Does Medicare only cover 80% of doctor bills?

[Anonymous]

I’ve just begun caring for my elderly relative who only has Medicare A and B.

Is it typical for a doctor’s bills to only be covered at 80% and you need to pay the other 20%?

There’s no other insurance and the person is on a fixed income (only social security).

[Anonymous]

Go on the Medicare website and that should help you out. It’s complicated

[Anonymous]

Yes, for physician. https://www.medicare.gov/coverage/doctor-other-health-care-provider-services

Make sure they don't have a Medigap plan or Medicare Advantage, but it sounds like they probably don't. Depending on how low income they are, they might qualify for some assistance programs.

[Anonymous]

If income is really low they might be dually eligible for Medicaid. Worth trying, especially if they may need long term care.

[Anonymous]

Anonymous wrote:If income is really low they might be dually eligible for Medicaid. Worth trying, especially if they may need long term care.

Long term care Medicaid is different than regular Medicaid. They have different eligibility.

Op depending on income the may qualify for regular Medicaid.

[Anonymous]

Contact the State Health Insurance Assistance Program (SHIP) office in the region where your relative lives. It’s a free service and they can help your relative navigate Medicare.

https://www.shiphelp.org/

[Anonymous]

This explainer from AARP —about why people get supplemental insurance on traditional Medicare — may be helpful:

https://www.aarp.org/health/medicare-insurance/info-2023/guide-to-medigap-plans.html#:~:text=Medigap%20insurance%20typically%20covers%20the,out%2Dof%2Dpocket%20costs.

[Anonymous]

And here is a good overview from AARP of what Medicare covers and doesn’t cover (without supplemental coverage):

https://www.aarp.org/health/medicare-qa-tool/what-is-original-medicare/

[Anonymous]

Anonymous wrote:This explainer from AARP —about why people get supplemental insurance on traditional Medicare — may be helpful:

https://www.aarp.org/health/medicare-insurance/info-2023/guide-to-medigap-plans.html#:~:text=Medigap%20insurance%20typically%20covers%20the,out%2Dof%2Dpocket%20costs.

That only works with higher incomes.

[Anonymous]

Do they have prescription coverage? I don't believe that's covered under A and B.

[Anonymous]

Anonymous wrote:Do they have prescription coverage? I don't believe that's covered under A and B.

Prescriptions are Part D.

-signed, 64-year-old who is sweating out going on Medicare in a few months, given all the confusing choices

[Anonymous]

Anonymous wrote:I’ve just begun caring for my elderly relative who only has Medicare A and B.

Is it typical for a doctor’s bills to only be covered at 80% and you need to pay the other 20%?

There’s no other insurance and the person is on a fixed income (only social security).

Yes it is typical. My husband has Medicare, and he also is a retired fed so he has that insurance as a retiree. The BCBS FEP plan covers the 20% that Medicare doesn't cover. As his spouse, when I retire, I will also have the same deal.

Your elderly relative had no other insurance before medicare? Any possibility he or she is a retiree or spouse of a retiree and could apply for health insurance again? (Probably not...but just wondering).

[Anonymous]

Anonymous wrote:

Anonymous wrote:This explainer from AARP —about why people get supplemental insurance on traditional Medicare — may be helpful:

https://www.aarp.org/health/medicare-insurance/info-2023/guide-to-medigap-plans.html#:~:text=Medigap%20insurance%20typically%20covers%20the,out%2Dof%2Dpocket%20costs.

That only works with higher incomes.

True, which is why some people opt for a Medicare Advantage plan instead. Unlike traditional Medicare, Medicare Advantage plans have an annual out-of-pocket spending limit. The trade off is Medicare Advantage plans come with limited networks of doctors and hospitals.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:This explainer from AARP —about why people get supplemental insurance on traditional Medicare — may be helpful:

https://www.aarp.org/health/medicare-insurance/info-2023/guide-to-medigap-plans.html#:~:text=Medigap%20insurance%20typically%20covers%20the,out%2Dof%2Dpocket%20costs.

That only works with higher incomes.

True, which is why some people opt for a Medicare Advantage plan instead. Unlike traditional Medicare, Medicare Advantage plans have an annual out-of-pocket spending limit. The trade off is Medicare Advantage plans come with limited networks of doctors and hospitals.

I am the PP who wrote this. OP, since your relative is on a fixed income it may make sense to try to get them on a Medicare Advantage plan during the open enrollment period that begins in October.

Some Medicare Advantage plans have “zero” premiums — meaning no premium beyond the basic Medicare premium that is typically automatically deducted from a retiree’s Social Security check, which is what your relative is probably already paying. And definitely call the SHIP service mentioned upthread. They may be able to help you figure out if your relative is eligible for extra help due to low income.

[Anonymous]

Advantage plans also come with a lot of restrictions- they’re more like an HMO in that you’re limited to particular doctors & service providers (pts, ots) vs regular Medicare, where all are in network. I’ve known people who were not eligible for the rehab center their doctor preferred because they were on Advantage - someone else with the same diagnosis on regular Medicare was approved.