ARE SURGERIEs COVERED UNDER PART B OR A???

[BillyC]

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!

 

[DS4]

Hopefully, Rick will be along shortly to answer this question. This question is way beyond my knowledge of Medicare.

 

[GoPokes]

Is the surgery inpatient or outpatient?

 

[GreenSky]

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 ***. Or go into FE.

Rick

 

[Josh]

https://www.medicare.gov/Pubs/pdf/10050.pdf

This is a GREAT read. Page 38 starts part A vs part B.

 

[BillyC]

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.)

 

[STIBROKER]

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 ***. Or go into FE.

Rick

 

[sman]

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.)

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.

 

[yogooglethis]

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!

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.

 

[MBSC]

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.