FAQs about Medicare and Medicaid

If paying your bill is a concern, please contact one of our Patient Financial Counselors at (605) 696-8030.

    Brookings Health System accepts Medicare Assignment Inpatient Stay. Medicare pays all but the Inpatient Deductible. For Outpatient Services, Medicare pays all but co-insurance and the deductible. Outpatient medications in the observation bed are not covered by Medicare.

    If any other insurance is primary over Medicare, we must file other insurance (including liability insurance) before Medicare will pay on your claim.

    Yes. Once we receive Medicare’s payment, the balance will be sent to your supplemental insurance company.

    The Medicare Explanation of Benefits form is a statement from Medicare showing what you were charged for a service, what Medicare paid, and the amount due from you or your supplemental insurance company.

    Medicare Part A covers inpatient hospital stay, limited skilled nursing home care, and hospice care. Medicare Part B covers physician services and most hospital outpatient services.

    The Medicare Explanation of Benefits is for your information. The hospital receives an Explanation of Benefits that we forward on to your supplemental insurance company for you.

    We will bill you for any balance after we have received payment from Medicare and your supplemental insurance.

    That will depend on what Medicare covers and what kind of Medicare supplemental insurance policy you have.

    Medicare Advantage Questions

    As of 2024, Brookings Health will no longer be in network for most Medicare Advantage Plans. Medicare beneficiaries should carefully weigh the pros and cons between original Medicare and Medicare Advantage Plans, including potential out-of-network healthcare costs. Brookings Health will provide the same high-quality care for all Medicare beneficiaries regardless of their plan choice. If you elect a Medicare Advantage plan in 2024, you may still receive care at Brookings Health. We encourage you to understand what your plan’s out-of-network benefit rates are. We recommend you call your insurance agent or the number on the back of your plan’s card for policy specific details.

    As of 2024, Brookings Health will no longer be in contract with Medicare Advantage plans from Aetna and Humana. We have reached an agreement with Medica for 2024. If your Medicare Advantage plan is from an insurance provider other than one of these, you may not experience any changes. We encourage you to contact your insurance agent to discuss your out-of-network costs, if any, for your specific plan. 

    If you elect an MA replacement plan that Brookings Health is out-of-network for, you may still receive care at Brookings Health System.

    Medica is the only Medicare Advantage plan Brookings Health will be in network with for 2024. After our announcement that we would no longer be in network for any Medicare Advantage plan in 2024, we were able to negotiate an agreement with Medica. The agreement aligns with traditional Medicare's accepted billing practices and reimbursement policies. 

    We routinely look at our contracts with insurers. We hope the regulatory environment and oversight for Medicare Advantage plans continues to progress, making it easier for Brookings Health to participate with all Medicare Advantage providers.

    If you elect an MA replacement plan that Brookings Health is out-of-network for, you may still receive care at Brookings Health System.

    Original Medicare refers to Medicare Part A and Part B. Part A covers hospital care, including hospital stays, short-term skilled nursing care, hospice, and home health. Part B covers clinic and outpatient care with doctors and other health care providers and certain preventative services.

    Medicare Advantage (MA) plans are offered by private insurance companies who are contracted by the federal government. Medicare Advantage, also referred to as Medicare Part C, covers the same healthcare services as original Medicare. Many MA plans also include prescription drug coverage and can also include coverage for routine vision, dental and hearing care. Health and wellness benefits, like fitness programs may be offered, as well.

    Medigap supplement insurance may help pay some healthcare costs that original Medicare leaves to patient responsibility or does not pay for that specific service. This may include copayments, coinsurance, and deductibles. We recommend you call your insurance agent or the number on the back of your plan’s card to get your plan specific information. Brookings Health DOES accept Medigap supplements.

    Medicare Part D is prescription drug coverage. It is optional coverage to help Medicare beneficiaries pay for prescriptions.

    Medicare is not mandatory. However, if you do not enroll for Medicare Part B (medical insurance) when you are first eligible, you may have to pay a higher premium cost. If you turn 65 and still have insurance through an employer or union, you can keep that insurance and wait to enroll in Medicare using a special enrollment period (SEP).

    We recommend you call your insurance agent or the number on the back of your card. You can find more information at Medicare.gov as well as Senior Health Information & Insurance Education (SHIINE) and Minnesota Senior Linkage Line.

    Depending on the plan chosen, a Medigap supplement will pick up some or all copays, deductibles and coinsurance left by original Medicare. A replacement Medicare Advantage plan usually has copays, deductibles and coinsurance amounts that are the patient’s responsibility. We recommend you call your insurance agent or the number on the back of your plan’s card to get your plan specific information.

    Not all hospitals accept Medicare, but the vast majority do. We recommend you visit Medicare.gov or call your social security office to find out if a facility and providers are in-network with Medicare. Brookings Health DOES accept Medicare.

    No. We recommend you call your insurance agent or the number on the back of your plan’s card to find out if your policy is in-network with your providers and facilities.

    Every Medicare Advantage policy and plan is different. Brookings Health cannot speak to your specific policy. We recommend you call your insurance agent or the number on the back of your plan’s card. 

    When you have a replacement plan, you have chosen that plan over traditional Medicare. As such, Brookings Health can no longer file to Medicare. The replacement plan replaces traditional Medicare. Brookings Health will still file your claim to your Medicare Advantage plan. 

    In order to receive Medicare Part B benefits under your replacement Medicare Advantage plan, you still need to pay Medicare. We recommend you call your insurance agent or the number on the back of your plan’s card if you have additional questions. 

    Based on our experience with Medicare Advantage (MA) plans, Brookings Health has chosen not to contract with most MA plans at this time. Brookings Health’s current experience with certain plans include preauthorization tactics that often delay or deny necessary patient care. We do not endorse these tactics nor MA plans’ payment practices. As a rural community hospital, Brookings Health must remain financially solvent so we can continue to deliver high-quality, compassionate, personalized health care. As these practices continue to be highlighted on the national level by the Centers for Medicare & Medicaid Services (CMS), we hope all MA plans can better align with original Medicare’s practices and policies. Brookings Health routinely reviews contracts and plans and may re-partner with MA plans in the future. If you elect an MA replacement plan, you may still receive care at Brookings Health System.

    Brookings Health System and Avera Health are separate entities who must each make the best business decisions for their respective system and the patients they serve.

    Some Medicare Advantage plans will cover at out-of-network benefit rates, but some do not restrict benefits. We recommend you call your insurance agent or the number on the back of your plan’s card to get your plan specific information. No matter a person’s insurance plan or ability to pay, Brookings Health promises to treat the whole person and deliver the high-quality care you need. Our priority is your physical health and healing. When you are concerned about paying your bill, we will work with you to find financial assistance and setup a payment plan.

    We recommend you call the number on the back of your Medicare Advantage plan’s card for your plan specific information. 

    The Centers for Medicare & Medicaid Services (CMS) has a fact sheet on 2023 Medicare Parts A & B Premiums and Deductibles.

    For 2023, the deductible for an inpatient stay is $1,600. Part B is $226. More information can be found on the 2023 Medicare Parts A & B Premiums and Deductibles.

    We recommend you call social security office or go to Medicare.gov for more information. 

    We recommend that you call your insurance agent or the number on the back of your plan’s card for your policy specific details.