ARE SURGERIEs COVERED UNDER PART B OR A???

Nov 16, 2015

  1. BillyC
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    BillyC Expert

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    excuse the elementary question...

    but i got confused when my manager tells me that PART-B covers surgeries and PART-A does not,

    BUT

    The Manager of a HUGE FMO's senior department tells me that Part A covers Surgeries.

    That seems wrong because it's like telling someone if they had heartsurgery, and the bill was 100,000 the patient only pays $1,260 deductible, and that's it.


    SO I think...
    PART A Covers: Surgery
    Part B Covers: Surgeons .......

    please help me so I know I'm not lying to prospects.. Thanks!
     
    BillyC, Nov 16, 2015
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  2. DS4
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    DS4 Guru

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    Hopefully, Rick will be along shortly to answer this question. This question is way beyond my knowledge of Medicare.
     
    DS4, Nov 16, 2015
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  3. GoPokes
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    Is the surgery inpatient or outpatient?
     
    GoPokes, Nov 16, 2015
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  4. GreenSky
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    GreenSky Guru

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    Surgeries may be covered under both A&B or just B. Usually.

    Tell your manager that I said he should lose his license for being an idiot. Or go into FE.

    Rick
     
    GreenSky, Nov 16, 2015
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  5. Josh
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    Josh Retired Agent, Current List Broker

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    Josh, Nov 16, 2015
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  6. BillyC
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    Thanks Guys,

    I did read through those pages before I posted. I have the book on my table.
    The only thing I took away from the book though, was on page 40 that states,

    "If you have part B, it generally covers 80%of the medicare-approved amount for doctor's services you get while you're in a hospital." doctor = surgeon?

    anyway, the MAJOR question is how an MA works around this problem.
    Will the client incur 20% of the surgery until he reaches the out-of-pocket max of say... $6700?

    OR

    as the FMO manager told me: NO after you meet you $400/day copayment as an inpatient, your surgery is included. And you will have no other coinsurance.. or copayment..( I still don't understand how to use those words lol.)
     
    BillyC, Nov 16, 2015
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  7. STIBROKER
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    STIBROKER Like My post and enter the DRAWING,,,, Moderator

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  8. sman
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    sman Guru

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    If you're talking about a Medicare Advantage plan then it doesn't matter whether it's covered by Part A or Part B. What matters is how the MA plan covers it. Might I recommend you get some additional training before advising people on their Medicare benefits. You can pay a small fee and join Rick's organization and got lots of training. Obviously your manager isn't doing a very good job.
     
    sman, Nov 16, 2015
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  9. yogooglethis
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    Tell your manager that part C of medicare combines a and b benefits .i believe all MA plans have to bundle all part a and b charges together and ma members pay only the plans applicable IP copayment.
     
  10. MBSC
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    I can't speak to a specific MA plan but for Original Medicare:

    Admitted for IP surgery:
    Facility charges are covered under Part A
    Professional charges (doctors/surgeon) are covered under Part B

    For OP surgery, both the facility charges and professional charges are covered under Part B.
     
    MBSC, Nov 17, 2015
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