Thanks for the info. I dread Mid-October every year. Not only do I have to worry about the medications but also which of my physicians will be on what advantage plan. Sometimes the insurance carriers negotiate with the providers up until a week before the cutoff of 12/7. I had that happen last year. I’d signed up with Humana only to have the network my PCP is in drop them at the last minute. I’ve gone to my PCP for over 30 years and I’m not about to switch without a fight. The other thing I learned this year is that you have no idea how your insurance is going to categorize the charges on a bill until they pay it. I learned this the hard way. I have a specialist whose office happens to be in one of the major medical facilities in the region. In past years when I saw this specialist I was only charged the flat fee for seeing a specialist - maybe $40-$45. In 2026, it cost me close to $450 a visit because I was charged a facility fee, the physicians fee and the fee for a “procedure” which took less than five minutes. I complained to both the hospital billing office and my insurance plan but neither would help. Needless to say, I have found another sinus doctor with a stand alone office.
Thank you. The site provides current and historical data which is helpful but no info about what might be ahead for 2027, i.e., increases in costs. I took another look at my EOBs and I’m going to pursue the billing charges up the chain of command. I think the hospital is playing dirty pool by charging for both a 20 min office visit ($55) AND an outpatient clinic visit ($425) and I think the insurance company was wrong to accept the charges the way they did. If I have to, I’ll send it to the insurance commissioner of our state…even though I live in a blue state I won’t hold my breath on that one, elected officials being what they are these days.
I am considering that. I guess it would come down to how much Medicare would pay, say for a visit to one of my specialists. I don’t have the classic major senior health issues like heart disease or diabetes but I need sinus, eye and asthma care from a specialist. Is there a way to figure what Medicare would pay before making a decision? I don’t know how I could without knowing what the physicians office would charge. I was blindsided this year by what the insurance chose to pay and what was passed on to me for services when the doctor’s office was inside a medical facility. Up until 2026 insurance only charged me the Specialist rate for these same visits; however, I believe this was renegotiated for 2026 to pass more costs onto the patient in order to keep those providers in network. The insurance companies that wouldn’t play ball lost that provider. In the end there was only one insurance company that had those providers in the network. Anyway that is my theory now. I seem to remember a time, before I was on Medicare, that some doctors wouldn’t take Medicare. Do you recall that or am I mistaken?
Appreciate the heads up on the changes coming.
Thank you for the warning. I had not heard about the changes for Part D. I will now be ready to do my homework and research the best plan for 2027.
thank you!
Thanks for the info. I dread Mid-October every year. Not only do I have to worry about the medications but also which of my physicians will be on what advantage plan. Sometimes the insurance carriers negotiate with the providers up until a week before the cutoff of 12/7. I had that happen last year. I’d signed up with Humana only to have the network my PCP is in drop them at the last minute. I’ve gone to my PCP for over 30 years and I’m not about to switch without a fight. The other thing I learned this year is that you have no idea how your insurance is going to categorize the charges on a bill until they pay it. I learned this the hard way. I have a specialist whose office happens to be in one of the major medical facilities in the region. In past years when I saw this specialist I was only charged the flat fee for seeing a specialist - maybe $40-$45. In 2026, it cost me close to $450 a visit because I was charged a facility fee, the physicians fee and the fee for a “procedure” which took less than five minutes. I complained to both the hospital billing office and my insurance plan but neither would help. Needless to say, I have found another sinus doctor with a stand alone office.
Perhaps consider getting off of an Advantage Plan?
I’m on regular Medicare plus a supplement and never have any of those problems.
Thank you. The site provides current and historical data which is helpful but no info about what might be ahead for 2027, i.e., increases in costs. I took another look at my EOBs and I’m going to pursue the billing charges up the chain of command. I think the hospital is playing dirty pool by charging for both a 20 min office visit ($55) AND an outpatient clinic visit ($425) and I think the insurance company was wrong to accept the charges the way they did. If I have to, I’ll send it to the insurance commissioner of our state…even though I live in a blue state I won’t hold my breath on that one, elected officials being what they are these days.
I am considering that. I guess it would come down to how much Medicare would pay, say for a visit to one of my specialists. I don’t have the classic major senior health issues like heart disease or diabetes but I need sinus, eye and asthma care from a specialist. Is there a way to figure what Medicare would pay before making a decision? I don’t know how I could without knowing what the physicians office would charge. I was blindsided this year by what the insurance chose to pay and what was passed on to me for services when the doctor’s office was inside a medical facility. Up until 2026 insurance only charged me the Specialist rate for these same visits; however, I believe this was renegotiated for 2026 to pass more costs onto the patient in order to keep those providers in network. The insurance companies that wouldn’t play ball lost that provider. In the end there was only one insurance company that had those providers in the network. Anyway that is my theory now. I seem to remember a time, before I was on Medicare, that some doctors wouldn’t take Medicare. Do you recall that or am I mistaken?
98-99% of doctors accept original Medicare.
Aside from the annual Part B deductible, I don’t remember ever getting a bill from a doctor.
Take a look at the Physician Fee Schedule. It’s at https://www.cms.gov/medicare/physician-fee-schedule/search/overview. I haven’t used it, having just run across the thing in my rummaging around the internet, but it might be the thing you’re looking for.
This site might be a bit more user-friendly.
https://www.medfeeschedule.com/ Shout (send direct message) if you want any help.
One can check if the doctor accepts Original Medicare. Medicare Advantage is totally different and some doctors are not accepting.