Can a Doctor Charge More Than the Medicare Approved Amount?

You’re eligible for Texas Medicare and that’s a relief. Now you can relax as Medicare picks up the tab for your care right? Wrong. While Medicare pays for a significant amount of your care, it doesn’t pay for it all. In fact, with deductibles, coinsurance and copays, you still owe quite a bit after enrolling in Medicare. But that’s not all. How about excess charges? Can your doctor charge more than the Medicare approved amount? He sure can and here’s what you need to know to protect yourself.

Medicare Doesn’t Cover Everything

Most people incorrectly assume that once they turn 65, their health care worries are over-at least paying for them anyway. This couldn’t be further from the truth. Yes, it’s true; Medicare pays quite a bit and covers you for routine doctor’s visits, tests and screenings, hospital stays and even emergency care. But Original Medicare (Part A and Part B) is limited by what is covered and what is not. That means if you need prescription drugs or home nursing care, you need to purchase additional coverage.

Even with Medicare coverage, you still owe out-of-pocket when you visit the doctor. You are responsible for paying a copay with every visit, a deductible before for receiving any benefits and 20 percent of all treatment costs from coinsurance. These expenses add up fast and with regular visits to the doctor or hospital, you could end up owing thousands of dollars in no time.

Excess Charges

There are regular expenses you owe with Medicare coverage. But there are also expenses called “excess charges” that you’re responsible for as well. Excess charges are legal and are created by your doctor deciding to charge more for a service than Medicare has agreed to pay. Not every doctor charges excess, but many do.

How do you know who does and who doesn’t? Generally, when a doctor “accepts assignment” for Medicare, he or she is agreeing not to charge more than the approved Medicare amount for services. When a doctor participates by treating Medicare patients but has not agreed to accept “assignment” then he or she can legally charge more for the same services. Therefore, it’s critical you find out if your doctor has accepted assignment.

Medicare Supplement Insurance as a Solution

Luckily, there is a solution to the excess your doctor may charge. If you choose to purchase Texas Medicare supplement insurance, you can pick a plan that provides coverage for these extra charges. Plan F and Plan G are the only two plans that give you this additional coverage and if you want protection, it’s highly recommended you consider looking into these plans.

Choose a reliable provider for ensuring your Plan F or Plan G benefits are delivered efficiently and on time. While every provider must offer the same coverage, there’s no guarantee they are as dependable. Stay with the names you recognize like Blue Cross Blue Shield of Texas orAetnafor getting dependability and security with a major company you can trust. Choose Plan F or Plan G for your Medicare supplement coverage and worry less about the extra charges your doctor may or may not decide to charge.

Take Action and Find the Right Plan

Becoming Medicare eligible is a great thing and adding on a gap plan like Plan F or G makes for an easy, wonderful medical experience, at least from the payment standpoint. Finding and securing one? Now that’s another matter. Sure you can select one and do all the needed paperwork yourself but can you be sure you are selecting the one that best fits your needs? That’s where experienced, licensed brokers come in, to assist in finding the lowest cost plan but also managing all the paperwork to get it approved and after the sale the broker is there to provide any and all customer service needs. Start today in securing the correct Texas Medicare Supplement plans with a qualified broker.