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Medicare Part B Excess Charges: What They Are, How to Avoid Them, & More

Written by 
Katee Fletcher

Article at a glance

  • Medicare Part B excess charges occur when accepts medicare assignment” is not chosen by providers when receiving requests from the federal Medicare program. If patients are unaware of this rejection, it could lead to a more costly medical bill.

  • There are a variety of ways to avoid being charged with Part B excess charges such as relocating to a state that prohibits them, asking a provider before being charged, and more.

  • Certain states do prohibit their providers from charging Part B excess charges such as Massachusetts, New York, and more.

  • Some supplemental Medicare plans cover Part B excess charges such as Medigap Plan F and Medigap Plan G.

Although it’s not extremely common, occasionally healthcare providers may charge patients with Medicare Part B excess charges after their visits. Over 96% of providers such as doctors, primary care physicians (PCPs), nurse practitioners, etc., choose to accept Medicare and receive the Medicare-approved amount as full payment. However, if a patient does receive a Part B charge, it’s crucial to know how to handle it and potentially avoid them in the future.

What Are Medicare Part B Excess Charges?

The federal Medicare program has allotted price amounts for all services and procedures that they agree to pay. This means, when a patient receives a medical service, their provider must agree to accept Medicare assignment” or agree to the Medicare-approved amount as payment for the service or equipment. From there, the provider sends out an invoice of the cost directly to Medicare where Medicare typically handles 80% of the payment, leaving a patient to pay the remaining 20%. However, if a provider does not accept assignment” they may charge a Part B excess charge of up to 15% more than the Medicare-approved amount.

What is a Medicare Assignment?

When a patient receives a service, their provider has the option to accept assignment.” When a provider accepts a Medicare assignment, it essentially means that the provider agrees to the Medicare-approved service amount and they won’t bill the patient above that rate. The Medicare-approved amount is how much Medicare agrees to reimburse the provider for the given medical service or equipment. At times, the Medicare-approved amount is lower than what a health care provider charges.

When providers choose not to accept assignment, they could charge up to 15% higher than the Medicare-approved amount, leading to excess charges.

What is Medicare Part B?

Medicare Part B refers to the part of Original Medicare or Medicare Advantage (MA) plans that covers medical insurance. Part B insurance requires Medicare beneficiaries to pay a monthly premium of approximately $148.50. All in all, it works to cover various outpatient services such as doctor visits, preventive care, ambulance services, ER visits, durable medical equipment (DME) and more.

Note: To learn more about Medicare Part B, visit this source.

How to Avoid Part B Excess Charges

There are quite a few ways patients can go about avoiding Part B excess charges, such as:

Relocate To A New State

Patients can choose to live in a state that prohibits excess charges.

Ask a Provider

Before scheduling an appointment, be sure to ask the provider if they accept assignment before following through with the appointment to be sure you won’t be overcharged.

Enroll in Medicare Supplement Insurance

Certain Medicare supplement plans, like Medigap (MedSupp), cover the cost of Part B excess charges. The two Medigap plans that cover all charges are Plan F and Plan G.

File a Reimbursement Claim

Providers that accept Medicare insurance will fill out the proper paperwork to ensure Medicare is paying the full amount possible before the patient takes on excess charges. However, patients can also file a claim through the Medicare Patient’s Request for Payment Form if they want coverage from their secondary insurance for the charges.

Note: If feeling confused about Part B excess charges in relation to your insurance plan or recent medical service(s), one should speak with their insurance company or a licensed insurance agent for assistance.

States that Prohibit Excess Charges

Certain states have made it illegal for providers to implement Medicare excess charges through the Medicare Overcharge Measure (MoM), such as:

  • Connecticut

  • Massachusetts

  • Minnesota

  • New York

  • Ohio

  • Pennsylvania

  • Rhode Island

  • Vermont

Since these eight states prohibit Part B excess charges, patients have no need to worry about them when visiting their doctor’s office.

Do Supplemental Medicare Plans Cover Excess Charges?

When it comes to Part B excess charges, it’s important to know how Medicare supplement insurance plans, like Medicare Advantage plans and Medigap, play a role. Review a Medicare supplement plan below to see how it interacts with Part B excess charges.

Medicare Advantage (MA) Plans

MA plans currently do not cover any amount of Medicare Part B excess charges.

Medigap Plans

Certain Medigap plans such as Plan F and Plan G, cover Part B excess charges in full when a patient is confronted with them. Medigap Plan F is the only plan that offers coverage in all nine benefit areas. Medigap Plan G also works to cover a variety of gaps in the standard Medicare plan.

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