Specific Questions Re: Original Medicare Surgery, Costs, Deductibles.

[pete oblonski]

I am enrolled via Social Security, will be 65 in November, so getting on this project now. I have a couple orthopedic surgical repairs coming up. I'm super healthy, but injure/wear out parts on occasion.

When I get scheduled for surgery...let's say a knee meniscus tear, how much of that expense will Medicare cover? How is that broken down? I understand my part D will pay for drugs after the deductible...which will be never because I rarely use anything but otc ibuprofen and vitamins. I understand that some percentage and deductible is a factor of Plan B.

How do I look at the cost of this surgery and let's say a cervical disc surgery in the same year? Plus the rehab and related MD visits.

Should I choose a Part B plan with a low deductible/high premium until I get these surgeries done? Is that the way to approach this?

Thanks,
Pete

 

[MBSC]

Should I choose a Part B plan with a low deductible/high premium until I get these surgeries done? Is that the way to approach this?

There is only one Part B plan. You can see your costs under original Medicare (Parts A/B) in this link: https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance

For outpatient surgery and follow-up care, you are responsible for the annual Part B deductible, currently $183, then a 20% coinsurance on the lower Medicare approved amount not the higher billed charge. There is no dollar limit on the coinsurance so most people buy a Medicare Supplement (aka Medigap) or Medicare Advantage plan to help control their potential cost sharing responsibility.

Inpatient hospital facility fees under original Medicare are billed to Part A and subject to a separate $1340 deductible that resets to $0 met 60 days after discharge. So, you could be responsible for the $1340 twice with two separate inpatient hospital admissions. There is no additional Part A cost sharing for the first 60 days in the hospital but the doctors and anesthesiologists bill separately to Part B with the 20% coinsurance.

One alternative to help control your costs is a Medicare supplement, also called Medigap. Medigap plans also have letter designations, such as 'G' and 'N'. You pay an additional premium in addition to the Part B premium for additional coverage. You can pick any Medigap plan during your initial enrollment period but, depending on your state's rules, may have to pass medical underwriting to change Medigap plans later. You can read more about Medigap plans here: https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies

Another alternative is Medicare Advantage. These operate more like under 65 health plans in that they use provider networks (PPO or HMO), require a referral to see a specialist, may limit the number of covered physical therapy visits, and have a defined out-of-pocket maximum. You can change MA plans annually without underwriting but the number of MA plans available may be limited if you live in a rural area. You can read more about MA plans here: https://www.medicare.gov/sign-up-ch...ge-plans/how-do-medicare-advantage-plans-work

If you would like to discuss these options in more detail, please include your state so I can respond to Medigap questions more accurately.