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Topic: Are Medicare costs 20%?  (Read 340 times)
poppy
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« on: July 26, 2017, 10:04:33 PM »

I am confused about how much we pay if we have Medicare only. My roommate has no advantage plan or supplemental plan. He broke is leg and got a hospital bill of $76220.30. His portion of it is only $1316.00. That is 1.7% of the total bill. I thought we had to pay 20%. I am wondering why I bother with an Advantage plan if our portion is so low in straight Medicare. I am very confused.
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Helper
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« Reply #1 on: July 26, 2017, 10:09:01 PM »

I am assuming that is the hospital bill.  There is a $1316 copay for hospitalization- see link https://www.medicare.gov/coverage/hospital-care-inpatient.html

However, your roommate will get additional separate bills for all the doctor's, radiologists, etc during the hospital stay.  Those are covered by Medicare Part B & a 20% copay is required.  Any medical equipment (walkers, etc) also falls under Medicare Part B.  https://www.medicare.gov/what-medicare-covers/part-b/what-medicare-part-b-covers.html
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Age at Application: 26 age of onset (but I did not apply until 28)
Date Applied: August 2011
First Approval/Denial Date: November 2011
Additional Info: I was fortunate to be approved on my initial application due to extensive medical records (12+ doctors) & documentation of unsuccessful work attempts even with significant accommodations

« Last Edit: July 26, 2017, 10:10:40 PM by Helper »
poppy
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« Reply #2 on: July 26, 2017, 10:18:29 PM »

I am assuming that is the hospital bill.  There is a $1316 copay for hospitalization- see link https://www.medicare.gov/coverage/hospital-care-inpatient.html

However, your roommate will get additional separate bills for all the doctor's, radiologists, etc during the hospital stay.  Those are covered by Medicare Part B & a 20% copay is required.  Any medical equipment (walkers, etc) also falls under Medicare Part B.  https://www.medicare.gov/what-medicare-covers/part-b/what-medicare-part-b-covers.html

Yes, I wrote that it was a hospital bill. Thank you so much for the copay answer. I was not aware of that.
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SFVLance
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« Reply #3 on: July 26, 2017, 10:48:37 PM »

Also, take another look at the bill. $76K+ plus sounds like the hospital's gross amount, but the negotiated Medicare amount will be much lower, and your roommate will be charged 20% of the negotiated amount. Roommate will (or did) get a notification from Medicare showing the actual amounts.

Some people need Advantage plans or Medigap because they have a lot of medical care and/or hospitalization needs.
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Name: Lance
Location: Los Angeles
Age at Application: 46
Disability: Severe Depression, Anxiety, PTSD
Date Applied: June 1, 2012
First Approval/Denial Date: Denied August 31, 2012
Reconsideration Approval/Denial Date: No Recon in my region of CA
Hearing Date: January 25, 2013; Remand Hearing March 13, 2017
ALJ Approval/Denial Date: Denied February 20, 2013; Federally Remanded, Bench Decision March 13, 2017
Additional Info: Got Federal remand; 2nd hearing postponed, rescheduled Fall 2016. Postponed again - finally held March 2017.
Helper
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« Reply #4 on: July 26, 2017, 11:15:41 PM »

Also, take another look at the bill. $76K+ plus sounds like the hospital's gross amount, but the negotiated Medicare amount will be much lower, and your roommate will be charged 20% of the negotiated amount. Roommate will (or did) get a notification from Medicare showing the actual amounts.

Some people need Advantage plans or Medigap because they have a lot of medical care and/or hospitalization needs.

The $1316 is the correct amount for an inpatient hospital stay of less than 60 days.  But it only covers the hospital itself & they will still owe 20% of all the addition charges (doctors, radiologists, sometimes labs, etc).
Logged
Age at Application: 26 age of onset (but I did not apply until 28)
Date Applied: August 2011
First Approval/Denial Date: November 2011
Additional Info: I was fortunate to be approved on my initial application due to extensive medical records (12+ doctors) & documentation of unsuccessful work attempts even with significant accommodations
SFVLance
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« Reply #5 on: July 26, 2017, 11:22:19 PM »

You know, as I was typing that I knew I shouldn't have butted in -- but did anyway! Sorry!
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Name: Lance
Location: Los Angeles
Age at Application: 46
Disability: Severe Depression, Anxiety, PTSD
Date Applied: June 1, 2012
First Approval/Denial Date: Denied August 31, 2012
Reconsideration Approval/Denial Date: No Recon in my region of CA
Hearing Date: January 25, 2013; Remand Hearing March 13, 2017
ALJ Approval/Denial Date: Denied February 20, 2013; Federally Remanded, Bench Decision March 13, 2017
Additional Info: Got Federal remand; 2nd hearing postponed, rescheduled Fall 2016. Postponed again - finally held March 2017.
Lit Love
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« Reply #6 on: July 27, 2017, 02:27:36 AM »


Some people need Advantage plans or Medigap because they have a lot of medical care and/or hospitalization needs.

I'd argue everyone should have a Medigap or Advantage plan because you can't plan on a broken leg.  Or cancer.  Etc.
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Helper
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« Reply #7 on: July 27, 2017, 05:17:26 AM »

Additionally, more & more care is going outpatient.  If your roommate had not been admitted to the hospital, then he would have owed a full 20% of the bill. 

Even with a broken leg, if the fracture is stable hospitalization is not always required (depending on any other medical conditions the person may have). Even appendicitis has started becoming a same day outpatient surgery for some patients.  (And a 23 hour stay where you stay overnight after a procedure for observation is actually still considered outpatient. )  You have to spend two nights in the hospital after bring formally admitted for the $1316 copay to apply instead of the 20% copay.
Logged
Age at Application: 26 age of onset (but I did not apply until 28)
Date Applied: August 2011
First Approval/Denial Date: November 2011
Additional Info: I was fortunate to be approved on my initial application due to extensive medical records (12+ doctors) & documentation of unsuccessful work attempts even with significant accommodations
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