Medicare Part B pays approximately 50 % of total expenses. To understand the reasons, read on.
Coinsurance
Medicare determines a specified amount that it will pay for a variety of services. This amount, called approved charges, is often less than the amount a patient would typically be charged. Next, Medicare pays 80 percent of this approved amount. The patient pays 20% of the approved amount. This is referred to as coinsurance.
Recently, Medicare Part B has begun covering some medical services at 100% rather than 80% of the approved amount. This includes the following:
- home health care
- clinical laboratory services
- flu / pneumonia vaccines
Non-participating Doctors or Providers
Non-participating Medicare doctors can choose on a case-by-case basis whether or not to accept Medicare assignment. In the case of a doctor not accepting Medicare, the patient will still receive the reduced Medicare-approved price, but might have to pay a 15% additional charge above the cost of the service, known as a Medicare excess charge. The patient would then be billed for up to 35% of the reduced Medicare price rather than 20%.
Uncovered Medical Services
A number of medical needs are not covered under Medicare including the following:
- eye glasses
- hearing aids
- dental work
- dentures
