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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 $233 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.