Medicare Part B excess charges are not common. Once in a while, a beneficiary may receive a medical bill for an excess charge. Doctors that don’t accept Medicare as full payment for certain healthcare services may choose to charge up to 15% more for that service than the Medicare-approved amount. Below, we’ll explain how excess charges work and what you can do to avoid them.
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What Are Medicare Part B Excess Charges?
Healthcare providers generally accept Medicare assignment. Meaning, they agree with Medicare’s payment terms and rates and bill Medicare accordingly.
However, there are a few doctors that may not accept Medicare-assignment and will charge you up to 15% more than the Medicare-approved amount for a specific service. Medicare excess charges are also known as balance-billing.
Today, over 96% of U.S. doctors choose to participate with Medicare and agree only to charge the amount Medicare has approved for the service.
How Medicare Part B Excess Charges Work
Let’s say you visit a nonparticipating podiatrist to get a wart removed from your foot. If the Medicare allowable charge for the procedure is $300, the podiatrist could bill you up to an additional $45. Making the total cost for the procedure, $345. If you’ve already met the Medicare Part B deductible, your out of pocket costs would be $45 in addition to the 20% coinsurance. 20% of $300 is $60. Therefore, your total out of pocket cost for the procedure would be $105.
How to Avoid Part B Excess Charges
The most obvious way to avoid Part B excess charges is by only visiting doctors who accept Medicare Assignment. The easiest thing you can do is simply ask them if they accept assignment upon scheduling an appointment. You can also use the Medicare.gov physician finder tool to help speed up the process of finding a doctor who participates in Medicare. Additionally, you can supplement your Medicare coverage with a Medicare Supplement (Medigap) Plan that protects you from excess charges.
Medicare Overcharge Measure
The Medicare Overcharge Measure prohibits providers from charging beneficiaries excess charges. Currently, eight states are prohibited from charging excess fees due to the MoM law. If you live in one of these eight states, you’ll never have to worry about excess charges.
FAQs
How to Get Help with Medicare Part B Excess Charges
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Part b excess charge is illegal in PA, what about out of state if I need to see doctor?
Hi Kate, you are correct! Medicare excess charges are illegal in PA. However, if you receive care out of state, you may be required to pay excess charges if that state/doctor allow the charges.
If I drop my supplemental insurance and rely on Medicare A and B alone, can I purchase supplemental insurance again in the future?
Susna, yes you would be able to buy supplemental coverage in the future, keep in mind, you would need to be able to pass medical underwriting to enroll in a plan.
My Question is : if you purchase a Medigap plan (N) in Pa (where they do not allow Part B excess charges) and you travel to another state and need emergency surgery …
can a surgeon in that state charge you excess charges if they dont accept Medicare assignment … even if you purchased the Plan in a state that doesnt allow Part B excess charges?
Hi Linda! Yes, that doctor can charge you excess charges if you received care in a state that allows them & you have a Medigap plan that doesn’t cover them.
Just turned 65. I live in pa which has outlawed excess charges. I am concerned about future rate increases. I am looking at Plan D vs Plan G. Do you know which plan has had steeper yearly rate increases? can you project which of these plans will have higher increases?
Hi Caroll! Rate increases are not based on the plan, but on the carrier as well as your location. One carrier could have a lower rate increase history than another for the same letter plan.
Although a relatively small percentage of doctors (who haven’t opted out of Medicare altogether) don’t accept assignment (and thus may charge Part B Excess Charges), are there categories of doctors — by their areas of specialty — in which there’s a much higher percentage of doctors who don’t accept assignment? I recall having read somewhere that anesthesiologists, for example, have a much higher percentage of those who don’t accept assignment, but I don’t know if that’s the only specialty in which this is the case. Thank you.
Hi Amy! I don’t believe there are any specific areas of specialty where a higher percentage of doctors don’t accept Medicare assignment.
I am currently on supplement plan G under part B. I am considering a change to plan N. If I have a carpal tunnel procedure and the doctor charges $12,000 and the Medicare assignment is for $4,000, could my doctor charge me An excess fee of 15% on the remaining unpaid $8,000? Thank you, Steve
Hi Steve! Doctors who do not accept assignment receive 95% of the Medicare-approved amount. Then they can add an excess charge of up to 15% of what Medicare will pay. So for your example, if the Medicare-approved amount is $4,000, and your doctors do not accept Medicare assignment, then Medicare will only pay 95% of the Medicare-approved amount. ($4,000 x 95% = $3,800) That is the amount your doctor can add on the 15% excess charge to. ($3,800 x 15% = $4,370) Since in this scenario, the Medicare-approved amount is 95% since your doctor does not accept Medicare assignment, Part B will cover 80% of the $3,800. Your Plan N will cover the remaining 20% of the $3,800. However, the difference between $4,370 and $3,800 is $570. If you have not met the Part B deductible, you’ll have to pay that in addition to the $20 copay if you have Plan N. ($570 + $198 + $20 = $788) What you would need to do is compare the annual premium for Plan G and Plan N side by side to determine if you’ll spend more out of pocket with Plan N premiums + excess charges then you would have with Plan G premiums with no additional excess charges. I hope this helps!
I was going to go to a doctor (specialist) that accepted Medicare but they asked for more than the medicare deductible allows. What do I do?
Hi Rosemarie! Your provider should not be asking you to pay the deductible, they should be billing everything through Medicare and allow Medicare to bill you for the deductible on their end. Always tell them to bill Medicare, otherwise, they may not have a record that you met the deductible for the calendar year.