Physicians mutual innovative plan g? what are the assigned medicare fees for pt?

Medicare Forum
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does anyone have experience with physicians mutual innovative plan g? it’s priced lower than a standard g but higher than a high-deductible g. you pay up to the deductible for the first 3 years, then it switches to a regular g (only the part b deductible) but still at the lower premium. valuepenguin has good info on when the innovative plan g pays off – about 8 years if you meet your deductible 1 year, or 23 years if you hit it all 3 years.

my question is, does anyone know the negotiated (assigned) rate for a physical therapy visit? or for a pcp, cardio pa? i understand a pt visit could include multiple codes like exercise, manipulation, evaluation … but any general idea would help. i need some pt and might see my cardio pa and pcp once a year. i think the innovative plan will be great if my co-pays stay under $600 a year (since medicare always pays 80%). for 2024, the $600 includes $240 part d deductible and $360 in yearly savings on innovative g vs. regular g. but i need to know the assigned fees specifically for colorado. i’m taking a risk that nothing major will happen in these first 3 years (well, 2 years and 10 months, as my plan b starts 3/1/2024).

i’m always jbit (just barely in time), so need to decide by 2/28/24 :slight_smile: thanks for any help.

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an innovative plan g from physicians mutual is still a medigap plan, though it has a higher deductible than a high-deductible g plan.

with original medicare, medicare is the first to pay your medical bills as long as the doctor accepts medicare and the service is covered. for outpatient services under medicare part b, medicare pays 80% of the negotiated rate for approved services. your cost before meeting the innovative plan g deductible is the 20% that medicare doesn’t cover – this goes toward your annual deductible (which is around $2700, if i remember correctly).

i haven’t used this tool myself, but medicare’s outpatient procedure cost estimate can give you an idea based on a national average. it’s not specific to your location, but it could be a good starting point:

medicare.gov - procedure price lookup

i believe preventive services approved by medicare don’t count toward your deductible – check medicare.gov to confirm the exact details.

medicare.gov - your guide to medicare preventive services

it’s always helpful to get familiar with what’s covered under medicare and when, so the resources on medicare.gov can be quite handy.

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@Kiran
thanks for the links!

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@Kiran
physicians innovative plan g has the same deductible as high g. it’s essentially like any other high g plan, but in the 3rd year it converts to a regular g. the draw is that premiums start lower and presumably rise a bit slower, or have a lower starting point, even if the rate increases on the same schedule as a regular g.