Monday, November 29, 2010

cost of Mediare advantage plan

What Does a Medicare Advantage Plan Cost?

Each month, Medicare pays your advantage plan a fixed amount of money to provide your care. The advantage plan is then responsible for paying your doctor, hospital, and other providers of care.

Although your advantage plan must follow Medicare’s rules, it can charge you a premium and additional out-of-pocket expenses, such as a copayment for a doctor visit, coinsurance for durable medical equipment (such as a wheelchair), and an annual deductible for prescription medications.
You also are responsible for your Medicare Part B monthly premium, which is taken out of your social security check.

For example: George C. lives in Massachusetts and has a Medicare Advantage Plan through Fallon Community Health, one of the highest-rated health plans in the country. He has an HMO plan with drug coverage. His monthly premium cost for the plan is $208.40 (the Medicare Part B premium of $96.40 plus $112 charged by Fallon). Also, his out-of-pocket expenses include a $15 copay for each PCP visit, $20 for each specialist visit, 10% coinsurance for durable medical equipment, and an annual deductible of $310 for prescription medications.

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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