Outpatient hospital services

Outpatient hospital services

How often is it covered?

 covers 

 diagnostic and treatment services you get as an outpatient from a Medicare-participating hospital. Covered outpatient hospital services may include:

Who's eligible?

All people with Part B are covered.

 

Your costs in Original Medicare
  • You generally pay 20% of the for the doctor or other health care provider's services, and the Part B applies.
  • For all other services, you also generally pay a for each service you get in an outpatient hospital setting. You may pay more for services you get in a hospital outpatient setting than you would pay for the same care in a doctor's office.
  • For some screenings and preventive services, , copayments, and the Part B deductible don't apply (so you pay nothing).

Note

If you get hospital outpatient services in a critical access hospital (CAH), your copayment may be higher and may exceed the Part A hospital stay deductible.

Note

To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:

  • Other insurance you may have
  • How much your doctor charges
  • Whether your doctor accepts assignment
  • The type of facility
  • Where you get your test, item, or service

Note

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.

Note

The copayment for a single outpatient hospital service can’t be more than the inpatient hospital deductible. However, your total copayment for all outpatient services may be more than the inpatient hospital deductible.

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