Medicare: Provider and Hospital Costs

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Transcript: Once you’re signed up for Medicare, you should check if your provider accepts Medicare and be aware of services that are or aren’t covered. You can ask your provider questions about Medicare coverage for recommended treatment. If your provider recommends a service or treatment that is usually covered by Medicare but your provider thinks it may not be covered in your case, you may need to sign a form called the Advanced Beneficiary Notice of Coverage (ABN), which explains that you may have to pay for the service if Medicare doesn’t approve it. If you have original Medicare (Parts A and B), before you get services, ask your healthcare provider if they charge the Medicare-approved amount. If they do, you won’t be billed for more than the standard Medicare deductible and coinsurance. You end up paying less out-of-pocket. If they don’t charge the Medicare-approved amount, they can charge you more than the amount Medicare approves for that service, and they may require you to pay the full cost at the time of service. If you have a Medicare Advantage plan, before you get services, call your plan to see if they have a network and check if your provider is in-network. Some plans allow you to use providers out- of-network, but it may cost you more out- of-pocket. Remember, you can always get emergency care and urgent care, even if the doctor or hospital isn’t in-network, but let your Advantage Plan know as soon as possible if you have received those services. If you have Part D, check with your plan to find out what pharmacies in your area are in- network. In-network pharmacies are “preferred” and normally offer the lowest cost for drugs. There may be circumstances where it is cheaper to forego using your Part D to cover medications, but any amount you pay for non-covered drugs will not go toward your deductible. If you use an out-of-network pharmacy, you might have to pay the full cost. Under Medicare Part A, you may have to pay a deductible for each benefit period when you stay in the hospital or receive mental healthcare as an in-patient. After you pay the deductible, you will have to pay a portion of the costs, called coinsurance. Your benefit period starts the day you are admitted as an in-patient and ends when you have not received any in-patient care for 60 days in a row. If you stay in the hospital after a benefit period ends, a new benefit period will begin. There is no limit to the number of benefit periods you may have. When you are in- patient for more than 90 days, Medicare will pay for additional days called Lifetime Reserve days. You have a total of 60 Lifetime Reserve days that can be used throughout your lifetime. When using reserve days, Medicare will pay all covered costs except for your daily coinsurance. If you need to be in the hospital longer than your benefit period and Lifetime Reserve days, you would be responsible for 100% of the costs unless you had additional benefits through Medigap or another insurance coverage. Under Medicare Part B, you will usually have to pay a 20% coinsurance for approved services after you meet your yearly deductible. There are some services that Medicare does not cover, such as long-term care, most dental care, dentures, eye exams for prescribing eyeglasses, cosmetic surgery, acupuncture, and hearing aids. If you need these services, you will have to pay for them out-of-pocket or have other insurance coverage that covers them. To find out if items, services, or tests you need are covered under Medicare, you can visit www.medicare.gov/coverage. [The screen fades to show a thumbnail of a faded white background of a doctor holding hands with another individual] Deaf. Healthy. DeafHealth. Learn more at www.deafhealthaccess.org. [The screen fades to show a thumbnail of a blue lighthouse] Paf. Patient Advocate Foundation. www.patientadvocate.org.]