Original Medicare provides basic medical care for seniors: it covers Part A (hospital insurance) and Part B (medical insurance). For most seniors, Part A is included without a monthly fee because they paid Medicare taxes during their working years. Medicare Part B, on the other hand, does come with a monthly fee. In 2020, the monthly fee is $144.60 or higher, depending on your income. If you are signed up for social security, the part B premium will be automatically deducted from your Social Security check. There are some out of pocket expenses associated with Medicare, such as deductibles and co-pays. The fees and any out of pocket expenses are used to compensate the hospitals and medical professionals who provide health care to Medicare recipients.
What is Original Medicare assignment?
In Original Medicare, assignment means a physician or other health care provider, hospital, or medical product supplier has accepted the Medicare-approved amount as full payment for services. Ideally, people on Medicare insurance will receive their medical care and supplies from a health care provider or supplier who accepts assignment because it can reduce out-of-pocket costs. The good news is that most health care providers and suppliers accept assignment.
To get the most benefit from Original Medicare assignment, keep the following things in mind:
• Even though most doctors and suppliers accept assignment, it’s important to double check before receiving treatment. This is especially important before a big procedure such as a hip replacement. Our Medicare agents are always here to help you double check whether your treatment will be covered at Medicare rates and/or to find health care providers who accept assignment in your area.
• If a health care provider or medical supplier has a participation agreement with Medicare, they are obligated to accept assignment when they provide services covered by Medicare.
• Once you have chosen a health care provider or supplier who accepts assignment, you will only need to pay the Medicare deductible or coinsurance for the service you are receiving. The service(s) will then be billed to Medicare and the provider will wait for reimbursement for the difference owed to them. Note that they cannot charge you for submitting the claim.
Here is what you need to know if your current doctor or health care provider does not accept Original Medicare assignment:
• If you choose to or without meaning to get Medicare-covered health care services from a doctor who does not accept Original Medicare assignment, they are still obligated to submit a claim to Medicare. If they won’t submit a claim you can contact the company who handles specific Medicare claims in your State to file a complaint.
o In Hawaii, claims for Parts A & B and DME are handled by Noridian Healthcare Solutions, LLC – Jurisdiction E. Home Health & Hospice claims are handled by National Government Services, Inc. – Jurisdiction 6.
o Unfortunately, you might need to pay the entire charge for your services at the time of service, and then submit your claim to Medicare to be reimbursed.
• Doctors and health care providers who do not accept assignment may charge you more than the Medicare-approved amount for certain services, within “the limiting charge.” This rule means that they can only charge you 15% over the Medicare-approved amount.
Our independent insurance agents are dedicated to assisting people on Medicare and those who are ready to transition from employer coverage to personal retirement coverage. We help kupuna understand their benefits options and apply for additional coverage, as needed. Because we represent all the major Medicare Advantage and supplement plans in Hawaii, we are able to offer unbiased advice; all at no cost to our clients.
At PBC, our clients are our number one priority and we look forward to getting to know you and your needs. Call us today at (808) 738-4500 to see how we may be of assistance.