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What Else Do I Need to Know About Medicare Costs?

Medicare cost is one of the biggest factors when signing up, dropping, adding or changing plans. After the coverage and care you get, cost can play the biggest part in your choice. Most people live on a fixed income, and no matter how much or how little they have, they do not want to overpay for healthcare.

What do I need to know about doctor choice?

Most doctors accept Parts A & B (Original Medicare.) Others do not. Some limit the number of Medicare patients they see.

Ask if your doctor accepts Medicare assignment. If a doctor accepts assignment it means they agree to the amount Medicare pays for a visit or service. This is also called the Medicare-approved amount. If they accept assignment, you would only pay the 20% coinsurance when you go to these providers.

Some providers see people with Medicare, but do not accept assignment. They can charge you up to 15% more than the amount Medicare approves. This means you would pay your usual 20% coinsurance, plus an extra 15%.

If you have a Medicare Advantage plan, your doctor agrees to accept the terms of the plan. He or she can only charge you the plan’s copayment. You would also have to pay your deductible, if the plan charges one.

What does it mean if my doctor “opts out” of Medicare?

Providers can also “opt out” of the Medicare program. This means they do not bill Medicare at all and they can charge you whatever they like for a service. A Medicare supplemental policy will not pay either.

Providers who opt out of Medicare must tell you before they treat you. They must give you a written statement that you and the doctor sign, to make sure you understand. You do not have to stay with a doctor who opts out of Medicare.

Check out the Parts A & B cost page, if you haven’t already, for more information on doctors and hospital costs. Learn about Parts A & B costs

What do I need to know about the costs of hospitals and facilities?

You must pay a hospital deductible when you go into a hospital. There is also a daily charge if you stay in the hospital more than 60 days. Medicare pays for 90 days in a hospital at one time. These days it is very rare for anyone to be in a hospital for that long.

For a nursing home stay, Medicare has no deductible. Medicare only covers up to 100 days in a skilled nursing facility. It only covers if you meet Medicare’s guidelines. Medicare will NOT pay if you only need help with your personal care, such as bathing, eating or dressing yourself. This is also called custodial care. After your 20th day in a nursing home, you pay a daily charge through the 100th day.

There is no deductible or copayment for home health and hospice care. You must meet certain guidelines to get this kind of care. If you qualify under Medicare’s rules, you can get this care as long as you need it. You may pay a small share of the costs of your drugs.

What if I have other health insurance?

Some people with Medicare also have another insurance plan or healthcare coverage. If you do, there are rules that say who will pay your doctor first and who will pay the rest of the bill. This is called Coordination of Benefits, or COB.

When you join Medicare, you will get an Initial Enrollment Questionnaire. The form lets Medicare know if you have other insurance. This way, Medicare will know who should pay which parts of your medical bills. Then it can process your claim.

With other health insurance and Medicare, who pays first?

If you get your health coverage through your current job or your spouse’s job, this insurance will probably cover you first, before Medicare pays anything. It is always best to double-check with your job’s health insurance plan administrator.

If you have retiree health insurance, Medicare usually pays first. Then your retiree plan fills in some of the remaining gaps. You can read how your plan works with Medicare in your other insurance plan booklet.

Keep these tips in mind when you have other insurance:

  • Make sure your employer has your current contact info.
  • Talk to the benefits administrator of your other insurance before you join Medicare to see how the two work together and if it is appropriate to take certain parts of Medicare.
  • Educate yourself about the different options available for those new to Medicare.
  • Send in the Initial Enrollment Questionnaire you receive from Medicare right away.

Next steps:

Learn About Enrollment  or  Get Help Comparing Plans with a Benefits Advisor