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Health Line
3 days ago
- Business
- Health Line
How Much Will Medicare Cover If I Need a CT Scan?
Key takeaways Medicare will cover any medically necessary diagnostic tests, including CT scans. Inpatient CT scans are typically covered by Part A, while outpatient CT scans are usually covered by Part B. Part C (also called Medicare Advantage) plans include at least the same level of coverage as parts A and B. Medigap plans can help decrease out-of-pocket costs associated with Original Medicare coverage for CT scans. Medicare will cover any medically necessary diagnostic tests you need. This includes computed tomography (CT) scans. Your exact coverage depends on where you have the test and which Medicare part covers it. Part A coverage for CT scans Part A is hospital insurance. It covers the care you receive during an inpatient stay at: a hospital a skilled nursing facility another inpatient facility This includes any tests your doctor orders during your stay. So, if you receive a CT scan in the hospital, Part A will cover it. In this situation, the cost of a CT scan will go toward your Part A deductible. In 2024, the Part A deductible is $1,632 for each benefit period, and in 2025, it is $1,676. Once you've met this deductible, Part A will cover all tests and procedures during your stay, with no coinsurance costs during the first 60 days of hospitalization. Part B coverage for CT scans Part B is medical insurance. It covers outpatient care at multiple types of healthcare facilities, such as: doctor's offices urgent care centers health centers outpatient clinics outpatient labs and testing facilities surgical centers Part B will cover your CT scan no matter which outpatient setting you have it in. You'll have coverage as long as the facility participates in Medicare and a doctor orders the scan. The Medicare website has a tool for checking which facilities and providers participate in Medicare in your area. After you meet your Part B deductible, Medicare will pay 80% of the approved cost of your CT scan. You'll be responsible for the other 20%. The Medicare Part B deductible is $240 in 2024 and $257 in 2025. Part C coverage for CT scans All Part C plans cover CT scans. However, many Part C plans have networks. You might pay much higher costs for leaving your plan's network. Sometimes, you may not have out-of-network coverage, even if the facility participates in Medicare. The deductible and any copayment or coinsurance amount depend on your specific plan. If possible, contact your insurance company ahead of time to get an estimate of how much this test will cost. Medigap coverage for CT scans Medigap is supplemental insurance that you can buy to cover your out-of-pocket costs from Medicare. Depending on your Medigap plan, you may be able to get coverage for your: Part A deductible Part B deductible Part A copays and coinsurance Part B copays and coinsurance That means that Medigap would cover any costs associated with your CT scan that would typically be your responsibility. Medigap plans have a monthly premium on top of your Medicare Part B premium. So, while you'll pay more each month, the costs will be covered when you need a service like a CT scan. The bottom line Part A will cover your CT scan if you have it during an inpatient hospital stay, and Part B will cover it when you have it as an outpatient. Part C will also cover a CT scan, but you'll typically need to stay within your plan's network. If Medicare doesn't cover your CT scan and you think it should, you can file an appeal. An appeal will give you several chances to explain why the CT scan was medically necessary and see whether Medicare will cover it.
Medical News Today
3 days ago
- Business
- Medical News Today
IV infusions and Medicare: Coverage details
Original Medicare provides coverage for IV infusion therapy when a doctor determines it to be medically necessary, both in a clinic setting and at home. Medicare Advantage (Part C) plans need to offer the same services as Original Medicare, though a person's out-of-pocket costs will differ and will depend on their plan. This article discusses coverage options for IV infusions through Medicare. When does Medicare pay for IV infusions? Medicare Part A, Part B, and Medicare Advantage (Part C) plans generally all cover IV infusions if these are medically necessary. However, whether Medicare deems a person's IV infusion medically necessary depends on each case. That said, examples of medications or other liquids that healthcare professionals administer via an IV include : chemotherapy drugs Immunotherapy drugs targeted therapy drugs anti-nausea medicines hydration fluids antibiotics Any IV infusion must last at least 15 minutes to qualify under Medicare. In addition, Medicare will cover hydration therapy when medically necessary with an IV infusion, which is considered part of the same treatment as long as the hydration therapy lasts 20 to 30 minutes or less. Does Medicare cover IV infusion at home? Medicare Part B covers the equipment for home IV infusion under its durable medical equipment (DME) benefit. In addition, Part B will cover the infusion drugs themselves and support the infusion through nursing visits, caregiver training, and patient monitoring. Are infusions covered by Medicare Part D? Medicare Part D covers drugs that a person can administer themselves. Because individuals cannot administer their infusion, their IV infusion will fall under the coverage of Part B. How much does an IV infusion cost? Original Medicare comprises parts A and B. Part A covers hospitalization and general Medicare care. A person receiving an IV infusion during their hospital stay must meet a 2025 deductible of $1,676 before coverage begins. In most cases, people do not pay a premium for Part A. A person receiving infusion therapy under Part B must pay a premium that starts at $185, depending on their income, and meet a deductible of $257. After that, Part B pays for 80% of infusion costs. A person enrolled in a Part D plan will get the same coverage as under Part A and Part B. However, private insurers manage these plans, which have different premiums, deductibles, and coinsurances. According to the Centers for Medicare & Medicaid Services (CMS), the average monthly premium for Part C plans is around $17 in 2025. How much does home infusion therapy cost? How much IV infusion, whether at home or in a medical setting, might cost out of pocket before and after insurance depends on the type someone needs and the duration of the treatment. One 2023 review estimated the cost per day for home infusion to be $122 and for inpatient infusion to be $798. This review also examined six studies, finding that home infusion therapy could save significantly more money than inpatient infusion. One study reported savings of over $40,000 per patient, while another projected nearly $3 billion in savings for Medicare over 5 years. Medicare parts A, B, and C (Medicare Advantage) cover IV infusions if doctors deem them medically necessary. Part B also includes home IV infusion equipment under the durable medical equipment benefit, including infusion medications, nursing visits, caregiver training, and patient monitoring. A person enrolled in Part C will get equivalent coverage to parts A and B. A person needs to verify their hospital status — whether the hospital classifies them as an inpatient or outpatient — with their healthcare team. This can influence their out-of-pocket expenses and determine which part of Medicare will cover the services. The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.
Health Line
23-05-2025
- Health
- Health Line
Medicare Part C Costs
Medicare Part C (Medicare Advantage) plans are provided by private insurance companies, which means that cost varies by provider, type of plan, and location. Original Medicare (Part A and Part B) and Medicare Part C (Medicare Advantage) are different insurance options with different costs. Medicare Part C might be a good option if you're eligible for Original Medicare but want additional coverage for prescription drugs and other services. Several factors determine Medicare Part C costs, such as: premiums deductibles copayments coinsurance These amounts can range from $0 to hundreds for monthly premiums and yearly deductibles. Most of your Medicare Part C costs will be determined by your chosen plan. However, your lifestyle and financial situation can also have an effect on your costs. Read on for everything you need to know about Part C-associated costs. Deductibles and Premiums While some Part C plans don't have a monthly premium, others do. According to the Centers for Medicaid & Medicare (CMS), the average monthly premium for Part C plans is around $17.00 in 2025. Even with a zero-premium Medicare Advantage plan, you may still owe the Part B premium. That said, some Part C plans may cover your Part B premium. In addition, Medicare Part C plans have a plan deductible and a drug deductible if the plan includes drug coverage. As with premiums, some plans may offer a $0 plan deductible. When the deductible is greater than zero, you'll need to meet this amount first before your plan will offer coverage. Once it does, your plan usually covers a certain percentage of the cost; the rest comes from your pocket. as copayments or coinsurance. Managing Part C costs One of the first things you can do to manage your Medicare Part C costs is to read through the following annual notices from your plan: evidence of coverage (EOC) annual notice of change (ANOC) These notices can help you determine exactly what costs you'll pay out of pocket for your plan and any price changes that will take effect the following year. Other factors affecting costs While Original Medicare covers services nationwide, most Medicare Advantage plans are location-based. If you travel often, you may find yourself stuck with out-of-town medical bills. Other factors that can affect costs include: Plan type: Your plan can also impact how much your Medicare Part C plan may cost. For example, if you're on an HMO or PPO plan but choose to visit an out-of-network provider, this can increase your costs. Spending limit: All Part C plans have an out-of-pocket maximum. This amount varies, but according to one 2021 study, the average out-of-pocket maximum for Part C plans was $5,000. Extra benefits: Many Part C plans offer additional benefits to Original Medicare. For example, in 2025, over 97% of Medicare Advantage plans include dental, hearing, and vision coverage, though extra costs may apply for specialized services like dentures or specific lenses. Income limits Your yearly gross income can also factor into how much you'll pay for your Medicare Part C costs. For people with a lack of income or resources, there are programs that can help lower their Medicare costs. These are called Medicare Savings Programs (MSPs). The federal government funds these programs, but Medicaid administers them in each state. These programs are: Medicare Part C plans have different costs. Your costs may vary depending on your coverage, plan type, and whether you receive additional financial assistance. Below is a small sample of Medicare Part C plan costs from major insurance providers in cities around the United States: Plan City Monthly premium Health deductible, drug deductible Primary doctor copay Specialist copay Out-of-pocket max Anthem Select (HMO-POS) Los Angeles, CA $0 $0 $0 in network $0 in network $800 in network Cigna Preferred Medicare (HMO) Denver, CO $0 $0 $0 $25 per visit $3,550 in network Humana Choice H5216-006 (PPO) Dane, WI $37 •$0 •$250 $0 in network $45 in network per visit •$4,900 in network •$10,100 in and out of network Humana Gold Plus H0028-042 (HMO) Harris, TX $0 •$0 •$300 $0 $20 $3,450 in network Aetna Medicare Value Plus (PPO) Nashville, TN $11 •$0 •$250 •$0 in network •$10 out of network •$35 in network •$45 out of network •$6,750 in network, •$7,750 in and out of network Kaiser Permanente Medicare Advantage Standard MD (HMO-POS) Baltimore, MD $21 $0 •$5 in network •$0 to 25 out of network •$25 in network •$0 to 50 out of network $6,900 in network The estimates above are for 2025 and are only a sampling of the many plan options offered in each area. For a more personal estimate of Medicare Part C plan costs based on your individual healthcare situation, visit this plan finder tool and enter your ZIP code to compare plans near you. Is Medicare Advantage more expensive than Original Medicare? While it may seem that Medicare Advantage plans cost more than Original Medicare, they can actually help reduce medical expenses. A 2017 study that compared Medicare Advantage to Original Medicare found that physician costs were lower for people who were enrolled in Medicare Advantage plans. In addition, Medicare Advantage plan beneficiaries saved more money on things like medical equipment and lab tests. How do I pay my Part C bill? Most companies offering Medicare Part C plans have various ways to pay your premium. These options include: online bill payment automatic withdrawal from your bank account automatic withdrawal from your Social Security or Railroad Retirement Board benefits check check or money order Help paying for Medicare If you're having trouble paying your Medicare Part C costs, there are resources that can help: Medicaid: This program helps people with low-income pay for medical costs. Medicare savings program (MSP): This benefit helps Medicare beneficiaries with low-income pay plan costs, such as premiums and copayments. Supplemental Social Security: Some individuals can apply for Supplemental Social Security benefits, which are monthly payments that help pay for Medicare costs. PACE: This program can help you get coordinated care within your local community. Extra Help: If you meet certain income and resource limitations, you may qualify for this Medicare program, called Extra Help, to pay for prescription drug costs, premiums, deductibles, and more. The takeaway Medicare Part C (Medicare Advantage) is a great coverage option for Medicare beneficiaries seeking additional coverage. Your Medicare Part C costs include premiums, deductibles, copayments, and coinsurance. Your costs will also be determined based on your plan type, how often you need medical services, and what type of doctors you see. If you're age 65 or older or have certain disabilities, you're eligible to apply for Medicare. Visit the Social Security Administration website for more information on how to apply and enroll. The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.
Miami Herald
13-05-2025
- Health
- Miami Herald
Could Prescription Drug Costs Change for Medicare Users? Experts Weigh In
As President Donald Trump signed an executive order Monday that promises to drastically lower prescription drug prices in the U.S., Newsweek spoke with experts to find out what the new order will mean for those on Medicare. The executive order is aimed at a long-standing issue: Americans pay significantly more for prescription medications than consumers elsewhere, with branded drugs in the U.S. costing around three times more than those in other countries. Gerard Anderson, a professor at the Johns Hopkins Bloomberg School of Public Health, told Newsweek: "Our published research shows that Americans pay on average three to four times more for brand name drugs than what people in other industrialized countries pay and for some brand name drugs it is 100 times more." The Trump administration said it would lower drug costs by tying them to the lowest price paid by any country in the world. The president said in a Truth Social post that the U.S. would no longer pay more than "the Nation that pays the lowest price anywhere in the World." The order could therefore reduce the costs of drugs used by millions of Americans on Medicare. However, whether the change in cost reaches Medicare recipients is another thing. Here's what the experts said. Americans who use Medicare Plan B drugs could see a drop in cost, Minal R. Patel, a professor at the School of Public Health, University of Michigan, told Newsweek. This depends on whether the Trump administration revives a version of the 2020 Most Favored Nation policy proposal, Patel added, a policy that Trump's first administration previously tried and failed to implement following legal challenges. Trump said in a Truth Social post on Sunday that he would be instituting the policy. The revival of the policy "would mean Medicare Part B payments for certain high-cost drugs are capped based on the lowest prices paid by other wealthy countries, which is typically much lower," Patel said. While this could lower drug costs for about 4 million Medicare beneficiaries who use Part B drugs, she added that "it wouldn't affect most people on Medicare or anyone with Part D, employer, Medicaid, or marketplace coverage." The affected drugs would likely be "typically physician-administered treatments for serious conditions like cancer, rheumatoid arthritis, or macular degeneration," Patel said, adding that these are high-cost medications used by about 7 percent of Medicare beneficiaries. "Drugs filled at retail pharmacies under Medicare Part D, like insulin or blood pressure medications, would not be included," she said. Citing RAND's 2024 report, Jean Bae, a professor at the School of Global Public Health, New York University, told Newsweek that U.S. drug gross prices were on average 278 percent more expensive than the prices in the 33 other Organization for Economic Co-operation and Development (OECD) countries. "Given that fact, this policy has a potential to substantially lower U.S. brand-name drug prices covered by Part B," Bae said. However, she added, this assumes that drug companies don't try to "game the system." Drug companies could limit the impact of the order for recipients by delaying the launch of a new expensive drug in referenced countries or pulling out of such countries altogether, Bae said. Medicare Part B also only covers drugs that are administered in a physician's office or hospital, rather than taken at home, so differences in cost seen by those on the Medicare program could be marginal. Bae also pointed to a study by Avelere, which found that less than 1 percent of seniors would have seen reduced out-of-pocket costs as a result of Trump's first-term rule, on which the new order appears to be based. Related Articles What Trump's Executive Order Means for Medicare, MedicaidNew Bill Would Tax Higher Earners To Cover Social Security, MedicareSocial Security, Medicare Cuts Face Massive Opposition in Deep Red StateRFK Jr. Gives Update on Autism Research Involving Medicare, Medicaid Members 2025 NEWSWEEK DIGITAL LLC.
