New to Medicare - Figuring out Costs in Advance

[MichaelB]

An $800 blood lab charge seems way too high. Even if you have to pay it in the end I bet you can ask for cash payer prices or whatever the reimbursement rate is for medicare and it might come down to $150 or less.

Good point. So, with regular insurance, if the service provider has a price agreement with the insurer, the individual gets the reduced price even if the service itself is not covered. Does the same apply to Medicare? And, if it does, does it appear on the EOB or does the person have to do something different?

 

[John Galt III]

........... i have been surprised how much DH and I have to pay our of pocket even though we have Medicare and a supplement (thousands).

Harlee, I read your other thread, which was very informative. On the subject of things not being 'covered' and traditional medicare vs. medicare advantage: my mom has a medicare advantage plan, and I see from her online claims website, that her advantage plans does not cover a lot of things, but instead of saying 'not covered', or 'not medically necessary' it just says 'denied', and something like 'provider billed $540, amount allowed $200, amount paid $0.00, amount patient owes $0.00'. Note the 'amount patient owes $0.00.' yay! Sometimes she gets a bill anyway from the sourpusses who are denied, but I call them up and so far the bills have been canceled. Maybe she just has lucked out by getting a good advantage policy that works out so well for her. I was leaning towards getting traditional medicare with a supplement, since the vibe so far from medical personnel to lay people has been that even though it may cost 2 or 3 hundred per month, it was supposed to be way better than any medicare advantage plan. Now I'm leaning towards a medicare advantage plan.

 

[MBSC]

So, with regular insurance, if the service provider has a price agreement with the insurer, the individual gets the reduced price even if the service itself is not covered.

Do you have a source or reference confirming this ability to get contracted rates on non-covered services? My regular insurance EOB usually looks like this.

Billed Charge: $100
This service is not covered.
Patient Responsibility: $100