What are MEdicare Part B Excess Charges?

As of 2020, the only Medigap Plans that cover Part B Excess Charges are Plan F and Plan G. If you have not shopped for either Plan G or Plan, you probably never heard of Medicare Part B excess charges. However, not knowing about these charges can cost you.

Medicare Part B excess charges

What is medicare assignment?

When your doctor accepts Medicare assignment, it means your doctor will submit medical claims directly to Medicare. Furthermore, your doctor can not charge you before submitting the claim. After Medicare approves the claim, you are billed the Medicare approved amount. Thus, at time of service you only pay Part B deductible of $198 in 2020. In the video below, Senior Healthcare Direct owner, Robert Bache, answers the question: Does Medicare Supplement Plan G cover Part B excess charges?

In the video above, Rorbert Bache says, “Every provider and doctor that accepts Medicare has one of two contracts.” Most doctors have a contract that accepts Medicare assignment. These doctors are called Participating doctors and accept the Medicare approved amount as payment for their medical services.

On the other hand, some doctors have a contract that allows them to charge more than the Medicare approved amount. These doctors are called Non-participating doctors. These doctors can either accept or not accept Medicare assignment. If your doctor does not accept Medicare assignment, you will have to pay a 15% additional charge without Medicare Supplement Plan F or Plan G. Moreover, if you only have Original Medicare Part A and Part B, your co-insurance amount would increase from 20% to 35%. As a result, a $500 medical bill would cost you $175. Furthermore, the $175 is due at the time of service for non-participating providers.

Doctors Who Accept Medicare Assignment

Most doctors, but not every doctor, accepts Medicare Assignment. To find a participating doctor in your area, you can use the Medicare.gov Physician Compare tool. Physician Compare helps you find and compare clinicians (doctors, physician assistant, pharmacist, nurse) who work directly with patients. This tool allows you to search by medical specialty, geographic area, or doctor’s name. Most important, you can find which clinicians accept Medicare-approved payment.

How to avoid Part B Excess Charges?

The best way to avoid Medicare Part B excess charges is to sign up for Medicare Supplement Plan F or Plan G. The good news is you can shop for a Medigap Plan anytime by calling Senior Healthcare Direct at 1-855-368-4717 and get your free quote. Otherwise, make sure to research clinicians before you schedule an appointment using the Physician Compare tool.

Medicare Part B excess charges
Avoid excess charges by using doctors who accept Medicare assignment.

Betty was new to Medicare in 2020. She already had a primary doctor, Doctor Cook, before she enrolled in Medicare. Since most doctors participate in Medicare, Betty thought Dr. Cook also participated in Medicare. So Betty scheduled her annual wellness visit with Dr. Cook. At the time of service, Betty was billed $400 for the exam and $60 in excess charges. It cost Betty 20% coinsurance amount $80 plus the 15% Part B excess charges of $60. Thus, Betty was stuck paying $140 out-of-pocket at the time of service.

States That Prohibit Part B Excess Charges

Some States protect seniors against excess charges. The following States passed laws prohibiting clinicians from charging Medicare beneficiaries anything higher than Medicare-approved amounts:

  • Connecticut
  • Minnesota
  • Ohio
  • Pennsylvania
  • Rhode Island
  • Vermont
  • Massachusetts
  • New York

If you live in any of the above States, you might consider signing up for Medigap Plan N which has similar benefits of Plan G. The big difference is Plan N does not cover Medicare Part B excess charges, so you pay lower premiums for Plan N. You can shop for Medigap Plan N anytime by calling Senior Healthcare Direct at 1-855-368-4717 or get your quote.