While most doctors accept Medicare, some do not. If you turn 65 and your physician does not accept Medicare, you will have some decisions to make. Choosing to stay with a doctor that does not accept Medicare can result in high out-of-pocket costs for you. There is a difference between a doctor who does not accept Medicare assignment and one who completely opts out of Medicare. If they do not accept Medicare assignment, you may be responsible for an excess charge of up to 15% of a service’s cost. If your doctor opts out of Medicare, you will likely have to pay for 100% of their services out-of-pocket and at commercial rates, which can be significantly higher than Medicare. Unfortunately, if you don’t want to pay those additional out-of-pocket costs, you will have to switch to a doctor that does accept Medicare. If this is the case, talk to your doctor, ask them to recommend a local doctor who does accept Medicare. If your doctor does not accept Medicare, they have probably already prepared for this situation and likely have a Medicare doctor they refer patients to. You must be logged in to bookmark pages. If you have Original Medicare, your Part B costs once you have met your deductible can vary depending on the type of provider you see. For cost purposes, there are three types of provider, meaning three different relationships a provider can have with Medicare. A provider’s type determines how much you will pay for Part B-covered services.
Providers who take assignment should submit a bill to a Medicare Administrative Contractor (MAC) within one calendar year of the date you received care. If your provider misses the filing deadline, they cannot bill Medicare for the care they provided to you. However, they can still charge you a 20% coinsurance and any applicable deductible amount. Be sure to ask your provider if they are participating, non-participating, or opt-out. You can also check by using Medicare’s Physician Compare tool. |