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

• 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.

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 doctor accepts Medicare assignments, 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. This applies to medical appointments as well as Medicare covered costs from durable medical equipment suppliers, pharmacies, and other Medicare and Medicaid services.

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.

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 if They Accept Medicare Assignment

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.

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.
 

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.

Excess charges aren’t paid to Medicare or out of the Medicare deductible. They are paid directly to the doctor or healthcare professional. Typically, these charges can be paid with a credit card, cheque, physical cash, or bank transfer, though available payment methods may differ from provider to provider. Often, healthcare providers also accept payments in installments, easing the upfront financial burden.

When someone has a Medicare supplement plan that covers excess charges, most doctors will submit the charge to the supplement provider directly. 

Frequently Asked Questions

Does my provider accept Medicare?

To avoid Medicare excess charges, it’s important to ensure medical providers accept Medicare patients. If they don’t, there may be a Medicare Part B excess charge, which you or a Medicare supplement plan are responsible for paying.

What happens if you overpay for Medicare Part B?

If someone receives medical care and healthcare providers don’t accept Medicare, they will bill Medicare an excess fee. Medicare will then charge the excess charges to the insured individual in what is known as a Medicare overpayment. The insured individual (or their Medicare supplement plan) is responsible for this additional fee and it may be possible to set up a payment plan.

When should Medicare overpayments be returned?

Medicare overpayments must be returned by one of two dates: 60 days after overpayment was identified or the date the extra charges are due. These are the same due dates when Medicare overpayments should be reported as well. 

Why does it matter if a doctor accepts Medicare assignments?

When a doctor or supplier accepts assignments, it means they will charge what they’ve already agreed upon with Medicare. If they don’t accept assignments, suppliers or doctors charge what they might to other insurance providers, which may lead to an excess charge. Medicare beneficiaries are then responsible for that charge.