Medicare Supplement Insurance Fights Part B Excess Charges
If you’re like most Americans (according to surveys), you may not know much about Medicare. Needless to say, you probably hadn’t even heard of “Part B Excess Charges,” much less understood how much they can cost you. It turns out that there really are a lot of holes in Medicare’s coverage. That’s why Medicare Supplement Insurance Plans are a booming business.
Medicare Part B coverage is full of very costly gaps. The $155 dollar annual deductible doesn’t sound so bad, and, of course, you have to pay a monthly premium for Part B. The penalty for late enrollment does sound a bit unnecessary – after all, this is supposed to help seniors get the medical care they need, right? After the deductible has been met, Part B handles physician services and supplies, clinical laboratory services and outpatient hospital treatment. Here’s the catch – it only pays for 80% of those bills at the Medicare-approved amount. Fortunately, every Medigap Plan pays the remaining 20 percent that Medicare does not cover, but they pay 20 percent of the Medicare-approved amount.
The Medicare-approved amount could actually be the biggest hole in Part B coverage. So, what happens when a provider charges more than the Medicare-approved amount? Here’s an example: Let’s start with a $1,000 doctor bill. The Medicare-approved amount for that procedure is $800 and Medicare pays 80% of $800 or $640. Then your Medigap Plan pays 20% of the $800 Medicare-approved amount or $160. Your doctor, however, billed $1,000, so you still owe $200 ever after both Medicare and Medigap have paid. That’s called Part B Excess Charges.
Fortunately, there are a couple of Medigap Plans that can protect you from Part B Excess Charges. Plan F pays 100% of Part B Excess Charges, and Plan G pays 80% in exchange for premiums that are slightly lower than those of Plan F.
How can you stay on top of all this to protect yourself against unnecessary losses due to gaps in your Medicare coverage? MediGap Advisors at www.MediGapAdvisors.com has lots of ideas to help seniors save money on Medicare gaps, prescription costs and lab tests. There you can even find out how to reduce your hospital bill after you leave the hospital. And, that’s something almost everyone could use!
August 17th, 2010 at 4:33 pm
You note that in 2010 Plan G only pays 80% of Part B Excess Charges. Per numerous sites I have checked they note starting 6/1/10 Plan G pays 100%.
October 16th, 2010 at 6:57 am
Hello:
With regard to Medigap, it is my understanding that some States do not allow physicians to apply a Part B Excess. Is this correct and if so, is Pennsylvania one of those States?
December 6th, 2010 at 1:39 pm
There are several states where mandated Medicare providers are not allowed to charge more than what Medicare allows (This is the MOM Law or Medicare Overcharge Measure). In these states, (Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island and Vermont), Part B excess coverage is not necessary.
In all other states, providers are able to bill UP TO 15% of what Medicare Allows directly to the Medicare Beneficiary. This is sometimes called “Balance Billing” or Excess Charging.
For Medigap Policy holders with Plan F and G, the Medigap Plan will cover 100% of the excess charges for the Policy Holder.