Basics for Medicare Patients
By Tucker Thompson, Collin County LIVING WELL Magazine
Where do I enroll for Medicare?
You can go online to www.Medicare.gov or visit your local Social Security office. The Centers for Medicare and Medicaid Services (CMS) is the federal agency that administers Medicare.
What is the cost of Medicare?
Most people pay $0 for Part A (Hospital and Skill Nursing Insurance) if you paid Medicare taxes while working. The cost for Part B (Medical Insurance) is $104.90 in 2014. If your individual income tax in 2012 was above $85,000 or you filed a joint income tax above $170,000, Social Security will charge you a higher monthly premium for Part B services.
Is there a deductible for Part A and Part B in Medicare?
Each time you’re admitted to a hospital you will have to pay $1,216 in 2014 (Part A Deductible) for what is known as a benefit period. If you have any Part B services, you will pay a one-time deductible of $147 in 2014.
What is “Assignment”?
It’s an agreement between Medicare and doctors, other health care suppliers and providers. If someone accepts assignment, they agree to accept only the amount Medicare approves for their services. You and your insurance can only be charged the Medicare deductible and coinsurance based on these approved charges.
What if the physician does not accept “Assignment”?
If the physician does not accept assignment, he may charge you 15% over the Medicare approved amount. This is called the “limiting charge” and applies to certain services and not to suppliers and durable equipment. You might have to pay the entire charge at the time of service. When the claim is processed, Medicare will send you a payment for only the Medicare approved amount.
If I have Medicare can a physician, lab or hospital bill me the difference between their charges and what Medicare allows?
Medicare has a set fee schedule that providers must follow. They cannot balance bill you the difference of what Medicare allows and their charges for Part A and Part B services except for the 15% limiting charge if they do not accept assignment.
Tucker Thompson, the author, has worked in the insurance field for over 20 years. His time is spent helping individuals review or sign up for new medical insurance, Medicare Supplements, Medicare Advantage Plans, Medicare Prescription Drug Plans, Life and Long-Term Care polices. With clients all over Texas and Oklahoma, he may be reached locally at 972-548-1629 or toll free 888-247-1829.
