How much of my bill will Medicare Part B pay?

How much of my bill will Medicare Part B pay?

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

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How much of my bill will Medicare Part B pay?