Checking to see if my understanding of the Medicare "limiting charge" is correct.
My understanding is for FEHB purposes, once a person is age 65 (for reference see Section 9 of FEHB brochures), then:
1. FEHB will pay no more than the Medicare "approved amount" (except for certain things like outpatient hospital and non-physician based care such as durable medical equipment)?
2. So, in the case of a "participating provider" who accepts Medicare assignment, the provider will accept the Medicare approved amount as payment in full (or whatever amount agreed upon if less)?
3. If the provider is a "non-participating" provider, they can charge up to 115% of the Medicare approved amount--actually I think it is 15% more than 95% of the approved amount--but thereabouts?
So then, is it correct that if a FEHB enrollee did not have Part B, then (except for the aforementioned exceptions) the enrollee will be paying as a maximum their selected plan coinsurance of 5%, 10%, 15% or whatever of the Medicare approved amount (or less if the FEHB plan allowance is less than the Medicare approved amount such as could be the case with BCBS Basic's set copays)? And, the extra 15% of the Medicare approved amount if a non-participating Medicare provider?
Am I missing anything?
My understanding is for FEHB purposes, once a person is age 65 (for reference see Section 9 of FEHB brochures), then:
1. FEHB will pay no more than the Medicare "approved amount" (except for certain things like outpatient hospital and non-physician based care such as durable medical equipment)?
2. So, in the case of a "participating provider" who accepts Medicare assignment, the provider will accept the Medicare approved amount as payment in full (or whatever amount agreed upon if less)?
3. If the provider is a "non-participating" provider, they can charge up to 115% of the Medicare approved amount--actually I think it is 15% more than 95% of the approved amount--but thereabouts?
So then, is it correct that if a FEHB enrollee did not have Part B, then (except for the aforementioned exceptions) the enrollee will be paying as a maximum their selected plan coinsurance of 5%, 10%, 15% or whatever of the Medicare approved amount (or less if the FEHB plan allowance is less than the Medicare approved amount such as could be the case with BCBS Basic's set copays)? And, the extra 15% of the Medicare approved amount if a non-participating Medicare provider?
Am I missing anything?
Statistics: Posted by tallguy3891 — Sat Jun 15, 2024 3:11 pm — Replies 0 — Views 138