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I-864 or I864a Form: What You Should Know

It's just one more piece in the puzzle. The last thing you need to know about your medical care plan is if the doctor/surgeon will bill you for the bill. You're covered for both the doctor services you receive (such as any prescribed drugs, X-rays or other medical tests you receive) and any tests the provider orders such as a procedure such as an MRI that's done in your hometown. Your provider might bill you either the full amount of your bill or the percentage amount that Medicare will automatically deduct from your Medicare Part B premium. The amount of your bill can vary. The Medicare provider or provider practice should tell you the actual percentage cost and how much you will be responsible for it. The amount your provider or practice will not bill you are called the “in-network cost”. If you received your diagnosis through Medicare's primary care option, you'll not be billed if your specialist or primary care provider does not bill Medicare for the services. Here's how the in-network and out-of-network rates are calculated: In-Network Your Medicare premium will never be higher than 50 percent of your Part B premium in-network. Out-of-Network Your Medicare premium will never be higher than 75% of your Part B premium in-network. If you have out-of-network care, you'll be credited with the difference. Your Part B premium includes the following out-of-network expenses: -Doctor's Out-of-Network If you pay your Part B premium out-of-pocket (such as by co-pays or deductibles) your Part B deductible will be applied. So if you have out-of-network care but have no Part B premium, and make no deductible, you'll be responsible for the out-of-network cost. Your out-of-network costs are considered as being 50 percent of your payment to your provider or practice, even though your Part B premium is 100 percent of your payment. These are the rules with respect to Part B coverage for out-of-network care: When you receive out-of-network care (out-of-network services) while you're covered by Medicare, you can't be covered for any other medical services. You may be able to get a copay in these cases. You are responsible for the whole Part B fee and deductible.

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