Medicare Has No Surprise Billing And Now Others Do Too

Since 1997 Medicare hasn’t had surprise billing, but the rest of health insurance just got the same guarantees 1/1/2022 with the No Surprises Act.

If you have Original Medicare Parts A & B you have been protected from seeing a doctor that opted out of Medicare Assignment sending you a huge bill. Medicare limits how much that doctor can bill you (just 15% more than Medicare allows) and requires that doctor to post in his or her waiting room that Medicare Assignment is not accepted. Nationally, the vast majority of doctors accept what Medicare has agreed to pay, so this has not been a large issue.

These states don’t allow Excess Medicare fees by law: Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont

People with Medicare Advantage plans that have networks (think HMO and PPO plans) won’t be hit with an out-of-network surprise either. With a MAPD plan, your Summary of Benefits explains what your costs will be. If you choose to get care outside of your plan’s service area (stay in network for the lowest prices), you may pay more for out of network care — but that shouldn’t be a surprise.

Your Summary of Benefits limits how much you must pay when you go out of network. Yes, some HMO plans won’t cover any care out of network, but again, that shouldn’t be a surprise too you.

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