Final answer:
Nonparticipating Medicare providers do not accept the Medicare-approved amount as full payment, resulting in patients directly paying the doctor for services that exceed the Medicare reimbursement.
Step-by-step explanation:
The correct answer to the question about nonparticipating Medicare providers is that B. The patient will directly pay the doctor. Nonparticipating providers have chosen not to accept the Medicare-approved amount as full payment for their services. While they can still accept Medicare patients, they may charge more than the Medicare-approved amount. Patients are then responsible for paying the difference between the provider’s charge and what Medicare will reimburse, a situation known as balance billing.
It is essential for patients with Medicare coverage to understand whether their healthcare providers are participating or nonparticipating. Participating providers agree to accept the Medicare-approved sum as full payment for covered services, whereas nonparticipating ones do not. This distinction affects the reimbursement mechanism and potential out-of-pocket costs for the patient.
The fee-for-service model and the potential for adverse selection in insurance markets highlight the complexities within the healthcare system and government spending on social safety nets and health insurance programs like Medicare.