Physical Therapy on a Plan N

[vic120]

My comment only relates to wheelchair.

I was wondering about this for a walker. Page 40 in the current Medicare and You talks about Durable Medical Equipment. DME is subject to the 20% coinsurance for Part B. I think caveats being, it has to be prescribed as medically necessary and sold by a provider enrolled in Medicare. I did not see any indication of $20 co-pay.

It was a rhetorical question I already know there is no copay for those things alone

 

[yorkriver1]

I don't like to sell MedSupp Plan N, if it can be avoided, for all the above reasons, and the slim potential for excess charges. One client example on the good side: many sessions of PT for wrenched shoulders from steering away in near miss with a deer, many sessions of cardiac rehab after surgery, no $20 for those, all paid 100%. Only one $20 from the surgeon's video appointment prior to cath surgery for valve replacement + stent. Echocardiogram covered after deductible, etc. So far no issues with the mistaken billing for office vs treatment. Any references to MAPD's are a completely different contract and a thing I bring up with clients who can afford Plan G vs. MAPD. The above client would have paid lots of copays on an MAPD. Looking for plans with lower PT/OT and cardiac rehab copays, etc. is one part of the process for those who want an MAPD or can't afford a MedSupp.

 

[Travis Price]

it looks like Plan N reads that


Yep. I was reading that earlier. The “SOME” is not much to go by. Thanks for your reply.

No. Only two things should be charged under Part B copay for Plan N. Medicare doesn't go into clarity over Medigap coverage too much. However Medicare has clarified this below:

https://www.cms.gov/Medicare/Health-Plans/Medigap/downloads/Plan_N_Guidance2.pdf

ER visits w/o admission and Doctor visits are the standard. Examination and treatment is the standard. Anything else is likely miscoded.

Google is pretty amazing, just saying. Unless if what I read was misinterpreted by me, which happens.