Quote:
Originally Posted by ARCHIE One thing we are confused on if the Dr. charges $200 for a visit & Medicare pays $100 if she would be responsible for the difference along with the $20 co-pay.
It is my understanding that a doctor can not bill more than 20% of Medicare
allowance. It's a law.
So if a Doctor charges $200.00 and Medicare allows $100.00 you would be responsible for $20.00. Because the doctor, by law, cannot bill more than
20%. A co-pay is a co-pay paid at time of service. In NY anyhow.
Hence the additional insurance Medicare recipients take out to cover
the additional 20%. |
Ok, I called the insurance company that has the plan for her Medicare Advantage plan & asked them.
Her co-pay for a primary care Dr. is $20 and that is ALL they can charge her. It's an HMO and she only has to pay the co-pay!
She pays $15 for lab/20% for certain radiology, etc..
Now if she had the original Medicare she would pay 20% of whatever they charge unless she had a Medicare supplement to cover the gap!
So confusing!!
We are trying to weigh now her total prescription + co-pay costs + diagnostic costs to see if it's less expensive to switch off the Advantage plan!