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.