Chapter 3 Medicare Cost Sharing Student Version
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Dec 6, 2023
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20 Points
Using tables 3.1 and 3.2 from the textbook, calculate the cost sharing amount for a beneficiary in the
following scenarios.
Scenario A
This is the third inpatient admission for Indie this year. Indie satisfied his deductible during the first
admission. The length of stay for the first admission was 28 days. The second admission was for 25 days.
The third admission was 19 days.
What is the cost sharing amount Indie owes for the third inpatient admission?
$4,224
$1,408 per benefit period for the first 60 days. Days after from 61-90 is $352 per day.
Scenario B
Chloe’s primary care physician sent her to Memorial Hospital laboratory to get some bloodwork. She has
already met her outpatient deductible for the year.
What is the cost sharing amount for Chloe for the laboratory services?
Nothing
Clinical laboratory services are fully covered and not the beneficiaries responsibility.
Scenario C
Raj is receiving home health services three times per week. The HHA approved two pieces of durable
medical equipment (DME), a lift chair and a walker. The total allowable charge for the two DME items is
$650. The total allowable charges for home health services for the most recent 60-day episode of care is
$1,435. Raj has already met his inpatient and outpatient deductible for the year.
What is the cost sharing amount for the home health services and the DME?
$130.00
Nothing for services regarding home health care. 20% of durable medical equipment though.
Scenario D
Savannah saw her primary care physician in January for a sinus infection. The total allowed charges for
the visit was $125. This was the first healthcare encounter for Savannah this year.
What is the cost sharing amount for the physician visit?
$125
Since first healthcare encounter, all services must be paid until deductible is reached.
pg. 1
CHAPTER 3 MEDICARE COST SHARING ANSWER KEY
Blooms - Level 3—Applying
pg. 2
CHAPTER 3 MEDICARE COST SHARING ANSWER KEY
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