Is a supplier supposed to waive my coinsurance or Part B Deductable?
The Medicare Part B deductible is the amount a beneficiary must pay for health care before Medicare begins to pay. The coinsurance is the percent of the Medicare approved amount that the beneficiary has to pay after he or she pays the Part B deductible. In the Original Medicare Plan, the Medicare Part B coinsurance is generally 20 percent of the Medicare approved amount for the item. Medicare law requires a supplier of durable medical equipment to bill Medicare for the supplier’s actual charge. Medicare pays 80 percent of the lesser of the supplier’s actual charge or the fee schedule amount, and the beneficiary pays the remaining 20 percent. It is unlawful for a supplier to routinely waive the Medicare Part B coinsurance and deductible, because that results in Medicare paying 100 percent of the supplier's actual charge.
Note: If your supplier routinely waives Medicare copayments and deductibles, you should report these actions to the appropriate Durable Medical Equipment Regional Carrier (DMERC) or by contacting the Inspector General's Hotline at 1-800-HHS-TIPS.