An Independent Medicare Health Insurance Agency

Medicare Part B

Covers Your Doctors' Visits and Home Health Services

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:

  1. Connecticut
  2. Minnesota
  3. Ohio
  4. Pennsylvania
  5. Rhode Island
  6. Vermont
  7. Massachusetts
  8. 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.

Related Services: Medicare Dental Plans, Medicare Supplement, Medicare Agents Near Me, Medicare Advantage, Prescription Drug Plans, Medicare Part A, Medicare Broker

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