The Medicare Program

Medicare Program

What is a “private contract,” and how does it work?

A private contract is an agreement between you and a doctor who has decided not to provide services through the Medicare program. If you sign a private contract with your doctor:

  • Medicare won’t pay any amount for the services you get from this doctor.
  • You will have to pay whatever this doctor or provider charges you for the services you get. Medicare’s limiting charge will not apply.
  • Medicare + Choice plans will not pay for these services.
  • No claim should be submitted, and Medicare will not pay if one is submitted.
  • Your Medigap policy, if you have one, will not pay anything for this service. Call your Medigap insurance company before you get the service if you have any questions.
  • Many other insurance plans will not pay for the service either.
  • Your doctor must tell you whether Medicare would pay for the service if you get it from another doctor who participates in Medicare.
  • Your doctor must tell you if he or she has been excluded from the Medicare program.

The private contract only applies to the services you get from the doctor who asked you to sign it. You cannot be asked to sign a private contract in an emergency or urgent health situation.

You may want to talk with someone in your State Health Insurance Assistance Program before signing a private contract.

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