Balance Billing

Per CMS, Medicare Beneficiaries are protected from balance billing. Balance billing encompasses any charges billed to a Medicare or Medicare Advantage enrollee above the provider’s contracted reimbursement or applicable cost sharing.

By agreeing to see an AgeWell New York Medicare Advantage member, providers agree to adhere to Medicare guidelines which include billing members no more than the plan-allowed cost share as defined by the Explanation of Coverage. Plan-specific cost share information is available in multiple locations:

  • The member’s AWNY ID card
  • Online at
  • Via the provider call center

Participating providers may never balance bill because they have agreed to always accept the Medicare allowed amount as payment in full. Members may only be billed for defined cost-shares. Any additional payment determined as owed must be addressed with AgeWell New York.

We thank you for working with us to ensure that your practice understands and maintains these requirements under the Medicare program.