There’s always more to discover with an AARP membership! Browse our member benefits.
by Patricia Barry, AARP Bulletin, December 14, 2009
Q. My husband’s doctor opted out of Medicare and now charges a high set fee for the year, which covers all his office services. My husband says that, even so, Medicare and his Medigap supplement will still cover hospital care, specialists, or outpatient tests should he need them. Is this true?
A. Yes, your husband is correct. In paying a fixed fee for his primary care, he has made a private contract with this doctor. Because the doctor has opted out of the program, Medicare will not pay for any services this doctor provides. Since Medigap supplemental insurance pays only for Medicare-covered services—which this is not—it won’t cover any of his out-of-pocket costs incurred with this doctor.
However, if your husband goes to any other provider—whether a physician, hospital, testing lab, or supplier of medical equipment—that does accept Medicare, he will receive the appropriate Medicare coverage. Also, his Medigap insurance will pick up the tab for the remaining costs, such as copays, according to the terms of his policy.
In this instance, a Medicare beneficiary made a definite decision, fully aware of the consequences. Other people, though, have often found themselves stuck with large bills because they assumed that Medicare automatically covers services from any provider—or that they can simply submit claims to Medicare themselves and have their costs reimbursed if the provider does not accept Medicare. This is not the case.
Bottom line: To avoid nasty billing surprises, make sure you find out in advance whether providers accept Medicare. They have an obligation to tell you. Even if they do accept Medicare, it’s wise to ask whether or not they take Medicare payment “on assignment” because this also makes a difference to your out-of-pocket expenses. For a more detailed explanation of these different billing situations, see this previous article.
Patricia Barry is a senior editor with the AARP Bulletin.
Please leave your comment below.
You must be logged in to leave a comment.
Members can take a free confidential hearing test by phone.
25% off device and online privacy protection plans
25% off the first healthy meal delivery of $99+.
AARP members receive exclusive member benefits & affect social change.
You are leaving AARP.org and going to the website of our trusted provider. The provider’s terms, conditions and policies apply. Please return to AARP.org to learn more about other benefits.
Your email address is now confirmed.
Manage your email preferences and tell us which topics interest you so that we can prioritize the information you receive.
Explore all that AARP has to offer.
In the next 24 hours, you will receive an email to confirm your subscription to receive emails
related to AARP volunteering. Once you confirm that subscription, you will regularly
receive communications related to AARP volunteering. In the meantime, please feel free
to search for ways to make a difference in your community at