What is referred to as the actual charge in Medicare?

The term "actual charge" in the context of Medicare refers to the invoice from medical providers for services rendered. This is the amount that healthcare providers bill for their services before any adjustments are made by Medicare or other insurers.

When a provider submits a bill, it reflects the actual cost of the services performed, which is known as the actual charge. Medicare uses this actual charge to determine what portion of the billing is covered under the program, taking into account any established payment schedules or adjustments based on accepted Medicare rates.

Other options do not accurately represent what is meant by the actual charge. For example, expected benefit payments refer to amounts that are projected to be reimbursed to providers, while premiums are monthly payments made by beneficiaries for their health insurance coverage. Average charges, meanwhile, refer to typical costs over a range of providers and services, which can differ from a specific provider's actual charges.