How Price Transparency Can Help Medicare Advantage Beneficiaries Save Money

• by Lisa Eramo, MA
• March 15, 2021

It’s a little-known fact that Medicare Advantage beneficiaries may not know: Not every hospital charges the same price for the same procedure or service.

This is confusing, we know. It’s the same procedure or service. Why wouldn’t the charge be the same as well? It’s partly because hospitals each negotiate their own separate contract with Medicare Advantage (Medicare Part C) plans. Separate contracts lead to different prices. 

The good news is that as of January 1, 2021, hospitals must make all of their prices available to the public thanks to a new federal rule that promotes hospital price transparency. This article describes the rule and how it could help you save money on your Medicare-covered care.

"For too long, Americans have been in the dark about the cost of their health care until after they obtain services and receive a bill." – Centers for Medicare & Medicaid Services, Oct. 29, 2020

What is hospital price transparency?

Hospital price transparency refers to the process of making health care price information publicly-accessible to you as a Medicare Advantage beneficiary. Normally, you might not see price information until you receive a medical bill. Now, you’ll be able to see it right up front – before you even receive your health care services. This enables you to shop around for the best deal.

What does the hospital price transparency rule require?

The rule requires hospitals to disclose payer-specific negotiated charges (including charges negotiated with Medicare Advantage plans) for a variety of services that you can schedule in advance (e.g., joint replacement surgery, physical therapy, outpatient visits and imaging and laboratory tests).

Hospitals must provide real-time, personalized access to cost-sharing information, including an estimate of your cost-sharing liability, through an internet based self-service tool. 

What is the purpose of hospital price transparency?

The purpose of price transparency is to empower people to make more informed, cost-conscious health care decisions. Price transparency may also lower the cost of health care services overall by bringing greater competition to the private health care industry.

How can I use the hospital price transparency rule to my advantage?

Before scheduling a health care service or procedure, visit your hospital’s website. Many hospitals provide a price estimator tool that will consider your unique Medicare Advantage plan and benefits when providing a cost estimate. You simply type your Medicare Advantage plan information and any keywords about your procedure or service.

To be sure you’re getting an accurate quote, you may need to ask your doctor for the specific medical code representing the service or procedure you intend to receive. Note the price, and then go to a different hospital’s website and repeat the same process. Shop around to find the most affordable option.

Why is the medical bill quote an estimate and not an exact amount?

It’s an estimate because it’s based on the insurance information that you provide at the time of the estimate. If your benefits and eligibility change, then your costs may change as well.

What else do I need to keep in mind when shopping around for health care services?

As with any shopping experience, health care isn’t only about cost – it’s also about quality.

To learn more about the quality of care at more than 4,000 Medicare-certified hospitals, you can use the Medicare Care Compare tool on Medicare.gov, the official website of Medicare.

What if I have additional questions about how much a health care service will cost?

If you have additional questions, your best bet is to contact your hospital’s billing department. Let them know that you’d like an estimate for services, and then provide them with your health insurance information and the name of your upcoming procedure or service.

Planning ahead and taking advantage of price transparency can help you save a significant amount of money, and it only takes a few minutes to compare costs. 

About the author

Lisa Eramo is an independent health care writer whose work appears in the Journal of the American Health Information Management Association, Healthcare Financial Management Association, For The Record Magazine, Medical Economics, Medscape and more.

Lisa studied creative writing at Hamilton College and obtained a master’s degree in journalism from Northeastern University. She is a member of the American Health Information Management Association, American Academy of Professional Coders, Society of Professional Journalists, Association of Health Care Journalists and the American Society of Journalists and Authors.

Lisa currently resides in Cranston, Rhode Island with her wife and two-year-old twin boys.

 

Website: LisaEramo.com

LinkedIn: Lisa Eramo

Twitter: @Lisa_Eramo

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