If you’re shopping for Medigap plans, you may have noticed that a couple of them (Plan G and Plan F) cover something called “Part B Excess Charges.” If you’re not sure what excess charges are, you’re not alone. Fortunately, they’re a rather rare occurrence for most Medicare beneficiaries. Nonetheless, it’s important to understand how Part B excess charges work and how they might affect your out-of-pocket healthcare expenses. Here’s what you need to know. What Are Part B Excess Charges? Part B excess charges are charges that a Medicare beneficiary may incur for services covered by Medicare Part B. These charges can only be levied by providers who do not accept assignment from Medicare. In other words, providers who agree to accept the Medicare-approved amount as payment in full. How Do Part B Excess Charges Work? If you see a provider who does not accept assignment from Medicare, you may be responsible for paying the Part B excess charges. These charges can be a percentage of the Medicare-approved amount for the service, or a set amount (such as $20 per office visit). What Does This Mean for You? 

 

Part B Excess Charges Defined

What are Part B Excess Charges? In short, Part B excess charges are the difference between what a Medicare-participating provider is willing to accept as payment in full for a covered service, and the Medicare-approved amount for that service. For example, let’s say the Medicare-approved amount for a doctor’s visit is $100. If your doctor has agreed to accept Medicare assignment, they can only charge you $100 for that visit – even if their usual fee for the same service is $200. However, if your doctor has not agreed to accept Medicare assignment, they can charge you up to 15% above the Medicare-approved amount for the service. In our example, that would mean your doctor could charge you up to $115 for the visit. Part B excess charges can apply to a wide range of services, including doctor’s visits, diagnostic tests, and outpatient procedures. How do I know if I’ll be responsible for Part B excess charges? If you see a doctor or other healthcare provider who does not participate with Medicare, they may charge you Part B excess charges. These charges are also sometimes called “non-participating provider charges.

 

What is Medicare Assignment?

 

If you’re enrolled in Medicare, you may be wondering what it means when a provider accepts Medicare assignment rates. In a nutshell, it means that provider won’t bill you above the Medicare-allowable rate. Providers who don’t participate in Medicare can bill you up to 15% more than the Medicare allowable amount, which is considered a Part B excess charge. You’ll have to pay this out-of-pocket unless you have a Medigap plan that includes benefits for Part B excess charges. There are other advantages to choosing a participating provider aside from avoiding Part B excess charges. For example, they agree to collect only your Part B deductible and/or coinsurance amount at the time of service. Most providers wait until Medicare has paid its share before billing you. Nonparticipating providers, on the other hand, may not bill Medicare, so you have to file a claim yourself to get reimbursed. If you’re considering enrolling in Medicare, be sure to ask your potential provider if they accept Medicare assignment rates. It could save you a lot of money down the road!

 

How Might Part B Excess Charges Affect You

If you’re enrolled in Medicare Part B, you may be wondering what your out-of-pocket costs will be for various medical procedures. In this blog post, we’ll take a look at how Medicare Part B works and what your costs may be if you see a nonparticipating provider. Medicare Part B is the portion of Medicare that covers outpatient medical care, including doctor’s visits, lab tests, and certain preventive services. Part B also covers some home health care and durable medical equipment. If you see a doctor who accepts Medicare assignment, your out-of-pocket costs will be 20% of the Medicare-approved amount for the service, plus any Part B excess charges that may apply. (Part B excess charges are charges that a doctor can bill you for services that exceed Medicare’s approved amount. These charges are not applied towards your Part B deductible.) Statistics suggest that as many as 95% of primary care providers accept assignment, and a slightly smaller number of specialist physicians accept it as well. However, not all nonparticipating providers will add Part B excess charges if you don’t have a Medigap plan, so you may only rarely see Part B excess charges. That said, there is no limit on the number of times a nonparticipating doctor can add excess charges to your bill. So, if you regularly see a provider who doesn’t accept assignment, you could easily pay hundreds of dollars in excess charges each year. Also, if you see a doctor who accepts Medicare assignment, but Medicare doesn’t accept the claim for the service billed, the doctor can charge you more than Medicare’s approved price. However, if an Advance Beneficiary Notice (ABN) isn’t signed, you may not be responsible for these charges. (An ABN is a notice that a doctor must give you before providing a service that Medicare may not cover. The notice explains your options and the estimated costs of the services.) To sum up, if you’re enrolled in Medicare Part B, your out-of-pocket costs for medical services will depend on whether you see a participating or nonparticipating provider. If you see a nonparticipating provider, you may be responsible for Part B excess charges in addition to your 20% coinsurance.

 

What Can You Do to Protect Yourself Against Part B Excess Charges?

If you’re enrolled in Medicare Part B, you may be wondering how you can protect yourself from unexpected charges. One way to do this is to make sure you only use physicians who accept Medicare assignment. This means that they agree to accept the Medicare-approved amount as payment in full. In other words, you won’t be billed for any more than what Medicare allows. It’s always a good idea to ask your doctor if they accept assignment before you make an appointment. And don’t forget to ask the same question of any other Medicare provider, such as lab facilities or home health care companies. You can also use the Medicare.gov physician locator tool to find providers in your area who participate with Medicare. Of course, another way to avoid paying excess charges is to buy a Medigap plan that includes this benefit. Currently, both Plan F and Plan G offer this protection.

 

Some States Prohibit Part B Excess Charges

As the number of Americans aged 65 and older continues to grow, so too does the need for affordable healthcare. Unfortunately, the cost of healthcare has been on the rise in recent years, leaving many seniors struggling to pay for the care they need. In an effort to make healthcare more affordable for seniors, some states have passed laws prohibiting healthcare providers from charging Medicare beneficiaries more than the Medicare allowable rate. This means that if a Medicare beneficiary receives care from a provider in one of these states, they will only be responsible for paying the Medicare Part B deductible and 20% of the Medicare-approved amount for covered services. The states that have passed these laws are: Connecticut, Minnesota, Ohio, Pennsylvania, Rhode Island, Vermont, Massachusetts, and New York. If you live in one of these states, you may want to consider enrolling in a Medigap Plan. Medigap Plans are private health insurance plans that help cover some of the costs that Medicare doesn’t, such as the Medicare Part B deductible and 20% coinsurance. One type of Medigap Plan, Plan N, has similar benefits to Plan G, but the premiums for Plan N are lower because it doesn’t cover excess charges. This means that if you receive care from a provider who doesn’t accept Medicare assignment, you may be responsible for paying the provider’s excess charges. If you’re considering enrolling in a Medigap Plan, be sure to check with your state’s insurance department to see if excess charges are allowed. If you live in a state that doesn’t allow excess charges, Plan N might be a good option for you. Just remember that when you are out of state, you need to ask the provider if they accept Medicare assignment before you receive care.

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