HOW MEDICARE HANDLES YOUR BILLINGS

Michael T. Braden February 21, 2026 MEDICARE 101

Whether you are new to Medicare or a seasoned Medicare Beneficiary, there are times when Billing issues can pop up out of nowhere and rain on your parade. In today's article, we wanted to pull back the curtain and give you a better understanding of how Medicare Billing works, both with Original Medicare and with Medicare Advantage plans. Our goal is to inform you of the differences so you can know what to expect.

YOUR FIRST INVOICE FROM MEDICARE

Did you know that every Medicare beneficiary is responsible for paying for Medicare Part B? Regardless of whether you have chosen Original Medicare, Original Medicare with a Medicare Supplement, or Tri-Care, Tri-Care for Life, or Champ VA, you must be enrolled in Medicare Part B. For some individuals who qualify as Dual Eligible beneficiaries, meaning they qualify for both Medicare and Medicaid, their Part B payments may be covered by their state's Medicaid office.

Once you are enrolled in a Medicare Health Plan and you are not yet enrolled in Social Security, your initial invoice from Medicare may be a shock to your system. We say this because you are new to Medicare and just starting out. Medicare always sends you a quarterly bill. So, for 2026, your first Medicare Part B bill won't be $202.90; it will be $608.70, as long as you have no IRMAA adjustments.

This is a standard practice that Medicare has used forever, simply because they want to ensure they receive payment before the next billing cycle when possible. You can easily change this to automatic monthly billing by logging in to Medicare's website at www.Medicare.gov and enrolling in Medicare Easy Pay. With easy pay, you can choose an option to have your monthly Medicare Part B premium paid automatically, and you will not need to worry about juggling a quarterly bill in the future.

Once you decide to enroll in Social Security in the future, you can choose to have your monthly Medicare Part B premiums automatically deducted from your Social Security check.

THE #1 BILLING ISSUE WHEN STARTING WITH MEDICARE

The Number One most common billing error when you first transition to Medicare from your employer's group insurance plan, COBRA, or your Private Insurance is that the doctor's office does not always cancel/remove your old insurance information from their systems/files. So, they often bill both your old insurance and Medicare, causing confusion and delays. It always gets sorted out, but it is entirely avoidable.

We started completing a Patient Information Cover Sheet for each of our clients in order to eliminate most of these errors. We recommend emailing your current doctors a copy and bringing one with you to your next appointment. It is a good idea to follow this procedure anytime you add a new provider.

Photo of a Sample Of Braden Medicare Insurance's Patient Information Cover Sheet Poster

IF YOU HAVE ORIGINAL MEDICARE

When you first visit your doctor after enrolling in Medicare, you have not met your Medicare Part B deductible amount of $283 (2026 Medicare Part B Deductible). Your doctor may collect this on behalf of Medicare, but they do not have to. Then, your doctor sends a copy of your invoice from your visit to Medicare for processing. Medicare receives the invoice, reviews your coverage, and then sends payment to the doctor on your behalf. If you are responsible for any part of the bill, Medicare will send you a Statement with your Monthly Explanation of Benefits Summary.

If you have not yet set up your own Medicare account, it is recommended that you do so in the Medicare Member Portal. Then we advise all our clients to enroll in Medicare Easy Pay. You can write a check to Medicare or pay online through the Medicare Member Portal.

IF YOU HAVE ORIGINAL MEDICARE WITH A MEDICARE SUPPLEMENT

When you first visit your doctor after enrolling in Medicare, you have not met your Medicare Part B deductible amount of $283 (2026 Medicare Part B Deductible). Your doctor may collect this on behalf of Medicare, but they do not have to. Then, your doctor sends a copy of your invoice from your visit to Medicare for processing. Medicare receives the invoice, reviews your coverage, and then sends payment to the doctor.

Medicare will also end your Medicare Supplement carrier notice of the amount that they are responsible for, and then the Supplement also pays your provider. on your behalf. If you are responsible for any part of the bill, Medicare will send you a Statement with your Monthly Explanation of Benefits Summary.

You are not responsible for paying anything up front. Medicare coordinates everything. If there is ever a question about your billing or payments, you should contact your Medicare Broker and/or Medicare directly at 1-800-MEDICARE. Medicare has customer service people who are friendly, well-trained, and helpful. If you ever need to call them, I am confident it will be a surprisingly nice and productive phone call. They are there to serve every Medicare beneficiary.

IF YOU HAVE A MEDICARE ADVANTAGE PLAN

If you have chosen a Medicare Advantage Plan (Medicare Part C), the process is slightly different. The provider's office will charge you any co-pays and/or coinsurance you are responsible for at the time of the appointment. Then, after they have collected your share, the provider sends the remaining balance of the bill to your Medicare Advantage Insurance carrier for payment.

Oftentimes, payments can be delayed or refused if you did not receive Prior Authorization from your PCP and your Insurance carrier. If there are any questions, it is strictly between you, your Medicare Advantage Insurance company, and your provider. Medicare will not be able to assist you.

WRAPPING THINGS UP

We hope you found this article, "How Medicare Handles Your Billings," informative and helpful. If you ever have any questions about Medicare or your Medicare plan, we encourage you to reach out to your Medicare Broker. Brokers will always be there to assist you whenever called upon. If you self-enrolled in Medicare or an agent at the Insurance company's Call Center assisted you, please reach out to us, and we will do our best to answer your questions.

As a Certified Medicare Insurance Planner, we know you have a lot to comprehend and take in as you transition into Medicare. We always encourage every client to look beyond the premiums and the information they see on television, on the radio, or in a flyer or brochure in their mailbox, and to imagine what they want their Healthcare Plan to look like and do for them5-15 years in the future. Things change, and what looks simple now may be difficult later, so do your best to set yourself and your loved ones up for success.

Photo of Michael Braden's Business Card. Michael is the founder and owner of Braden Medicare Insurance Services.

Please feel free to call, text, or email me anytime, or just fill out a contact form on our website.