When you’re covered by Medicare for your health insurance, it is important that your doctors accept Medicare assignment. What this means is that your doctor, provider, or medical supply provider agrees to accept the Medicare amount as payment for services. In some cases, medical service providers and suppliers are actually required by law to accept Medicare’s approved amount.
In most instances, providers and suppliers will accept Medicare assignment. However, it is always a good idea to ensure that they do so prior to moving forward with using their services.
Advantages for Medicare Enrollees
There are many advantages to Medicare enrollees if they’re assignment gets accepted. First, the out-of-pocket expenses to the enrollee may be less. In addition, you will just be charged the Medicare enrollee the amount of the Medicare deductible and coinsurance, and will then wait for Medicare to pay its share of the bill before requesting the enrollee to pay his or her share.
The claim must be submitted directly to Medicare (or a Medicare supplement plan). This means that whenever the enrollee has used a service, he or she cannot be charged for submitting the claim.
What if a Provider or Supplier Does Not Accept Medicare Assignment?
If they choose not accept Medicare assignment, they are referred to as “non-participating” providers. This means they haven’t signed on to coverall every service. However, there are certain services they can be used for.
If, however, they rebuff the Medicare assignment:
- An enrollee will probably pay the full amount. They are supposed to submit a claim to Medicare for any type of Medicare covered service that they provide. However, they cannot charge a Medicare enrollee for submitting a claim.
- The supplier can charge the enrollee more than what’s approved by Medicare. When a Medicare enrollee uses the services of a non-participating places, they may be charged higher than the Medicare approved amount for their services or medical supplies. In this case, however, they cannot be charged over “the limiting charge” on certain Medicare covered services.
What Are Private Contract Agreements?
In some cases, the health provider and a patient may work via a private contract. This is a written agreement between a Medicare enrollee and a medical provider that has opted not to offer services through Medicare. The contract will apply only to the services offered by the provider who asked the enrollee to sign it.
It is important to note that if a Medicare enrollee signs a private contract, Medicare will not pay any amount for the services that are received from that provider – even if it is a Medicare covered service – and, the enrollee will be required to pay the full amount that is charged by the provider.
What to do if your Doctor Opts-Out
Every year there are hundreds of doctors that decide to stop accepting Medicare assignment, which could leave some enrollees wondering what they should do for health care. It’s not uncommon for a doctor to leave or enter certain insurance networks, and Medicare is no different. After that, they can refuse Medicare assignment and it would leave you paying for the visit and treatments yourself.
How to know if a Health Care Provider Accepts Medicare
If you’re enrolled in Medicare and looking for a hospital or physician, it’s vital that you find one that accepts Medicare, otherwise you could be left spending hundreds of dollars out-of-pocket. Luckily, finding a doctor that accepts assignment is simple.
Medicare provides a tool, Physician Compare, which allows you to search doctors in your area based on if they participate in Medicare. This makes it quick and easy to find a doctor that fits your needs. If you just enrolled in Medicare, and don’t know if you doctor accepts Medicare, you can use the Physician Compare tool, or simply call the office, and one of the professionals can tell you if they accept Medicare reimbursement.
Medicare Excess Charges
There is another aspect of physician payment that you should be aware of, and that’s excess charges. Even if the doctor accepts Medicare, they are legally allowed to charge 15% than the pre-approved amount by Medicare. In most cases, this isn’t a huge cost of the enrolling, but depending on the service or treatment, it could compound quickly.
The cost of health insurance and Medicare will normally rise, but there are plans that can keep the extra costs down. Original Medicare doesn’t cover the expenses of excess charges. Buying a medsup policy, such as Medigap Plan F, can ensure that you don’t have your savings drained by expensive hospital bills.
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