Question

In a hospital setting, a doctor, who participates in Medicare, performs a $450.00 service for a patient. The patient has met her deductible for the current year. The Medicare allowable charge for the service is $500.00. Medicare will pay:

Select one:
a.$450.00
b.$4250.00
c.$380.00
d.$500.00

Answer 1

Medicare will pay the actual billed amount for a service if it is lower than the Medicare allowable charge and the patient's annual deductible has been met. Therefore, Medicare will pay $450.00 (option a) for the service, which is the actual cost of the service provided.

Step-by-step explanation:

The student's question is about how much Medicare will pay for a medical service that costs $450.00 when the Medicare allowable charge for the service is $500.00 and the patient has met her annual deductible. Given this information, when a doctor who participates in Medicare performs a service, Medicare typically pays the Medicare allowable amount for that service if the annual deductible has been met by the patient.

Since the Medicare allowable charge is $500.00 and it exceeds the actual cost of the service, which is $450.00, Medicare will pay the lower of the two costs. Therefore, the correct answer is that Medicare will pay $450.00 for the service as it is the actual billed amount. No further cost-sharing like copayments or coinsurance needs to be factored in once the deductible is met, as long as the charged amount is within the allowable charge limit set by Medicare.