If you're one of the people who qualified for a Medicare Supplement Plan F, (AKA Medigap Plan F) and decided to keep it, then you already know that Plan F covers the deductibles and copays of original Medicare at 100%. This means that people with a Plan F don't have to pay anything for covered services, except their monthly premium,.
Many people have moved to Plan G in anticipation of premiums increasing over the years, but if you have a Plan F, you can keep it, and many more people have decided to keep their Medicare Plan F policies.
This post is designed for people who've decided to keep their Medigap Plan F policies but are noticing that they've started getting bills from their doctor's office or other providers.
Yes, it's true. I've been getting more and more complaints that my clients with a Medicare Supplement Plan F are getting bills from their doctor offices.
If you don't have a Plan F, you might be wondering, “What's so wrong about that?” Well, the issue is that a Plan F is supposed to cover 100% of everything that Medicare covers.
I never used to get these complaints until this year, 2020. I'm not sure what is going on with doctor offices, but it seems to be nationwide, or at least I can verify that I've gotten complaints from San Diego all the way to South Carolina. In fact, my own husband has been getting bills.
If you have a Plan F, and the service is covered by Medicare, you should NOT be getting billed. Plan F covers all services at 100%. Even excess doctor charges.
Below is a copy of the chart taking directly from the CMS (Center for Medicaid and Medicare Services) booklet, “Choosing a Medigap Policy”. Everyone who purchases a Medicare Supplement Plan is supposed to get one of these booklets.
What should I do if I am getting bills and have a Plan F?
The first thing you should do if you are getting bills is to contact your doctor's office. This might be an honest mistake.
If they seem like they don't know that you shouldn't have been billed, send them a copy of this article.
- Always be polite. This means be polite to the doctor or other medical provider, and the doctor's staff. You won't get anywhere if you are belligerent. And the provider could refuse to provide care for you in the future. Remember, politeness goes a long way. No one wants to deal with a mean person.
- You should know that Medicare doesn't cover everything. It could be that you've had a service that isn't covered by Medicare. If you've been provided with a non-covered service, you should have been given a disclosure that indicates this. Ask your medical professional what the non-covered service was, and for a copy of your signed disclosure. If the service you had was a covered expense, then you shouldn't be getting bills.
- If your service was a covered expense, then ask them if they have a copy of your Medicare Plan F card. If so, then you shouldn't have gotten a bill. If they say that your bill is because of “excess doctor fees”, then refer the office to the chart above. Plan F covers these fees.
- Once you and the doctor's office have had the discussion, ask them to remove the item from since you shouldn't be getting billed.
- If the doctor still won't remove the bill, contact your insurance company (the number is listed on the back of your card) and ask them for advice. Work with your insurance company to get the bill removed.
- Only as a last resort should you contact Medicare and file a complaint against the provider.
One thing that you should know is that CMS (The Center for Medicaid and Medicare Services) is proposing another reduction of payments to providers. This is not new. Payments have been reduced before, and some doctors are opting out altogether. In fact, my personal doctor, who operates as a direct primary care doctor, has opted out of ALL insurance programs, including medicare. I pay her an annual fee, and in exchange, she provides me with all primary care services. I still carry insurance because she doesn't provide specialty services, but when I need to see her I'm able to get an appointment right away. Keep in mind that I live in a rural area so doctors are scarce here. I'd gladly pay the fee so that I have faster access to care.
Although I don't think many doctors will likely opt out of Medicare soon, I do expect that more providers in the future will start charging excess doctor fees, or else doing whatever they can to maintain their profitability. Remember, if it's not profitable or enjoyable for a provider to stay in business, we'll see less choice of providers in the future. So be nice to your provider, but also understand your rights as a Medicare beneficiary.
And if you've purchased a Plan N, which doesn't cover excess doctor fees, you might want to consider whether the choice you've made will be the right choice for you in five or ten years.