What Part B-covered costs do participants have to pay?

Page 8 of Medicare Part B (Medical Insurance): How It Works

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In addition to their monthly premium (see Who's eligible for Medicare Part B coverage -- and who pays? above), participants are likely to be responsible for a large portion of their doctor and other outpatient medical bills, despite Part B coverage. Why is this? First, there's a yearly deductible ($140) each participant has to pay before Medicare will pay anything. Also, when Part B pays only part (usually 80 percent) of an approved charge, participants are personally responsible for the unpaid remainder.

Participants may also be responsible for the difference between the Medicare-approved amount and what the doctor or other provider actually charges. By law, this can't exceed 15 percent more than the approved charge.

Whether someone is charged this extra 15 percent depends on whether the doctor or other provider accepts "assignment." This means the provider accepts the Medicare-approved charge as the entire amount of the bill. Most doctors accept assignment of Medicare charges -- but not all will do so, and many outpatient clinics do not. So participants need to check on their doctor's or provider's policy about assignment before beginning any care. To fill the unpaid gaps in Part B coverage and payment, participants may want to buy a Medigap insurance policy. Or, if they have low income and few assets, they can look to Medicaid or other programs for low-income seniors for help paying these bills.

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8 months ago

Clear, concise, comprehensive overview!!


8 months ago

Hi jnsidlo, Thank you for your comment. Unfortunately, at this time, I'm unsure exactly what you are asking. If you'd like, you can re-post your question to our Ask & Answer section with more information about your situation. You can post your question here: ( http://www.caring.com/ask ) Thank you! -- Emily | Community Manager


8 months ago

Dear Mr. or Mrs : I have medical insurance premiums due trough July 2011 out of the check I will receive around July1, 2011. These premiums total $230,80. These premiums cost every month ?? Thanks for ansver.


10 months ago

Hi mose, Thanks for your comment. Check out these google search results: ( http://maps.google.com/maps?hl=en&q=Houston,+Tx+oral+surgeons+%22accept+medicare+%22&bav=on.2,or.r_gc.r_pw.&um=1&ie=UTF-8&sa=N&tab=wl ). You may have to do a little more research to find out if they accept medicare, but that list should help you get started. I'd just give a facility you are interested in a call, and ask if they accept medicare. If they don't maybe they'll know someone who does. Good luck! -- Emily | Community Manager


10 months ago

My brother is mentally challenged and is 45 years old has medicare a,b,d his doctor told us he needs to have a tooth pulled been to 2 oral surgeons thay do not accept medicare we are in the Houston area we need a oral surgeon that accepts medicare can anybody help


about 1 year ago

can i get paid to be caregiving.


over 1 year ago

How can I find out if any of my providers chose "assignment" for payment?


over 1 year ago

I am trying to find out just how much Medicare pays for cataract surgery. I am having it and cannot find out how much it costs...tho' I am still calling around and trying to get an answer so if I know what Medicare pays I can then anticipate what out of pocket I have to pay. I already know what my supplemental insurance pays but don't know what they will pay AFTER Medicare. I am considering "premium" lenses.


over 1 year ago

medicare and Gyms - is there a list of gyms in RI? How do i get one?


over 2 years ago

Will Medicare Part B cover medical expenses while abroad on vacation?


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