Example: How Plans Pay Benefits
An example showing a doctor’s charges
The following are examples of how the plans pay benefits for Part B charges, assuming a doctor bill of $2,000 and the annual Medicare Part B deductible of $240 has been met.
| Plans: A, D and N | Doctor accepts assignment | Doctor does not accept assignment |
|---|---|---|
| Charges approved for payment by Medicare | $1,850 | $1,850 |
| Medicare pays 80% of approved charges | $1,480 | $1,480 |
| This policy pays | $370 | $370 |
| You pay coinsurance | $0 | $150 |
If your doctor accepts assignment of Medicare benefits, the difference between your doctor’s charge, ($2,000) and the Part B charges approved for payment by Medicare ($1,850), is absorbed by your doctor and you pay no coinsurance. If your doctor does not accept assignment of Medicare benefits, you pay the Part B excess charges.
| Plans: F, High Deductible F, Innovative Plan F, G, High Deductible G and Innovative Plan G | Doctor accepts assignment | Doctor does not accept assignment |
|---|---|---|
| Charges approved for payment by Medicare | $1,850 | $1,850 |
| Medicare pays 80% of approved charges | $1,480 | $1,480 |
| This policy pays | $370 | $520 |
| You pay coinsurance | $0 | $0 |
Unlike plans A, D, and N, plans F, High Deductible F, Innovative Plan F, G, High Deductible G, and Innovative Plan G pay Part B excess charges. Part B excess charges are the difference between doctor charges and the charges approved for payment by Medicare.