When people turn 65 and get ready to enter Medicare, they are sometimes fearful about whether their doctors will continue to see them. Fortunately, Traditional Medicare offers the largest network of doctors and hospitals in the nation.

Over 90% of primary care physicians in the United States accept Medicare and over 70% of those are still taking new patients into their practices. Recent legislation in 2015 was also enacted to help preserve payments to primary care physicians under Medicare.

                                                                                Image Source : Healthmarkets

When treating with doctors on Medicare, it’s important to understand the difference between participating and non-participating providers. These two groups establish how the doctor will bill for your healthcare services.

Participating vs Non-participating

 

Most physicians are participating doctors who have agreed to “accept Medicare assignment” rates. This means which that they agree to whatever Medicare’s schedule allows for payment of their services. They won’t charge any more than that, so you don’t have to worry about getting any balance bills in the mail.

Some doctors, however, are nonparticipating doctors.  These physicians have the right to charge 15% above and beyond the ordinary cost of medical services as outlined in Medicare’s payment value scale. This upcharge is commonly called an “excess charge.”

Under Medicare Part B, beneficiaries are generally only responsible for 20% of charges after their annual Part B deductible has been met. However, if a doctor charges an excess charge, then in that circumstance the beneficiary is responsible for 35% of the Medicare-approved rate.

Avoiding the Balance Bill

If this concerns you, then there are a couple of ways to actively avoid it. First, you can ask your providers up front whether they accept assignment. If they say yes, you need not worry about balance billing.

Keep in mind that you would need to ask this of all healthcare providers and not just doctors. This means asking at lab facilities and imaging centers, etc. too. There’s nothing worse than going to get some labwork done and getting a bill in the mail two weeks later when you thought everything was covered.

The second way is to consider a Medigap policy Plan F or Plan G. Both of these supplement plans cover Part B excess charges, so the company like Health insurance Kenya will pay the balance bill, not you. Incidentally, these polices also pay for your Part A deductible and coinsurance, Part B coinsurance, skilled nursing, and foreign travel as well.

Medigap policies pay after Medicare. After Medicare pays its share of a claim, it will send the remainder to your Medigap insurance company to pay most of the rest. A full coverage supplement like Plan F or Plan G will mean that you have very little out of pocket on medical expenses.

Lastly, you can search the Medicare Provider Directory to find out whether your physician is a participating provider. The provider directory is extensive and can be very helpful. All of these are great ways to minimize your risk of paying balance bills and to budget well for your healthcare needs in retirement.

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