Resources > Medicare Part B
Medicare Part B covers various outpatient medical services and other doctor services. Part B is a voluntary program and Medicare-eligible individuals must enroll in Medicare Part B in order to receive the programs benefits.
Medicare Part B covered services are reimbursed at 80% of the “reasonable charge” for the service. The individual receiving the service is responsible for paying the remaining 20%. However, this reasonable charge is determined by Medicare and may not adequately reflect the costs you pay to your physician.
When a doctor agrees to accept the Medicare-set “reasonable charge” as full payment, he or she is said to accept “assignment.” When a doctor does not accept “assignment,” the patient is responsible for paying the outstanding balance minus the Medicare-determined reimbursement. However, federal law sets a limit as to the maximum amount a doctor may bill for a service.
The maximum amount to be billed for a Medicare Part B covered service is 115% of the Medicare “reasonable charge.” If the doctor bills above this cap, he or she violates federal law.