Pennsylvania law makes health care
more affordable for its older residents.
Called the Medicare Fee Control Act,
this law is for seniors who sometimes find it difficult to pay for the health
care they need.
on the law can be obtained from your local Area Agency on Aging
or from the
DEPARTMENT OF AGING
555 Walnut St.,
Anita Astorino Kulik
1350 5th Ave.
Coraopolis, PA 15108
Fax: (412) 269-2767
QUESTIONS & ANSWERS ABOUT MEDICARE FEES
Can you explain how this law affects
The law protects older people
from paying more for doctor visits covered by Medicare. Known as the Health Care
Practitioner's Medicare Fee Control Act, the law protects people on Medicare
from being overcharged by doctors and other health-care practitioners by making
it illegal to charge a higher fee than that approved by Medicare.
What is an overcharge?
An overcharge is the amount of
money billed by a health-care practitioner to a patient that is in excess of the
Medicare reasonable charge. Many people have never been
overcharged by a doctor. For others, the overcharges can total several thousand
dollars a year.
How does the Medicare Fee Control Act
If you are a Medicare recipient,
doctors and other health-care practitioners must accept the Medicare reasonable
payment for the Medicare covered services they offer. In other words, they may
not bill you for more than the reasonable charge set by the U.S. secretary of
Health and Human Services.
Is there an example?
A practitioner's fee for a
procedure is $130 and the Medicare reasonable charge for the procedure is $100.
Medicare will pay $80 and you (or your insurer) must pay the remaining $20. You
may not be charged the $30 amount that exceeds the reasonable charge.
Does the Law change what Medicare will
No, the law does not change the
list of services Medicare covers. Services such as routine examinations and
tests and cosmetic surgery still will not be covered by Medicare.
Will I still be
responsible for the 20 percent copayment that Medicare requires?
Yes. Many people
carry medigap policies, which cover the 20 percent copayment.
Either you or your insurance company still will need to pay the
20 percent copayment. Also, you still are responsible for the
annual Medicare deductible.
Are all doctors covered by this Law?
The law applies to all health-care
practitioners. This law includes medical doctors, osteopathic doctors, dentists,
optometrists, chiropractors, pharmacists, physical therapists and others.
Does this include non-participating
Yes. Non-participating physicians
and providers cannot charge or collect more than the reasonable charge from the
What should I do it I am overcharged in
spite of the law?
The Pennsylvania Department of State
has the responsibility to enforce the law and resolve claims of overcharges. If
you believe that you are being overcharged and want to report your doctor, you
should contact the Pennsylvania Department of State Professional Compliance
Office toll free at (800) 822-2113. To make a financial claim you must talk to
What punishment does the Law provide
The law includes reprimands and
substantial fines for practitioners found in violation of the law. These fines
will be imposed by the state's appropriate professional licensing board.