by Nicholas_peters_ » Sat Jun 05, 2010 12:47 am
Hello Insurance Forum,
I am going to post a few times some scenarios that I have trouble with and would need some help understanding.
Okay, I get that the deductible has to be met before the patient can pay coinsurance. But let's say the patient had a $200.00 bill. All the while the patient is responsible for a $200.00 bill. He will have (the billed amount? Can someone fill this in to be what he would have?) sitting there waiting for him to pay it even if he has not satisfied the deductible yet. Now let's say he has Medicare primary and AARP secondary that would cover 80%/20% and Medicare allowed the $200.00 that he was billed to pay. He will have the $155.00 Medicare deductible he needs to pay and still need to owe the $45.00 balance left $200.00 allowed - $155.00 deductible, right? But if he has Medicare as primary and AARP as secondary and Medicare will pay 80% of (what amount??? - coinsurance amount? Can someone fill this in with what is paid by Medicare?) and AARP will pay 20% of (what amount??? - coinsurance amount? Can someone fill this in with what is paid by AARP?) none of them will pay any of their coinsurances to the $45.00 until the patient meets his Medicare deductible (assuming AARP does not pay the Part B deductible), and until that $155.00 deductible is met, the patient owes the deductible ($155.00 of $200.00) and technically the $45, right? But if the deductible is met, and the patient has a Medicare 80%/AARP 20%, Medicare will pays its 80% of the rest of the bill that the patient did not pay because the patient already paid his portion of what he owes (Medicare paying its 80% of $45 = the $36) and AARP will pay its 20% of the rest of the bill that the patient did not pay because the patient already paid his portion of what he owes (AARP pays its 20% of $45 = $9) to have the deductible satisfied by the patient and the (coinsurances 80% - the $36 and the 20% - the $9 right?? - someone please confirm?) satisfied by the two insurance companies right?
Thank you,
Nicholas
I am going to post a few times some scenarios that I have trouble with and would need some help understanding.
Okay, I get that the deductible has to be met before the patient can pay coinsurance. But let's say the patient had a $200.00 bill. All the while the patient is responsible for a $200.00 bill. He will have (the billed amount? Can someone fill this in to be what he would have?) sitting there waiting for him to pay it even if he has not satisfied the deductible yet. Now let's say he has Medicare primary and AARP secondary that would cover 80%/20% and Medicare allowed the $200.00 that he was billed to pay. He will have the $155.00 Medicare deductible he needs to pay and still need to owe the $45.00 balance left $200.00 allowed - $155.00 deductible, right? But if he has Medicare as primary and AARP as secondary and Medicare will pay 80% of (what amount??? - coinsurance amount? Can someone fill this in with what is paid by Medicare?) and AARP will pay 20% of (what amount??? - coinsurance amount? Can someone fill this in with what is paid by AARP?) none of them will pay any of their coinsurances to the $45.00 until the patient meets his Medicare deductible (assuming AARP does not pay the Part B deductible), and until that $155.00 deductible is met, the patient owes the deductible ($155.00 of $200.00) and technically the $45, right? But if the deductible is met, and the patient has a Medicare 80%/AARP 20%, Medicare will pays its 80% of the rest of the bill that the patient did not pay because the patient already paid his portion of what he owes (Medicare paying its 80% of $45 = the $36) and AARP will pay its 20% of the rest of the bill that the patient did not pay because the patient already paid his portion of what he owes (AARP pays its 20% of $45 = $9) to have the deductible satisfied by the patient and the (coinsurances 80% - the $36 and the 20% - the $9 right?? - someone please confirm?) satisfied by the two insurance companies right?
Thank you,
Nicholas
Posted: Sat Jun 05, 2010 05:56 pm Post Subject:
Nicholas . . . if the discussion is about Medicare A/B, then my previous answer to your questions remains the same.
If this is the first visit to any service provider for the year in 2010, and the allowable amount is $200, the patient is responsible for $155 + 20% of the remaining $45, or $9. His total out of pocket expense is $164. Medicare pays the remaining $36.
He can cover the deductible and coinsurance with personal money or with a Medicare supplement plan, or perhaps avoid the whole discussion of deductibles by joining a Medicare Advantage (HMO/PPO) plan.
If the patient has a Medicare supplement plan, depending on the actual plan (A-N, now excluding H-I-J), it may pay the $155 Part B deductible in addition to the 20% Part B coinsurance amount.
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