The Anthem Med Supp enrollment/sales kit I use has an example of what a beneficiary would spend if they just used their Medicare card and was hospitalized for 15 days, and how a Medigap policy would cover these charges. The chart shows the Part A deductible cost of $1,340 for 2018. It also list Part B charges of $12,000 and the patient would be responsible for 20% of that amount, which is $2,400, as well paying the Part B deductible of $183 for 2018. Is it typical for someone to be billed $2,400 for their 20% cost-sharing of the $12,000? $12,000 seems high for Part B charges, but since I work mainly with Medicare Advantage members I am not familiar enough with what typical charges for a hospital stay would be for someone on Original Medicare. It these types of charges are common, then going the MAPD route makes a lot of sense for folks that cannot afford, or qualify for a Medigap plan, since they only pay the per diem rate for the first 3-5 days of the hospital admission. I know there are lots of reasons for folks to avoid MAPD plans, but my question is about typical Part B charges for hospital stays.
Typical Part B expenses for hospital admissions for folks on Original Medicare
- Thread starter timeflies
- Start date
I would love to know how they came up with $12k for B charges as an inpatient.
I can't say what "typical" B charges are for an inpatient stay. If there was a surgeon and gas passer those would fall under B. Depending on the source of the B charges I would not be surprised to see $12k repriced by 85% or so of gross billed charges.
About $1800 max allowable charge with Medicare paying $1440 and patient paying the $360 balance.
I can't say what "typical" B charges are for an inpatient stay. If there was a surgeon and gas passer those would fall under B. Depending on the source of the B charges I would not be surprised to see $12k repriced by 85% or so of gross billed charges.
About $1800 max allowable charge with Medicare paying $1440 and patient paying the $360 balance.
- 6,457
Using your comments above, have you seen an MSN which would show the $12K as Part B facility costs and then the allowed column also showing the $12K figure, but then the 2 cash columns dropping to the $1800 figure?
I'm wanting to understand what sort of Medicare procedure is going on there.
I'm wanting to understand what sort of Medicare procedure is going on there.
Unusual for hospital INPATIENT facility fees to hit $12k. Outpatient, as in ER, yes, but not for hospital inpatient. Most B charges by a hospital under inpatient start in the ER. Cutters and gas passers usually not on staff and they bill separately.
And yes, deep discounts by Medicare for outpatient care happens a lot. Not unusual to see 60 - 70% reductions but 80%+ on things like DXL
And yes, deep discounts by Medicare for outpatient care happens a lot. Not unusual to see 60 - 70% reductions but 80%+ on things like DXL
- 6,457
ok, thanks. looks like i need to learn about differences between in and out patient charges for medicare.
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A 15 day hospital stay is not typical, for Medicare beneficiaries, or anyone. The average length of stay for Medicare-age patients is around 5 days, which tells you the typical stay will be under that duration - probably significantly.
Orion1
Expert
- 35
I thought depending on the reason for the stay it's a straight line 80/20 split on original medicare eligible billings from the hospital (20% of medicare discounted provider rates) for any Part B coverage.
If the patient is observed or inpatient
the MedSup/MA would pickup the rest including the Part A/B deductible. (depending on which Medsup is in place). Some people ditch their K/F plans for MA's specifically for the cost savings and lack of any meaningful difference in coverage for their situation.
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If the patient is observed or inpatient
the MedSup/MA would pickup the rest including the Part A/B deductible. (depending on which Medsup is in place). Some people ditch their K/F plans for MA's specifically for the cost savings and lack of any meaningful difference in coverage for their situation.
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