HI 00610.440 Coinsurance

After the deductible has been satisfied, providers will be paid whichever is lower, 80 percent of the reasonable cost or the provider's customary charge for the covered services; and physicians and other suppliers 80 percent of the reasonable charges, incurred during the balance of the calendar year. When payment is made on the patient's behalf, the patient is responsible for a coinsurance amount equal to 20 percent of the reasonable charges for the items and services furnished.

The coinsurance requirement was eliminated for home health services provided on or after 1/1/73.

For rural health clinic services and comprehensive outpatient rehabilitation facility services, Medicare generally pays providers the reasonable cost of the services less the coinsurance amounts, but no more than 80 percent of the reasonable costs.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0600610440
HI 00610.440 - Coinsurance - 09/15/1989
Batch run: 01/27/2009
Rev:09/15/1989