What are Medicare Part B Excess Charges?

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What are Medicare Part B Excess Charges and will they affect me?

This is a question that may come up after you’ve been on Medicare for awhile.  Chances are this was not explained when you first enrolled in Medicare. Medicare Excess Charges are related to your Medicare Part B coverage for Medical Services.

Providers can bill you for “excess charges” if they do not accept Medicare Assignment. The Part B Excess Charge is the amount above what Medicare approves for a procedure or office visit. Let’s say you visit the doctor and have a Medicare approved test done that cost $500.

The doctor performing the test does not accept Medicare Assignment and decides that $500 is not enough for the test. Because the doctor does not accept Medicare Assignment, he or she is able to charge an additional amount…this is the Part B Excess Charge.

The doctor, however, is limited to charging 15% over the Medicare approved amount.  So, Medicare will pay the doctor $500 and the doctor can bill you $75.

What is Medicare Assignment?

Medicare Assignment refers to providers who WILL accept full payment by Medicare.  If a doctor does not accept Medicare Assignment, he or she IS allowed to bill you for Part B Excess Charges.

Accepting Medicare patients vs. Accepting Medicare Assignment

There are providers who see Medicare patients but do not accept Medicare Assignment.  If a doctor “accepts Medicare”, it doesn’t necessarily mean he or she accepts Medicare assignment and might charge you up to 15% more than the Medicare approved amount.

If you do not have a Medicare Supplement and use only Original Medicare Part A and B, you are still subjected to excess charges.  You pay the standard coinsurance of 20%, plus the excess charge up to 15%.

For example, you visit the doctor and the office visit is $100.  Your doctor accepts Medicare patients, but does not accept Medicare Assignment. You are billed the usual 20% coinsurance on the $100 visit ($20), plus the 15% excess charge that Medicare does not cover ($15).  Your final bill is $35.

 3 tips to avoid Medicare Part B Excess Charges

#1 Choose a Medigap Plan that pays for all Part B Excess Charges.

There are ten standardized Medigap Plans and only two will pay all Medicare Part B Excess Charges.  Presently, Medigap Plan F and Medigap Plan G will pay 100% of all excess charges.

#2 Ask your doctor if he or she accepts Medicare Assignment.

If you currently have Medigap Plan A, B, C, D, K, L, M, or N, then you are responsible for paying any excess charges billed to you. Ask your doctor if he or she “accepts Medicare Assignment”.  If the answer is “yes”, and they absolutely accept Medicare Assignment, then you will not have to pay an excess charge.

#3 Verify Medicare Assignment through Medicare.

Calling the doctor’s office to verify Medicare Assignment is helpful, but I also like the idea of double checking with Medicare.  This can be done by visiting Medicare.gov and searching the database for your doctor or specialist through the Find Doctors feature.

Once you locate their information, the database will tell you whether or not he or she accepts Medicare Assignment.

It’s a good idea to check Medicare Assignment before any doctor visit or procedure.

If, for example, you have to have surgery, ask who the anesthesiologist will be and verify their Medicare Assignment before the procedure.  It’s often the specialists we don’t think about that will bill you for excess charges.

There are some states which have instituted the MOM Law (Medicare Overcharge Measure).  This means providers are not allowed to charge a patient any Part B excess charges. The states who fall under the MOM Law are:  Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont.

Additional Resources:

Reviewing Medigap Plan N

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What are Medicare Part B Excess Charges

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