What are Medicare Part B Excess Charges?

People who have a Medicare Supplement Plan N might be surprised to learn that it does not cover any excess charges. Excess is what a doctor can charge a client above what Medicare is willing to pay.

So, for example, Medicare has a schedule of what they wil pay for every procedure. They pay so much for a hip, so much for a rotator cuff, it’s extremely low. Let’s say you need a hip replacement, and Medicare is only willing to pay $1000. If your doctor accepts Medicare assignments, then that is the most your doctor can charge, and it’s about 80% of doctors across the nation that accept Medicare assignments.

If they do, it has to be posted in their waiting room, and they cannot charge you above what Medicare pays. Now, since Medicare is cutting reimbursements and health inflation continues to go up, more and more doctors are not willing to accept Medicare’s low payment. If they don’t, they can charge you excess. It can only be 15% above what Medicare is willing to reimburse them.

So they can get 15% extra dollars in their pocket. If your surgery was $1000, and Medicare is only willing to pay $1000, that doctor could charge up to an extra $150 to you. Not from your insurance company, from you.

So if you have a Medicare Supplement plan that doesn’t cover the excess charges, you have to be aware that you can be responsible for up to another 15%. Thankfully most doctors across the nation accept Medicare assignment, but it’s becoming more popular that they won’t.

When you do find out doctors that don’t accept assignments, it’s generally the doctors that you don’t need. Your anaesthesiologist, or perhaps a doctor that comes in after a surgery. You may never talk to the doctor at all, however if they are involved at all in your procedure the charges might show up.

These can add up quickly as well if you have on-going outpatient treatment. Therefore if this is the case and your Medigap Plan doesn’t cover excess charges it’s important to let your primary doctor know that you want to be referred to other doctors who also accept the assigned rates from Medicare.