Medicare Part B Excess Charges and the Medicare Overcharge Measure

Some healthcare providers don’t accept Medicare as full payment for their services. They may bill you for an “excess charge” over and above the amount that Medicare will pay. You can keep your health care costs down by understanding and avoiding excess charges.

Excess charges are a part of Medicare Part B’s medical coverage. Medicare has list of approved rates that it considers to be reasonable for medical procedures, including doctor visits and tests. Some healthcare providers agree to be paid these rates, and they bill Medicare directly. This is known as accepting “Medicare assignment.”

For example, if Medicare’s approved reimbursement rate for a test is $1000 and your healthcare provider accepts Medicare assignment, the total fee will never be more than $1000. Of that, you will be responsible for paying a 20 percent co-pay, or $200, plus any deductible you have not yet met.

Other healthcare providers take Medicare, but they don’t think Medicare pays them enough. Medicare rules allow these providers to charge up to 15 percent more than the Medicare reimbursement amount. These extra fees are known as “excess charges.” If Medicare will pay $1000 for your test, a provider who doesn’t accept Medicare assignment can charge you an additional 15 percent fee – or $150 – in excess charges over and above the $1000 Medicare rate. This means your test could cost you $150 more than if you had gotten the test from a provider who accepts Medicare assignment.

If you have Original Medicare, you are responsible for paying excess charges. In addition, some providers may require you to pay up front and then file a claim to get reimbursement from Medicare. There are several strategies you can use to avoid excess charges.

Original Post Medicare Part B Excess Charges and the Medicare Overcharge Measure was Published on MedicareFAQ.


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