Find the average price in calendar year 2016 for various types of hospital outpatient charges to Medicare patients. File should show charges by physician name, state average and national average prices. Extremely difficult to use, even if somewhat familiar with using Excel files. From CMS updated 2019.
Six-page Tip Sheet explaining how prescription drugs, medicines and immunizations might be covered under Medicare Part B, Medicare Advantage plans (Part C) or Medicare Part D (the drug plan for seniors). Includes guidelines for cancer drugs, injectibles and IV drugs. Generally, Part A (hospital insurance) does not cover outpatient drugs. Publication 11315-P revised October 2018
Find monthly premium cost and annual deductibles for 2019 Medicare Prescription Drug Plans (Part D) in Indiana. Health insurance plans listed in alphabetical order in a 2-page PDF called Complete list of Medicare Prescription Plans in Indiana. Monthly premiums for 2019 range from $15.50 (Wellcare) to $91.90 (Anthem). Annual deductible ranged from 0 to $415. From In.gov, updated Jan. 8, 2019
CMS announced the standard Medicare Part B monthly premium will be $135.50 in 2019 for some ($1626 per year), with a $185 deductible (up $2). High income seniors will pay between $189.60 and $460.50 per month. CMS says about 5% of Medicare beneficiaries pay the high-income premiums for Part B. Medicare Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and other items. The Medicare Part A hospital insurance deductible will rise $24 to $1364. Released Oct. 12, 2018
Based on the bids submitted by Part D Medicare prescription drug plans, CMS estimates that the average monthly premium that beneficiaries will pay for standard Part D coverage in 2019 will be $32.50, a slight decline from 2018. Reported September 2018.
This site helps you locate supplemental health insurance plans, find out their prices (premiums), and link to a page to check Medicare Eligibility. Generally, one has to be age 65 or disabled to qualify for Medicare. Early retirement at age 62 does NOT by itself allow someone to receive Medicare benefits
Medicare’s help line for selecting a prescription drug plan (Medicare Part D) is 1-800-633-4227 (1-800-MEDICARE), or click on how to get drug coverage
April 2019 report by CMS discusses the state of the Medicare Trust funds – a $741 billion program for 59.9 million people in 2018. Medicare expenditures alone are estimated at 3.7% of gross domestic product (2018). The depletion of the hospital trust fund is projected occur by 2026 (the same as projected last year). In 2018, the average benefit per enrollee was $13,257.
Analysis by the American Hospital Association shows that Medicare and Medicaid under-pay the true cost of hospital care by about $77 billion. This cost ends up being borne by other payors and commercial insurance. Using 2017 data, it is estimated Medicare pays 87 cents on the dollar, and Medicaid also pays 87. January 2019 report
Special report on Health Care Expenditures for the Elderly Age 65 and over, shows median annual expenditures were $4206. Average expenses for those with expense were $9863 in 2011. Medicare paid over 62% (up considerably from 10 years ago); private insurance paid 16%; out-of-pocket amount declined to 12%. 96% of seniors had some healthcare expense, most often office-based care and prescribed medicines. Medications took up 22% of the total, averaging $76 per purchase. For seniors, the inpatient room rate averaged $3199 per day (sticker shock); ER visit was $884 on average; office visit was $228. MEPS Statistical Brief #429, Jan. 2014
Annual FOBTs are free under Medicare. Other more expensive colon cancer screening tests such as colonoscopy and sigmoidoscopy are covered periodically, without cost to the patient if your doctor accepts Medicare assignment as full payment. Find out Medicare’s details. Unfortunately, Medicare does not provide cost estimates for the public at this site
Theoretically, consumers should be able to compare the star ratings for nearly 700 health insurance plans that are part of the Medicare Part D Prescription Drug program at this site. But the files linked here are darn near impossible to use, even if you know Excel. Best bet is to review the overall summary file at the bottom of the zipped file download. Other files show performance scores including member ratings. But you will have to phone a friend with a PhD to help. From CMS, updated spring 2019
Compare the prices (monthly premium average cost) for prescription drug coverage through Medicare (medicare.gov) and see which plans have higher ratings. Uses a 5-star quality rating system that includes member satisfaction survey reports. 2018 premiums available for open enrollment ending Dec. 7, 2017
Outline of Medicare’s five original value-based programs: End-Stage Renal Disease (ESRD) Quality Incentive Program, Hospital Value-Based Purchasing, Hospital Readmission Reduction, Physician Value-Based Modifier program, and Hospital Acquired Conditions Program. Also Skilled Nursing Facility and Home Health Value-based programs.
Find out what Medicare paid for certain types of office visits and procedures in 2012. Average doctor’s price is NOT SHOWN, but only the allowed amount determined by Medicare, and how much Medicare paid on average (for every state). Must know how to use Excel files and billing code knowledge would also be helpful. Medicare paid $49 for a 99213 office code (15 minute office visit for an established patient) and $73 for a 25-minute office visit, and just $101 for a 60-minute visit (est. patients). If the patient was new, Medicare paid $73 on average for a 30 minute visit, and $116 for 45 minutes. Medicare’s annual wellness visit was paid at $165 for new enrollees, then $111 for subsequent annual visits. The most common EKG was paid at $14, ear wax removal at $36, pneumonia or annual flu shot at $23. Difficult file to use. Terribly dated; last updated Sept. 2013
Find the Allowed Medicare amounts (rather than prices) in the Ambulatory Surgery file for 25 Common high volume outpatient surgical procedures in an Ambulatory Surgery Center (not hospital-based). File shows what Medicare paid during 2012 for cataract surgery, different types of endoscopy, spinal injections, some hernia repairs, carpal tunnel release, kidney stone crushing, prostate biopsy (avg $530 paid on $670 allowable charge; full charge is not shown), correction of bunion, and more. Uses CPT codes, and all states are listed. Difficult file for consumers to use unless familiar with Excel. Terribly dated; last updated Sept. 2013. Federal government could show its commitment to price transparency by updating this file, and showing full sticker prices.
Link to Pubmed abstract in December 2009 Annals of Internal Medicine on study of 4567 adults who didn’t have insurance prior to enrolling in Medicare. Once acquiring coverage, those with diabetes, heart disease or joint replacements had 21% higher medical expenditures through Medicare, than those who were previously insured. Article by McWilliams, Meara et al.