What is a Medicare Part B Excess Charge?

  • 6 Comments
  • Posted on Aug. 2nd, 2010

by Mary Jane Stern

Many people struggle trying to understand what a Medicare Part B Excess charge is.  I know I did initially. It’s an additional charge a physician or other healthcare provider can charge.

There are many doctors and facilities who accept the Medicare allowed charge.  However, there are also doctors and other healthcare providers who DO NOT accept the allowed charge and have excess or additional charges.

Here’s an Example of a Medicare Excess Charge

Jane is visiting a new physician for an office visit and has Original Medicare Part A and Part B, but no supplemental insurance.  Medicare’s allowed charge for her visit is $100.  The physician has the option and a right to charge up to 15% over the Medicare approved charge.

Jane’s physician doesn’t accept the Medicare allowed payment and charges the additional 15 percent or in this case $15.00.

The allowed charge is $100 and Medicare will pay 80%, which means they will send the physician $80.00.  You are responsible for the 20% or $20 plus the 15% Medicare excess charges or $15.00 making your out-of- pocket cost $35.

Remember, if a doctor or other healthcare provider does not accept Medicare assignment, (Medicare refers to them as a nonparticipating provider), they can charge you, the patient, for the co-insurance plus an additional 15% of the total allowed charge.

Do You Have Supplemental Insurance?

In the above example Jane doesn’t have any supplemental (Medigap) coverage.  She is 100% responsible for the 20% ($20) and the 15% ($15) excess charge.

There are Medigap plans that DO cover the excess charge and most do.  If you are not enrolled in a Medicare Advantage Plan, and have Original Medicare A and B, you should consider a Medigap plan.  It will help, especially if you have any type of chronic illness.

The good news is that right now there are only a few healthcare providers that actually charge more than the Medicare payment.

It would be a great resource to list here any physicians or other healthcare providers who do not accept the Medicare allowed charge and charge the 15% excess. If you know of any, let us know and we will start keeping a list.

  • 6 Comments... Add your opinion!
  1. On Aug. 9 2010 @ 11:22 am David Forbes Medicare Advisor said

    Medigap plan F will give a Medicare beneficiary coverage for Part B excess charges. Those on Medicare should enroll in plan F during open enrollment or if they have a guaranteed issue period, as Plan F is generally underwritten.

    reply to this comment
  2. On Oct. 26 2010 @ 2:20 pm T Barnes said

    What is the need for a plan with Part B excess charge coverage if your using doctors that accept Medicare? The only need I can see here isif you are traveling and have to visit a doctor that refuses to deal with MC and if that were the case how would his bill get paid at all?

    reply to this comment
  3. On Oct. 26 2010 @ 2:42 pm T Barnes said

    If you go to doctors that accept MC as payment in full how would there be any part B excwss?

    reply to this comment
  4. On May. 10 2011 @ 3:05 pm David Burlew said

    Doctors have the right to opt. out of medicare every two years. They may also agree to bill medicare but not accept medicare assingment.

    reply to this comment
  5. [...] PlayStation 3 Charge Base 2 | Malopuff Games DepotIt's What You Make of It: Take Charge! | Our Mommyhood1 charge to climb UK's tallest mountain – Karameloo News U.K.What is a Medicare Part B Excess Charge? | Elder Care ABC [...]

  6. [...] This post was mentioned on Twitter by steve Joyce, Laurel Kennedy. Laurel Kennedy said: What is a Medicare Part B Excess Charge? – by Mary Jane Stern Many people struggle trying to understand what a Me… http://ow.ly/18oBD8 [...]

Have an opinion? Leave a comment?

You must be logged in to post a comment.

Receive our FREE Ebook!

Name:
Email:
Eldercare ABC will never rent, sell or trade your contact information to anyone for any reason.


Welcome Message
Sponsors

Search EldercareABCBlog.com
Search Form
Categories
Caregiver List
Archives
Alty Blog Award Nominee – Joy Loverde
Self Help Magazine

SelfhelpMagazine - SelfhelpMagazine is trusted educational site developed by licensed mental health professionals since 1994. We offer thousands of articles, a large support community, books, blogs, cartoons, over eight FREE email newsletters, and telephone-based classes (TeleWorkshops). Tell us what you need!

Self Growth
The Online Self Improvement and Self Help Encyclopedia