What are the key elements and factors that contribute to Medicare cost?

Medicare cost is usually determined through deductibles, premiums, and copayments. Medicare is generally divided into Part A (hospital insurance) and Part B (medical insurance). Part A covers inpatient hospital care, home health care, some skilled nursing care, and hospice care. Part B pays for outpatient hospital care, doctor services, home health care not covered by Part A, durable medical equipment, and other services.

Existing guidelines indicate that the actual purpose of Medicare is to assist you to pay a portion of your medical expenses. Medicare cost guidelines suggest that as a Medicare beneficiary, you are expected to pay a fraction of your medical expenses such as copayments, deductibles, and other services not covered under Medicare. Deductible and copayment amounts vary and change at the beginning of each year.

Some of the major factors that determine your eligibility for Medicare include your age, your Social Security or Railroad Retirement Board benefits, Medicare-covered government employment, disability benefits, and whether you have a certain illness such as End-Stage renal disease.

Part A hospital deductibles are determined by your hospital benefit period and treatment from the hospital or skilled nursing facility. Copayments for Part A Medicare vary depending on the number of days you were hospitalized or the number of days you stayed at a skilled nursing facility. As beneficiary, you generally have to pay all costs for each day beyond 100 days. A Medicare Supplemental policy will usually cover for Part A deductibles and copayments.

Medicare Part B monthly premium is usually deducted from your Railroad Retirement, Social Security, or Civil Service Retirement check. If you are enrolled in Part B, you are expected to pay a monthly premium. Part B beneficiaries who do not receive a retirement check each month are paid by Medicare every three months.

Medicare cost guidelines indicate that Medicare usually covers 80 percent of Medicare-approved amount for Part B beneficiaries. The beneficiary usually pays 20 percent of the Medicare-approved amount. As a beneficiary, you will have to pay all of the limiting charge when a provider refuses assigned. A 15 percent surcharge will be imposed on you by providers who do not accept assignment. You should always ask a provider to accept assignment so that you can avoid the 15 percent surcharge.

Answer by general public — June 19, 2009 @ 3:53 pm

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