Does Medicare really pay 80% Really?

[ivinsfan]

Quote:

Originally Posted by audreyh1 The Critical Access Hospital program was created in response to a string of hospital closures in the 1989s. https://en.m.wikipedia.org/wiki/Crit...ccess_Hospital https://www.ruralhealthinfo.org/topi...cess-hospitals

Rural living can be expensive, this is a good case of that. We have less choices for health care and yet have to pay more for less choice.

[pedidiva]

My understanding:

If you have Medicare Part B, it will cover 80 percent of all approved charges for doctor’s office visits, blood tests, X-Rays, CT scans, MRIs and ER visits. It even covers IV medications when given at an office or hospital infusion center or a nursing home. This is after you pay a $147 deductible each year.

Now, I want to be clear about what it means when I say Medicare covers 80 percent of approved charges. Let’s say your doctor orders an MRI of your knee. The hospital where you get that MRI might bill Medicare $4,000. Medicare looks at that $4,000 bill and says “we think that MRI is really worth $580 and not a penny more!” That means that Medicare pays $464 for that MRI, you pay $116, and the remainder is completely disregarded. No health care provider who accepts Medicare is allowed to go after you for any more than what Medicare approves.

FRom: https://www.huffingtonpost.com/david...b_3901861.html

[braumeister]

pedidiva, your entire post is a quote from the linked article. When you do that, please be sure to mark it as a quote (and keep it short). Thanks.

[ivinsfan]

Quote:

Originally Posted by pedidiva My understanding: If you have Medicare Part B, it will cover 80 percent of all approved charges for doctor’s office visits, blood tests, X-Rays, CT scans, MRIs and ER visits. It even covers IV medications when given at an office or hospital infusion center or a nursing home. This is after you pay a $147 deductible each year. Now, I want to be clear about what it means when I say Medicare covers 80 percent of approved charges. Let’s say your doctor orders an MRI of your knee. The hospital where you get that MRI might bill Medicare $4,000. Medicare looks at that $4,000 bill and says “we think that MRI is really worth $580 and not a penny more!” That means that Medicare pays $464 for that MRI, you pay $116, and the remainder is completely disregarded. No health care provider who accepts Medicare is allowed to go after you for any more than what Medicare approves. FRom: https://www.huffingtonpost.com/david...b_3901861.html

Huffington post doesn't know what they are talking about as we have provided many times over on this thread.... Medicare approved charge 580 true....you part of the bill 116 true.. Medicare part of the bill 464 minus what ever state and or federal rules allow it to pay, which might be well under 464...but you still pay the 116, that doesn't change. Point being that sometimes Medicare does not pay a full 80% of the actual Medicare approved amount. You however do pay 20 of that charge...

[haha]

Quote:

Originally Posted by ivinsfan Huffington post doesn't know what they are talking about as we have provided many times over on this thread.... Medicare approved charge 580 true....you part of the bill 116 true.. Medicare part of the bill 464 minus what ever state and or federal rules allow it to pay, which might be well under 464...but you still pay the 116, that doesn't change. Point being that sometimes Medicare does not pay a full 80% of the actual Medicare approved amount. You however do pay 20 of that charge...

Would this be most relevant for a patient who does not carry a Medigap policy?

Ha

[ivinsfan]

Quote:

Originally Posted by haha Would this be most relevant for a patient who does not carry a Medigap policy? Ha

Well even if you have a Medigap policy the 20% co pay has to be settled so I'm not really sure what you are asking. Technically they should be saying is you pay 20% of the Medicare approved charge which is not the same as saying that Medicare pays 80% of the charges.

[W2R]

Quote:

Originally Posted by ivinsfan Well even if you have a Medigap policy the 20% co pay has to be settled so I'm not really sure what you are asking. Technically they should be saying is you pay 20% of the Medicare approved charge which is not the same as saying that Medicare pays 80% of the charges.

Wow, that does sound less than ideal when the Medicare approved charge is so much higher than what is actually paid.

Luckily my federal BCBS health insurance converted to some sort of Medicare supplement or Medigap or something (? I'm not sure what they call it!) when I reached Medicare age. It has no co-pay and no deductible, and it pays whatever Medicare doesn't pay. Its premiums do cost a bit. Still, between the two of them I have not paid a cent for anything except for part of any prescription drug costs, during the past 5 years since I went on Medicare.

[ivinsfan]

Quote:

Originally Posted by W2R Wow, that does sound less than ideal when the Medicare approved charge is so much higher than what is actually paid. Luckily my federal BCBS health insurance converted to some sort of Medicare supplement or Medigap or something (? I'm not sure what they call it!) when I reached Medicare age. It has no co-pay and no deductible, and it pays whatever Medicare doesn't pay. Its premiums do cost a bit. Still, between the two of them I have not paid a cent for anything except for part of any prescription drug costs, during the past 5 years since I went on Medicare.

That's the policy my DH is on and I just went on, it was a little more then I wanted to pay, but what supplement isn't....DH had a super complicated cardiac surgery, 4 days in the ICU and 8 days total in the hospital and it didn't cost us one cent out of pocket but it is a little pricey.

[pedidiva]

Ok, thanks. Will do.

[braumeister]

Quote:

Originally Posted by pedidiva Ok, thanks. Will do.

Great.
But one more thing. When you respond to a post (as you just did to mine), it's best to quote the post you're replying to (or at least the relevant part of it), as I did here.

For other little details, you might want to take a look at this (the section on reading and posting messages):

Early Retirement & Financial Independence Community - FAQ: Board FAQ

[Fedup]

Quote:

Originally Posted by ivinsfan That's the policy my DH is on and I just went on, it was a little more then I wanted to pay, but what supplement isn't....DH had a super complicated cardiac surgery, 4 days in the ICU and 8 days total in the hospital and it didn't cost us one cent out of pocket but it is a little pricey.

That’s the simplicity I’m looking forward to when I get older. It will be easier for my kids to take over our finance one of these days.

[dtbach]

One of the great deals of being a retired veteran is Tricare for Life. They totally pay for anything that Medicare doesn't.

[jimandthom]

We will also have a federal employees plan acting as our supplement.

I am thinking of switching from Rural Carriers Benefit(Aetna run) to Aetna Direct at 280 per month with a $1800 reimbursement fund. Website and online chats all say no deductible, copay or coinsurance.

Between lower premium, $50 per month and the fund, going to reduce our medical cost by almost $2500 per year. Still reading and looking for the fine print however that will render the potential savings meaningless.

[Steve s]

So the government is telling the rural hospital they will approve a much higher approved amount that I will pay the %20 on but the gov will only pay their already preapproved amount set much lower then the billed preapproved amount.
Got it!