What Are Medicare Part B Excess Charges?

If you are shopping for Medicare Supplement Insurance Plans, you have noticed that some Supplement plans like Plan N  don’t cover Part B Excess Charges. Now you may be worried if is it a bad thing. Beneficiaries shouldn’t worry that much about those charges because they are pretty rare. 

Medicare Part B Excess Charges Explained 

Original Medicare consists of Parts A and B, and only Part B which covers medical services has those charges. Part B Excess Charges can happen if you go to a provider who accepts Medicare patients but they don’t accept Medicare as payment in full. This is also called Medicare Assignment ( when a provider accepts Medicare’s payment as payment in full for covered services). 

So if a provider doesn’t accept Medicare Assignment that means that they don’t accept Medicare’s payment in full and can bill you in excess of a Medicare payment amount. Those are called excess charges and can only ever be up to 15% above the Medicare-approved amount.  In some states, the Part B Excess charges are completely illegal like Connecticut, Minnesota, Massachusetts, New York, Ohio, Pennsylvania, Rhode Island, and Vermont. In these particular states, doctors are forbidden to charge you a higher amount for provided services.

Are Part B  Excess Charges Common?

Medicare Part B excess charges are not really very common because, statistically, above 90% of providers accept Medicare Assignment. Therefore, they do accept Medicare’s payment as payment in full. Even Aetna, one of the largest insurance companies stated several years ago that 99% of Medicare claims that they are processing don’t have any excess charges. Alongside, it is important to know that only doctors can bill you an excess charge, which means that hospital, durable medical equipment providers do not charge excess. This is valid for any kind of doctor such as primary care doctors, specialists, surgeons, etc. 

How To Cover Part B Excess Charges?

For most people, today, who are enrolled in Part A and B of Medicare the best way to cover out-of-pocket costs is to buy a Medicare Supplement plan. Remember that Original Medicare (parts A and B) covers only 80% of services and the other 20% in form of deductibles, coinsurance, copays, and excess charges are the responsibility of every Medicare beneficiary. Therefore, if beneficiaries want to get covered for the other 20%, they buy Medicare Supplement plans which cover gaps left by Parts A and B. What amount of supplemental coverage the beneficiary is going to get depends on which plan letter you choose. Some plans cover part B excess charges but some plans don’t.

There are ten standardized supplemental plans on the market but only two of them cover part B excess charges, and those are plan F and Plan G. So if you don’t buy or are not eligible for plan F or G and choose another supplemental plan letter you’ll have to pay an excess if you go to a provider that doesn’t accept Medicare Assignment.

However, not everyone is able to purchase plan F because those plans are not available for new Medicare beneficiaries who weren’t eligible for Medicare prior to January 1st, 2020. So, if beneficiaries weren’t eligible for Medicare prior plan G is the only option for those who want Part B excess charges covered.

How to Avoid Part B Excess Charges?

We have established that today a vast majority of physicians and doctors who are billing Medicare are Participating Providers which means that they accept Medicare’s payment in full for provided services. But, there leaves still a small number of providers who don’t. To avoid paying out-of-pocket for Part B excess charges you can find providers which accept Medicare Assignment Medicare’s Compare search tool. This tool gives you instant access to find providers, hospitals, and nursing homes in your area that accept Medicare insurance. Participating doctors and providers are indicated with a “dollar sign symbol”. 

Beneficiaries can also sort the results to only show providers which accept Medicare payments in full, which makes it easier in searching for doctors and hospitals near you. As already told, another way is to buy a Supplemental plan which covers Part B excess charges or to switch to Medicare Advantage plans.

If you have a Medicare Advantage plan, no matter which one you choose contracted providers aren’t allowed to bill you any amount over and above their contracted rate with the carrier for the provided services. However, to avoid out-of-pocket costs with the Medicare Advantage plan the best way is to stay in your provider’s network of doctors and hospitals.

If you still have any doubts about how Part B Excess Charges work and are not sure what to do, our experienced agents in Temmen Insurance can help you to find the best coverage or way to avoid out-of-pocket costs according to your budget and needs. We are aware that the world of Medicare sometimes can be tricky, but you don’t have to do this alone. For any information, call us or text us today, we are more than happy to help you with your Medicare journey!

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