Wiki Medicare Replacement Policy/commercial policy?

[sjfarnsworth]

Hey all,
Could anyone tell me if the Medicare replacement polices are considered commercial plans? Or are they considered Medicare policies?

If a provider is not an in network Medicare provider, are they bound to take the contractual adjustments if there is no contract with Medicare?

 

[thomas7331]

Medicare replacement plans are not considered commercial plans. They are often administered by the same companies that offer commercial plans, but the terms of the plan are set by federal law so the insurance companies are just considered contractors of the government for purposes of running the Medicare program.

In general, yes, providers are obligated to accept Medicare terms and rates unless they formally opt out of Medicare and sign a written contract with the patient notifying them of this and obtaining their agreement to pay for services.