If you have done any homework or research in to how Medicare Part A and B will cover you once you turn 65 or age in to Medicare, you more than likely have come across what is know as the Medicare Part B Excess Charge. In my years of helping Texans understand their options with filling in the gaps left by only having Original Medicare, this is the one question that seems to always come up.
When looking at the benefits of Medicare Part B, you will notice that Medicare will pay for 80% of their approved charges for covered services. Without having any supplement, you will automatically pay the other 20% of approved charges. These approved charges are called Medicare assignment, and the good news is as of now most hospitals and doctors accept Medicare pay schedule. What most people do not understand is that any hospital or doctor has the option and the right to charge up to 15% more than Medicare’s approved charges. If you do not have a supplemental insurance plan that covers these excess charges than you may be responsible for up to 15%.
For example, let us take a doctor visit that cost $100. If $100 is the approved Medicare amount for that doctor visit, than a doctor can charge 15% more than $100, which would be an extra $15. Medicare would pay 80% of the $100, which would be $80, leaving a balance of $20 owed for the Medicare approved amounts. If you are covered by a Medicare supplement plan, most will pick up the $20 charge that is left over from this doctor visit, but what if the doctor charges the extra $15?
This is where choosing the right Medicare Supplement in Texas can protect you from any and all unexpected out of pocket expenses. Since June 1, 2010, when the Modernized Medicare Supplements were released, Medicare Supplement Plan F and Plan G are the only two plans that cover the excess charges. Now, understand there is a Part B deductible that has to be met with a Plan G, but other than that both Plans will cover not only the Medicare approved amounts, but the excess charges as well.
The problem with excess charges, or just Medicare Part B alone, is the fact that there is not a cap on how much the charges could be. So, if all you look at is a $100 doctor visit that you could be responsible for an extra $15, it does not seem to be that much of a worry. Now, if you consider that Medicare Part B deal with all outpatient medical services, paying an extra $15,000 on $100,000 worth of charges brings a little more importance to having the excess charges covered.