In this example, the doctor’s fee is $300, but the Medicare-approved amount is $220. So, the doctor accepts $220 as full payment.
Medicare pays 80% of the cost, which is $176. Joe pays 20% of the cost, which is $44. If Joe has a Medicare supplement insurance plan, his share of the cost might be covered by the plan.
Do Medicare Advantage Plans Have Coinsurance?
Medicare Advantage plans (Part C) share costs with plan members, but it’s mostly with copays rather than coinsurance. Copays are a small fee that you pay when you receive a health care service. So, if Joe had a Medicare Advantage plan rather than Original Medicare in the example above, he might pay a $30 copay when he visited the doctor.
Medicare Advantage is an alternative to Original Medicare (Parts A & B). It’s another way to get your Medicare benefits. Plans are offered by private insurance companies approved by Medicare.
Medicare Advantage plans are required to set an out-of-pocket limit for plan members. There’s no out-of-pocket limit with Original Medicare.
It’s your money, and it’s important to understand your Medicare costs and how they are calculated. Look over the medical bills you receive and the Medicare Summary Notices you get from Medicare. Talk to your provider or your plan, or call Medicare, if you have questions.