The average American sees a doctor roughly four times per year, whether it’s their primary care physician or a specialist. That number is higher the older we get, as our health needs become more complicated.
You can make the most of each visit by coming prepared with your concerns or choosing virtual appointments. However, each doctor’s visit has a cost, known as copays or coinsurances.
Copays and coinsurance are your shares of the cost of medical treatment. Usually, you pay this amount at each visit to the doctor. This may be what you think of when trying to figure out your cost to see a doctor with Medicare.
In this article, we will cover four scenarios:
- Cost to see a Doctor with Part B only
- Cost to see a Doctor with Medicare advantage
- Cost to see a Doctor with Medicare Supplement Plan G
- Cost to see a Doctor with Medicare Supplement Plan N
We will cover each scenario in detail, and then you can compare the costs for yourself.
Who is covered?
When we talk about a doctor’s visit, this can refer to your primary care physician and a specialist. Medicare defines a doctor as a Doctor of Medicine (MD) and a Doctor of Osteopathic Medicine (DO). You can also be covered for services from other healthcare providers, such as nurse practitioners, clinical social workers and physical therapists.
A dentist, podiatrist, optometrist, or chiropractor can be covered in some specific cases.
Seeing the Doctor: With Part B
Medicare Part B will cover 80% of your doctor’s fee for your visit and any required diagnostic tests. This fee would apply after the annual deductible has been paid. This means that you will only be responsible for paying 20% of the bill.
Make sure your provider accepts Medicare payment, called accepting assignment, for the lowest cost to see a doctor with Medicare. If your doctor will accept Medicare’s fee for the visit and doesn’t charge anything else, they are said to “accept assignment.” But if your doctor charges more than Medicare pays, you are responsible for the difference.
If your doctor does not accept assignment, they may still accept Medicare on a case-by-case basis. In these situations, you may be responsible for the whole amount up front, and you or the provider will need to submit the claim to Medicare.
There are also two annual appointments that have no out-of-pocket costs.
“Welcome to a Medicare” preventive care visit.
During your first year in Medicare Part B, Medicare provides complete coverage for a preventive care doctor visit, which includes:
- a review of your medical history
- a simple vision test
- certain screenings
- a measurement of your vital signs (such as weight and blood pressure), and
- a plan of any other screenings or preventative services you may need.
Annual wellness visit.
After your first year of coverage, you are covered for one annual wellness visit. Your doctor will review your medical history, update your list of medications, measure and update your vital signs and discuss your health.
Seeing the Doctor: With Medicare Advantage
Medicare Advantage plans are managed care plans that cover all the benefits you receive under Original Medicare (Part A and Part B). However, some plans may have additional benefits and may charge a premium.
Your Medicare Advantage plan will typically cover most of your doctor’s visits, although you must pay a copay. That copay will vary depending on your plan. Instead of a percentage, it would be a set amount (such as $20 per visit).
Seeing the Doctor: With Medicare Supplement Plan G
Medicare Supplement Plan G is gaining popularity with many seniors as it covers the gaps that Original Medicare does not. With Plan G, you will be responsible for paying the annual Part B deductible. After that, Plan G will pay 100% of your doctor’s visit costs.
Seeing the Doctor: With Medicare Supplement Plan N
Medicare Supplement Plan N is similar to Plan G in that it covers the gaps not covered by Original Medicare. However, there are some differences. With Plan N, you will be responsible for paying the annual Part B deductible and a copay of up to $20 for some doctor’s visits and up to $50 for an emergency room visit that does not result in your admission.
Medicare provides a summary of the differences between their Medicare Supplement Plans.
Comparing Your Costs
By way of example, say a doctor charges $100 for each visit. Under each plan, how much would you owe?
Under Medicare Part B, you would owe $20 after you had paid your deductible. With Medicare Advantage, it would depend on your co-pay. Once your deductible has been paid, you would have no costs under Supplement Plan G. Depending on the type of doctor’s visit, you would owe between $0 and $50 under Medicare Supplement Plan N.
Making the Right Choice With The Medicare Family
Navigating how to choose your Medicare plan can be overwhelming. There are many choices, and each has advantages and disadvantages. Of course, you must also consider your health needs and concerns.
Health care is already expensive, don’t add to your costs by making mistakes with your Medicare coverage. Schedule an appointment with The Medicare Family today, and let us help you get the coverage you need.