What are Medigap Excess Charges?

What are Medigap Excess Charges?

When looking for Medigap options, you might have found that some of them include coverage for Medicare Part B Excess Charges. What are Medicare Part B Excess Charges, or Medigap Excess Charges? You're not alone if you have no idea what these additional charges are. Fortunately, this is not a normal occurrence for most Medicare beneficiaries. However, it's crucial to understand how Medicare Part B operates and how excess charges will affect your out-of-pocket medical costs.

Excess Charges in Medicare Part B

Healthcare providers have the choice of participating in Medicare or not. If your doctor accepts Medicare, you should expect them to charge you only the Medicare-approved amount for their services and procedures. In other words, they agree to accept the Medicare fixed amount as payment in full for the treatment. Accepting Medicare assignment is what physicians and healthcare professionals refer to it as.


Also Read Tips on How To Choose A Primary Care Doctor


Doctors that approve Medicare assignment are implicitly promising not to charge you for any services above the Medicare allowable rate. If a provider refuses to participate in Medicare, they can charge you up to 15% more for a treatment or service than the Medicare allowable charge. Medicare Part B excess charges are the excess charges that exceed the allowable charges by up to 15%. You will be responsible for this amount in addition to all other Medicare-approved fees and charges. Both Medigap plans F and G have compensation for Part B excess payments, saving you money if you need to visit a physician that does not accept Medicare.


What are Medigap Excess Charges?


What are the Benefits?

Many benefits come with choosing a Medicare-participating provider. They are unlikely to charge you upfront. At your appointment, they can just ask for the agreed-upon Part B Deductible or coinsurance amounts. They will wait until Medicare and your Medigap plan have paid their parts of the bill before billing you. They must file your application with Medicare on your behalf and at no cost to you. Non-participating providers are not required to bill Medicare and will require you to pay for all services upfront and send receipts for reimbursement.

Since many primary care providers support Medicare assignments, you will never have to pay a Medicare Part B excess fee. Specialists are more likely to refuse the Medicare assignment and impose excess Part B charges.

A Part B excess fee has no dollar cap or limit to how many times it can be applied to your bill. You could potentially be paying hundreds of dollars in excess charges per year if you chose to see a doctor who does not accept Medicare assignments on a regular basis.


Excess charges and how to avoid them

Using only service providers that support Medicare assignment is the easiest way to stop paying Medicare Part B excess charges. This ensures that you will never be charged more for your appointments and treatments than what Medicare allows. Before you schedule an appointment, double-check with your doctor. This advice applies to any additional services or facilities, such as home health care, reliable equipment, lab work, and so on.

Another option is to buy a Medigap package that will cover all of your out-of-pocket expenses. Both Medigap plans F and G provide this benefit, which can provide a great deal of comfort.


State Laws

Medicare, as well as the companies and doctors that bill Medicare, are governed by various laws in different states. Connecticut, Massachusetts, New York, Ohio, Pennsylvania, Rhode Island, and Vermont have all passed legislation banning health-care providers from charging Medicare patients more than the Medicare-approved allowable rates. A Plan N might be a good fit if you live in one of these states and are looking for a Medigap plan. Plan N offers similar benefits to Plan G, with the exception that Plan N does not cover excess costs and usually has a lower premium. If you live in a state where excess charges are prohibited, plan N might save you money!

However, keep in mind that if you use your policy out of state, you should do your homework because Plan N would not cover you from unnecessary costs as Plan G or Plan F would.

We will be happy to assist you if you have any additional concerns about Medicare Part B Excess Charges or would like to learn more about how to tailor your Medicare coverages to suit your specific needs.


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