Physical Therapy on a Plan N

[vic120]

one thing I can say some of my lowest increases are on plan

talking outside of FL an NY which is more equal in increases

I do sell much more G then N but I have some N clients with less than $15 in increases total in 3 or 4 years

Ran across few today when going through clients for increases 2 or 3 had less than $5 total in over 2 think one was 3 years

this is not always the case nor can I count on it, Otherwise I would push it more

just don't think I ever see that on Plan G

 

[MedicareAgent]

Had my husband on a plan N for years with no issue. His "up to $20 copay" was usually 8-10 bucks and sometimes none at all.

 

[wehotex]

I despise Plan N. I will only use it cases where I don't want an SSA only person going on MAPD, because they damn sure don't have the $1500 to get their hip replaced.

"Here's my answer on Plan N. My grandmother at age 90 had the money to pay the $20 copays. What she did NOT have is the physical or cognitive ability to do so" #whatsnext

What would make PT different than other Part B benefits?

Plan N does not require copays for PT.

On the other hand, the damn card says $20 copay and the front desk people cannot be expected to get the nuances of 100’s of plans.

At the time of sale for Plan N, bring up this issue, because it’s 100% going to happen. (My slide on this is titled “I don’t like calls that begin with you never told me…”

From a practical perspective, have the client pay the first $20 but ask them to contact the Med Supp carrier to confirm they owe the $20 copay. Most of the time, my clients get a refund before they leave the 1st session.

I guess that I just don't get how outpatient PT would be any different than any other Part B benefit subject to the Plan G deductible and "up to $20" charge?

 

[vic120]

What would make PT different than other Part B benefits?


I guess that I just don't get how outpatient PT would be any different than any other Part B benefit subject to the Plan G deductible and "up to $20" charge?

is MRI or Chemo therapy, Oxygen or Wheel chair subject to $20 copay

 

[policywunk]

What would make PT different than other Part B benefits?


I guess that I just don't get how outpatient PT would be any different than any other Part B benefit subject to the Plan G deductible and "up to $20" charge?

If no physician consultation involved then no co insurance after deductible.

 

[LostDollar]

is MRI or Chemo therapy, Oxygen or Wheel chair subject to $20 copay

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.

 

[LostDollar]

What would make PT different than other Part B benefits?


I guess that I just don't get how outpatient PT would be any different than any other Part B benefit subject to the Plan G deductible and "up to $20" charge?

See page 48 of Medicare and You, second subheading Physical Therapy.
You pay 20% of described services, subject to Part B deductible. No discussion of co-pay.

There is more in the paragraph than I want to try to retype here.

 

[LostDollar]

What would make PT different than other Part B benefits?


I guess that I just don't get how outpatient PT would be any different than any other Part B benefit subject to the Plan G deductible and "up to $20" charge?

Note that only certain services are subject to the co-pays.

see page 76 Medicare and You 2022.

***Plan N pays 100% of the Part B coinsurance. You must pay 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 an inpatient admission.

Note the "SOME" in the quote. In a thread I linked earlier @WCMason cited the the specific codes subject to the copay. I doubt there have been significant changes to those in the last 5-6 years.

Again this has been the thrust of the multiple threads on this issue over the years. Billing codes in that specified range will get a co-pay charge. Non-physician physical therapists should be billing for their services under codes that are subject to Part B coinsurance but which do not have the copay requirement.

 

[wehotex]

is MRI or Chemo therapy, Oxygen or Wheel chair subject to $20 copay

it looks like Plan N reads that

Note that only certain services are subject to the co-pays.

see page 76 Medicare and You 2022.



Note the "SOME" in the quote. In a thread I linked earlier @WCMason cited the the specific codes subject to the copay. I doubt there have been significant changes to those in the last 5-6 years.

Again this has been the thrust of the multiple threads on this issue over the years. Billing codes in that specified range will get a co-pay charge. Non-physician physical therapists should be billing for their services under codes that are subject to Part B coinsurance but which do not have the copay requirement.

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

 

[kgmom219]

This entire thread demonstrates why I hate Plan N.