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Your Medicare Benefits

Doctors who don’t accept assignment may charge you more than the Medicare approved
amount for a service, but they can’t charge more than 15% over the Medicare approved
amount for non-participating suppliers. This is called the “limiting charge.”

The limiting charge applies only to certain services and doesn’t apply to some supplies
and durable medical equipment (DME). When getting certain supplies and DME,
Medicare will only pay for them from suppliers enrolled in Medicare, no matter who
submits the claim (you or your supplier).

Your doctor or other health care provider may recommend you get services more
often than Medicare covers. Or, they may recommend services that Medicare doesn’t
cover. If this happens, you may have to pay some or all of the costs. It’s important to ask
questions so you understand why your doctor is recommending certain services and
whether Medicare will pay for them.

If you disagree with a Medicare coverage or payment decision, you have the right
to appeal. For information on how to file an appeal, see your “Medicare & You”
handbook, or visit

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Published in Medicare Publications