of over $10,000, with the average in that group being $15,400.

http://medpac.gov/docs/default-source/r ... Report.pdf
Thanks for that report. I had seen that one before but it didn't go into specifics on the extreme claims within that 2% bucket. I actually reached out to somebody I know who works with Medigap data and they said claims above $100k can happen but are extremely rare. Ballpark estimate would be 1 in 500k seniors each year.

I need to clarify my statements on the Part A deductible being $1,484. This is true but only for the first 60 days. Not many people will be in inpatient care for more than 60 days but it can happen and this is where the large claims would occur. From the CMS website.
https://www.medicare.gov/coverage/inpat ... ll%20costs.

You pay this:
$1,484 deductible for each benefit period.
Days 1–60: $0 coinsurance for each benefit period.
Days 61–90: $371 coinsurance per day of each benefit period.
Days 91 and beyond: $742 coinsurance per each "lifetime reserve day" after day 90 for each benefit period (up to 60 days over your lifetime).
Beyond lifetime reserve days : All costs.

So how the large claims happen is you are in the hospital for many months.
Days 61-90: $371 x 30 = $11,130
Days 91-150: $742 x 60 = $44,520
Days 151+: You pay Medicare allowed amounts per day. Probably $2-3k per day.

The last one is where the claims can really add up. A medigap policy may cover an additional 365 inpatient days. If you go beyond that then you pay. Going beyond 90 days is probably very unlikely but it may be worth purchasing a Medigap plan if one is worried about this risk. Just make sure it covers the additional inpatient days.

Skilled Nursing Facility is another benefit that Medigap could pay a $15k claim on. From the CMS website.
https://www.medicare.gov/coverage/skill ... y-snf-care

You pay:
Days 1–20: $0 for each benefit period .
Days 21–100: $185.50 coinsurance per day of each benefit period.
Days 101 and beyond: All costs.

So Medigap would pay the $185.50 from days 21-100 which is $14,840 if you stayed the entire 100 days. After that, Part A and Medigap won't pay anything. You either need LTC coverage or you pay out of pocket. I see this as a far greater risk than being in the hospital past 90 days.

There may be some large Part B claims but I would be surprised if there were many were the patient was paying more than $10-20k.


So in summary, I'm not sure I strongly lean in any direction between Original Medicare (Part A +B), Medigap, or Medicare Advantage. If Medigap then I think Plan G HD is a great option as the premiums are low but it protects you from the large claim scenarios. It also puts you in a more favorable risk pool since less healthy members will most likely choose a richer Medigap plan like plan G. Being in the HD plan will reduce your liklihood for rate increases in the future. Medicare Advantage can be a good option because they all have a maximum out of pocket and have to offer benefits at least as rich as Original Medicare.
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Re: Medicare - just A + B?

Post by susa »

Kenkat wrote: So a $1,000,000 cancer incident (which is very possible) results in you being responsible for $200,000 of that cost.
Apparently a common misunderstanding, ie, about 1400 vs "some huuuge 20% cost"

See medicare video series (short versions) by Dr Belk .. youtube.com/user/davidbelk46/playlists
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Re: Medicare - just A + B?

Post by susa »

pshonore wrote: I believe there's a late enrollment penalty for Part D if you don't take it when initially eligible.
Again a common misunderstanding of the true cost(s) for the delay.

See Dr Belk short series on Medicare .. youtube.com/user/davidbelk46/playlists
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Re: Medicare - just A + B?

Post by bberris »

Chip Munk wrote: Mon May 10, 2021 10:29 am
PowderDay9 wrote: Sun May 09, 2021 7:47 pm Typically the really large claims are for Part A and the amount you have to pay is only $1,484.
The thing that surprised me about this when I was preparing to sign up for Medicare is that the Part A deductible is per "benefit period", not per year. You could end up paying this deductible more than once in one year. Here's how Medicare describes "Benefit Period" in the "Medicare and You" handbook:

Benefit Period
The way that Original Medicare measures your use of hospital and skilled nursing facility services. A benefit period begins the day you’re admitted as an inpatient in a hospital or skilled nursing facility. The benefit period ends when you haven’t gotten any inpatient hospital care (or skilled care in a skilled nursing facility) for 60 days in a row. If you go into a hospital or a skilled nursing facility after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There’s no limit to the number of benefit periods.
Yes, you could pay a part A deductible more than once a year. But "no limit" is unnecessarily scary. You would have to be extremely unlucky to incur 7 benefit periods in a year. I'd wager a small sum that it has never happened.
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Re: Medicare - just A + B?

Post by tj »

bberris wrote: Tue May 11, 2021 7:53 am
Chip Munk wrote: Mon May 10, 2021 10:29 am
PowderDay9 wrote: Sun May 09, 2021 7:47 pm Typically the really large claims are for Part A and the amount you have to pay is only $1,484.
The thing that surprised me about this when I was preparing to sign up for Medicare is that the Part A deductible is per "benefit period", not per year. You could end up paying this deductible more than once in one year. Here's how Medicare describes "Benefit Period" in the "Medicare and You" handbook:

Benefit Period
The way that Original Medicare measures your use of hospital and skilled nursing facility services. A benefit period begins the day you’re admitted as an inpatient in a hospital or skilled nursing facility. The benefit period ends when you haven’t gotten any inpatient hospital care (or skilled care in a skilled nursing facility) for 60 days in a row. If you go into a hospital or a skilled nursing facility after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There’s no limit to the number of benefit periods.
Yes, you could pay a part A deductible more than once a year. But "no limit" is unnecessarily scary. You would have to be extremely unlucky to incur 7 benefit periods in a year. I'd wager a small sum that it has never happened.
7 $1500 deductible would be a lot more manageable than one extended period...
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Re: Medicare - just A + B?

Post by bberris »

....

Benefit Period
The way that Original Medicare measures your use of hospital and skilled nursing facility services. A benefit period begins the day you’re admitted as an inpatient in a hospital or skilled nursing facility. The benefit period ends when you haven’t gotten any inpatient hospital care (or skilled care in a skilled nursing facility) for 60 days in a row. If you go into a hospital or a skilled nursing facility after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There’s no limit to the number of benefit periods.

[/quote]

Yes, you could pay a part A deductible more than once a year. But "no limit" is unnecessarily scary. You would have to be extremely unlucky to incur 7 benefit periods in a year. I'd wager a small sum that it has never happened.
[/quote]

7 $1500 deductible would be a lot more manageable than one extended period...
[/quote]

Go up a few posts and look at what susa wrote.
tj
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Re: Medicare - just A + B?

Post by tj »

bberris wrote: Tue May 11, 2021 5:14 pm Go up a few posts and look at what susa wrote.
nothing susa said addresses this:
So how the large claims happen is you are in the hospital for many months.
Days 61-90: $371 x 30 = $11,130
Days 91-150: $742 x 60 = $44,520
Days 151+: You pay Medicare allowed amounts per day. Probably $2-3k per day.

The last one is where the claims can really add up. A medigap policy may cover an additional 365 inpatient days. If you go beyond that then you pay. Going beyond 90 days is probably very unlikely but it may be worth purchasing a Medigap plan if one is worried about this risk. Just make sure it covers the additional inpatient days.
kelangov
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Re: Medicare - just A + B?

Post by kelangov »

Kenkat wrote: Tue Apr 13, 2021 11:31 am I am not on Medicare yet but my big concern would be that there are no upper limits / out of pocket maximums as there are with private or ACA plans. If you have a major medical incident like cancer or a major heart issue, you are responsible for 20% of the cost, with no limit. So a $1,000,000 cancer incident (which is very possible) results in you being responsible for $200,000 of that cost.
True... there is no OOP maximum in part-B; for that reason, one must buy 'Medicare supplement' (such as AARP United Healthcare) to pick up that 20% cost, that is not covered by Part-B.
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Re: Medicare - just A + B?

Post by PowderDay9 »

kelangov wrote: Wed May 12, 2021 2:26 pm
Kenkat wrote: Tue Apr 13, 2021 11:31 am I am not on Medicare yet but my big concern would be that there are no upper limits / out of pocket maximums as there are with private or ACA plans. If you have a major medical incident like cancer or a major heart issue, you are responsible for 20% of the cost, with no limit. So a $1,000,000 cancer incident (which is very possible) results in you being responsible for $200,000 of that cost.
True... there is no OOP maximum in part-B; for that reason, one must buy 'Medicare supplement' (such as AARP United Healthcare) to pick up that 20% cost, that is not covered by Part-B.
Also Medicare Advantage plans have maximum out of pockets. In 2021, the highest maximum they can have is $7,550.

Check the policy of each Medicare Advantage plan. It probably covers an unlimited number of impatient days, which is even more protection than Medigap (which has limits and after those you owe the full amount for each day).
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Re: Medicare - just A + B?

Post by bertilak »

Misinformation deleted.
Last edited by bertilak on Thu May 13, 2021 10:41 am, edited 1 time in total.
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ModifiedDuration
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Re: Medicare - just A + B?

Post by ModifiedDuration »

bertilak wrote: Thu May 13, 2021 10:33 am
pshonore wrote: Tue Apr 13, 2021 11:27 am I believe there's a late enrollment penalty for Part D if you don't take it when initially eligible.
That's Part B.
There is a late enrollment penalty for Part D of 1% of the national base beneficiary premium ($33.06 for 2021) for each month late.

So, the late enrollment penalty is currently about $4 a month for each year late.

https://www.medicare.gov/drug-coverage- ... nt-penalty
Last edited by ModifiedDuration on Thu May 13, 2021 10:43 am, edited 1 time in total.
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bertilak
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Re: Medicare - just A + B?

Post by bertilak »

ModifiedDuration wrote: Thu May 13, 2021 10:38 am
bertilak wrote: Thu May 13, 2021 10:33 am
pshonore wrote: Tue Apr 13, 2021 11:27 am I believe there's a late enrollment penalty for Part D if you don't take it when initially eligible.
That's Part B.
There is a late enrollment penalty for Part D of 1% of the national average of $33.06 (for 2021) for each month late.

https://www.medicare.gov/drug-coverage- ... nt-penalty
Thanks! I did not know that. I was familiar with the Part B penalty because I almost stumbled into it!

I will delete my post so as to not spread misinformation.
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Re: Medicare - just A + B?

Post by hicabob »

Dr Belk mentions that costs can be higher in "rural" regions.

https://www.youtube.com/watch?v=qTpErd_ ... =DavidBelk

He says ....
"In rural areas, Medicare recipients are responsible for 20% of the FULL billing charges for certain services." (empahsis on full added by me)

I have not been able to find maps or definitions of said rural regions?
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Re: Medicare - just A + B?

Post by tj »

hicabob wrote: Thu May 13, 2021 10:41 am Dr Belk mentions that costs can be higher in "rural" regions.

https://www.youtube.com/watch?v=qTpErd_ ... =DavidBelk

He says ....
"In rural areas, Medicare recipients are responsible for 20% of the FULL billing charges for certain services." (empahsis on full added by me)

I have not been able to find maps or definitions of said rural regions?
It's not about rural vs not, it's if the doctor particpates in Medicare, if a lot of these rural doctors don't participate in medicare, they can bill whtaever they want, and i highly doubt there's a cap of 20%.
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Re: Medicare - just A + B?

Post by bberris »

If a doctor does not participate in Medicare, Medicare won't pay. If Medicare won't pay, neither will a supplemental. So there is no 20 % copay issue, it's a 100 % issue.
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Re: Medicare - just A + B?

Post by ModifiedDuration »

Only 1% of non-pediatric physicians have opted out of Medicare, with almost half of the doctors who have opted out being psychiatrists.

Of course, there are also physicians who accept Medicare but are not accepting new Medicare patients.

As usual, I don’t have a clue as to what Dr. Belk is talking about in the above quote.
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Re: Medicare - just A + B?

Post by beyou »

David Jay wrote: Thu Apr 15, 2021 1:29 pm
hicabob wrote: Thu Apr 15, 2021 1:14 pm Thanks for the answers all. One more medicare question .... I've heard that some docs will not take medicare patients due to the lower compensation. Has anyone found this to be true? If so I suppose that would be a huge advantage for an HMO type advantage plan.
A doctor can choose to take no Medicare patients whatsoever (i.e. this would probably work for a pediatrician...), but if they accept one Medicare patient then they must generally accept Medicare patients.
Father went for knee surgery, under Medicare.
Went back a few years later to same doc for other knee, same surgery, doctor said he no longer takes Medicare, had to find new doctor.

I simply would never use Medicare Advantage though, do not want an insurance company deciding what docs I can see. If docs wont see me that’s there business, but insurance companies have proper incentive to allow you to see anyone at all. Note my experience with checking in-network lists for coverage is that such activity only tells you the best case, not reality. I often have to go through many in-network choices on my private employer plan until I find a doc who has not moved to a new location, or retired, or too busy to make a near term appt, or treats my condition etc. Medigap maybe depending on cost, but not MA.
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Re: Medicare - just A + B?

Post by beyou »

ModifiedDuration wrote: Thu May 13, 2021 2:49 pm Only 1% of non-pediatric physicians have opted out of Medicare, with almost half of the doctors who have opted out being psychiatrists.

Of course, there are also physicians who accept Medicare but are not accepting new Medicare patients.

As usual, I don’t have a clue as to what Dr. Belk is talking about in the above quote.
Psychiatrists often wont take private insurance either.
That’s a whole other topic.

They can say “not taking new patients” but that must be regardless of type of insurance I presume, not just limited to new Medicare patients ? Can they really see legacy Medicare patients and only take new private insurance/cash patients (and still get paid for legacy Medicare patients) ?
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Re: Medicare - just A + B?

Post by ModifiedDuration »

beyou wrote: Fri May 14, 2021 6:15 am
ModifiedDuration wrote: Thu May 13, 2021 2:49 pm Only 1% of non-pediatric physicians have opted out of Medicare, with almost half of the doctors who have opted out being psychiatrists.

Of course, there are also physicians who accept Medicare but are not accepting new Medicare patients.

As usual, I don’t have a clue as to what Dr. Belk is talking about in the above quote.
Psychiatrists often wont take private insurance either.
That’s a whole other topic.

They can say “not taking new patients” but that must be regardless of type of insurance I presume, not just limited to new Medicare patients ? Can they really see legacy Medicare patients and only take new private insurance/cash patients (and still get paid for legacy Medicare patients) ?
A physician can elect to not take new Medicare patients, but can take new patients with other types of insurance.

A physician can elect to see legacy Medicare patients and can take new private insurance / cash patients. The physician will get paid by Medicare for the legacy Medicare patients.
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Re: Medicare - just A + B?

Post by beyou »

ModifiedDuration wrote: Fri May 14, 2021 6:56 am
beyou wrote: Fri May 14, 2021 6:15 am
ModifiedDuration wrote: Thu May 13, 2021 2:49 pm Only 1% of non-pediatric physicians have opted out of Medicare, with almost half of the doctors who have opted out being psychiatrists.

Of course, there are also physicians who accept Medicare but are not accepting new Medicare patients.

As usual, I don’t have a clue as to what Dr. Belk is talking about in the above quote.
Psychiatrists often wont take private insurance either.
That’s a whole other topic.

They can say “not taking new patients” but that must be regardless of type of insurance I presume, not just limited to new Medicare patients ? Can they really see legacy Medicare patients and only take new private insurance/cash patients (and still get paid for legacy Medicare patients) ?
A physician can elect to not take new Medicare patients, but can take new patients with other types of insurance.

A physician can elect to see legacy Medicare patients and can take new private insurance / cash patients. The physician will get paid by Medicare for the legacy Medicare patients.
Does that apply to Medicare Advantage or any private insurance ? If they are “in-network” for my employer plan could they just stop taking new patients but keep legacy patients on same plan (yet take other patients) ? I have had doctors announce they no longer take my employer plan and if we wanted to continue we’d presumably have to pay cash (never saw them again, lots of doctors in our urban area).
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