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Things to Know (when Looking at Health Care Charges)

If You Have Commercial Insurance:

  • Commercial insurers negotiate discounts with hospitals on behalf of the patients they represent. The discounts vary among insurers.
  • Numerous factors, such as type of plan, co-pay, co-insurance, deductible, out-of-pocket maximums and other limitations will also affect your financial responsibility to a hospital.
  • Begin by contacting your insurance company to understand all of the factors affecting your financial responsibility.

If You Have Medicare:

  • Medicare has a set fee schedule that represents a discount from hospital billed charges.
  • Medicare will pay for many of your health care expenses but not all of them.
  • Special rules apply if you have employer group health insurance coverage through your own job or a spouse's job.
  • If you have a supplemental insurance policy, it may cover some costs Medicare does not cover.

If You Have Medicaid:

  • Medicaid pays hospitals in accordance with a set fee schedule that represents a discount from hospital billed charges.
  • Generally, Medicaid recipients are not responsible for any portion of the bill.


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