What is Medicare Part B?
What is Medicare Part B?
This covers doctors’ visits, services provided by doctors while in the hospital, ambulance rides, outpatient procedures, durable medical equipment (things like oxygen machines, CPAP devices, blood sugar monitors, diabetic test strips, etc.), and a very small number of prescription drugs (which are often extremely expensive). These include drugs typically administered by a doctor, particularly those drugs used in the treatment of cancer, chemotherapy, immunosuppressants, or infusion therapy. You must pay a monthly premium for Part B, normally right out of your Social Security check. If you are on Medicare but not yet drawing Social Security, you must pay your Medicare Part B monthly premiums directly to the federal government.
Part B also covers home health services (but not custodial care), preventive screenings and counseling, outpatient physicals, occupational and speech therapy, mental health, x-rays, and lab tests. It basically covers (almost) everything Part A does not, with the exception of retail prescription drugs, which are covered under Part D.
Medicare Part B Excess Charges and How to Avoid Them
What are excess charges? Well, first, let’s briefly outline how doctors get paid if you have Original Medicare (Medicare Advantage is different).
The vast majority of doctors and hospitals across the country accept what’s called “Medicare Assignment.” In plain English, that means Medicare says they’ll pay the doctors and hospitals a certain amount for a procedure or a doctor’s visit, and those doctors and hospitals essentially say, “Okay.” These folks are then “participating” in Medicare. In return, they’re not allowed to bill the patient any additional amounts over the deductibles and coinsurance necessary under Original Medicare. If a doctor, hospital, or other facility does not accept Medicare Assignment (non-participating), they can still bill Medicare, get paid that same amount outlined by Medicare, and then bill you an additional 15% above and beyond what Medicare paid them. This is called the Medicare Excess Charge. Yes, Medicare allows this. Of course, doctors and hospitals that opt out of Medicare altogether can bill you whatever they want.
The excess charges only apply to physicians or items billed under Medicare Part B.
Eight states have laws prohibiting Medicare Part B excess charges:
- Connecticut
- Minnesota
- Ohio
- Pennsylvania
- Rhode Island
- Vermont
- Massachusetts
- New York
The financial exposure to excess charges is an oft-cited reason Medicare insurance agents and companies use to sell certain types of Medicare Supplement plans. Some Medicare Supplement plans cover the potential 15% upcharge for Medicare Part B excess, and of course, usually charge higher premiums for plans that cover this possibility. Medicare Advantage plans don’t normally have to deal with this because they don’t allow excess charges to be billed for providers in their networks and will usually cover them if you have a PPO and decide to go out of network.
Part B Excess Charges and Using Insurance to Prevent Them
Only two Medicare Supplement plans cover Medicare excess charges, and one of them is no longer available for people who turned sixty-five on or after January 1, 2020. People who turned sixty-five before that date may still have access to this plan called Medicare Supplement Plan F. The other is Medicare Supplement Plan G, which is essentially the new replacement for Medicare Supplement Plan F now that it’s going away for people who turn sixty-five after 2020. The only difference between the two is that Plan F covers the Medicare Part B deductible. Plan G does not.
The other option? Get a Medicare Advantage plan. You don’t have to worry about the Medicare Assignment question because the insurance companies contract providers who already accept Medicare Assignment. Even if you have a Medicare Advantage plan that allows you to go outside of the insurance company’s network, such as a PPO or an HMO-POS plan, you most likely won’t get charged Medicare Part B Excess Charges. If you have questions, call your Medicare insurance company.
Is it worth a few extra bucks in premiums to get a Medicare Supplement plan that covers these excess charges? At Chicagoland Medicare, we say yes. Medicare Supplement Plan G is the only one that covers these, and it’s the most popular, best-selling Medicare Supplement plan you can currently buy. If you already have a Medicare Supplement Plan F (again, no longer able to be sold if you became eligible for Medicare after January 1, 2020), that covers the Medicare Part B excess charges, too.
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Frequently Asked Questions
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Independent Medicare insurance agents and agencies such as Chicagoland Medicare get paid by the insurance companies they represent. The commissions we are paid are already built into the insurance policy you’ve purchased, and there isn’t a way to carve them out of the monthly premium. There is no extra fee for buying a Medicare insurance policy through Chicagoland Medicare, nor will you ever pay a fee for our help.
A local, independent Medicare insurance agent represents multiple carriers so that they can work to give you an unbiased opinion on your Medicare insurance plan options. Chicagoland Medicare agents and agencies are state-licensed, trained, tested and appointed by a hand-selected number of Medicare insurance companies to be able to shop and compare Medicare insurance polices to make sure we find the right fit for you! We explore your healthcare and financial needs and listen to your feelings around options available in your local area. We search for a plan that most closely fits your individual needs and budget.
Is Chicagoland Medicare free? Yes, our services are completely free to you and anything we get paid is paid to us by the Medicare insurance companies.
The monthly premiums you pay for your Medicare insurance policies are exactly the same. You cannot buy a Medicare insurance policy directly from a Medicare insurance company at a lower rate.
We have years of experience selling Medicare insurance in the Chicago area including Illinois, Wisconsin and Indiana.
There are all sorts of differences in the amount of coverage and they type of Medicare insurance coverage you can buy depending on what state and county you live in! Chicagoland Medicare independent Medicare agents have a lot of real-world experience and insight regarding the inner-workings of Medicare insurance companies that you, the consumer, may not have access to, such as Medicare Advantage service areas, Medicare Supplemental (Medigap) annual premium increase trends, application fees, discounts programs and more.
Only independent Medicare insurance agents and agencies like Chicagoland Medicare can offer a variety of plans and an unbiased, multi-company approach so our recommendations are objective unbiased and personalized when we sell you a Medigap, Medicare Advantage or Part D drug plan that’s right for you.
At Chicagoland Medicare, we specialize in Medicare insurance products. Period. We’re not distracted by attempting to sell you life insurance, financial planning services, stocks, bonds or anything else. Medicare insurance is all we do! Unlike many other Medicare insurance agents and brokers, we don’t sell group small business health insurance polices, disability insurance, home or auto insurance. We are a boutique Medicare insurance agency, we like it that way and we’re awesome at what we do.
We only partner with ‘A’ rated, household name, established Medicare insurance companies who offer Medicare Advantage, Medicare Supplement, Medigap and Medicare Part D plans in Illinois, Indiana and Wisconsin.
We do not contract with, nor offer our clients startup, new or state-based, regional Medicare insurance companies. We believe in partnering with established companies for consistency, financial strength and experience.
Sometimes, Medicare insurance agents and agencies try to offer too many different insurance products from too many companies. There are literally thousands of combinations of Medicare insurance plan combinations to choose from in the Chicago area – we choose to focus on a select few of large, reliable, well-established, and financially sound Medicare insurance companies to partner with. Oftentimes, other local Medicare agents and agencies get pulled in too many directions with too many insurance offerings and therefore can’t be as knowledgeable as possible about any carrier or one insurance type over another.
At Chicagoland Medicare, we limit the number of Medicare insurance carriers who have access to our clients. We work hard to know the deep inner-workings of each of our Medicare insurance partners which means our agents and our clients aren’t distracted by small, startup Medicare insurance companies who may have a great product for a year or two, then fade into the background and exit the market. We know our Medicare insurance company representatives by name, and know how to navigate their systems and processes.
The bottom line: Chicagoland Medicare is an independent Medicare insurance agency. We are not owned by a Medicare insurance company or by some large, national entity. We’re your local Medicare insurance agency for the Chicago area. This means we only work with hand-selected Medicare insurance companies so that we can provide you with the best Medicare plan for you that’s individualized and personalized. We exist and work ONLY for our clients, unencumbered by having to push just one company’s Medicare insurance products.
