Are You A Rural Medicare Recipient? Expect Less Care For More Money

While you would think that all Medicare is created equal; you may want to think again.  If you live in a rural area, you are paying more for your care provided through Medicare.  In fact, a recent study by the Inspector General Senior manfor the Department of Health and Human Services found that Medicare patients receiving outpatient procedures at “critical care” hospitals in rural areas are paying 2 to 6 times more than other Medicare recipients.  Even though the procedures were the same, the difference in costs was caused by the difference in location.

The difference is caused by the Medicare reimbursement model that pays smaller “critical care” hospitals in rural areas more money to help keep them in business.  Since you have to pay 20% of the cost those additional moneys are passed on to you as well.  Not all seniors are able to afford the Medicare Supplement that helps pay the 20% for them.  Some examples from 2012 showed Medicare beneficiaries paying $33 for an electrocardiogram while the normal cost was at $5.  Another example was $56 for a vein infusion while other hospitals charged $25.

The Inspector General has urged CMS (Centers for Medicare and Medicaid) to have Congress make changes to the Medicare payment structure to better reflect the true cost of services, but under the law any such changes must be made legislatively.  The Inspector General has suggested a couple of options that CMS is considering as alternatives to make the payment structure better.

The extra cost has not translated into better care.  In fact, these rural “critical care” hospitals are exempt from a key Obamacare provision that was designed to improve the quality of care.  The problem is that the funding has yet to be provided by Congress for these hospitals in order to include them under the provision.