2008 Medicare Deductible, Coinsurance & Premium Rates

The Centers for Medicare & Medicaid Services (CMS) has announced changes for Deductible, Coinsurance and Premium Rates. More information regarding this matter can be found on the CMS Web site at: http://www.cms.hhs.gov/apps/media/press/factsheet.asp?Counter=2488. 

Part B Deductible Information - Expenses count toward the deductible on the basis of incurred, rather than paid, expenses, and is based on Medicare allowed amounts. Non-covered expenses do not count toward the deductible. Even though an individual is not entitled to Part B benefits for the entire calendar year (i.e., insurance coverage begins after the first month of a year or the individual dies before the last month of the year), he or she is still subject to the full deductible for that year. Medical expenses incurred in the portion of the year preceding entitlement to medical insurance are not credited toward the deductible. 

Providers must collect the unmet deductible and coinsurance from the patient. Consistently waiving the deductible or coinsurance could be construed as program abuse. If the patient is unable to pay, the provider should have them sign a waiver outlining their financial hardship. If no waiver is signed, the patient’s medical record should reflect that there were normal/reasonable attempts to collect from the patient prior to writing off the charge. Coinsurance - The patient or the patient’s supplemental insurance company is responsible for paying the provider the coinsurance amount that Medicare will not pay.