Medicare Part B Excess Charges – What Are They and When Do They Occur?

Medicare Part B Excess charges are charges that occur when a doctor does not take Medicare “assignment”. These charges are passed on to the patient in the form of Part B excess charges. These do not occur in many instances; however, if you have a doctor that chooses not to take “assignment”, they can occur and result in additional expense for you. To understand how this works and the implications of it, we need to define a few terms:

  • “Assignment”: This is the reimbursement rate that Medicare normally pays a doctor for a service or procedure. Most doctors that take Medicare (at least currently) also take Medicare “assignment”. In fact, by most figures, Part B Exces charges occur in less than 1% of instances nationwide.
  • “Part B Excess Charges”: These are the charges that result in a doctor not taking “assignment”. These charges are limited in most cases (sometimes by state law) to a certain percentage.
  • Plan N: Plan N is one of the prominent Medigap plans that does not cover Part B excess charges.

To find out if you have a doctor that does/does not take Medicare “assignment”, you should be able to simply call the doctor’s office. Make sure you ask to speak to someone who handles insurance. Verify whether they accept Medicare patients, first of all (if you don’t already know this). Then, ask whether they accept Medicare “assignment”. They should know what you are talking about and be able to answer accurately.

If you find out that your doctor does NOT accept Medicare “assignment”, there are a couple of things you can do. First of all, if you have a Medigap Plan F or a Medigap Plan G, you do not have to worry about the excess charges at all. Both of these Medigap plans cover the excess charges in full, so that you have no exposure to these charges. If you do not have a Medigap plan, or if you have one of the plans that does not cover Part B Excess charges (like Plan N), this is something you may want to take into consideration, particularly if you are doctor “shopping”.

If you have questions about Part B Excess charges, Medicare Supplement plans, or Medicare in general, please contact us at 877.506.3378 or via our website at: http://medicare-supplement.us.

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