The Medicare income limits can be adjusted according to a physician’s recommendation, or in some cases, by the Secretary of Health and Human Services, known as the CMS. These changes in the income limits can have a significant effect on a doctor’s practice and the patients he or she treats. Some of the adjustments are due to inflationary increases, while others are based on an individual’s current age and health status.
Most of these adjustments will apply to Part A of Medicare, or Part B of the same program. Those with high incomes must also pay high monthly Medicare premiums for two separate Medicare plans. These include Part A, which are the traditional Medicare benefits, and Part B, the supplemental insurance plan for prescription drugs. The two plans serve different groups of people. This article describes the various parts of Medicare for which higher premiums can, or may not, affect.
Both Part A and Part B cover routine medical services, but Part A covers those covered by Medicare while on Medicare Parts A and B, such as nursing home care and home health agencies, while Part B covers those treated in a doctor’s office, hospitals, and other health care facilities. All Part A and Part B services are covered by Part C, which pays for specialized services.
The cost of these plans depends on a number of factors, including the age of the enrollee, gender, medical conditions, the Medicare Part A or Part B deductible, family medical history, Medicare Part D prescriptions, and the type of medical equipment or supplies purchased. The most important factor is how much money a doctor or hospital charges for services rendered by a patient in order to determine what Medicare Part A or Part B premium should be charged.
To adjust Medicare income limits, a doctor first determines the new level of Part A or Part B premium to charge. Medicare Part C costs are then used to calculate the adjusted Medicare Part A or Part B premiums. There are several ways to help reduce the Medicare Part C costs, ranging from lowering deductibles and co-payments to changing the length of service covered by a provider or increasing the scope of service provided.
The Part D prescription drug plan covers some medications that are not covered by Part B and is intended to be purchased by seniors who cannot afford Part A. Part D covers common types of drugs, including blood pressure medications, diabetic supplies, antidepressants, tranquilizers, and some vision and hearing aids. Most Medicare Part C premium costs are based on the age and type of prescription drugs as well as the prescribed quantity and frequency.
Medicare Part D is a supplemental insurance plan that helps to replace the prescription drugs, as well as other out-of-pocket costs, if the Part A or Part B premiums cannot be paid. Many seniors have trouble affording the medication expenses and Part A and Part B premiums, so a Medicare Part D supplement is often used to ensure that the prescriptions are covered. However, Part D does not cover services that are medically necessary, such as vision or hearing aids. The Medicare Part C premium is paid for by the insured and the Part D deductible is paid by the Medicare beneficiaries.
In addition to adjusting the Part A and Part B income limits, a doctor also has to adjust their fee schedule and reimbursement rules to meet Medicare guidelines. Payment for services can be made directly to a doctor, or to an approved payer.
For example, Medicare pays a doctor for each Medicare Advantage Plan member. In order to maintain this fee schedule, doctors must maintain records of the number of members, their current doctor, and the number of services received by each member. These records are used to determine whether the physician is eligible for an Advantage Plan and to determine how much of the payment is applicable to the physician.
Each physician in the care network is required to participate in the same health insurance network in order to be reimbursed for services. For example, if a doctor practices at a hospital, they must be affiliated with the same network. and must accept Medicare Part B and Part D medications.
Another way to help lower Medicare costs is to enroll in HMO, PPO, or POS plans. HMO plans allow patients to choose from a group or individual policy, which provides coverage for specific services. While PPO plans are managed care plans that offer the same benefits and options as traditional Medicare plans.