2022 Medicare Information

Inpatient Hospital Deductible: $1,556 for days 0-60 in each benefit period
$389.00 for days 61-90 each benefit period
$788.00 for days 91-150 lifetime reserve
Outpatient Deductible: $233.00 per year
Outpatient Co-Insurance: 20% Medicare approved charges
Swing Bed Co-Insurance: $0.00 for days 1-20 each benefit period
$194.50 per day for days 21-100 each benefit period
All costs after day 100 each benefit period

A new benefit period begins after a 60-day break in inpatient care.
For comprehensive information about Medicare and you for 2022, go to www.medicare.gov.

Surprise Billing

When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

What is “balance billing” (sometimes called “surprise billing”)?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs, or have to pay the entire bill, if you see a provider or visit a health care facility that isn’t in your health plan’s network.

“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay, and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in- network facility but are unexpectedly treated by an out-of-network provider.

You are protected from balance billing for:

Emergency services

If you have an emergency medical condition and get emergency services from an out-of- network provider or facility, the most the provider or facility may bill you is your plan’s in- network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

Certain services at an in-network hospital or ambulatory surgical center

When you get services from an in-network hospital or an ambulatory surgical center, certain providers there may be out of network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount.
This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.

If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.

You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.

When balance billing isn’t allowed, you also have the following protections:

• You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.

• Your health plan generally must:

  • Cover emergency services without requiring you to get approval for services in advance (prior authorization).
  • Cover emergency services by out-of-network providers. o Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
  • Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

If you believe you’ve been wrongly billed, you may contact 1-800-985-3059.

2022 Poverty Guidelines

for the 48 Contiguous States and the District of Columbia

Persons in Family/Household Poverty Guideline
1 $13,590
2 $18,310
3 $23,030
4 $27,750
5 $32,470
6 $37,190
7 $41,910
8 $46,630

For families/households with more than 8 persons, add $4,720 for each additional person.

Source: https://aspe.hhs.gov/poverty-guidelines
If you believe you qualify for a reduced bill, please complete a financial statement and submit it to the business office.

FAMC Insurance Participating Providers

  • Araz Great Plains
  • Avera Health Plans
  • Dakotacare
  • First Choice of the Midwest
  • Medicaid – South Dakota

  • Sanford Health
  • TLC Advantage
  • Wellmark BC/BS South Dakota

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