Community Chat

[monicakm]

I never saw a single bill for my 10-day Hospital stay for my triple bypass surgery. I can't even imagine how much that bill would have been. So is there a limit to how much Medicare will pay in a calendar year?

Thanks

[Kachina624]

@monicakm. Do you have a supplement?  I've never seen a bill or paid a co-pay in the years I've had Medicare.   I had major surgery and spent 2 weeks in a rehab facility afterwards.  Medicare + my supplement pay all my bills.

[CelticCrafter]

Look in the the Medicare and You book that gets sent out every year.  I'm sure that's addressed.

[Sooner]

You can always go on line and see the bills and payments can't you?  We saw everything for my mom either on paper or on line. 

[Nightowlz]

I should know how that works but I'm not sure.

My SIL had a Stroke & was in the hospital around 10 days. She was on Blue Cross Blue Shield Advantage Plan. Her bill was $300,000. She had to pay $3,000. This has to be from co-pays, deductibles because it's sure not 20% for her part??? 

My MIL had full hip replacement on Medicare with no Medigap or Supplement. She paid the $1500 or so Part A deductible only. No 20% here either???

Do Advantage Plans not have a 20% to pay? They have a yearly out of pocket at $8850 in network in 2024. 

So why do we get ripped on Medicare being told we need supplement???

[bikerbabe]

I suggest looking up online from an official source rather than asking on a message board. 😉

[Bookplate]

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@bikerbabe wrote:
I suggest looking up online from an official source rather than asking on a message board. 😉

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I second this advice.

This information is pretty easy to find online directly from Medicare but I can tell you annecdoctally that no, there is no annual limit for traditional Medicare, but there are for Medicare Advantage plans.  But don't take my word for it; check with Medicare.gov.

[Carmie]

For an inpatient hospital stay there is no dollar limit.

There are limits on days.

Not too many people ever reach or exceed it unless they are really sick or injured.

The first 60 days are covered 100% minus a deductible which is covered by the supplemental plan.  After 60 days, there is a copayment for the next 30 days which is covered by the supplemental plan.

You also have 60 Medicare lifetime reserve days.  After being out of the hospital for 60 consecutive days, your benefits start over again.  

If you use your 90 inpatient days and your 60 lifetime reserve days, your 365 days from the supplement kick in. If you are discharged for 60 consecutive  days, you get another 90 days from Medicare   This is called a benefit period.

All supplemental plans offer you an additional 365 days of inpatient care if you run out of Medicare days.

So, if you have Traditional Medicare and a supplement, you have benefits for 90+60+365 days.  

That is enough for most people.  I wouldn't worry about it.

[Kachina624]

Thanks for chiming in @Carmie .  I was hoping you would.

[Carmie]

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@Nightowlz wrote:

I should know how that works but I'm not sure.

My SIL had a Stroke & was in the hospital around 10 days. She was on Blue Cross Blue Shield Advantage Plan. Her bill was $300,000. She had to pay $3,000. This has to be from co-pays, deductibles because it's sure not 20% for her part??? 

My MIL had full hip replacement on Medicare with no Medigap or Supplement. She paid the $1500 or so Part A deductible only. No 20% here either???

Do Advantage Plans not have a 20% to pay? They have a yearly out of pocket at $8850 in network in 2024. 

So why do we get ripped on Medicare being told we need supplement???

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Advantage Plans all have different benefits.  The plans are not cut and dry like Traditional Medicare and Supplements.

Some Advantage Plans have inpatient deductibles.  They might also have copays.  They also have a stop loss which means after you pay a certain amount out of pocket, everything that is covered pays 100% for the rest if they calander year.  Perhaps that $8850 was the stop loss amount. $3000 probably included the deductibles and coinsurance amounts.

If you have Traditional Medicare, your inpatient bill is paid at 100% minus the inpatient deductible $1632.  If you had a supplement, the supplement would cover that expense.

Only outpatient care and professional services have a 20% copayment under Medicare.  So, you would be responsible for 20% of the covered charges for your doctors and other professional providers without a supplement.

A supplement would cover the 20% for you.  In addition, Supplements cover an additional 365 days in the hospital if your run out of covered Medicare days.

In some states doctors can charge you more than 20% because they do not accept Medicare assignment  

Example

Surgery $10,000

Medicare allows $6000 and pays 80% or $4800

20% copayment is $1200

amount you can be billed is $1200 plus an additional 15%.

Some states do not allow provider to bill you the access amount.  Those states are CT, MA, MN, OH, PA, RI, NY and VT.

Your MIL will be billed 20% for services provided by her surgeon, anesthetist, doctor who read labs and X-rays and also for a walker or crutches.  Her physical therapist will also bill 20%.

There is so much more involved in getting surgery than just a hospital bill.