There are three ways your doctor can be paid if you are on Medicare. The three ways are through Medicare assignment, Medicare excess charges or by not taking Medicare at all. Today we will discuss these three methods.
The most common way a physician gets paid is by Medicare assignment. These physicians are called “participating doctors”. After the Part B deductible of $198 is met, participating doctors will accept the Medicare approved amount for their services. These doctors charge Medicare 80% and the beneficiary 20% of the cost of the benefit. For example, if your doctor charges $200 for a service and Medicare only approves $100, Medicare would pay 80%, or $80, and you would be responsible for the other 20%, or $20.
A “non-participating doctor” can choose to accept or not accept Medicare assignment. If the doctor does not accept Medicare assignment you may have to pay an additional 15% of the cost of the service the doctor provided. This is call a Medicare excess charge. It means you would be responsible for 35% of the Medicare reduced amount instead of 20%. If we follow the example in the previous paragraph, if your doctor charges $200 for a service and Medicare only approves $100, Medicare would pay 80%, or $80, but you would be responsible for 35%, or $35.
Doctors who opt out of Medicare can charge whatever they want for their services and you are responsible of 100% of the cost. The majority of doctors in north Alabama accept Medicare, so you won’t be faced with this situation very often.
Most people who have Medicare also have a supplemental policy that helps cover the 20% Medicare doesn’t cover. If you are just entering Medicare and would like to know which policies cover what Medicare doesn’t pay, you can contact our office for more information.
If you have questions regarding any aspect of Medicare or Medicare health plans feel free call us at Alabama Health Guidance (256-648-5710), stop by our office at 885 Florence Blvd (Four Lane Shopping Center) or email me at firstname.lastname@example.org.