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Medicare Excess Charges are additional fees charged on top of the Medicare-approved amount for certain services. This usually occurs with nonparticipating providers, who may charge higher rates than those approved by Medicare. These fees can be up to 15% more than the amount approved by Medicare, so be certain that you understand what these charges are and take steps to avoid them.

What are Medicare Part B excess charges?

Medicare Part B covers a range of medical services and treatments, including doctor’s visits, preventive services, outpatient care and medical equipment. Medicare Part B excess charges refer to additional fees charged by certain providers for any of these services or treatments that exceed the amount approved by Medicare. For example, a doctor may charge $1000 for services rendered that Medicare only approves $750 for. This means the doctor can only charge 15% more to you on the $750 approved by Medicare. The remaining balance you would be required to pay would an excess charge of $112.50.

How common are Medicare excess charges?

It’s not very common. However, it can happen. Occasionally, Medicare beneficiaries may be faced with a medical bill that includes an excess charge. This is more likely to occur when the provider does not accept Medicare as full payment for a particular service. In that case, the provider may charge up to 15% more than Medicare has approved.

It’s always a good idea to ask the billing department at your doctors office about their policy with excess charges.

What states allow Medicare excess charges?

Medicare excess charges are allowed in almost every state, although some states have additional regulations or policies that may limit or prohibit these charges. It’s important to check with your state’s Department of Insurance to find out its specific policies regarding Medicare excess charges. That way you understand the rules in your state and take steps to minimize any excess charges you may incur.

What states do not allow Medicare excess charges?

As of 2023, there are 8 states that do not allow Part B excess charges. Those states include:

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

These states have additional regulations or policies that prohibit the use of these charges.

How do I avoid Medicare excess charges?

The best way to avoid Medicare excess charges is to make sure you understand the rules in your state regarding these charges. Only use providers who accept Medicare as full payment for the services you need. You should also be aware of any additional charges that may not be covered by Medicare. Always ask your provider if they will accept Medicare as full payment before receiving any services. That way you don’t have to worry about any unexpected costs later.

Additionally, you could purchase a Medicare Supplement Plan (Medigap Plan) to help cover the excess charges. Not all Supplement plans pay cover the Part B excess charges.  Be sure to look at Medicare Supplement Plan F and Plan G.

How do I pay an excess charge?

Excess charges are typically paid directly to the provider who charged the fee. You can usually pay the fee with cash, check, or credit card. It’s important to ask your provider for the exact amount of the fee and what payment options they accept before receiving any services.

Is there a Medigap plan that covers everything?

Yes, Plan F is a supplemental health insurance plan (Medigap Plan) designed to cover all approved cost left behind by Original Medicare Parts A and B, including the excess charges. Remember, while Plan F covers all approved medical services, it does not include drug coverage (Part D) and other supplemental benefits, such as dental, vision and hearing.

Plan F is not available to everyone. But, Medigap Plan G is, and is the only other Medigap Plan to pick up the Part B excess charges. Both the Plan F and Plan G provide great supplemental health insurance to Original Medicare and help cover the costs of medical care that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles.

2023 Medigap Plan Comparison Chart

2023 Medigap Plan Comparison Chart

Conclusion

Understanding Medicare Excess Charges will help you to avoid any unexpected costs. You should be aware of any charges that may not be covered by Medicare and only select providers who accept Medicare as full payment. Remember to always ask your provider if they will accept Medicare as full payment before you receive any services. By taking the time to understand excess charges, you can save money and make sure you are only paying for the care you need.

If you need help understanding Medicare Excess Charges or want to make sure you are getting the best coverage for your health care needs, contact a Senior Healthcare Solutions Medicare expert at 866-MEDIGAP (866-633-4427). Our team of experts can provide you with personalized advice and guidance, as well as answer any questions you may have about Medigap Plan F and Plan G.

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