Medicare Part B Excess Charges
Medicare Part B excess charges are, thankfully, not very common. However, they can be stressful for their beneficiaries when they occur. They are often a surprise cost and come at an already difficult time because of health trouble in the beneficiary’s life.
The majority of doctors and hospitals will “accept assignment” from Medicare Part B. This means that they accept the Medicare-approved amount as full payment or a service. When a doctor or hospital “accepts assignment,” they will send their bill directly to Medicare which will then pay 80% of the fee. The beneficiary is responsible for the remaining 20% (coinsurance).
How to Avoid Them
When a doctor or hospital does not accept Medicare assignment, that means they will charge more than the Medicare-approved total for the service. They may require the beneficiary to pay the bill upfront and then submit it to Medicare later for reimbursement. The beneficiary, in this case, is responsible for their coinsurance and the difference between the Medicare-approved amount and what the service actually cost.
Only 1% of non-pediatric physicians have opted out of the Medicare-approved costs for services. And, in the following states, it is illegal to charge more than the Medicare-approved amount: Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont.
For beneficiaries who do not live in those states, Medicare Part B excess charges must be paid once they are charged. However, there are two steps that they can take next time to ensure they do not get charged again.
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Discuss Medicare reimbursement in advance with health care providers. Finding out beforehand if they accept assignment will save beneficiaries from excess Medicare Part B costs. If the healthcare provider does not accept assignment, the beneficiary can choose to go elsewhere for their services.
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Purchase a Medigap supplement policy. These insurance policies cover Part B excess charges if they are Plan F or Plan G.
While Medicare Part B excess charges are uncommon, when they do occur they can bring surprise costs and financial difficulty to beneficiaries. It is worth planning ahead to avoid them by discussing costs upfront with healthcare providers as well as purchasing a Medigap supplement policy that covers those fees if they occur.
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