Wisconsin Medicare Plans

​Speak with an Agent

Medicare Part B Excess Charges

Part B Excess Charges

Medicare Part B, your medical insurance, covers the cost of supplies and services that are deemed necessary for your medical health, such as x-rays, oxygen tanks, outpatient physical therapy, and regular check ups.  If your doctor does not accepts Medicare but is not assigned by Medicare you could end up paying Medicare Part B Excess Charges.  The Medicare B Excess rider will cover this, for more information on how to avoid the Medicare Medicare Part B Excess charges continue reading or call 920-545-4884.

You are probably already aware that Part B has a deductible of $183 per year (in 2018) as well as a variable monthly premium.

However, did you know that you might be asked to pay something known as “excess charges” in addition to these regular insurance costs?

Read our Wisconsin Medicare Part B excess charges guide to learn everything you need to know about what these extra fees are and—more importantly—how you can avoid them.

What Are Medicare Part B Excess Charges?

Every year, the federal government creates a fee schedule that dictates the appropriate charge for almost every medical procedure imaginable. The fee provided for any given service in this list is known as Medicare’s “assigned” rate. Most doctors who accept Medicare will charge you this assigned rate, and in these cases, there are no Part B excess charges.

Doctors are permitted, however, to charge patients up to 15% higher than the rate assigned on the Medicare fee schedule. The difference between the assigned rate and the doctor’s actual cost are the Medicare Part B excess charges—fees above and beyond what Medicare will cover, even after you’ve met your deductible.

Medicare Part B Excess Charges

Suppose you needed an outpatient procedure for which the Medicare assigned rate is $3,000. Your doctor may charge up to 15% extra, or $3,450 total. Those additional $450 are the excess charges that you will be required to pay out-of-pocket (and that’s in addition to your usual deductible and copay!).

The good news is that doctors who accept Medicare aren’t allowed to charge any more than 15% above the assigned rate. The bad news is that you might get hit with a really large and unexpected bill despite having high quality health insurance

How to Avoid Medicare Part B Excess Charges in Wisconsin

There are a lucky few states in which excess charges are actually against the law. In New York, Pennsylvania, Connecticut, Rhode Island, Ohio, Vermont, Massachusetts—and even next door in Minnesota—physicians are prohibited from billing more than the assigned Medicare rate.

Unfortunately, here in Wisconsin, doctors are free to charge the extra 15%, so an important part of planning out your health care is to understand how to avoid Medicare Part B excess charges.

Find Your High Quality, Low Cost Medicare Plan Today!

Find a Doctor Who Accepts Medicare Assignment

Fortunately for you, approximately 95% of primary care physicians “accept assignment”, which means that they bill according to the Medicare fee schedule. Specialists are slightly more likely to bill excess charges, but not by very much. So, odds are that your usual doctors aren’t going to be charging you anything extra.

If you do need to look for a new doctor, Medicare.gov has a handy tool to help you find health care providers who accept Medicare assignment. Just enter your location and the type of care you need (such as “general practice” or “chiropractic”), and you’ll be provided with a long list of providers near you indicating whether or not they bill at Medicare’s rates

Find a Doctor Who Accepts Medicare Assignment

Maybe you’ve been seeing the same doctor for twenty years only to discover upon enrolling in Medicare that she doesn’t accept assignment. You’re stuck between a rock and a hard place: do you leave the doctor who has come to understand your medical needs or do you face the possibility of paying 15% extra for every medical service covered under Part B?

Luckily, there’s a third option: Medicare Supplement Insurance. These additional plans (also known as Medigap) extend beyond the usual coverage of Original Medicare in order to help you prevent unexpected out-of-pocket costs from things like copays, deductibles, and—in this case—Part B excess charges.

In Wisconsin, your Medicare supplement is built by adding optional riders to the base coverage. One of these, the “Part B Excess Charges Rider”, covers 100% of the extra fee that your doctor might bill beyond the assigned rate. So if you know that your primary care physician or specialist of many years does not accept assignment, adding this rider to your plan is definitely the way to go to cover the Medicare Part B Excess Charges.

Even if your usual doctor does bill at Medicare’s rates, the Part B Excess Charges Rider could help protect you from unnecessary hassles or extra costs. If you travel regularly, you never know when you might encounter a medical situation away from home. Even if you’re a homebody, you might end up with medical needs that require finding a new specialist for a new health condition.

In either of these situations, knowing that you are protected from excess charges allows you to find the doctor that is best for you, rather than being forced to shop around in order to save your wallet. Finding a new provider is already stressful enough. Why add worrying about money into the mix?

Wisconsin Medicare Part B Excess Charges

If you still have questions about how excess charges work or you’re looking to enroll in the right Medicare Supplement Insurance to avoid these Medicare Part B Excess Charges, we are here to help.

The experts on the Medicare Solutions Team are just a phone call away at 920-545-4884. Or feel free to contact us through our website at your convenience