Medicare News
Your Medicare Benefits – What Is the Limiting Charge

We Will Call You

Fill out some basic information and one of our Licensed Sales Agents/Producers will contact you.

Your Medicare Benefits – What Is the Limiting Charge

Wednesday, July 12, 2017 10:49 AM

When you visit a doctor or provider that accepts assignment, you know that they are contracted with Medicare to accept the Medicare-approved amount for a particular service as full payment. If you choose to go to a physician or supplier that does not accept assignment, there are a few things you should know.

If your doctor doesn't accept assignment, they may charge you more than the Medicare-approved amount for a service. However, there's a limit called "the limiting charge," which means the provider can't charge more than 15% over the Medicare approved amount for non-participating providers.

The limiting charge applies only to certain services and doesn't apply to some supplies and durable medical equipment (DME). When getting certain supplies and DME, Medicare will only pay for them from suppliers enrolled in Medicare, no matter who submits the claim (you or your supplier).

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn't cover. If this happens, you may have to pay some or all of the costs. It's important to ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.

If you disagree with a Medicare coverage or payment decision, you have the right to appeal. For information on how to file an appeal, see your Medicare & You handbook, or visit Medicare.gov/appeals.

 

MULTIPLAN_GHHK3T9EN_Accepted

Medicare.Org is a non-government site and is operated by HealthCompare Insurance Services, a licensed health insurance agency certified to sell Medicare products. It contains information about and access to insurance plans for Medicare beneficiaries, individuals soon eligible for Medicare and those advising on behalf of Medicare beneficiaries. Medicare.org is not endorsed by the Centers for Medicare & Medicaid Services (CMS), the Department of Health and Human Services (DHHS), or any other government agency.

If you're looking for the government's Medicare site, please navigate to www.medicare.gov.

HealthCompare Insurance Services, Inc. is a licensed and certified representative of Medicare Advantage HMO, PPO and PFFS organizations and Medicare Prescription Drug plans with a Medicare contract. Enrollment in any plan depends on contract renewal.

The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent/producer or insurance company.

Limitations, copayments, and restrictions may apply. Benefits, premium and/or copayments/coinsurance may change on January 1, of each year.

The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. To learn more about a plan’s nondiscrimination policy, please click on the carrier’s link below.

Aetna
Anthem
Blue Cross Blue Shield - Illinois
Blue Cross Blue Shield - Montana
Blue Cross Blue Shield - New Mexico
Blue Cross Blue Shield - Oklahoma
Blue Cross Blue Shield - Texas
Blue Shield of California
Capital Blue Cross
Cigna Health Spring
Global Health
Highmark
Humana
Humana
Premera Blue Cross
SCAN
Scott & White
United HealthCare
Vibra Health Plan

Last Revised 11/15/2017