If you are a current Medicare beneficiary, or soon to be eligible, you may have questions about how and where you can use your Medicare coverage and which hospitals near you accept Medicare. You may also want to compare hospitals based on certain quality measures and their experience in treating health conditions you may have. This article will help you understand your benefits and how to find and compare hospitals near you that participate in Medicare.
What is Original Medicare?
Original Medicare, which consists of Part A (hospital insurance) and Part B (medical insurance), is the name given to the coverage managed by the federal government. Under Original Medicare, payment for health-care expenses (that are medically necessary) is divided into two main categories: inpatient and outpatient care. To be an inpatient, you must be formally admitted to the hospital under a doctor’s order. For more information, please see here about inpatient hospital care.
Broadly speaking, Medicare Part A may cover medically necessary care and treatment you receive as an inpatient in a hospital, hospice, or skilled nursing facility. It also covers certain home health-care expenses.
Medicare Part B, on the other hand, may cover outpatient doctor visits, lab tests, surgeries, and medical supplies and equipment you may need to diagnose and treat your condition. Part B also may provide certain preventive services (such as flu shots) at no cost to you if your health care provider accepts Medicare assignment.
In some cases, you may use both your Part A and Part B benefits for a single medical event. For example, if you have knee surgery as an inpatient in the hospital, Part A covers all eligible hospital charges up to the amount Medicare allows, while Part B may cover your Medicare-approved doctors‘ fees and equipment, such as crutches or a walker.
If you need health-care services, it is important to choose doctors, hospitals, and medical equipment suppliers who participate in the Medicare program to get the most financial benefit from your Medicare coverage. Of course, you may choose to see any provider you’d like (you would likely be responsible for all related costs if the provider isn’t Medicare-approved, if you don’t have other health insurance), but costs are generally lower if the provider accepts Medicare assignment.
How do I find hospitals near me that accept Medicare coverage?
Hospitals must adhere to certain safety and health regulations to participate with Medicare. The Medicare.gov website contains a useful Hospital Locator Tool, which allows you to enter your city, state, or zip code to find a list of hospitals in your area that accept Medicare. Once the list is displayed, you may view important information about the type and even quality of care provided at a particular hospital, and you may compare several different hospitals.
The tool includes easy-to-understand charts and graphs that demonstrate:
- The percentage of people who were satisfied with certain aspects of their care, such as whether nurses responded promptly or pain control was adequate
- How quickly care is administered during life-threatening situations such as a heart attack or stroke
- How many patients had surgical complications or developed an infection as a result of their care
Will I have out-of-pocket costs if my hospital accepts Medicare?
Under Original Medicare coverage, you are responsible for your Part A deductible and coinsurance, even if your hospital accepts Medicare assignment, and there is no cap on your out-of-pocket expenses. If you decide to stay with Original Medicare, an option you may have is to sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. Different Medigap plans pay for different amounts of these costs, such as copayments, coinsurance, and deductibles.
An alternative way to receive your Original Medicare benefits is through what’s called a Medicare Advantage plan (except for hospice benefits, which Part A will still provide). If you choose a Medicare Advantage plan to receive your Medicare benefits, the plan may also offer other additional benefits such as prescription drug coverage and routine vision and dental care, all in one plan (benefits vary by plan and location). You’ll still need to keep paying your Part B premium, along with any premium, deductible, coinsurance, or copayments your Medicare Advantage plan requires.
For more information about choosing a hospital, please see:
“Guide to Choosing a Hospital, ” Centers for Medicare & Medicaid Services (CMS), last modified May 2010, https://www.medicare.gov/Pubs/pdf/10181.pdf