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Medicare Part B Excess Charges - What They Are & How To Avoid Them

Medicare Excess Charges relate to Medicare "Part B" coverage--which is for Medical services. If you are on Medicare, and happen to go to a doctor who does not accept Medicare assignment (accept full payment by Medicare), he is allowed to have an "excess charge". This excess charge would be an amount above and beyond what Medicare approves for a specific procedure / doctor office visit.

Medicare basically has a big book of each and every imaginable procedure, and what it should cost to perform. They might say a specific test will cost $400. If you were to go to a doctor, and have that specific test performed, Medicare will pay a maximum of $400, because that is what they deem reasonable and customary.

If the doctor decided the $400 payment is not enough--he is able to charge more--and this "additional" amount would be called the excess. However, the doctor is limited to charging an additional 15% over an above what Medicare approves. In our example, you went to the doctor for a test, and Medicare approved $400. The doctor would be able to charge 15% higher, in this case roughly $60 additional to the original $400 already approved by Medicare. The total allowable charges in this case would be $460. ($400 X 15% excess = $60 + original $400 = $460 total).

If you purchase Medicare Supplemental Insurance, you can shield against the cost of any "excess charges" that you may be faced with. However, not all Medicare Supplement Plans will provide Medicare excess charge coverage. Currently, only Medicare Supplement Plans F & Plan G will provide excess charge coverage. Both Plan F & G will pay 100% of any excess charges you may incur.

If you purchase a Medicare Supplement Plan that does not provide excess charge coverage, you can still shield against ever paying any excess charges as long as you simply ask your doctor before you go to him "Do you accept Medicare assignment?". As long as they say YES, and they DO accept Medicare assignment, you will never have a Medicare excess charge.

The following states do NOT allow any excess charges no matter what, due to the MOM Law (Medicare Overcharge Measure): Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island and Vermont.

To learn more about excess charges and compare Medicare Supplement Plans, you can compare plans on our website, or call us today and talk to one of our expert Medicare Advisors who are standing by ready to answer all your questions.

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