What are Medicare excess charges?

When choosing a Medicare Supplemental Plan, I find that a lot of clients are confused about Medicare excess charges.  This is especially true in RI and MA where law does not permit Medicare excess charges – hence we don’t see much of it at all. 

However, we certainly get a lot of snowbirds traveling south to Florida or South Carolina for the winter. 

Most individuals who choose a Supplemental Plan prefer the flexibility of going to any doctor or hospital in the country that accepts Medicare.   Understanding the excess charges can avoid surprise bills down the road.  

Doctors in some states can charge above what Medicare reimburses them for visits and procedures under Part B.

For example, let’s say Medicare reimburses $500 for procedure.  A doctor who does not take assignment or agree to only accept what Medicare pays can charge an additional amount on top of the $500 for services. 

 

Which states DO NOT ALLOW excess charges?

Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont 

How do I know if my doctor will bill excess charges?

Ask your doctor whether he or she accepts Medicare assignment.  If the answer is yes, then you will not be liable for excess charges. 

What services are subject to excess charges?

Services falling under Part B (doctor and outpatient) are subject to excess charges in allowable states.

 

Supplemental plans F and G will pay for excess charges but others will not, leaving you with the difference.  When choosing a supplemental plan, be sure to take excess charges into consideration.