Q: I am about to sign up for Medicare and have more than a few questions. But the question I currently have regards doctors and why, when selecting a doctor, you should ask, “Does he or she take assignment?” What does that mean?
A: There are many questions that could and perhaps should be asked about Medicare before enrolling. The subject you have asked about is one that many enrollees have trouble understanding.
Many doctors and other healthcare providers agree to accept the Medicare-approved amount as their total payment for services rendered. This is known as “accepting assignment.”
Assignment applies if you are covered by the original fee-for-service Medicare program. It does not apply if you are enrolled in a Senior Advantage Plan — an HMO plan.
If your provider accepts assignment, Medicare will, in most cases, pay your provider 80 percent of the amount approved by Medicare and you or your secondary insurance will be responsible for the remaining 20 percent, known as your co-insurance. Your provider will be satisfied with that total amount no matter what he or she originally billed Medicare.
Providers who treat Medicare patients but do not accept assignment are known as “non-assignment providers” and can charge up to 15 percent more than the approved amount and you, the patient, will be responsible for that additional amount. This amount is referred to as an “excess charge” or “limiting charge.”
A non-assignment provider will receive 80 percent of the approved amount from Medicare and you or your secondary insurance will be responsible for both the remaining 20 percent and the excess charge.
When you review your Medicare Summary Notice it will show if the service was covered, the amount charged by your provider, the amount approved by Medicare, the amount Medicare paid the provider and the amount for which you or your secondary insurance are responsible. At the right side of the page you will find a column headed “See Notes Below.” This column consists of various letters which correspond to statements at the bottom of the form. These statements provide further clarification for the maximum you may be billed.
Q: With the cost of everything going up and my income staying fixed, I am always interested in senior discount offers. Do you know of a list that provides such offers?
A: Senior discounts are popping up all over the place. Some establishments provide a discount to senior shoppers on specific days of the week, while others — many restaurants for example — may offer them at certain times of the day. Some discounts may even be seasonal offers.
I am sure that merchants in every part of the county are offering the same type of discounts as it is an excellent way to encourage the senior shopper to frequent their place of business and a win-win situation for both seller and buyer.
You asked if I knew of a list of such offers. No, I don’t. Since businesses change hands and new businesses come into being such a list could become outdated very quickly.
The best way for seniors to obtain such discounts is to ask the individual establishments they frequent if a senior discount is available. Usually the discount, when available, is for those 60 or older. So the best advice I can give is to ask. The answer may be “no,” but it could just as likely be “yes.”
