While Medicare Part B excess charges aren’t commonplace, they can happen. If a provider takes Medicare assignment, some can still charge patients up to 15% on top of the original amount of the service.

But what does it mean to accept Medicare assignment? It means the provider agrees with Medicare’s rates and bills Medicare’s specified amounts (and most healthcare providers do). When a provider doesn’t accept Medicare assignment, they can charge more than the pre-approved amount. This is known as Medicare Part B excess charges, or balance-billing.

A first step to helping your clients avoid these excess charges might be to assist them in finding a doctor near them that accepts Medicare assignment. Medicare.gov has a helpful Physician Compare tool to help find participating providers.

Clients who reside in certain states can also avoid paying Medicare Part B excess charges with the right Medigap plan.

These States Prohibit Excess Charges

In states that prohibit Medicare Part B excess charges, providers cannot issue these charges and must adhere to the Medicare-approved payment amount.

There are currently only eight states that prohibit excess charges, and your client must live in one of these states in order to avoid them:

  • Connecticut
  • Massachusetts
  • Minnesota
  • New York
  • Ohio
  • Pennsylvania
  • Rhode Island
  • Vermont

Medigap Plans To Navigate Excess Charges

Some Medigap plans were intended to cover excess charges in full. Currently, there are only two available Medigap plans that cover Part B excess charges. Likewise, clients who have Medigap Plan F (which is no longer available for people new to Medicare) can also avoid excess charges.

  • Medigap Plan G enrollment is rapidly increasing, making it the current fastest-growing Medigap plan available. This plan provides the same coverage as Plan F, but it has a lower monthly premium, allowing your clients to save $500 or more per year in premiums. Plan G covers all Medicare coverage gaps except the Part B deductible.
  • Medigap Plan N offers the same benefits for all carriers at a much lower premium than other, more popular plans. It pays the 20% coinsurance that isn’t covered by Medicare parts A and B. However, it doesn’t cover excess charges. If your client lives in one of the eight states above that prohibit excess charges, they can enroll in Plan N for a lower premium without worrying about excess charges.


LEGAL DISCLAIMER: The above is meant to be strictly educational and not intended to provide medical advice or solicit the sales of an insurance product or service of any kind.