What are the Medicare Part B Excess Charges? And will you have to pay them. That is the focus of this article.
First of all, you have to understand what Medicare B is, and I am sure that many of you do. But for those who don’t Medicare Part B is that Medicare coverage that covers doctor’s visits and durable medical equipment. Medicare Part B covers 80% of the costs of these doctor’s visits or for the designated equipment.
As far as the remaining 20%, you either pay that out-of-pocket or through a Medicare Supplement Plan that you own.
Currently in 2017 the monthly premium for Part B is $134 a month (for those making $85,000 a year).
Now, where does this Medicare Part B Excess Charge come into play? Here’s how…
If your doctor does not accept what is known as Medicare assignment, they are allowed to have an “excess charge” that is passed along to you.
First, what is assignment? Medicare assignment is the full cost of a procedure as deemed by Medicare. They have a listing of the costs of every possible procedure that you may have to have done to you. They also have with this list of procedures what it should cost to perform.
So, Medicare will pay the doctor a certain amount for the cost of your visit, procedure, test, etc… But if the doctor makes the determination they want more, they are allowed to charge more and pass that along to you.
To help you understand this better, let’s say you go to the doctor and a lab test costs $500. Medicare might pay that but the doctor might want more. In this case, they can charge an “excess charge” of up to $75.
Note: they are limited to a maximum of 15% over-and-above the Medicare assignment fee to charge you. So, in this example if Medicare is paying $500 the doctor can charge a maximum of $500 x 15% = $75 as an excess charge.
Is There Any Help In Paying the Medicare Part B Excess Charge?
There MAY be help. If you have purchased a Medicare Supplement Plan they may pay for the excess charge. Currently, only Plans F & G pay for the excess charge.
And it should be noted that certain states do not allow doctors to charge the excess charge…
- New York
- Rhode Island
The best way to shield yourself is to ask your doctor up front. If they take Medicare assignment then you are set, but if they plan charging more maybe you need to think about getting another doctor.