Saturday, July 10, 2010

What you Pay Medicare Part C Advantage Plan




Your out-of-pocket costs in a Medicare Advantage Plan depend on the following:

■Whether the plan charges a monthly premium in addition to your Part B premium.

■Whether the plan pays any of the monthly Part B premium. Some plans offer this option, usually for an extra cost.

■Whether the plan has a yearly deductible or any additional deductibles.

■ How much you pay for each visit or service (copayments).

■ The type of health care services you need and how often you get them.

■Whether you follow the plan’s rules, like using network providers.

■Whether you need extra coverage and what the plan charges for it.



If you have limited income and resources, you may qualify for the following:

■ Extra Help paying your Part D premium and other prescription drug coverage costs.
■ Help from your state to pay your Part B premium.

■Whether the plan has a yearly limit on your out-of-pocket costs for all medical services.

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Medicare physician fee schedule - Quick overview

Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:

* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.


Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)


Medicare Physician Fee Schedule Payment Rates Formula


The Medicare PFS payment rates formula is shown below:

[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF

Medicare fee schedule download