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. There are many questions about how this law affects senior citizens. To help you understand what the Medicare Fee Control Act means for you, this brochure contains important information about the law, and provides telephone numbers and addresses for further information. I hope you find it useful, and I urge you to contact my office by telephone or mail if you would like additional copies of this brochure for friends or family.

More information on the law can be obtained from your local Area Agency on Aging or from the

Pennsylvania Department of Aging

555 Walnut St., Fifth Floor Harrisburg, PA 17101-1919 (717) 783-1550

State Representative

Compliments of

Jesse White

Capitol offiCe: 102B East Wing P.O.Box202046 Harrisburg,PA17120-2046 Phone:(717)783-6437Fax:(717)780-4781 DiStRiCt offiCeS: Cecil: 3855MillersRunRoad P.O.Box285Cecil,PA15321 Phone:(724)746-3677Fax:(724)746-3799 Burgettstown: 1425BurgettstownPlaza#5 Burgettstown,PA15021 Phone:(724)947-4422Fax:(724)947-5386 Canton Township: 2403JeffersonAve.SuiteC Washington,PA15301 Phone:(724)222-4192Fax:(724)222-4194

lpojcrev0808

WeBSite: www.pahouse.com/white

Questions and Answers about Medicare Fees

Can you explain how this law affects Medicare charges?
The law protects older people from paying more for doctor visits covered by Medicare. Known as the Health Care Practitioners 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. Medicare reasonable payment for the Medicarecovered 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. dentists, optometrists, chiropractors, pharmacists, physical therapists and others.

Is there an example?
A practitioners 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 this include non-participating physicians?

Yes. Non-participating physicians and providers cannot charge or collect more than the reasonable charge from the beneficiary.

What should I do if 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 Medicare directly.

Does the law change what Medicare will cover?

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.

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.

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.

What punishment does the law provide for violators?

The law includes reprimands and substantial fines for practitioners found in violation of the law. These fines will be imposed by the states appropriate professional licensing board.

How does the Medicare Fee Control Act affect me?

If you are a Medicare recipient, doctors and other health-care practitioners must accept the

Are all doctors covered by this law?

The law applies to all health-care practitioners. This law includes medical doctors, osteopathic doctors,