Patient Responsibility

If you’re seeing charges for deductibles, coinsurance, or copays, Medicare didn’t deny your claim — they paid their share and this is yours. These aren’t appealable, but it’s worth verifying the amounts are correct.

• Extra Help Copay Not Applied at Pharmacy
  You qualify for Medicare Extra Help but your pharmacy charged you the full copay. Learn how to get the correct lower copay and a refund for overpayments.
• Medicare Advantage Charged You Past the Out-of-Pocket Max
  You hit your Medicare Advantage plan's annual out-of-pocket maximum but still got a bill. Your plan must pay 100% after the max. Learn how to dispute.
• Medicare Part D Overcharged: Insulin, Vaccine, or OOP Cap
  Your pharmacy charged more than the law allows for insulin ($35/mo), vaccines ($0), or exceeded the $2,000 annual cap. Learn how to get a refund.
• Medicare Balance Billing: Is This Legal?
  A provider is billing you for the difference between their charge and what Medicare paid. This is often illegal. Learn your Medicare balance billing rights and what to do.
• Medicare Bill Higher Than the Allowed Amount
  Your provider charged more than Medicare allows. Learn what the Medicare-approved amount means, what a limiting charge is, and whether you are responsible for the difference.
• Medicare Coinsurance: Why You Owe 20%
  Your Medicare statement shows a coinsurance amount. This is not a denial but your share of the bill after Medicare pays. Learn what coinsurance means and how to manage it.
• Medicare Copay: Why You Owe a Fixed Fee
  Your Medicare statement shows a copay amount. This is not a denial but a fixed fee your plan charges for covered services. Learn how Medicare Advantage copays work.
• Medicare Deductible: Why You Owe This Amount
  Your Medicare statement shows a deductible charge. This is not a denial but your share of the cost before Medicare pays. Learn what it means and how to verify the amount.