Question

Sal is enrolled in Medicare Parts A and B. He goes to the hospital seniors clinic for congestive heart failure. He had a regular visit in November when Dr. Nauman examined him, checked his medications, and suggested a high fiber diet. The approved amount for her visit is $275. Sal met his outpatient deductible in February. What is his cost sharing amount for the visit to Dr. Nauman?

a. $275
b. $220
c. $198
d. $55

Answer 1

After meeting his deductible, Sal would be responsible for the coinsurance payment of 20% of the approved amount for his visit to Dr. Nauman under Medicare Part B. This comes to (option d) $55 for his visit.

Step-by-step explanation:

Sal is covered by Medicare Parts A and B and has visited his doctor for a regular visit in November.

Given that Sal has already met his outpatient deductible earlier in the year (February), he will only be responsible for the coinsurance amount of his visit.

Medicare Part B typically covers 80% of the approved amount for outpatient services after the deductible is met, with the patient being responsible for the remaining 20%.

Hence, for Dr. Nauman's visit with an approved amount of $275, Sal would be responsible for 20% of that cost.

Sal's cost-sharing for the visit would be 20% of $275, which is:

• 0.20 × $275 = $55

Therefore, the cost-sharing amount for Sal's visit to Dr. Nauman would be $55, making the correct answer (d) $55.