When a non-participating provider charges more than Medicare approves, it is called an excess charge. These charges are generally 15% of the Medicare-approved cost. These additional costs are avoidable with additional insurance, called a Medicare Supplement, or by choosing healthcare providers that accept Medicare’s standard rates.
Original Medicare (Part B) provides coverage for preventive care, outpatient medical services, ambulance services, durable medical equipment, and lab work. Doctors, hospitals, and other healthcare providers must accept Medicare assignment to provide coverage.
What is Medicare assignment?
Medicare assignment is a process through which physicians bill Medicare for their services. Medicare will reimburse a portion of the fee to the participating provider. The patient will be responsible for the remainder. Some doctors do not accept assignment, however, and patients may have to pay for the services out of pocket. Medicare does not cover the cost of non-participating providers.
Medicare assignment is a legal agreement between a physician and a beneficiary whereby the beneficiary authorizes the physician to bill Medicare for the services rendered. When a beneficiary signs the assignment form, he or she authorizes the physician to bill Medicare for the full amount. The beneficiary’s choice of physician is limited by the assignment agreement, but most preferred providers accept assignment. This decreases the patient’s out-of-pocket costs and administrative hassle.
Medicare assignment can be a complicated process, especially if you have multiple insurance plans. However, it is important to choose a health provider that accepts Medicare assignment, as it can streamline the claims and billing processes. The Medicare State Health Insurance Assistance Program (SHIP) can guide you in making the right decision by identifying healthcare providers that accept Medicare assignment.
How do I avoid excess charges?
If you are on Medicare, you may wonder how to avoid Medicare Part B excess charges. These charges can amount to 15% or more, depending on the state. While some states ban these charges entirely, others place strict restrictions on them. To avoid them, you should make sure your doctor is Medicare-approved.
Inpatient services are exempt from Part B excess charges. Certain outpatient services, such as emergency room visits, are also exempt from them. Most doctors and other healthcare providers accept Medicare assignment, but you should ask about it before undergoing any procedure. In addition, you should choose a Medigap plan that covers these charges. Usually, Medigap plan G or F cover them 100%.
Medicare Supplement plans are also a good way to avoid Part B excess charges. Medicare Supplement Plans F and G do not apply to new beneficiaries after 2020. Both Plan F and Plan G are government-regulated add-ons to Medicare. In addition, plan F and Plan G come with a benefit that covers Medicare excess charges.