Whether you receive your Medicare benefits straight from the government, or through a Medicare health plan offered by a private Medicare-approved insurance company, you may be wondering how Medicare billing works. Read on to learn about Medicare billing and some tips about managing your Medicare bills.
Depending on what Medicare coverage you have, you may be faced with several premiums to pay each month. In addition, you might get bills from medical service providers that require copayment or deductible payments.
Billing under Medicare Part A and Part B
Under Original Medicare, Part A and Part B, you usually pay a copayment or coinsurance for Medicare-approved services and items. You might receive a bill in the mail for the copayment or coinsurance, or in some cases, you might be asked to pay your share before you see the doctor.
Keep in mind that you may have to pay a Part A and/or Part B deductible before Medicare covers certain services and items.
Billing under Medicare Advantage plans and Medicare Prescription Drug Plans
Medicare Advantage plans and stand-alone Medicare Part D Prescription Drug Plans are available from private insurance companies that contract with Medicare to provide services to you. These companies typically handle billing, so if you have questions about bills or claims, start by contacting your plan.
As with Original Medicare, Part A and Part B, you usually pay a copayment or coinsurance for Medicare-approved services and items, and you might have to pay a deductible amount before the plan starts covering your medical services.
Every Medicare Advantage plan has an annual maximum out-of-pocket amount. If you reach this amount, the plan pays for your Medicare-covered services for the rest of the year – you won’t have to pay copayments or coinsurance.
Medicare Advantage plans and stand-alone Medicare Part D Prescription Drug Plans also might have deductible amounts that you have to pay before the plan starts to cover your medical services or prescriptions.
How your choice of providers may affect your Medicare bill
It’s important to be aware that it might cost you more money if you don’t use a doctor or other health-care provider who doesn’t accept Medicare assignment. If your provider accepts Medicare assignment, he or she agrees to accept the Medicare-approved amount for a particular service as payment in full, and agrees not to bill Medicare beneficiaries except for the standard Medicare coinsurance or copayment amount.
If your provider doesn’t accept Medicare assignment, in most cases she or he can charge you up to 15% more than the Medicare-approved amount for Medicare-covered services. However, if you receive medical supplies or equipment from a provider who doesn’t accept assignment, these limits generally don’t apply, and you may have to pay the full amount.
In some cases, if you’re enrolled in Original Medicare Part A and/or Part B, a provider is allowed to charge more than the Medicare-approved amount for a service. The amount that’s more than the Medicare-approved amount is called an “excess charge.” Some Medicare Supplement plans may cover Part B excess charges (these plans are discussed below).
If you’re enrolled in a Medicare Advantage plan, you might need to use providers in the plan’s provider network. Check with your plan for details, and to find out which doctors in your vicinity are in the plan network (if applicable).
Similarly, if you have Medicare prescription drug coverage, you might be able to save money by using the plan’s “preferred” pharmacies or pharmacies in the plan network. Check with your stand-alone Medicare Part D Prescription Drug Plan or Medicare Advantage Prescription Drug Plan for details.
How a Medicare Supplement plan might help lower your Medicare bills
Medicare Supplement (Medigap) plans may help pay for some of your out-of-pocket costs under Original Medicare (Part A and Part B), including cost-sharing expenses such as copayments, coinsurance amounts, and deductibles. Some Medicare Supplement plans may cover Part B excess charges. Plan benefits are standardized across 10 plan types (labeled letters A through N), and each plan includes different benefits and level of coverage. In 47 states, Medicare Supplement plans offer the same standardized benefits for plans of the same letter type. In other words, a Medicare Supplement Plan M has the same standard benefits no matter where you buy the plan.
Medicare Supplement plans can only be used to help with Original Medicare costs, and you’ll need to stay enrolled in Part A and Part B for your hospital and medical coverage. In addition, keep in mind that prescription drug coverage isn’t included in these plans, so if you want help with your medication costs, you may want to enroll in a stand-alone Medicare Prescription Drug Plan.
Specific plan types and premium amounts may vary depending on where you live in the state.
Tips to help manage your Medicare bills
You may want to keep your Medicare Summary Notices (MSN) handy. You’ll receive this document in the mail each quarter and it will contain a list of claims for each provider service you utilized during that quarter. Compare the MSN with the claims and plan’s statements, reviewing all of the bills for the corresponding quarter.
If you have a Medicare Advantage plan or a Prescription Drug Plan, you typically receive an Explanation of Benefits (EOB) each month detailing how much you and your plan paid for your covered services including medications.
You can get help understanding your Original Medicare, Part A and Part B, bills by calling 1-800 MEDICARE (TTY: 1-877-486-2048) 24 hours a day, 7 days a week.
For questions about bills from any other type of Medicare coverage, contact your plan (contact information is on your plan membership card), no matter whether you’re enrolled in:
- A Medicare Advantage plan
- A stand-alone Medicare Prescription Drug Plan
- A Medicare Supplement plan
If you disagree with an item on your Medicare bill, read about Medicare appeals.
If you can’t afford to pay your Medicare bills, contact your state’s Medicaid office to find out if you might qualify for assistance.
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