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Medicare Supplements
essentially look to Medicare to determine if a
benefit is allowed and if a provider (i.e. doctor or
hospital) is participating in the network.
There can be a difference in how the Medicare
Supplemental plans pay depending on whether a
physician accepts Medicare's rates or charges
Excess. By law, a provider can charge up to
15% higher than the standard Medicare rate and still
be considered participating. This is a big
deal for two reasons. First, you do want to
pay 15% of a $100K hospital bill ($15,000).
Secondly, as the Medicare program finds itself under
more financial pressure, reimbursement to providers
will be under pressure. This means that more
providers will likely charge the excess in the
future. This is the sole reason we recommend
the F plan over the C plan. The C plan does
not cover Excess where the F plan does cover excess.
For the small monthly premium difference, it makes
sense to cover this potential amount. Keeping
that in mind, please look at the following
directory.
Medicare Doctor Network Search
Some carriers apply
their PPO networks to Medicare Supplements.
Typically, this only results in a copay situation
for physicians up to the Part A deductible.
It is important to
make sure you use in-network Medicare Supplement
providers. To go off the network could result
in considerable out of pocket expenses to you.
If you have a doctor already, sometimes it easier to
call the office and ask if they are a participating
Medicare provider. It is also important to
make sure that a particular benefit is allowed by
Medicare. If your provider is in network but
the benefit is not allowed, Medicare will still not
pay out...and nor with the Medicare supplement.
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