In late November of 2018, the Centers for Medicare and Medicaid Services (CMS) launched a new tool that’s expected to help seniors and Medicare insurance enrollees save money and stress. Citing a recent statistic that “1 in 5 of every dollar spent in our country” goes to health care costs, CMS Administrator Seema Verma noted the need to get patient spending increases under control. One way CMS is aiming to improve this is by making “transparency in health care … a priority.” So how does this new tool propose to do this?
The Procedure Price Lookup Tool
The Procedure Price Lookup on Medicare.gov allows users to compare the costs for certain procedures performed at different facility types. The tool displays comparative costs for procedures and services performed in hospital outpatient facilities and ambulatory surgical centers, as well as the national copayment averages for Medicare insurance beneficiaries without supplemental coverage. Ultimately, the goal of the tool is to help Medicare insurance enrollees make more informed decisions about where to have their Medicare-covered procedures done.
Working with their clinicians, Procedure Price Lookup will help patients with Medicare insurance consider potential cost differences when choosing among safe and clinically appropriate settings to get the care that best meets their needs. — Seema Verma, Administrator of the CMS
Using the Tool
Using the Procedure Price Lookup is pretty simple. There are two ways to find a specific procedure — by searching the name of the procedure or searching its code. You’ll need to search the technical medical name of the procedure, for example, Removal or shaving of knee joint cartilage using an endoscope. The code is five numbers that correspond to a specific medical procedure. Luckily, if you don’t remember the exact code or name, you can type a bit of the code or name into the search bar and suggestions pop up to help you out.
Luckily, if you don’t remember the exact code or name, the search bar will give you suggestions to help you out.
When you select your procedure, you can view the cost information and the next steps you can take. The cost information is broken down into a comparison between average costs of ambulatory surgical centers and hospital outpatient departments nationally. The costs are further split by how much the procedure costs in total, how much Medicare insurance covers, and your costs.
Keep in mind, these prices are all averages and your individual costs may, and probably will, vary. Also, all prices are based on national averages. If you want local data, you’ll need to research independently. Finally, the tool only tells you what the costs are under Original Medicare. If you’re curious about your costs in Medicare Advantage, investigate your individual plan’s coverage or check out the summary of benefits of plans on the Shop & Enroll Plan Finder.
The eMedicare Initiative
The Procedure Price Lookup tool was launched as part of the eMedicare initiative, which aims to modernize and enhance Medicare’s services to its beneficiaries. Throughout the course of this multiyear initiative, CMS is rolling out programs in an attempt to streamline your online health care services. Others will incorporate consumer data integration and web development to create a stronger Medicare insurance service package for seniors. See the eMedicare announcement for a deeper dive into the programs and initiatives that CMS plans to release.
