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Understanding Medicare Excess Charges: How to Reduce Costs and Improve Access - Trusted Senior Specialists

03/12/2023 | 06:00 AM | 3 Min Read
Understanding Medicare Excess Charges: How to Reduce Costs and Improve Access - Trusted Senior Specialists

Have you heard the term Medicare Excess Charge?  

If you have not, it is a term you may want to become familiar with. One of the components of Medicare Part B is the excess charge. These Part B charges can come about if an enrollee goes to see a physician or receives services from a hospital or facility that does not accept Medicare. If they do not accept Medicare, and the Medicare approved amount for service is lower than what they charge, then the doctors or hospitals can claim excess charges. This means that depending on what your plan pays- you could be left responsible paying the difference between what Medicare pays versus what the doctor charges.  

A good majority of physicians accept Medicare assignment meaning that few enrollees run into an excess charge, but it does happen. Now that you know what an excess charge is, we want you to understand what you can do to prevent and avoid being left with hundreds, even thousands of dollars in medical bills. With all of the related expenses that come with Medicare, it can be confusing when you are paying several different bills. We don’t want excess charges to be just another fee you have to worry about. Even if you never encounter excess fees yourself, it is important to stay on top of Medicare matters as it continues to change and evolve so you can remain protected.  

There are ways that you can protect yourself from Medicare excess charges: 

  1. Choose a doctor who only bills the assigned Medicare rate.  
  1. Enroll in a Medicare Supplement policy that pays for Part B excess charges. Medicare Supplement Plans F and Plan G both provide coverage for excess charges.  
  1. Explore a Medicare Advantage, Part C Plan. 

Worried about Part B excess charges? Give us a call! We can help you find a doctor that accepts your plan, or we can discuss with you the benefits of a Medicare Supplement policy. Do not leave yourself open to the possibility of extra charges!   

*There are few laws that prevent physicians from charging what they want for checkups and procedures. If they do not accept Medicare they cannot charge more than 15% of the approved amount. This prevents them from overcharging services that would typically cost less.  

*States that prohibit excess charges 

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

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