Can Medicare deductible be waived?
Asked by: Dr. Travis Crona DVM | Last update: January 14, 2026Score: 4.3/5 (74 votes)
Does everyone on Medicare have to pay a deductible?
Medicare plans have deductibles just like individual or employer health insurance plans do. Both Original Medicare and, typically, Medicare Advantage Plans , require you to meet a deductible—an amount you pay for healthcare or for prescriptions—before your healthcare plan begins to pay.
Which of the following is true about waiving Medicare patient copayments?
Medicare allows copayment waivers for any patient below the poverty level. Patients covered by Medicare may petition the agency for waiver of their copayments. Routine waiver of Medicare copayments is considered insurance fraud.
Is waiving deductibles illegal?
Deductibles. It is illegal for a contractor to pay, waive, or discount your insurance deductible. It is insurance fraud if homeowners don't pay their deductible. Some contractors offer waived or discounted deductibles as a selling point to their customers.
Can a medical deductible be waived?
Waiving copays and deductibles removes the disincentive for utilization, thereby potentially increasing payor costs. Accordingly, federal and state laws as well as payor contracts generally prohibit waiving cost-sharing absent genuine financial hardship.
Can Your Auto Insurance Deductible Be Waived?
Can you waive a Medicare deductible?
copayments or deductibles directly from the patient. Any waiver or reduction of Medicare coinsurance or deductible amounts that do not strictly comply with the above policy standards are subject to potential criminal and civil sanctions and are strictly prohibited by this policy.
Can you get out of paying your deductible?
Some insurers even offer a disappearing deductible program. It's what it sounds like. If you go a set amount of time without a claim or violation your deductible amount will decrease or be waived.
What to do if a patient asks you to waive the deductible?
The only legitimate reason to waive co-pays and deductibles is the patient's genuine financial hardship. Documentation in patients' own handwriting must include income; assets; expenses, including the local cost of living; family size; and the extent of their medical bills.
Is deductible mandatory?
Depending on your policy, and the types of coverages you have, a deductible may be required. With an auto insurance policy, coverages like comprehensive and collision may require a deductible before said coverages apply in the event of a covered incident.
Can doctors give discounts to patients?
Generally speaking, there is no prohibition against a physician discounting a fee for a self-paying patient (that is, a patient who pays out-of-pocket and is not covered by a health plan, including Medicare or Medicaid). However, there are some considerations to keep in mind when using any discount program.
Can you discount a patient's deductible?
A provider who routinely discounts or waives a patient's copayment or deductible (collectively referred to as copayment) obligations, for example, can run afoul of the federal antikickback statute, 42 U.S.C. § 1320a-7b, or be accused of false billing by private insurance carriers not receiving the discount.
Is a true or false waiver of Medicare deductibles allowed under the anti-kickback statute?
Waiving Medicare deductibles is not allowed under the anti-kickback statute, and CMS considers it a misrepresentation of the actual charge. While commercial insurance companies may also prohibit waiving co-payments or deductibles, the statement specifically addresses Medicare.
Does everyone have to pay $170 a month for Medicare?
Most people pay no premiums for Part A. For Medicare Part B in 2025, most beneficiaries will pay $185 per month. Certain factors may require you to pay more or less than the standard Medicare Part B premium in 2025.
Are deductibles optional?
In some states, policyholders can choose to pay a higher premium in return for a traditional dollar deductible; however, in high-risk coastal areas, insurers may make the percentage deductible mandatory.
Why do people say not to get a Medicare Advantage plan?
Disadvantages of Medicare Advantage plans can include difficulty switching out of the plans later, restrictions on care access, limited provider networks, and limitations on extra benefits.
Can deductible be waived?
In most situations, for coverages with a deductible, a deductible will apply - but there are some circumstances in which the deductible may be waived. For example, if you have comprehensive coverage and make a claim to repair windshield glass damage, then your deductible may be waived.
How do I avoid deductible?
- Choose not to file a claim until you have the money.
- Check your policy, as you may not have to pay up front.
- Work out a deal with your mechanic.
- Get a loan.
Is it possible to have no deductible?
A no-deductible health plan, also called a zero-deductible policy, is a health insurance plan that doesn't require participants to meet a minimum out-of-pocket amount before their insurance company begins paying their medical expenses.
Can a Medicare deductible be waived?
Despite these concerns, the anti-kickback statute does allow physicians to waive co-payments and deductibles for indigent Medicare patients, provided the following conditions are met: The waiver must be based on a good faith determination of the patient's financial need.
Can I negotiate deductible?
Negotiate a Payment Plan
Your healthcare provider can't waive or discount your deductible because that would violate the rules of your health plan. But they may be willing to allow you to pay the deductible you owe over time.
Is it legal to waive deductibles and copays?
Routine waiver of deductibles and co-pays violates the law for two reasons. First, it violates the Anti-Kickback Statute. Second, it causes Medicare to pay more than it should in violation of the False Claims Act.
Do you always have to pay a deductible?
What Coverage Requires Deductibles? Liability insurance may not require deductibles, but other kinds of car insurance do, according to Esurance. Uninsured motorist coverage may require a deductible, but comprehensive and collision insurance nearly always do.
Why do doctors bill more than insurance will pay?
It is entirely due to the rates negotiated and contracted by your specific insurance company. The provider MUST bill for the highest contracted dollar ($) amount to receive full reimbursement.
Do copays count towards deductible?
No. Copays and coinsurance don't count toward your deductible. Only the amount you pay for health care services (like the medical bill you receive) count toward your plan's deductible.