Medicare Part B Excess charges are related to doctors and other outpatient healthcare providers, including medical supplies. This is not charged by all providers, however, in most states, providers have the option to charge “excess”.
Participating Providers are ones that have signed an agreement to charge you a Medicare approved amount for their services, which is also known as “accepting Medicare Assignment”. Most doctors, providers, and suppliers do accept assignment.
Non-Participating Providers are those that have not signed an agreement to accept Medicare Assignment. Due to this, they can charge excess charges. These excess charges can be up to 15% above the Medicare approved amount.
To illustrate, for example, say a procedure has a Medicare approved amount of $1,000. The most the provider could charge you, in this case, is $1,150. If you carried Medicare Supplement Plan that didn’t cover excess charges, you would pay the additional $150 “excess charge” ($1,000 x 15% = $150 excess charge).
What are the odds you’ll be charged excess charges? And How can you avoid them?
Statistics have shown that 96% of providers do accept Medicare Assignment. Thus, excess charges are fairly uncommon. What can you do to protect yourself from excess charges? Ask the doctor you are about to see if they accept Medicare assignment before you make an appointment. Then you will know you won’t be charged excess charges. Further, I would also advise asking this same question of other providers such as rehabilitation services, lab facilities, medical supplies, etc.
Currently, both Medicare Supplement Plan F and Plan G cover excess charges, so you could avoid paying having to pay anything out of your own pocket, should they be charged.
Some states do prohibit excess charges. Those states are: Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont. If you reside in or receive services in these states, you cannot be charged excess charges.