What Are Medicare Excess Charges

By Ed Crowe | General Articles | 0 comment | 24 October, 2023 | 0

What Are Medicare Excess Charges

Excess Medicare charges can come as a surprise to many beneficiaries. Excess charges are seen in the following situation: A beneficiary goes to a doctor or provider who does not accept Medicare assignment, although they are included in the network. That doctor or provider may charge up to 15% of the bill in addition to what is provided by Medicare Part B as compensation. That 15% is known as an excess charge. As you can imagine, depending on how much the bill costs in the first place, that 15% charge can very quickly add up.

Does Connecticut Allow Excess Charges?

The short answer is yes. Most states allow excess charges. The exceptions are thought to be Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont. However, for Connecticut, this is misleading information. Connecticut providers and doctors can, and do, use Medicare excess charges to Part B beneficiaries. However, they cannot use these charges if that beneficiary is enrolled in a QMB, or Qualified Medicare Beneficiary program. This is a level of Medicare Savings Program (MSP) that ensures that additional charges cannot accrue for those enrolled.

How to Avoid Excess Charges

There are two types of Supplement Insurance policies, or Medigap policies, that cover excess charges for Medicare Part B. They are Medigap Plan F and Medigap Plan G. Plan F is not available to people who became eligible for Medicare after January 1, 2020. Plan G is nearly identical to Plan F and accessible to later-qualifying beneficiaries. It does not, however, cover the Medicare Part B deductible. The other option for avoiding excess charges, if the beneficiary does not want to purchase Medigap insurance, is to make sure that the doctor or provider they have chosen to work with accepts Medicare assignment. If the doctor accepts Medicare assignment, there will not be any additional payment due.