Asked by Vanessa Natalie on Apr 29, 2024
Verified
Mr. Johnson came to the office today complaining of headache and upset stomach. He has the traditional Medicare fee-for-service plan. Your office's usual fee for an established patient visit is $125. Medicare's allowable charge is $100. If Mr. Johnson does not have Medigap insurance, how much will he have to pay for this visit?
A) $20
B) $25
C) $80
D) $100
E) $125
Medicare Fee-for-service
A payment model under Medicare where providers are paid for each service they render, including tests, surgeries, and other procedures.
Medigap Insurance
Supplemental insurance that covers costs not covered by Medicare, such as copayments, coinsurance, and deductibles.
Allowable Charge
The maximum amount a health plan or insurance pays for a covered healthcare service, also known as the approved, eligible, or allowed amount.
- Outline the repercussions for a physician choosing to accept assignment for individuals covered by Medicare.
- Learn the prerequisites for Medicaid eligibility.
Verified Answer
SB
Stephanie BougratMay 02, 2024
Final Answer :
A
Explanation :
Under traditional Medicare fee-for-service, Medicare typically covers 80% of the allowable charge, leaving the patient responsible for the remaining 20%. In this case, with an allowable charge of $100, Mr. Johnson would be responsible for 20% of that amount, which is $20. The difference between the office's usual fee and Medicare's allowable charge does not affect the patient's cost in this scenario.
Learning Objectives
- Outline the repercussions for a physician choosing to accept assignment for individuals covered by Medicare.
- Learn the prerequisites for Medicaid eligibility.