What is the limiting charge in relation to Medicare beneficiaries?

The limiting charge is a key concept when discussing Medicare and how physicians can bill for their services. Specifically, it refers to the maximum amount a physician or supplier can charge a Medicare beneficiary when they do not accept Medicare assignment. Accepting assignment means a provider agrees to accept the Medicare-approved amount as full payment for covered services. When a provider does not accept assignment, they are allowed to charge more, but the limiting charge puts a cap on how much above the Medicare payment amount they can charge.

This is critical for protecting Medicare beneficiaries from excessive out-of-pocket costs when they visit non-participating providers. The limiting charge is calculated based on the allowable charge determined by Medicare, ensuring that beneficiaries are not overburdened financially.

The other choices refer to different aspects of how Medicare operates but do not properly describe the limiting charge. For example, while the maximum amount a physician can charge if they accept assignment is relevant, it does not address the situation of not accepting assignment. Understanding the limiting charge is essential for both providers and beneficiaries to navigate the costs associated with Medicare services effectively.