Perspective               

New "Outpatient Prospective Payment System"

If your only health insurance is Medicare, you should know that there's a new system for calculating your out-of-pocket costs for outpatient hospital services. If you also have Medicaid, retiree coverage, or Medicare supplemental coverage, this new system will not affect you. Medicare's new system applies to people whose only insurance is Original Medicare and who receive outpatient services, such as x-rays, stitches, emergency care, and any other services you may get in one day at a hospital.

Because of the complexity of the new system, it's still not possible to say whether you will pay more or less for outpatient hospital services today. The amount you pay out-of-pocket will very depending on the service you get and where you get it. Unfortunately, there is no easy way to figure your out-of-pocket costs. Because the system is so complicated, question your outpatient hospital bill because it may have errors.

But, the new system will help hospitals predict how much Medicare will pay them for outpatient services and should also reduce your out-of-pocket costs over time and limit the coinsurance or copayment amount you must pay for each service to $776. You must still pay the yearly Medicare Part B deductible of $100.

Keep in mind that the new system will not change the kinds of services that Medicare covers. It will not cover prescription drugs nor change the way you get outpatient health services. For more information about the system, call 1-800-MEDICARE and request the free brochure called "Outpatient Prospective Payment System."

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