For Medicare-covered services, you must first pay the Medicare Part B annual deductible, which is $155 in 2010.
After you have met your deductible, you pay a Part B coinsurance for Medicare-covered services. For doctors’ visits you generally pay 20 percent of the Medicare-approved amount. For mental health services you pay 45 percent of the Medicare-approved amount.
You may have to pay more depending on what your doctor charges and whether the doctor takes Medicare assignment:
- Most doctors who treat patients with Medicare accept assignment, which means they agree to accept the Medicare-approved amount as payment in full. Participating providers always take assignment. When you see a doctor who takes assignment, you are only responsible for the coinsurance amount.
- Non-participating doctors, or doctors who don’t routinely take assignment, can bill their Medicare patients up to 15 percent more than the Medicare-approved amount for most services and can request full payment up front for services. When you see a doctor that does not take assignment, you pay up to 15 percent of the Medicare-approved amount in addition to 20 percent of the Medicare-approved amount (45 percent for mental health services).
- Some states may have stricter limits on what doctors may charge you. See the MI Extra to find out what percent of the Medicare-approved cost for services a non-participating doctor may charge you in your state in addition to your coinsurance. You can also call your State Health Insurance Assistance Program (SHIP) to find out more.
- Providers who have opted out of Medicare can charge their Medicare patients whatever they want. They must officially opt out. These providers do not submit any claims to Medicare and are not subject to the Medicare law that limits the amount providers may charge patients. When you see a doctor who has opted out of Medicare, you pay the entire cost of your care (except in emergencies). The doctor should have you sign a private contract that states that you understand you are responsible for the full cost of the services. Medicare will not pay for any of the cost of services you receive.