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Medicare Part B Excess Charges

Medicare Part B Excess Charges

One of the many confusing components of Medicare is Part B excess charges. These Part B excess charges are used if any enrollee is going to a physician or hospital that doesn’t accept Medicare. If the doctor doesn’t accept Medicare payments because the Medicare approved amount is lower than what they charge, they can then claim excess charges. Depending on your plan, you can be left paying the difference between what Medicare is paying versus what the doctor is charging.

The majority of physicians accept Medicare assignment, meaning that few enrollees ever run into an excess charge, but they do happen from time to time. You should be aware of what it means, and what you can do to avoid being left with hundreds or even thousands of dollars in medical bills. These excess charges can become very expensive depending on what type of procedure you had as well as what the Medicare approved amount is.

While the idea of excess charges can sound confusing, it’s actually quite simple. Here is an example to help explain the concept. If a Medicare enrollee, let’s call him Jason, goes to the doctor for a check-up, and the Medicare-approved amount for this specific check-up is $100, and the doctor charges $100, then perfect! Jason won’t have to pay anything. On the other hand, if the physician doesn’t accept assignment for the check-up, they can charge the excess amount to Medicare, and Jason will be responsible for paying his portion of the leftover amount. Medicare will pay their 80% of the approved amount, $100.

There are a few laws that prevent physicians from charging anything they want for check-ups and procedures. If they don’t accept Medicare assignment, they can’t charge more than 15% than the approved amount. This prevents them for overcharging for services that would typically cost a lot less.

Medigap Policies and Excess Charges

While excess charges are not as common, it’s expected that they will start to become more common as medical costs continue to rise, and more physicians stop accepting assignment. There are some ways that you can avoid paying for excess charges left by your Medicare coverage. Not every Medicare supplement insurance policy is the same, but some of them cover the costs of any excess charges that you occur. If you are worried about these excess charges, you should consider getting a Medicare supplement insurance plan. Both Medicare supplement Plan F and Plan G will cover 100% of any excess charges.

There are several situations that a Medicare enrollee should consider getting a Medigap plan to go alongside their original Medicare policy. If you have less than great health and expect to be going to the doctor often, then purchasing an additional Medigap policy will save you money in the long run. To determine if it’s worth it, get a quote for a Medicare supplement policy in your area and do the math to see if it’s less than what you will pay for your doctor visits or procedures.

Will I Be Charged Excess Charges?

If you are going to a new doctor, or you’ve just entered Medicare, you’re probably wondering if you’ll be left with any extra charges that Medicare won’t cover. Figuring out of if your physician charges excess fees are simple, ask them. If you don’t know, the front office of the doctor will be able to tell you about excess charges and can walk you through any fees that you will have to pay.

Part B Excess Charges

With all of the related expenses and costs that come along with Medicare, it can be confusing when you’re paying several different bills, and excess charges are just another fee you’ll have to worry about. Even if you never encounter excess fees, it’s important for you to understand the idea of excess charges, especially because they will become more common as Medicare continues to evolve.



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