What is Medicare Billing?

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  • Written By: Amy Hunter
  • Edited By: Andrew Jones
  • Last Modified Date: 10 September 2019
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Medicare is a medical plan that pays for many healthcare expenses. Medicare billing can be a complicated matter, and, because it changes annually, just when the user starts to figure it out, it often changes. Fortunately, most healthcare providers are familiar with Medicare billing so patients aren’t on their own to determine what is owed at each medical appointment.

Medicare billing uses a set rate that they pays for every healthcare procedure completed. The amount that they will reimburse the healthcare provider is determined by the fixed rate, and then adjusted up or down, depending on the average cost of healthcare in the area. In addition to the payment amount determined by Medicare, there are two other factors that determine that amount that is billed.

Medicare Part B has an annual deductible that must be paid before the medical plan starts reimbursements. The amount of the deductible adjusts annually. Local healthcare providers or Medicare’s website are the best place learn the deductible amount, which can change each year. Once the annual deductible is met, a co-payment will be due at each doctor’s visit.

Medicare billing procedures allow people who qualify for Medicare to have access to affordable healthcare coverage. Medicare pays for outpatient procedures in the same way that a traditional health insurance company pays. Using a provider that is familiar with Medicare billing is the best way to have guaranteed access to affordable healthcare.


Many people become confused by Medicare billing because of frequent changes to the plan. Each year, the amount that Medicare will pay and the amount that the patient is expected to pay is reviewed and, quite often, adjusted. Many of the people who use Medicare suffer from long term health conditions that require frequent, routine healthcare. The confusion starts when the amount that they are expected to pay changes, while the service that they are receiving does not.

Another area of confusion is that the amount that Medicare will reimburse changes depending on the area of the country where the patient is located. Medicare considers regional healthcare costs, such as nurse’s salaries, when setting their rates. This means that a retiree that winters in the South and heads North in the warmer months may pay two entirely different rates for the same service.


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