How To Avoid Medicare Part B Excess Charges

Medicare Bob
Medicare General Info
How to avoid Medicare Part B excess charges by understanding Medicare Assignment, living in a prohibited state or choosing the right Medigap plan.
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While Medicare Part B excess charges aren’t commonplace, they can happen. If a provider takes Medicare assignment, some can still charge patients up to 15% on top of the original amount of the service. 

But what does it mean to accept Medicare assignment? It means the provider agrees with Medicare’s rates and bills Medicare’s specified amounts (and most healthcare providers do). When a provider doesn’t accept Medicare assignment, they can charge more than the pre-approved amount. This is known as Medicare Part B excess charges, or balance-billing. 

A first step to avoiding these excess charges might be to find a doctor near you that accepts Medicare assignment. Medicare.gov has a helpful Physician Compare tool to help find participating providers.

Beneficiaries who reside in certain states can also avoid paying Medicare Part B excess charges with the right Medigap plan.

In states that prohibit Medicare Part B excess charges, providers cannot issue these charges and must adhere to the Medicare-approved payment amount. 

There are currently only eight states that prohibit excess charges, and the Medicare beneficiary must live in one of these states in order to avoid them:

  • Connecticut

  • Massachusetts

  • Minnesota

  • New York

  • Ohio

  • Pennsylvania

  • Rhode Island

  • Vermont

Some Medigap plans were intended to cover excess charges in full. Currently, there are only two available Medigap plans that cover Part B excess charges. Likewise, beneficiaries who have Medigap Plan F (which is no longer available for people new to Medicare) can also avoid excess charges.

Shop for a Medigap Plan during the Annual Election Period. Otherwise, you can switch Medicare Supplement plans anytime. Call Senior Healthcare Direct at 1-833-463-3262, TTY 711 or get your quote .

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