Original Medicare Costs Hawaii

Mar 6, 2019

  1. alphawave2k
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    alphawave2k Super Genius

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    So, my wife and I have friends that live in Hawaii who only have original Medicare though they could easily afford a Med Supp and PDP. The MAPD plans there to want a hefty premium. They've had many health issues, surgeries, hospital stays where the medical services OOP do not match the 80/20 split we all know and preach. Below is an example they recently sent. Is Hawaii and possibly other states exceptions to the rules?

    Here’s an example of a bill we just received: 2/4/19 CT scan of chest/thorax/abdomen & pelvis w/contrast.
    All we have is standard Medicare.
    The original bill was $3,435.00.
    After adjustments our co-pay was $110.95.
     
  2. Chazm
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    Chazm Guru

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    Maybe the original bill was that amount, but after it was sent to Medicare the amount was adjusted to $550.
     
    Chazm, Mar 6, 2019
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  3. WCMason
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    WCMason Guru

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    Hawaii isn’t exceptional and the bill looks right. You just left out the Medicare assigned rate. Assuming Part B deductible is met your $111 coinsurance would be 20% of the Medicare assigned rate for a CT scan, which would be $555. Pretty typical assigned rate for a diagnostic test.

    Edit: posted this without seeing the reply above. What he said.
     
    WCMason, Mar 6, 2019
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  4. TwoCents
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    I would think $3435 is much higher than the Medicare allowable so you'd need to know that figure and take 20%. Either that or your friends have no idea what kind of insurance they have.
     
  5. somarco
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    somarco GA Medicare Expert

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    Have your friends check their MSN. That will show the original amount, how much was approved and paid by Medicare.

    And the amount they owe.
     
    somarco, Mar 6, 2019
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  6. alphawave2k
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    alphawave2k Super Genius

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    Yep, I forgot about the Medicare Assigned Rate.

    Ditto as above, and I assumed they had met their annual deductible.

    That was part of the point of my post...they have Original Medicare and keep bragging or claiming that they are better off with it than with anything else. Last time I ran a quick quote for MAPD's in their zip code, premiums were a little high or at least not zero and they end up paying more for services.
    I will direct them to that...so they can better understand. They've had major surgical procedures (knee replacements, kidney removals) some with hospital stays, and the deductibles never seem to show up, i.e. Hospital Part A deductible of $1364, etc. Unless they're BSing me and not being truthful. Which is why I came to ask here.

    Thanks for everyone's replies....cannot stop learning. I had made a comment to a chiropractor recently that I keep trying to learn everything there's to know about Medicare and can't seem to get there. His comment was
    "and you never will"
     
  7. Chazm
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    Of course they will be ok with these small bills. Ask them what do they do when their bill is in the tens of thousands?
    I just had a client stay 35 days in inpatient rehab but he has a plan G so he paid nothing. It would of been 15x170.50 without it.
     
    Chazm, Mar 8, 2019
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  8. LostDollar
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    For me, that is another advantage of the medicare supplement. I have found some hospital information on the MSN to be unclear. I just wait for the MedSupp EOB to show me the proper amounts before I make any payments.

    Also, in regard to the 20% Medicare liability and cost of MedSupp--I think the unlimited nature of the 20% charge is a pretty big risk and I have found the High Deductible F plan to be a good compromise between the other Medigap plans and no plans at all.
     
  9. alphawave2k
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    alphawave2k Super Genius

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    Yes, LD thank you for pointing out the super-obvious. Any 1/2 way good agent is totally aware of this point, and do well to explain it to potential clients. The couple in question both profess to have genius IQ's, but they are die-hard, angry liberals. So maybe the IQ points are shaved off considerably once you cross that divide. Me? I'm as dumb as they come, but God blessed me with a ton of pragmatism...these 2 are not mutually exclusive. I'll take that over IQ points any "day of the hour" :jiggy:
     
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