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Author Topic: Are Medicare costs 20%?  (Read 581 times)

poppy

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Are Medicare costs 20%?
« on: July 26, 2017, 09:04:33 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.

Helper

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Re: Are Medicare costs 20%?
« Reply #1 on: July 26, 2017, 09:09:01 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
« Last Edit: July 26, 2017, 09:10:40 PM by Helper »

poppy

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Re: Are Medicare costs 20%?
« Reply #2 on: July 26, 2017, 09:18:29 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.

SFVLance

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Re: Are Medicare costs 20%?
« Reply #3 on: July 26, 2017, 09:48:37 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.
Los Angeles, CA

Short Version: Filed in June 2012 at age 46; major depression + general anxiety. Denied all the way through. Fed district court remanded, 2nd hearing delayed twice (11 months total delay). Bench approval at remand hearing in March 2017. Took six months to receive most of back pay.

Helper

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Re: Are Medicare costs 20%?
« Reply #4 on: July 26, 2017, 10:15:41 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).

SFVLance

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Re: Are Medicare costs 20%?
« Reply #5 on: July 26, 2017, 10:22:19 PM »
You know, as I was typing that I knew I shouldn't have butted in -- but did anyway! Sorry!
Los Angeles, CA

Short Version: Filed in June 2012 at age 46; major depression + general anxiety. Denied all the way through. Fed district court remanded, 2nd hearing delayed twice (11 months total delay). Bench approval at remand hearing in March 2017. Took six months to receive most of back pay.

Lit Love

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Re: Are Medicare costs 20%?
« Reply #6 on: July 27, 2017, 01:27:36 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.

Helper

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Re: Are Medicare costs 20%?
« Reply #7 on: July 27, 2017, 04:17:26 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.

 

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