Key Takeaways
● Why did Medicare pay part of this but not all of it?
● Is this bill from my doctor or from Medicare?
● Does this mean I have the wrong coverage?
● Could a coding or billing issue be involved?
Coverage vs. Payment: The Most Common Misunderstanding
When Medicare covers a service, it means the service is approved under Medicare rules. It does not automatically mean Medicare pays 100% of the cost.
Deductibles, copays, and coinsurance still apply, even when care is covered. This distinction explains many surprise bills
Where the Bill Is Coming From Matters
Many bills people receive are not from Medicare.
They may come from:
● A doctor’s office
● A hospital or outpatient facility
● A laboratory or imaging center
Medicare typically processes the claim first, then the provider bills you for any remaining balance.
Timing Can Make Bills Look Worse Than They Are
Bills often arrive before Medicare’s Explanation of Benefits (EOB). Without the EOB for context, a bill can feel alarming.
In many cases, the EOB explains:
● What Medicare paid
● What portion is your responsibility
● Whether additional insurance was applied
When Coding and Billing Issues Are Involved
Not all bills are purely cost-sharing issues. Sometimes, billing surprises are caused by:
● Incorrect procedure codes
● Diagnosis codes that don’t match the service
● Claims submitted before all documentation is complete
These issues are more common than people realize and can often be corrected.
Why This Doesn’t Automatically Mean You Chose the Wrong Coverage
A bill does not mean:
● Your Medicare coverage is bad
● You made a mistake enrolling
● You need to change plans immediately
Most billing issues are transactional, not structural. Understanding what triggered the bill is the first step.
Q & A: Medicare Bills
Does receiving a bill mean Medicare didn’t cover my care?
No. Covered services can still involve deductibles, copays,
or coinsurance.
Should I pay the bill immediately?
Not always. It’s best to review the Explanation of Benefits
first.
Can billing or coding errors be fixed?
Yes. Many errors can be corrected once identified.
Does this mean I need to change my Medicare plan?
Not necessarily. One bill alone is not enough to make that
determination.
A Reassuring Takeaway
Receiving a bill when you have Medicare is frustrating — but it’s also common. Most of the time, the issue is about understanding how Medicare processes claims, not about poor coverage.
Clarity, not panic, leads to better outcomes. Next in this series: My Medicare Costs Went Up This Year — What Are My Options?
