You’re delving into Medicare and considering Plan N, but what about Medicare Part B Excess Charges? They’re sneaky little fees that can pile up if your provider doesn’t accept Medicare‘s set rates.
Don’t let confusion reign – we’re here to help you understand these charges and find out if they even matter for you.
It’s time to become an informed health care consumer, ready to navigate Medicare and Plan N with confidence. Let’s get started.
Table of Contents
- Medicare Part B excess charges can be avoided by choosing a Medigap plan that covers them, such as Plan G.
- “Medicare assignment” refers to the assigned prices for every medical charge under Medicare. Every procedure has a code, and every code has a price assigned by Medicare that the doctor can charge. Less than 4% of physicians have opted out of Medicare assignment. This makes excess charges uncommon.
- Eight states have made it illegal for providers to charge Part B excess charges, providing protection for residents in those states.
- Patients can avoid excess charges by asking healthcare providers if they accept Medicare reimbursement for payment in full and finding providers who won’t charge Part B excess charges.
Understanding Medicare Part B Excess Charges
How well do you understand Medicare Part B excess charges and the impact they could have on your medical bills? If you’re not quite sure, let’s dive into understanding Medicare Part B excess charges.
When a doctor doesn’t accept Medicare’s approved amount for a service, they can charge up to 15% more. This is the excess charge, and it’s important to know, it’s you who’s responsible for it.
Now, you might think, what about choosing Plan N? Good question. While Plan N is a great option, it doesn’t cover these excess charges. So, if you often see doctors who don’t accept Medicare’s approved amount, you might face these additional costs. However, don’t be too alarmed. More than 96% of doctors do accept the approved amount, and certain states even prohibit these charges.
The Prevalence of Medicare Excess Charges
You’ll often find that Medicare excess charges aren’t as prevalent as you might think, but it’s essential to stay informed and plan accordingly. As part of your planning, you might be considering choosing Plan N, which may leave you wondering about the prevalence of Medicare excess charges.
- First, it’s essential to understand that Medicare excess charges only apply if you visit a doctor who doesn’t accept Medicare. These doctors can charge up to 15% over the Medicare-approved amount.
- Most doctors, however, do accept Medicare assignment. In fact, only about 4% of doctors nationwide opt out of Medicare assignment.
- It’s also worth noting that several states have laws prohibiting excess charges. If you live in one of these states, you’re protected from this potential cost.
- Lastly, remember that even if you do encounter excess charges, they’re often relatively small.
In August 2016, Aetna reported that 99.34% of the claims they process have no excess charges. Of the 0.66% of claims that do have Medicare excess charges, the average amount of the charge is less than $20.
Tips to Evade Medicare Part B Excess Charges
To evade Medicare Part B excess charges, it’s crucial that you’re proactive in seeking healthcare providers who accept Medicare assignment. It’s important to ask your healthcare providers if they accept Medicare before receiving services to avoid any surprise bills.
If your provider doesn’t accept Medicare assignment, you might be subject to an excess charge, which could be up to 15% more than the Medicare-approved amount. Because of the difference in how Medicare pays non-participating doctors, it actually comes out to 9.25%. This is from our article on whether you should be concerned at all about excess charges:
Non-participating (non-PAR) physicians are limited to how much they can charge you for services. This amount is set at 15% above the Medicare-approved amount for any given service. Because the Medicare-approved amounts for non-PAR physicians are 95% of the rates for PAR physicians, the 15 percent limiting charge is effectively only 9.25% above the PAR-approved amounts for any given service.
Remember, you have the power to control your healthcare expenses. By choosing providers who accept Medicare assignment, you can protect your budget while receiving the care you need. In doing so, you’ll not only serve yourself but also contribute to a sustainable healthcare system.
Medigap Options for Covering Part B Excess Charges
While exploring Medicare supplement insurance options for covering Part B excess charges, you’ll find that Plan G, by providing coverage for these charges, can help you avoid unexpected medical costs and offer you greater peace of mind. Plan G is comprehensive coverage and will spare you from any out-of-pocket expenses related to Part B excess charges.
However, you might be considering Plan N. It’s a cost-effective alternative, but it doesn’t cover Part B excess charges. So, what can you do to protect yourself?
- Understand the risks: Only a small percentage of doctors charge Part B excess charges, but it’s crucial to be aware of the potential for unexpected costs.
- Do your research: Before receiving treatment, ask if your doctor accepts Medicare assignment to avoid excess charges.
- Consider your lifestyle: If you travel frequently or live in a state where excess charges are allowed, Plan G might be more suitable.
- Review your budget: Can you afford potential excess charges? If not, the peace of mind offered by Plan G might be worth the additional premium.
Are Medicare Part B Excess Charges Covered by Medigap Plan N?
Medicare Part B excess charges are not covered by Medigap Plan N. If you want comprehensive coverage that includes these charges, it’s crucial to compare the different Medigap plans to find the best Medicare Supplement plan that suits your needs.
Extra Guidance and Available Resources
Don’t worry, there’s plenty of extra guidance and available resources to help you navigate through Medicare excess charges. You’re not alone in this journey.
If you’re worried about possible excess charges, one resource you should definitely utilize is your provider. Ask them directly if they accept Medicare assignment. They’re required to provide this information.
Additionally, there are numerous online resources available to further guide you in understanding Medicare excess charges and choosing Plan N. Websites such as Medicare.gov provide comprehensive information, and you can always seek advice by contacting us through the form or the phone number on the right side of the page. We are experts in their field and can provide personalized guidance based on your specific needs and circumstances. We have been helping people with Medicare plan choices since 1996.
Identifying States Do Not That Permit Medicare Excess Charges
In your research for states that allow Medicare excess charges, you’ll find that only eight states, including Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont, do not allow for providers to charge Part B excess charges as of the writing of this article. This means that in these states, providers must accept the Medicare-approved amount as full payment.
However, you’ll discover that in the remaining states, providers may impose Medicare excess charges, which are amounts above the Medicare-approved payment. These can be up to 15% higher than the approved amount. It’s essential to understand the laws in your state when choosing a healthcare provider or planning for healthcare expenses. It helps you make informed decisions about where to receive medical care and how to budget for potential excess charges.
Frequently Asked Questions
How Does a Medicare Part B Excess Charge Differ From a Regular Medical Bill?
A Medicare Part B excess charge differs from a regular medical bill in that it’s an additional fee that some doctors who don’t accept Medicare’s approved amount might charge. It can be up to 15% more than the approved amount.
Your regular medical bill is what Medicare agrees to pay for a service, but you’re still responsible for a portion of it.
Excess charges can add up, so it’s essential to be aware of them.
Are There Any Penalties for Doctors Who Charge Medicare Part B Excess Charges in States Where It’s Prohibited?
Yes, there are penalties for doctors who unlawfully impose Medicare Part B Excess Charges in states where it’s prohibited. If caught, these providers can face fines, penalties, or even exclusion from the Medicare program.
Therefore, it’s crucial for you to verify whether your state allows these charges, and if your provider accepts assignment, to prevent unwanted costs.
What Happens if I Can’t Afford to Pay the Medicare Part B Excess Charges?
If you can’t afford Medicare Part B excess charges, it’s important to communicate with your provider about payment options. They may offer a payment plan or, in some cases, waive the fees.
Also, consider getting a Medigap plan that covers these charges. Medigap Plan G is a great choice. It’s your health and finances, so you’ve got options.
Can a Provider Decide to Stop Accepting Medicare Assignment After They Have Already Started Treatment?
Yes, a provider can decide to stop accepting Medicare assignment even after starting treatment. However, they’re required to inform you first.
If this happens, you’re responsible for paying the Medicare Part B excess charges. To avoid surprises, always check with your provider about their Medicare assignment status before starting any treatment.
How Can I Find Out if a Potential Healthcare Provider Has a History of Charging Medicare Part B Excess Charges?
To find out if a potential healthcare provider charges Medicare Part B excess charges, you’ll need to ask directly. Call their office, explain you’re a Medicare recipient, and specifically inquire as to whether they accept “Medicare assignment.”
It’s your health and your budget, so don’t hesitate to ask questions.
In conclusion, understanding Medicare Part B excess charges is essential, especially when considering Plan N. Although only a small fraction of doctors impose these charges, being aware could save you from unexpected costs.
Utilize the tips provided to evade these charges and consider Medigap options that cover them. Remember, some states outlaw these charges.
By educating yourself, you’re in a better position to make informed decisions about your healthcare coverage. Stay empowered, stay informed.
Stanley Keith Murray is an independent agent and the founder of Integrity Senior Solutions Inc. He has been working with Seniors to meet their insurance and financial needs since 1996.