When you’re on Medicare, it’s important to understand what Medicare Part B excess charges are and how they can affect your out-of-pocket costs. These charges occur when a doctor or healthcare provider doesn’t accept Medicare’s approved amount as full payment for a service. In these cases, you could be responsible for paying up to 15% more than what Medicare covers. While these extra fees might seem small, they can add up quickly. Knowing what excess charges are and how to avoid them can save you money on your healthcare expenses.
How Medicare Assignment Works
Medicare assignment is the amount that Medicare has approved for specific services or treatments. When a doctor or healthcare provider accepts Medicare assignment, it means they’ve agreed to take the Medicare approved amount as full payment for their services. This works in your favor because Medicare will pay 80% of the approved amount, and you’ll only be responsible for the remaining 20%. In this situation, your doctor bills Medicare directly, and you won’t have to worry about any extra charges beyond your coinsurance or deductible.
However, not all doctors accept Medicare assignment. If a doctor doesn’t, they’re allowed to charge you more than the Medicare approved amount. This is where excess charges come into play. A doctor who doesn’t accept assignment can ask for up to 15% more than what Medicare has approved for a particular service. These additional costs are known as Medicare Part B excess charges, and they’re separate from your regular coinsurance, copayments, or deductibles.
While it might seem like a small percentage, these extra costs can add up, especially if you see a provider who regularly bills more than the Medicare approved amount. It’s essential to understand whether your doctor accepts Medicare assignment before receiving any services, so you can avoid unexpected bills.
What are Medicare Part B Excess Charges?
Medicare Part B excess charges are the additional costs you could face when you visit a doctor who doesn’t accept Medicare assignment. If your doctor decides not to accept the Medicare approved amount as full payment, they can charge you up to 15% more than what Medicare allows. This extra amount is called a Part B excess charge, and it’s something you’ll have to cover out of your own pocket. These charges don’t count toward your Medicare Part B deductible or your coinsurance, so they’re truly an additional expense you might not expect.
Let’s say your doctor performs a service that Medicare approves for $300. If your doctor accepts Medicare assignment, they’ll bill Medicare for the service, and you’ll be responsible for only 20%, or $60. But if your doctor doesn’t accept assignment, they can charge you up to 15% more over the approved $300. That extra $45 is the Part B excess charge, making your total out-of-pocket cost $105 instead of $60.
It’s important to be aware of this because you might assume your only responsibility is the standard 20% coinsurance, but that’s not always the case. If your doctor doesn’t accept assignment, these excess charges can come as an unwelcome surprise, adding more to your medical bills than you anticipated. Understanding this difference can help you avoid being caught off guard.
Avoiding Medicare Part B Excess Charges
You don’t have to be stuck paying Medicare Part B excess charges. One of the easiest ways to avoid them is by making sure your doctor or healthcare provider accepts Medicare assignment before you receive any care. Don’t assume that just because a provider accepts Medicare, they also accept assignment. It’s always a good idea to double-check, even with doctors you’ve seen before, since policies can change.
When you call to book an appointment, ask if the doctor accepts Medicare assignment. This simple question can save you from the extra 15% in excess charges. If they don’t accept assignment, you have two options. Either be prepared to cover the additional costs or find a provider who does accept it. Many healthcare providers do accept assignment, so you can likely avoid these charges without having to change your preferred care.
You can also avoid excess charges by looking into a Medicare Supplement plan that covers these costs. Certain Medicare Supplement plans, like Plan F or Plan G, will cover Medicare Part B excess charges. Both plans help you avoid these out-of-pocket healthcare costs. If you’re unsure about your options or need additional help, it’s a good idea to seek professional guidance from a licensed agent. Please call 866-633-4427 to speak with one of our Medicare experts today.
States That Ban Medicare Part B Excess Charges
In some states, you don’t have to worry about Medicare Part B excess charges at all. Eight states have passed laws that make it illegal for healthcare providers to charge more than the Medicare-approved amount. If you live in Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, or Vermont, you’re protected from these extra fees. This means that if you’re receiving care from a doctor within your state, you won’t have to pay any Medicare Part B excess charges, even if your doctor doesn’t accept Medicare assignment.
However, if you travel outside your state for medical care, these protections won’t necessarily apply. A doctor in a state without these laws can still charge you up to 15% more than the Medicare approved amount. So, while you’re safe from excess charges at home, it’s still important to check if a provider accepts Medicare assignment when seeking care elsewhere. It’s especially worth keeping in mind if you frequently travel or have multiple residences in different states.
Being aware of the rules in your state can help you better plan your medical care and avoid any unnecessary out-of-pocket costs. If you live in one of these eight states, you’ve got some extra peace of mind, but it’s still smart to ask about Medicare assignment wherever you go.
The Role of Medicare Supplement Plans
Medicare Supplement is a type of insurance that helps cover some of the gaps in Original Medicare, including things like deductibles, copayments, and coinsurance. There are two Medicare Supplement plans that specifically cover Medicare Part B excess charges, meaning you won’t have to worry about that extra 15% when you see a doctor who doesn’t accept Medicare assignment.
The Medicare Supplement plans that cover these charges are Plan F and Plan G. Plan F is the most comprehensive Medicare Supplement plan, covering just about everything that Original Medicare doesn’t, including Part B excess charges. However, Plan F is no longer available to people who became eligible for Medicare after January 1, 2020. If you were eligible before that date, you can still purchase it, but if not, you’ll need to look at Plan G.
Plan G is a great option to consider and covers almost everything Plan F does, except for the Medicare Part B deductible. Like Plan F, it covers Part B excess charges, so you won’t have to worry about paying that extra 15%. Just keep in mind that Medicare Supplement plans come with their own monthly premiums, which you’ll need to pay on top of your Medicare Part B premium.
If you frequently visit doctors who don’t accept Medicare assignment or want to ensure you’re fully protected from excess charges, Medicare Supplement can be a valuable addition to your coverage. Supplemental insurance plans give you peace of mind knowing that even if your provider charges more than the Medicare approved amount, you won’t be left owing any more money.
Examples of Medicare Part B Excess Charges
To understand how Medicare Part B excess charges can affect you, it helps to look at a few real-life scenarios. Let’s say you visit a doctor who accepts Medicare assignment. In this case, the doctor will agree to the Medicare approved amount for any service or treatment you receive. For example, if the approved amount for a procedure is $500, Medicare will cover 80%, or $400. You’ll only be responsible for 20%, which in this case would be $100. Since your doctor accepts Medicare assignment, you won’t face any additional charges.
Now, imagine you see a doctor who doesn’t accept Medicare assignment. For that same $500 service, the doctor is allowed to charge you up to 15% more, which means the bill could now be $575. You would be responsible for the full payment up front, but you can file a claim with Medicare to get reimbursed for 80% of the Medicare-approved amount. In this case, you’d get back $400, leaving you to cover the remaining $175. The extra $75 beyond the Medicare approved amount is your Part B excess charge, and it comes straight out of your pocket.
In another scenario, you might visit a doctor who has opted out of Medicare entirely. If that happens, you’ll have to pay the entire bill yourself, and Medicare won’t cover any part of it. For example, if the doctor charges $600 for the same service, you’ll be responsible for the full $600, with no help from Medicare. In some cases, you might be able to work out a payment plan directly with the doctor, but you won’t be able to file a claim with Medicare or get any reimbursement.
These examples illustrate why it’s essential to know whether your doctor accepts Medicare assignment or if they’ve chosen to opt out of Medicare. The difference in what you pay can be significant, so be certain you understand your provider’s Medicare status before receiving care.
Conclusion
Understanding Medicare Part B excess charges is an important part of managing your healthcare costs. If your doctor doesn’t accept Medicare assignment, you could end up paying more than you expect for services. These excess charges can add up over time, so be sure to know when and where they might apply. That way you can ensure that you’re not caught off guard by unexpected expenses.
Living in a state that has banned Medicare Part B excess charges means you won’t be liable for this extra expense. Additionally, Medicare Supplement plans like Plan F and Plan G provide protection from Medicare Part B excess charges. For more information about Medicare Supplement plans, please call 866-633-4427 to speak with a Senior Healthcare Solutions Medicare expert.
