Medicare Plan N Excess Charges Explained. Medicare Part B is an essential health insurance program that provides coverage for medically necessary services such as doctor’s visits, preventive care, and outpatient care. While this program covers most of the costs of these services, it does not cover all of them. One of the costs that Medicare Part B does not cover is excess charges. In this article, we will help you understand what Medicare Part B excess charges are, how they work, and what you can do to avoid them. Medicare Plan N Excess Charges will be explained in this article.
What Are Medicare Part B Excess Charges?
Medicare Part B excess charges are the additional costs that healthcare providers can charge above the Medicare-approved amount for a service. If a healthcare provider does not accept Medicare’s approved amount as full payment, they can charge you up to 15% more than the Medicare-approved amount for a service. This additional amount is known as the excess charge.
How Do Part B Excess Medicare Charges Work?
Medicare Part B excess charges work in a simple way. If you receive medical care from a healthcare provider who does not accept Medicare’s approved amount as full payment, you may be charged an excess charge. This excess charge is calculated as a percentage of the Medicare-approved amount for a service. The maximum excess charge that a healthcare provider can charge is 15% of the Medicare-approved amount.
What Can You Do to Avoid Medicare Part B Excess Charges?
There are several things you can do to avoid Medicare Part B excess charges. The first and most important thing is to choose a healthcare provider who accepts Medicare’s approved amount as full payment. You can do this by checking with your healthcare provider before you receive any medical care.
If you need to receive medical care from a healthcare provider who does not accept Medicare’s approved amount as full payment, you can ask them if they will accept the assignment. If a healthcare provider accepts an assignment, they agree to accept Medicare’s approved amount as full payment. This means that you will not be charged an excess charge.
Medicare Plan N Excess Charges
Let’s take a look at some scenarios to see how Medicare Plan N Excess Charges work.
Scenario 1 – Your doctor accepts the assignment: If you visit a general practitioner who accepts Medicare, and they charge $300 for an in-office test, your doctor would send the bill directly to Medicare. Medicare would cover 80% of the bill ($240), and your doctor would send you a bill for the remaining 20% ($60). Therefore, your total out-of-pocket cost would be $60.
Scenario 2 – Your doctor does not accept assignments: If you visit a doctor who does not accept Medicare assignments, they might charge you $345 for the same in-office test. This additional $45 is the Part B excess charge, which is 15% more than what your regular doctor would charge. In this scenario, the doctor would ask you to pay the entire amount upfront instead of sending the bill directly to Medicare. It would then be up to you to file a claim with Medicare for reimbursement. However, the reimbursement amount would only be equal to 80% of the Medicare-approved amount ($240). In this case, your total out-of-pocket cost would be $105.
Which states don’t allow Medicare Part B excess charges?
It’s illegal for healthcare professionals to charge Medicare Part B excess charges in these states:
- Connecticut
- New York
- Minnesota
- Massachusetts
- Vermont
- Pennsylvania
- Rhode Island
- Ohio
You don’t have to worry about Part B Medicare excess charges with Plan N when you see a doctor in your state if you live in one of the states above. You can still be charged Part B excess charges if you receive medical care from a provider outside the state you live in with a doctor who doesn’t accept assignments.
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