Medicare, the government’s insurance plan for people disabled or 65 or older, sets prices for the services it funds. These prices are typically much lower than what either an uninsured person is charged, or what a commercial health insurance company negotiates in the private sector of the economy. Medicare prices create a clear benchmark for a fair price we should be willing to pay. Even if you agree to pay up to twice the Medicare rate it’s a good deal compared with how much hospitals and doctors would otherwise charge. The commercial health plans that cover most Americans below the age of Medicare eligibility unfortunately allow hospitals, doctors and other medical industry vendors to charge their insureds anywhere from two to ten times more than Medicare prices.
We discourage other forms of age discrimination in this country but regrettably this form of discrimination has become the norm in the private sector health care market which covers most Americans of working age and their families. It would be as if McDonalds sold Big Mac’s for $4 to anyone over age 65 but from $8 to $45 for everyone else.
There is no reason why you should have to pay more than Medicare would pay for the same service just because of your age. Discrimination is wrong, and you should challenge it in health care pricing as in other venues where it might appear. You can do this by finding what Medicare pays for the particular service you received. When you have the Medicare price in hand you acquire leverage to ask for a better deal and this could be essential if you are uninsured or have a high deductible insurance plan.
How do you get the Medicare price? It is easy if your servicing hospital posts on its website the prices it receives from Medicare for your particular procedure. If not, you can go to the official Medicare website and download the Procedure Price Lookup Comparison File. That is an Excel spreadsheet that provides the national average total payment that Medicare makes for almost four thousand services and procedures in ambulatory surgical centers and hospital outpatient departments. The prices would be an estimate of what Medicare would pay in your area because the actual Medicare payments are adjusted for labor costs and other region specific factors in your part of the country.
You can also use the Medicare outpatient procedure cost lookup tool. Type in the name of the procedure or its billing code to see the total cost paid by Medicare. For example, a colonoscopy price is listed at $715 at an ambulatory surgical center and at $1212 at a hospital outpatient department. Again, these are national averages so the Medicare price may be higher or lower in your region.
Since the Medicare rates obtained through its website only provide an approximation of what the federal government health plan would pay for a particular service at your local facility in your region of the country, you should ask your hospital or outpatient facility to tell you as they are legally obliged to do exactly what price they get from Medicare for your procedure. Then tell them you want to pay the same price unless you have a lower copay or deductible under your particular insurance plan .