The patient must pay the bill. Medicare will reimburse the patient for the reasonable charge. The patient must pay the difference between the reasonable charge and the actual charge, but the doctor cannot charge more than 115 percent of the reasonable charge. An individual may also choose to enter a private contract with a doctor who does not participate in Medicare. The charge is whatever is negotiated in the contract.
Federal law requires the doctor to complete the paperwork.
You will receive an Explanation of Benefits from Medicare, showing what Medicare has and has not covered. Medicare covers skilled nursing home care for a limited time, and only in certain circumstances. Medicare covers no basic care. Medicaid does cover both skilled and basic care. Medicaid is a program funded jointly by the federal government and Michigan, administered by the Michigan Family Independence Agency.