Medicare Part B Excess Charges
For those of us who elect to stick with Original Medicare (not Medicare Part C (Medicare Advantage)), Medicare Part B Excess Charges are charges that a doctor adds above and beyond the Medicare-approved amount for a procedure or service.
When a provider/doctor accepts Medicare “assignment”, the provider/doctor won’t bill you above the Medicare-allowable rate. For example, if you have a procedure that Medicare states the allowable rate for that procedure is $10,000, that provider has to stand by the allowable rate and cannot charge more.
There are providers/doctors that participate with Medicare but do not accept assignment with Medicare.
If your doctor/provider is not a Medicare participating provider, Medicare part B Excess Charges are the difference between your doctor’s charge for a service and Medicare’s approved amount,
In most states doctors, surgeons, specialists etc (providers) who do not accept assignment with Medicare though they participate with Medicare are allowed to bill 15% above Medicare’s approved amount for medical procedures. If you go to a doctor that does not accept “Medicare assignment”, the provider can charge 15% over Medicare’s approved amount.
If you encounter Medicare Part B excess charges, you will have to pay the charges unless you have a Medicare Supplement (Medigap) plan that covers Medicare Part B excess charges
Some states prohibit Medicare Part B excess charges, i.e. in Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont, you do not have to worry about Part B Excess Charges. However, if you travel to a state that does not prohibit Medicare Part B excess charges and are not covered by your Medigap plan, you will have to pay the excess charges.
Does your Medigap plan cover Medicare Part B excess charges?
Medicare Supplement (Medigap) Plans F and G are the only two plans that cover Medicare Part B excess charges, Medicare Supplement (Medigap) Plan F is being discontinued as of January 1, 2020.
In researching Medicare Supplement (Medigap) Plans for myself, I am looking at Plans D and G. Plan G covers excess charges. Plan D does not cover excess charges. In my area (East Tennessee zip code 37701), Plan D is about $22.00 a month cheaper than Plan G. That’s $264.00 a year and $2,640.00 over 10 years. I have a little time to make my decision. I’ll try to research and determine how often I might encounter a provider/doctor that does not accept assignment with Medicare. I will be taking a chance either way, Plan G will cost more forever, but Plan D may result in occasional excess charges.
You might want to think twice before signing up for Medicare Supplement (Medigap) Plan F (or Plan C), since they will be discontinued in 2020. If you sign up for Plan C or F and choose to keep the plan, there is no way to know at this time if the premiums will rise too much. Plan G is a good alternative. Plan D might work as well.