Medicare Part B Excess Charges are very rare because most health providers accept Medicare Assignment. In New Jersey, beneficiaries can be billed for Part B excess charge if a provider doesn’t accept Medicare payment as payment in full. Doctors can bill you up to 15% above the Medicare-approved amount for provided services. Medicare Part B is a part of Original Medicare that is your medical insurance and covers 80% of the services. You are typically responsible for 20% of the remaining Part B costs if the provider accepts Medicare Assignment, but if don’t you will pay that additional 15% alongside that 20%.
What Are Part B Excess Charges?
Medicare Part B Excess Charges can happen when beneficiaries go to a doctor or a hospital that accepts Medicare but doesn’t accept Medicare payment as payment in full. This means that those providers don’t accept Medicare Assignment.
So, you may ask yourself- “what is Medicare Assignment?”
If health providers are participating, this means that they accept Medicare assignment rates and they won’t you bill above Medicare permitted rates. If a provider is non-participating, that means that you can be billed up to 15% above the Medicare- allowable rate. Those additional charges are known as Part B Excess charges.
However, if you enroll in Medicare supplement plans, also known as Medigap plans you can cover the cost of Part B Excess charges. Plans which cover them are Plan G and Plan F. But, plan F is no longer available to purchase for beneficiaries who weren’t eligible for Medicare prior to January 1st, 2020.
Will Part B Excess Charges Affect Me?
Let’s say you go to a specialist who doesn’t accept Medicare Assignment, and you don’t have a supplemental plan which covers excess charges. For, example you have to go to a dermatologist to get a mole removal. This procedure can be charged up to 400$ because this is Medicare approved rate for this procedure. Since Medicare covers only 80% of the services, you are still responsible for an additional 20% of the cost (copayment or coinsurance). Therefore, if you’ve met your Part B deductible your cost will be 80$ plus 15% of excess charges.
Also, you have to be aware that there is no limit on how many times non-participating providers can bill you for Medicare Part B excess charges. However, almost 95% of the providers accept Medicare’s payment as payment in full, so it is not that common that you will face them even without a Medicare supplement plan.
How Can I Avoid Part B Excess Charges?
The most logical and easiest way to avoid excess charges is to go to a doctor or a hospital that accepts Medicare Assignment or medicare payment rates in full. So, we advise you to check which providers do accept it to avoid additional costs. You can check which providers accept Medicare payments by using Medicare’s Compare search tool. With this tool, you can see which providers and hospitals won’t bill you for excess charges.
However, if you want to have more flexibility and don’t want to worry if you will ever be billed for it you can consider a supplement plan options that will help with covering Part B excess charges,
There are only two supplemental plans on the market that cover this cost- Plan F and Plan G. So, if you are new to Medicare, and weren’t eligible before 2020, your only option to get this coverage is supplement Plan G.
However, if you have a Medicare Advanatage plan, plan carriers aren’t allowed to bill you above their contracted rate with carrier. But, with Medicare Advantage plans you need to stay under the provider’s network of doctors and hospitals to avoid out-of-pocket costs.
Should I Worry About Excess Charges If I Have Plan N?
Medicare Supplement Plan N in New Jersey is one of the three most comprehensive plans on the market, alongside plans G and F. But, unlike Plans G and F, Plan N doesn’t cover Part B excess charges. Since plan F is not available for most beneficiaries, Plan N has increased its popularity. However, if you satisfied with your plan, you don’t have to change it because of Part B Excess charges. There are not, that common, and you can easily avoid them by choosing the doctors and hospitals which accept Medicare-approved payment rates.
Medicare Supplement Plan Enrollment Period
The best time to enroll in the Medicare Supplement plan is during the Initial Enrollment period. This period begins when you are first eligible for Medicare coverage. This is a 7-month open enrollment window that starts three months before your 65th birthday and ends three months after. You can enroll in the Medigap policy when your Part B becomes effective. If you enroll during this time you don’t fall under medical underwritting which means you cannot be declined based on some pre-existing conditions.
However, you certainly can apply for a Medigap plan if you have missed your IEP but your application may be declined due to some pre-existing health conditions.
If you already have a Medigap plan but want to switch to a plan which provides more coverage, like Part B excess charges you can do so during the Annual Enrollment Period which runs from 15th October to 7th December or any time of the year.
Special Enrollment Period
You can qualify for Special Enrollment Period without medical underwritting certain conditions like:
- you have to move out of your plan’s service area
- your Medigap plan or Medicare Advantage plan stops providing coverage in your area
- losing a group health care plan that has been secondary to Medicare
- you want to drop your Medicare Advantage plan and switch back to Original Medicare and purchase a Medicare Supplement plan (this is your right if you enrolled in an MA plan when first eligible and you decided to switch within one year)
Medicare Advantage Enrollment
Beneficiaries can purchase a Medicare Advantage plan during the Initial Enrollment period after your Part B becomes effective. Even though the Medicare Advantage plan becomes your primary source of coverage beneficiaries still have to pay Medicare Part B monthly premium.
You can also purchase it during the Annual Enrollment Period which runs from the 15th of October to the 7th of December. During this period, can also change your existing Medicare Advantage plan or switch back to Original Medicare and purchase a Medicare Supplement plan if you are not satisfied with your current coverage.
You can also purchase a Medicare Advantage plan during the General Enrollment period which runs from January 1st till March 31st. During this time you can enroll in Medicare if you didn’t do it when you have first become eligible. Since you have to wait for your Part B effective date to start before enrolling in the Medicare Advantage plan, your coverage will start in July when Part B becomes active.
If you have any questions about Medicare Part B Excess charges in New Jersey and want to know more about your Medicare coverage, call us or text today. Our experienced licensed agents are eager to help you!
Craig W. Hansen is an insurance professional and co-founder of William & Michael Advisor Group LLC and Jersey Insurance Solutions. Craig has served his clients in many facets of the insurance industry, always with the same goal: excellence in service while building solid, long-term, lasting relationships. With over a decade of experience in the insurance benefits industry, Craig’s clients know they can call on him anytime and receive platinum service with a smile.
