Medicare Billing Terms You Need to Know

medicare billing

Medicare bills are annoying and frustrating

Complicated Medicare billing statements give everyone a headache! Unfortunately for families caring for older adults, going through those bills is an unavoidable chore. After all, someone needs to make sure the charges are correct.

 

Knowing is half the battle

Part of the headache is the industry terms that are used. We explain 7 terms commonly used on Medicare statements. Knowing what the terms mean helps you understand the billing and coverage for your older adult’s medical care. To keep things simple, we use “you” below to refer to your older adult.

 

Medicare billing terms

Deductible

  • The amount you pay for health care or prescriptions before Medicare, a prescription drug plan, or other insurance begins to pay.
  • You usually have to pay a deductible each year.
  • Part A and Part B have separate deductibles.

 

Premium

  • Payment, usually monthly, for health insurance coverage.
  • This is paid to Medicare, an insurance company, or a health care plan for health or prescription drug coverage.
  • People who paid Medicare taxes while they were working usually don’t pay a premium for Part A.
  • Most people pay a Part B premium each month.

 

Coinsurance

  • The amount you may have to pay as your share of the cost for services.
  • This is after you pay any deductible.
  • Coinsurance is usually a percentage of the total cost.
  • For example, you pay 20% of the total procedure cost and Medicare pays the other 80%.

 

Copayment

  • The amount you may have to pay as your share of the cost for a medical service or supply.
  • Examples include: a prescription, doctor’s visit, or hospital outpatient visit.
  • A copayment is usually a set amount of money.
  • For example, you might pay $10 or $20 for a doctor’s visit or a prescription.

 

Coordination of Benefits

  • This is when you have Medicare and another health insurance plan, there are rules about which insurer pays your health care bills first.
  • Sometimes, the other health insurance pays the health care bills first and Medicare pays the amount the first insurance company didn’t pay.
  • If you have other insurance, it is important to tell the doctor, hospital, and pharmacy so the bills will get paid correctly.

 

Medicare Summary Notice (MSN)

  • A notice that you get after a doctor or medical provider files a claim for services covered by Medicare Part A or B.
  • It explains the charges that Medicare will pay and the charges that you have to pay
  • It’s the one labeled ‘This is Not a Bill.’ Dont’ worry, you’ll get the bill later.
  • It has info about how to file an appeal if you disagree with a payment decision.

 

Advance Beneficiary Notice (ABN)

  • A notice a medical provider will give you to warn you that some services may not be covered.
  • It’s not an official denial of coverage, but you can use it to estimate your expenses.

 

Next Step  Print a copy of “Medicare Terms Caregivers Should Know”

 

By DailyCaring Editorial Staff
Image: Senator Bernie Sanders

 

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