Does Medicare Part A Cover Physician Charges for Inpatient Care?
While Medicare Part A covers many costs associated with inpatient hospital stays, it does not directly cover the fees charged by the physicians who treat you while you are hospitalized. Physician services, including consultations, surgeries, and other medical treatments provided by doctors, are typically covered under Medicare Part B.
Understanding Medicare Part A and Inpatient Care
Medicare Part A is a crucial component of the Original Medicare program, primarily covering expenses related to inpatient hospital care. This includes a semi-private room, meals, nursing care, hospital services and supplies, and lab tests performed in the hospital. To understand what is not covered, it’s crucial to clarify what is included under Part A. Knowing this foundation helps explain where physician charges fit (or don’t fit) into the equation of Does Medicare Part A Cover Physician Charges for Inpatient Care?
What Medicare Part A Covers for Inpatient Stays
Here’s a breakdown of what Medicare Part A typically covers during an inpatient hospital stay:
- Hospital Room: Semi-private room.
- Meals: Regular hospital meals.
- Nursing Care: General nursing services.
- Hospital Services and Supplies: Items like bandages, hospital gowns, and other necessary supplies.
- Lab Tests and X-rays: Ordered by the hospital physician for your inpatient treatment.
- Operating Room Fees: For surgeries performed during your stay.
- Rehabilitation Services: If you require physical, occupational, or speech therapy during your inpatient stay.
- Prescription Drugs: Administered to you as part of your inpatient treatment.
The Role of Medicare Part B in Covering Physician Services
Medicare Part B, on the other hand, is designed to cover medical services and outpatient care. This includes doctor visits, preventative care, diagnostic tests, and crucially, physician services provided during an inpatient hospital stay. So, in answer to the query, Does Medicare Part A Cover Physician Charges for Inpatient Care?, the answer is almost always no.
Understanding the Claim Submission Process
When you receive inpatient care, the hospital will submit a claim to Medicare Part A for the covered services. Simultaneously, the physicians who provided your care (such as surgeons, specialists, and attending physicians) will submit claims to Medicare Part B for their services. This separation of billing is essential to understanding the comprehensive cost of inpatient care and how Medicare handles it.
Potential Gaps and Considerations
Even with both Part A and Part B, there are still potential out-of-pocket costs to consider. These can include:
- Deductibles: Both Part A and Part B have deductibles that you must meet before Medicare begins to pay its share.
- Coinsurance: After meeting your Part B deductible, you typically pay 20% of the Medicare-approved amount for most doctor services.
- Excess Charges: If your doctor does not accept Medicare assignment, they can charge up to 15% more than the Medicare-approved amount.
- Non-covered Services: Certain services may not be covered by either Part A or Part B.
Medicare Advantage Plans (Medicare Part C)
Medicare Advantage plans offer an alternative way to receive your Medicare benefits. These plans are offered by private insurance companies and must cover everything that Original Medicare (Part A and Part B) covers. Many Medicare Advantage plans also offer additional benefits, such as vision, dental, and hearing coverage. When evaluating a Medicare Advantage plan, it is crucial to understand how physician charges are handled, as the cost-sharing and network rules can vary significantly. The impact of Medicare Advantage Plans on Does Medicare Part A Cover Physician Charges for Inpatient Care? is indirect: it still doesn’t, but an Advantage plan may offer more comprehensive coverage than Original Medicare and therefore help you with doctor bills.
Avoiding Common Mistakes and Ensuring Proper Billing
Navigating Medicare billing can be complex. Here are a few tips to help avoid common mistakes:
- Review Your Medicare Summary Notices (MSNs): Carefully review your MSNs to ensure that the services billed match the services you received.
- Question Any Discrepancies: If you notice any errors or have questions about your bill, contact your healthcare provider or Medicare directly.
- Understand Assignment: Ask your doctor if they accept Medicare assignment. This can help you avoid excess charges.
- Keep Good Records: Maintain records of your medical appointments and services to help track your healthcare expenses.
Understanding Observation Status
It’s important to note that even if you’re in a hospital bed, you might be classified under “observation status,” which affects how Medicare pays. Observation status is considered outpatient care, even if you stay overnight. In such cases, hospital services are billed under Part B, not Part A, potentially affecting your costs.
Table: Medicare Part A vs. Part B Coverage During an Inpatient Stay
| Coverage Area | Medicare Part A | Medicare Part B |
|---|---|---|
| Room and Board | Covered | Not Covered |
| Nursing Care | Covered | Not Covered |
| Hospital Services | Covered | Not Covered |
| Physician Services | Not Covered | Covered (subject to deductible and coinsurance) |
| Lab Tests (Inpatient) | Covered | Typically Not Covered |
Frequently Asked Questions (FAQs)
Will I receive separate bills for hospital services and physician services during an inpatient stay?
Yes, you will likely receive separate bills. The hospital bills for services covered under Medicare Part A, while physicians bill separately under Medicare Part B for their professional services.
What happens if a physician doesn’t accept Medicare assignment?
If a physician doesn’t accept Medicare assignment, they can charge you up to 15% more than the Medicare-approved amount. This is known as an excess charge. You’ll be responsible for paying this additional amount out-of-pocket.
Are there any situations where Medicare Part A would cover physician charges?
There are very limited situations where Part A might indirectly cover some physician costs, such as when a physician is directly employed by the hospital and their services are included in the hospital’s bundled payment to Medicare. However, this is rare.
How does Medicare Supplemental Insurance (Medigap) affect coverage of physician charges during inpatient care?
Medigap plans can help cover the out-of-pocket costs associated with Medicare Part B, such as deductibles and coinsurance for physician services. The extent of coverage depends on the specific Medigap plan you have.
Does the type of hospital (e.g., for-profit vs. non-profit) influence whether physician charges are covered under Medicare Part A?
No, the type of hospital does not directly influence whether Does Medicare Part A Cover Physician Charges for Inpatient Care?. The key factor is whether the charges are for hospital services (covered under Part A) or physician services (covered under Part B).
If I’m readmitted to the hospital shortly after being discharged, will I have to pay another Part A deductible?
If you are readmitted to the hospital within 60 days for the same or a related condition, it’s considered one “spell of illness,” and you will not have to pay another Part A deductible.
What should I do if I suspect that I’ve been incorrectly billed for physician services during an inpatient stay?
If you suspect an error, contact your healthcare provider’s billing department and Medicare directly. Review your Medicare Summary Notice (MSN) carefully and be prepared to provide documentation to support your claim.
How does observation status affect my Part B costs?
Observation status is considered outpatient care, so hospital services are billed under Part B. This means you’ll typically pay a copayment for each service you receive, and those costs can add up quickly.
Are anesthesiologists’ fees covered under Medicare Part A or Part B?
Anesthesiologist fees are considered physician services and are therefore covered under Medicare Part B, subject to your deductible and coinsurance.
What if I am admitted for psychiatric inpatient care. Does Medicare Part A cover physician services then?
No. Even in the case of psychiatric inpatient care, physician services are covered under Medicare Part B, following the standard Part B cost-sharing rules. Does Medicare Part A Cover Physician Charges for Inpatient Care? – remains generally no, irrespective of the nature of the inpatient treatment.
Can I appeal a denial of coverage for physician services under Medicare Part B?
Yes, you have the right to appeal a denial of coverage for physician services under Medicare Part B. Medicare will provide you with information on the appeals process in your denial notice.
If I have other insurance in addition to Medicare, how does that affect coverage of physician charges during inpatient care?
If you have other insurance, such as employer-sponsored insurance or a Medicare Supplement plan (Medigap), the other insurance may act as a secondary payer, covering some or all of the out-of-pocket costs for physician services under Part B that Medicare doesn’t cover. Coordination of benefits rules apply.