Paying at the doctor's office with Original Medicare

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It depends on your doctor and on whether your doctor accepts assignment.

If your doctor accepts assignment:

He or she can only ask you to pay the 20 percent coinsurance (including mental health services) up front (and your Part B deductible if you have not yet reached it—$147 in 2014). Your doctor files the claims, and Medicare pays the doctor directly.

If your doctor does NOT accept assignment:

Your doctor may ask you to pay the full amount for services in advance and charge you up to 15 percent more than Medicare’s approved amount under federal law. Some states have stricter limits on what your doctor can charge you.

Medicare will reimburse you directly for its part of the bill (80 percent of Medicare's approved amount for most medical services, including mental health services).

 


Case Examples
Mrs. B's gynecologist did not accept assignment and refused to bill Medicare.

Related Questions
Can my state give me more rights and protections than federal law regarding Medigap plan enrollment?

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GO TO
Medicare Part B costs

What can I do if my health provider is unable or refuses to file a Medicare claim?

 
LINKS
Medicare.gov -- Search for Participating Physicians

State Health Insurance Assistance Program (SHIP) Directory

National Directory of Medicare Regional Carriers and Intermediaries

Medicare.gov: National A/B MAC Information

 
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