What Is the Limiting Charge?
Not every medical professional acceptsMedicare.
Even for those who do, they do not all play by the same rules.
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That includes how much they will charge you for their services.
Knowingwhat to look for when you choose your doctormay save you money.
Healthcare Providers Who Opt-Out of Medicare
First things first, does your healthcare provider take Medicare?
To do so, your practitioner needs to opt-in for Medicare.
Although the number decreased to 3,732 in 2017, this may not be an accurate estimate.
It once was the case that a medical professional had to opt out every two years.
Starting in 2015, an opt-out request can last indefinitely.
If your healthcare provider does not accept Medicare for payment, then you could be in trouble.
In the case of a true medical emergency, he is obligated to treat you.
Outside of that, you will be expected to pay for his services out of pocket.
This can get expensive quickly.
It is obviously in your best interest to choose a practitioner that opts into Medicare.
Practitioners who accept Medicare for payment fall into two categories.
Those that accept assignment and those that do not.
They agree not to charge you more than the recommended amount for any given service.
Preventive screening tests are free to you when they are ordered by a participating provider.
The majority of physicians that opt into Medicare, approximately 98%, also accept assignment.
These non-participating providers will charge you more than other doctors.
Medicare has set a limit on how much those practitioners can charge.
That amount is known as the limiting charge.
Sadly, the limiting charge only extends to healthcare providers.
In 2019, the U.S. Department of Justice uncovered one of the largest Medicare fraud schemes in history.
Incentives for Doctors
What is to stop all Medicare providers from not participating?
Wouldnt the limiting charge help them make more money?
The answer is simple.
Healthcare providers are incentivized by Medicare to participate in the fee schedule.
Understanding how the system works will help you to make the most of your dollars.
Medigap plans F and G will pay any limiting charges for you.
Summary
Health care is expensive enough without having to worry about your healthcare provider charging you more.
Find a participating Medicare provider and reap the benefits.
MedicareInteractive.org.Participating, non-participating, and opt-out providers.
Kaiser Health News.CMS sees sharp drop-off in number of doctors dropping out of Medicare.
KFF.How many physicians have opted out of the Medicare program?.
Centers for Medicare and Medicaid Services.Physician fee schedule.
Medicare.gov.Preventive and screening services.
Medicare.gov.Durable medical equipment (DME) coverage.
American Academy of Family Physicians.Medicare options.
Medicare.gov.Find and compare doctors, hospitals, and other providers.
Department of Health and Human Services Center for Medicare and Medicaid Services.Your Medicare benefits.
