Does Medicare Cover Nurse Practitioners? 

Most seniors in the United States have a family physician that they visit when feeling sick or when seeking treatment for an ongoing medical issue. Doctors in the U.S. are required to possess a medical license, have the proper training and hold accreditation from various state boards. Unfortunately, doctors these days are often busy, and healthcare facilities can become short-staffed, especially during health emergencies or during certain times of the year when cold and flu viruses are going around.

The good news for seniors is that nurse practitioners can often step in to provide medical care in the event that family physicians are not available. A nurse practitioner has advanced training and can provide many of the same healthcare services as a doctor, including carrying out exams, prescribing medications and diagnosing health conditions.

How does Medicare cover nurse practitioners?

Medicare does offer coverage for nurse practitioner services. Seeing a nurse practitioner is essentially the same thing as seeing a doctor in the eyes of the Centers for Medicare & Medicaid Services (CMS), the governing body that oversees the Medicare Program. This means that even if your family doctor is not available or you need to see a nurse practitioner at a Medicare-participating walk-in clinic, your visit is covered.

Are costs different for seeing a nurse practitioner?

When it comes to costs for Medicare recipients who see a nurse practitioner instead of a doctor, there is no change in costs. Because most seniors will see a nurse practitioner during an outpatient medical visit, these services are covered under Medicare Part B. This is the outpatient portion of Medicare insurance, and it covers doctor visits, diagnostic testing and durable medical equipment (DME).

The cost of Medicare Part B

Under Medicare Part B coverage, Medicare recipients only pay 20% of the cost of covered services. Medicare picks up the remaining 80% as long as you have met your Part B deductible for the year. In 2024, the standard Part B deductible is $240. After you have incurred this much in outpatient costs, your Medicare benefits go into effect and apply toward the cost of outpatient services.

Part B premiums in 2024 start at $174.70 per month. As your income level goes up, your Part B premium also goes up. For instance, Medicare recipients with a single income of $500,000 or more or married couples filing joint tax returns earning $750,000 or more, can expect to pay $594 for their Part B premium each month.

Seeing a nurse practitioner while admitted to a hospital

If you are hospitalized and receive inpatient treatment from a nurse practitioner, Medicare Part A benefits apply toward the cost of your care. Under Medicare Part A, the inpatient benefit, all medically necessary care is covered at 100% for a total of 60 days in a Medicare-participating hospital when you’re formally admitted.

If you are admitted to a skilled nursing facility (SNF), you can receive up to 20 days of fully covered care. If you require inpatient care beyond these limits, additional days are available, but they come along with an added coinsurance cost.

The cost of Medicare Part A

Medicare Part A has a deductible you’ll need to pay before your coverage begins. In 2024, the Part A deductible for all Medicare recipients is $1,632. Most Medicare recipients do not need to pay a monthly premium for Part A due to deductions from pay in the form of FICA taxes during a retiree’s working years. If you do not qualify for premium-free Medicare Part A, the cost of your monthly premium for 2024 can be as high as $505 per month.

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