Medicare Policies

We bill Medicare for inpatient and outpatient services. If supplemental insurance information is provided, we will be happy to bill that for you. Patients are responsible for any charges not covered by Medicare and/or supplemental insurance. Patients are responsible for any charges not covered by Medicare and/or supplemental insurance.

Medicare Deductible and Coinsurance Amounts for 2021:

Part A Inpatient Deductible: (pays for inpatient hospital, skilled nursing facility, and some home health care)

For each benefit period Medicare pays all covered costs except the Medicare Part A deductible (2021 = $1,484) during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days. For each benefit period you pay:

  • Days 1 - 60 $1,484.00
  • Days 61 - 90 $371.00 per day
  • Days 91 - 150 $742.00 per day (Lifetime Reserve Days)
  • All costs for each day beyond 150 days

Note: You have 60 Lifetime Reserve Days available at day 91

Part B Outpatient Deductible: (covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment)

  • $203.00 per year. (Note: You pay 20% of the Medicare-approved amount for services after you meet the $203.00 deductible.)

Skilled Nursing Facility Co-insurance

  • Days 1 - 20 Medicare Covers
  • Days 21 - 100 $185.50.00 per day

In addition to your deductible, you may be liable for co-insurance.

Additional information regarding Medicare can be found on the Medicare Frequently Asked Questions page.

Medicare-What's Excluded?

What isn't covered by Medicare Part A and Part B?

  • Acupuncture
  • Chiropractic services
  • Custodial care (help with bathing, dressing, using the bathroom and eating) at home or in a nursing home
  • Deductibles, coinsurances, or copayments when you get certain health care services. (People with limited income or resources may get help paying these costs.) Please contact our Billing Office at 207-351-2398 to find out if you would qualify for Financial Assistance.
  • Dental care and dentures
  • Diabetic supplies
  • Eye care (routine exam), eye refractions and most eyeglasses
  • Foot care (routine) such as cutting of corns or calluses
  • Hearing aids and hearing exams for the purpose of fitting hearing aids
  • Hearing tests that have not been ordered by your doctor
  • Laboratory tests (screening). You will be asked to sign a medical ABN (Advanced Beneficiary Notice) if your physician has not included a covered medical diagnosis. This test becomes the patient's financial responsibility.
  • Long term care, such as custodial care in a nursing home.
  • Orthopedic shoes
  • Physical exams (routine or yearly). (Medicare will cover a one-time physical exam within the first six months you have Part B.)
  • Prescription drugs-most prescription drugs aren't covered by Medicare Part A or Part B.
  • Shots (preventive vaccinations) with the exception of influenza and pneumococcal (pneumonia) injections.
  • Tests (screening)
  • Travel (Health care you get while traveling outside the United States.)

Medicare Prescription Drug Coverage

Medicare offers prescription drug coverage for everyone with Medicare. This is called "Part D". This coverage may help lower prescription drug costs and help protect against higher costs in the future. It can give you greater access to drugs that you can use to prevent complications of diseases and stay well.

If you join a Medicare drug plan, you usually pay a monthly premium. Part D is optional. If you decide not to enrol in a Medicare drug plan when you are first eligible, you may pay a penalty if you choose to join later. The plans are run by insurance companies and other private companies approved by Medicare.

There are two ways to get Medicare Prescription Drug Coverage:

  1. Join a Medicare Prescription Drug Plan that adds drug coverage to the Original Medicare Plan, some Medicare Cost Plans, some Medicare Private Fee-For-Service Plans and Medicare Medical Savings Account Plans.
  2. Join a Medicare plan (like an HMO or PPO) that includes prescription drug coverage as part of the plan. You get all of your Medicare coverage through these plans, including prescription drugs.