Vincent Thrasher
Founder at - over65 insurance optionsVincent Thrasher, the pioneering founder of Over65InsuranceOptions, has an impressive 20-year tenure in the insurance industry. His in-depth expertise spans the entire spectrum of senior...Read more
As we age, the cost of healthcare becomes a primary concern for many seniors. Medicare is an essential program that provides health insurance coverage for individuals aged 65 or older. But did you know that some doctors and hospitals may charge you more than what Medicare covers? These additional charges are known as Medicare excess charges, and they could add up quickly. In this article, we’ll explore whether you should worry about Medicare excess charges and what you can do to avoid them.
Should I Worry About Medicare Excess Charges?
As you approach retirement age, you may begin to think about Medicare and what it covers. Medicare is an essential program that helps millions of Americans get the healthcare they need, but it can also be a source of confusion. One question that many people have is whether they should worry about Medicare excess charges. In this article, we’ll explore what excess charges are, how they work, and whether they are something you should be concerned about.
What Are Medicare Excess Charges?
Medicare excess charges are additional fees that some doctors and hospitals can charge if they do not accept Medicare assignment. When a doctor or hospital accepts Medicare assignment, they agree to accept the Medicare-approved amount as payment in full for a particular service. However, some providers choose not to accept assignment, which means they can charge up to 15% more than the Medicare-approved amount for that service. These additional charges are known as excess charges.
How Do Medicare Excess Charges Work?
Medicare excess charges can be a bit confusing, so let’s walk through an example to help illustrate how they work. Suppose you need to see a specialist for a particular medical condition, and you find a doctor who does not accept Medicare assignment. The Medicare-approved amount for that service is $100, but the doctor can charge up to 15% more, or $115, because they don’t accept assignment. If you have Original Medicare (Parts A and B), you would be responsible for paying the excess charge of $15 out of pocket. If you have a Medicare Supplement (Medigap) plan, your plan may cover some or all of the excess charge.
Should I Be Concerned About Medicare Excess Charges?
Whether or not you should be concerned about Medicare excess charges depends on your situation. If you have Original Medicare and don’t have a Medigap plan, you may be responsible for paying excess charges out of pocket. However, if you have a Medigap plan that covers excess charges, you may not need to worry about them at all. Some Medicare Advantage plans also cover excess charges, so if you have one of these plans, you may not need to worry about them either.
Pros and Cons of Medigap Plans That Cover Excess Charges
If you’re considering a Medigap plan that covers excess charges, it’s important to weigh the pros and cons carefully. On the one hand, a plan that covers excess charges can provide valuable peace of mind, knowing that you won’t be responsible for paying them out of pocket. On the other hand, these plans can be more expensive than those that don’t cover excess charges, and they may not be necessary if you don’t see doctors or hospitals that don’t accept Medicare assignment.
Pros
– Provides peace of mind
– Eliminates out-of-pocket costs for excess charges
– Can be a good option if you see doctors or hospitals that don’t accept Medicare assignment
Cons
– More expensive than plans that don’t cover excess charges
– May not be necessary if you don’t see doctors or hospitals that don’t accept Medicare assignment
Medicare Advantage Plans That Cover Excess Charges
Some Medicare Advantage plans also cover excess charges, which can be a good option if you prefer the convenience of an all-in-one plan. However, it’s important to note that not all Medicare Advantage plans cover excess charges, so you’ll need to do your research carefully.
Pros
– All-in-one coverage for medical and prescription drug costs
– May have lower out-of-pocket costs than Original Medicare
– Some plans cover excess charges
Cons
– May have limited provider networks
– Can change from year to year, which may impact your coverage
– Not all plans cover excess charges
Conclusion
In conclusion, Medicare excess charges are something to be aware of, but whether or not you should be concerned about them depends on your situation. If you have Original Medicare and don’t have a Medigap plan, you may be responsible for paying excess charges out of pocket. However, if you have a Medigap plan or a Medicare Advantage plan that covers excess charges, you may not need to worry about them at all. It’s important to weigh the pros and cons carefully and do your research to make an informed decision about your Medicare coverage.
Contents
Frequently Asked Questions
What are Medicare excess charges?
Medicare excess charges are additional fees that healthcare providers can charge above the Medicare-approved amount. These charges can occur when you see a doctor who does not accept Medicare assignment. The excess charges can be up to 15% of the Medicare-approved amount.
It’s important to note that not all healthcare providers are allowed to charge excess fees. Only providers who do not accept Medicare assignment can charge excess fees. Providers who accept Medicare assignment are not allowed to charge excess fees.
Should I be worried about Medicare excess charges?
If you see a healthcare provider who does not accept Medicare assignment, you may be subject to excess charges. These charges can add up quickly, especially if you require frequent medical care. However, it’s important to note that not all healthcare providers are allowed to charge excess fees.
Before seeing a healthcare provider, it’s important to check if they accept Medicare assignment. If they do not, you may want to consider finding a different provider who does accept assignment to avoid excess charges.
How can I avoid Medicare excess charges?
You can avoid Medicare excess charges by seeing healthcare providers who accept Medicare assignment. Providers who accept assignment are not allowed to charge excess fees, so you can be sure that you will only be responsible for the Medicare-approved amount.
If you do see a provider who does not accept assignment, they are required to notify you of their excess charges before providing services. It’s important to ask about these charges before receiving care so that you can make an informed decision about whether to proceed with the care or find a different provider.
What should I do if I receive a bill with excess charges?
If you receive a bill with excess charges, you should review the bill carefully to make sure that the charges are legitimate. If you believe that the charges are not legitimate, you can contact the healthcare provider to discuss the charges and try to resolve the issue.
If you are unable to resolve the issue with the healthcare provider, you can contact Medicare to file a complaint or appeal the charges. Medicare can investigate the charges and help you resolve the issue.
What are my options if I cannot afford Medicare excess charges?
If you cannot afford Medicare excess charges, you may be able to find a healthcare provider who accepts Medicare assignment. Providers who accept assignment are not allowed to charge excess fees, so you can be sure that you will only be responsible for the Medicare-approved amount.
If you are unable to find a provider who accepts assignment, you may be able to enroll in a Medicare Supplement Insurance (Medigap) plan. Medigap plans can help cover the cost of excess charges and other healthcare costs that are not covered by Medicare.
In conclusion, it is important to understand what Medicare excess charges are and how they may affect you. While some healthcare providers may charge more than what Medicare covers, there are ways to protect yourself from these charges.
One option is to choose a healthcare provider who accepts Medicare assignment. This means they agree to accept the Medicare-approved amount as payment in full for their services. Another option is to purchase a Medicare Supplement Insurance plan, also known as Medigap, which can help cover excess charges.
Ultimately, the decision of whether or not to worry about Medicare excess charges is up to you. By educating yourself on the options available and choosing a healthcare provider who accepts Medicare assignment or purchasing a Medigap plan, you can protect yourself from potential financial burden.
Vincent Thrasher, the pioneering founder of Over65InsuranceOptions, has an impressive 20-year tenure in the insurance industry. His in-depth expertise spans the entire spectrum of senior insurance, encompassing Medicare, Medigap, long-term care insurance, life insurance, and dental, vision, and hearing insurance. Vincent's unwavering passion for guiding seniors through the intricate insurance landscape and crafting customized solutions to address their individual needs has earned Over65InsuranceOptions an esteemed reputation as a dependable ally for seniors nationwide.
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