Every day in America, a grandfather walks into the dermatologist’s office, the doctor examines a concerning mole, then removes it during the same visit. Medicare may pay for the office visit and the procedure separately, at close to full price. That’s one visit but two charges, and grandpa owes coinsurance on both. This could be the eye doctor or another specialty, also, but the double billing for both an evaluation and a procedure is quite common.
And it’s a problem. The evaluation and management fees can total hundreds of dollars. With Medicare Part B coinsurance at 20%, a senior may owe nearly $50 for the visit, then face another cost for the same-day procedure. For someone living on a fixed income, that money might have been needed for groceries, utilities, or a prescription.
More than 80% of seniors describe their retirement finances as vulnerable or at risk, 57% live on less than $2,000 a month, and 58% report skipping an essential medical product or service because they could not afford it. In addition, 22% of adults age 65 and older carry medical or dental debt.
The Census Bureau’s supplemental poverty measure, which accounts for out-of-pocket medical costs, places 15% of seniors, or 9.2 million people, in poverty. Research shows nearly 1 in 10 adults age 50 and older faced food insecurity in 2024.
Higher bills also affect health. Older adults who encounter cost barriers are more likely to report fair or poor health. Delaying care can worsen illnesses, postpone diagnoses, and create higher costs later. Seniors should never have to avoid a needed appointment because Medicare pays twice for overlapping services.
In an audit of eye injections, the Department of Health and Human Services Office of Inspector General found that 42% were billed as a same-day office visit. Investigators concluded that 92% of the sampled office-visit claims did not satisfy Medicare’s documentation standard. That pattern cost Medicare $124 million in 2024 alone.
A dermatology audit estimated $62.9 million in overpayments on claims that failed requirements, even though dermatologists were compliant 90% of the time overall.
This is not an accusation against an entire profession. It is a targeted effort to correct a payment method that rewards unnecessary duplication and costs seniors and taxpayers tens of billions of dollars. The Center for Medicare & Medicaid Services reported $28.83 billion in improper Medicare fee-for-service payments in fiscal 2025.
CMS deserves credit for recognizing this concern and has proposed a sensible answer. When an office visit and a procedure are billed on the same day, the more expensive service would be paid at 100% and the other service at 50%.
For example, if a procedure pays $300 and an office visit pays $235, the procedure would still receive its full payment and the visit would receive about $118. The combined payment would be about $418 rather than $535.
Providers remain fully compensated for the higher-valued service and receive meaningful payment for the additional office work. Medicare, taxpayers, and beneficiaries no longer pay nearly full price twice for overlapping efforts. The policy also applies a clear rule instead of forcing patients to challenge confusing claims after the fact.
Policymakers should ensure that genuinely separate, medically necessary work is recognized. But preserving full payment for the main service and half payment for the overlapping service protects access while respecting the basic principle that Medicare should purchase value, not duplication.
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Eliminating a duplicative charge may appear small in Washington, where everyone is swimming in taxpayer dollars. But for seniors on a budget, it can mean filling a prescription or keeping the heat on.
CMS should finalize this proposal with safeguards for truly distinct services and transparent guidance for clinicians. Congress, providers, insurers, and beneficiary groups should support that effort. Seniors have paid into Medicare throughout their working lives. They deserve a program that pays fairly, protects access, and refuses to charge them twice for one doctor’s visit.
Saul Anuzis is president of 60 Plus Association, American Association of Senior Citizens.