Everything You Need to Know About Medicare Part B Excess Charges




Have you heard someone mention potential Medicare Part B excess charges? Or have you heard some chatter lately about Medicare Overcharge Measure (MOM Legislation)? At Plan Medicare, our goal is to make all aspects of Medicare easy! Here’s a quick rundown of everything you need to know about Medicare Part B excess charges and Medicare Overcharge Measure.

 

WHAT IS THE ISSUE WITH MEDICARE OVERCHARGE?

Some healthcare providers don’t accept Medicare as full payment for their services. They may bill you for an “excess charge” over and above the amount that Medicare will pay. This makes it difficult for people to plan and manage their healthcare costs when they are at risk for being charged overages.

WHAT ARE MEDICARE PART B EXCESS CHARGES?

Medicare has created a list of reasonable, approved rates, for doctor and hospital visits. Medicare assignment, is when doctors and healthcare providers, agree to the accepted Medicare rate. The doctors and healthcare providers bill Medicare directly to collect payment.

But some healthcare providers and doctors don’t find the approved rates to be acceptable, and therefore impose excess charges on patients. These doctors still accept Medicare, but they will bill individuals on top of what they get paid from Medicare. They have the right to bill up to 15% of the total approved Medicare rate.

If you have Original Medicare, you are responsible for paying excess charges. In addition, some providers may require you to pay up front and then file a claim to get reimbursement from Medicare. This could put you out of pocket several thousands of dollars!

ARE MEDICARE PART B EXCESS CHARGES LIKELY?

The good news is, that it’s unlikely to encounter a doctor who will charge Medicare Part B excess charges. According to a recent study, only about 5% of doctors in the country will charge the excess amount, and the majority of those doctors are specialists. .

If you go to healthcare providers that accept Medicare assignment, you will not have to deal with excess charges. So it’s important to ask up front when making your appointments. And when you make appointments, ask whether your provider accepts Medicare assignment. Don’t just ask if your doctor “takes Medicare.” A doctor may take Medicare and not accept assignment, leaving the door open for excess charges.

MEDICARE OVERCHARGE MEASURE (MOM LEGISLATION)

Another piece of good news- if you live in the following states, you can’t be charged excess: Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island or Vermont. This is due to the Medicare Overcharge Measure (MOM Legislation).

WANT MORE INFO?

Medicare is confusing. We make it easy! Reach out to the experts at Plan Medicare and get all of your Medicare questions answered! 516-900-7877.