What are Medicare Part B excess charges?
Medicare Part B Excess Charges
Did you just learn the term Medicare Part B excess charges? And now you’re wondering what it is? Well you aren’t alone.
What are Medicare Part B Excess Charges?
Providers like doctors and hospitals can choose to participate in Medicare or not. Providers who participate in Medicare agree to charge you what Medicare approves for that service.
This is called “accepting Medicare assignment.”
But doctors who don’t accept Medicare assignment reserve the right to bill you an extra 15% more than what Medicare allows.
That 15% is considered Medicare Part B excess charges.
You will have to pay the extra 15% on your own unless you have a Medicare supplement that covers Excess charges.
How do excess charges impact you?
Let’s say you were to see a doctor that does not accept assignment and you only have Original Medicare (Parts A and B).
You see the doctor who runs several tests. The Medicare allowable charge for everything in this treatment is $1,000. Since the doctor does NOT accept assignment, you could be charged an extra 15%. In this case, that’s an extra $150.
We’re going to assume you’ve already paid your Medicare Part B deductible for the year. So what happens with the bill is:
- Medicare pays 80% of $1,000 which is $800
- You pay 20% that Medicare doesn’t cover which is $200
- You also pay the excess charges which is $150
So what can you do to avoid paying excess charges?
One option to avoid paying excess charges is to confirm your provider accepts Medicare assignment before getting any treatment there. Most doctors and hospitals do already so your odds of success are high to start.
You can always call the provider and ask. Or you can look them up online here
The second thing you can do is buy a Medicare supplement that covers excess charges. If you do this, then even if you see a provider that doesn’t accept assignment, you will NOT have to pay excess charges yourself because your Medicare supplement company will pay it on your behalf.
What Medicare Supplements cover Part B excess charges?
Most states offer Medicare supplements the same way so let’s start there. These are the Medicare supplements with letter names like Plan F, Plan G, or Plan N.
Traditional Medicare Supplements
Plan F and Plan G are the only two traditional Medicare supplements that cover Part B excess charges. For that reason, they are great options to consider first.
Plan N does NOT cover Part B excess charges. That’s one of the reasons the monthly premium is lower.
Wisconsin Medicare Supplements
Wisconsin has a base Medicare supplement policy. And you can increase the coverage by adding riders to the base plan for an extra charge. In general, the more riders you add, the more comprehensive the coverage.
One of the riders you can choose to add is Part B excess charges.
Unlike other states where they can only choose the plan, you have the option of tailoring your coverage more a la carte style.
Some states don’t allow Part B excess charges
If you live in the following states, you don’t have to worry about excess charges. At least when you see a provider in your state.
- Connecticut
- Massachusetts
- Minnesota
- New York
- Ohio
- Pennsylvania
- Rhode Island
- Vermont
If you live in one of those states then you don’t need to worry about excess charges while you’re home state. But if you get treatment outside of your home state, then you would have to consider them.
Now that you know what Part B excess charges are, you can reach me, Medicare Mike, directly at 608-571-4461 or by email at Mike@askMedicareMike.com Together we can review plans that make the most sense financially for you. So you get the coverage you need, without overpaying.