What are Medicare Part B Excess Charges?

Excess charges are the amount a doctor or hospital charges above the Medicare approved amount.


Medicare Part B excess charges are the amount a doctor or hospital, who does not accept Medicare assignment, charges above the medicare approved amount. The excess charge is capped at 115% of the Medicare approved amount.

An example of Excess Fees:

Medicare tells doctors what it feels is an appropriate price for a procedure, this is called, The Medicare Approved Amount. Most doctors accept this price and go about their business of healing people. Some doctors, the best doctors, charge more than what Medicare says it will pay for a procedure. They charge above what Medicare says it will pay, this is an EXCESS CHARGE. The United States Government will only allow doctors to charge 15% above the Medicare Approved Amount. An example of this is as follows:

 
Medicare Approved Amount for a heart bypass
$100,000
Dr. Smith, a heart surgeon, does not accept Medicare assignment. He charges:
$ 115,000
Medicare pays 80% of the Medicare Approved Amount
$ 80,000
Patient pays 20% of the Medicare Approved Amount
$ 20,000
Patient also pays 15% Excess Charge
$ 15,000
Total Charges to the Patient without a Supplement
$ 35,000
Charges the Patient will pay with Medicare Supplement Plan F
$0

 

 

Plan F Medicare Supplement will cover all of the patient’s charges in this situation!

10 Steps to understand Medicare Supplemental Insurance

Medicare Part A - Hospital Insurance is coverage for inpatient hospital care, skilled nursing, hospice and some home healthcare, it can be thought of as room and board.

Medicare Part B - Medical Insurance is coverage for the services of medical professionals and supplies such as durable medical goods.

Medicare Part C - Medicare Advantage is private insurance that you can obtain by dropping traditional Medicare. It is also called Medicare Advantage..

Medicare Part D - Prescription Drug Coverage is insurance coverage that is added to traditional Medicare. It is usually purchased in addition to a Medicare Supplement.
Deciding between Medicare Supplement or Medicare Advantage? Choosing between Medicare Supplement and Medicare Advantage is an important decision we have provided a side by side comparison.

Gaps in Medicare Coverage Medicare part A and B recipients still have out-of-pocket charges in the form of deductibles, copayments, coinsurance, and benefit periods. We have outlined the current out of pocket charges.

Compare the different Medicare Supplement Plans Medicare Supplement plans A, N, and F are the most popular. Depending on your specific needs you may find one of the other plans more beneficial for you.
Medicare Supplemental Plan F is by far the most popular Medigap policy, it is also the most comprehensive covering more than any other plan.

Medicare Part B - Excess Charges are charges above the Medicare approved amount for a procedure, most doctors accept Medicare assignment but some specialists charge 115% of the Medicare approved amount.

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