Medicare Part B overpayments: Key insights to bear in mind
For individuals with multiple Medigap policy options to compare, it's essential to understand which plans cover Medicare Part B excess charges. In this article, we will explore the specific plans that offer protection against these charges and provide practical advice for consumers.
Only two Medigap plans, **Plan F** and **Plan G**, cover Medicare Part B excess charges. These plans pay the full amount of any allowable excess charges (up to 15% above the Medicare-approved amount) that a healthcare provider may bill if they do not accept Medicare assignment. The high-deductible versions of Plan F and Plan G also cover excess charges, but only after the deductible is met.
Excess charges occur when a provider does not accept Medicare assignment and bills up to 15% more than the Medicare-approved amount for covered services. If a provider accepts assignment, they cannot bill excess charges; Medicare pays 80% and the patient is responsible for the remaining 20% coinsurance after the deductible. If a provider opts out of Medicare, Medicare does not cover any costs, and the patient is responsible for the full bill unless covered by other insurance.
Eight states (Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, Vermont) prohibit providers from charging Part B excess charges. This means that residents of these states are protected by law and do not need to worry about excess charges regardless of their Medigap plan.
Other Medigap plans, such as Plan N, Plan K, Plan L, and all others, do not cover Part B excess charges. With these plans, patients are responsible for paying any excess charges out of pocket if they see a provider who does not accept Medicare assignment.
In summary, here is a table outlining the coverage for Part B excess charges for various Medigap plans:
| Medigap Plan | Covers Part B Excess Charges? | Notes | |-----------------------|------------------------------|--------------------------------------------------------| | Plan F | Yes | Also covers Part B deductible; not available for those new to Medicare after 2020[3]. | | Plan G | Yes | Does not cover Part B deductible; available to all beneficiaries[3]. | | High-Deductible Plan F| Yes | Only after deductible is met[3]. | | High-Deductible Plan G| Yes | Only after deductible is met[3]. | | Plan N, K, L, others | No | Patient pays any excess charges[2][5]. |
To avoid Part B excess charges, choose providers who accept Medicare assignment (which most do), or enroll in Medigap Plan F or Plan G if coverage for excess charges is a priority. If you need help choosing a Medigap policy, contact your State Health Insurance Assistance Program (SHIP) for guidance. Help is available to cover out-of-pocket expenses, including Part B excess charges.
When selecting a Medigap plan, it's crucial to consider the various benefits and levels of coverage each option offers. As of January 1, 2020, Plan F is not available to those newly eligible for Medicare, and Medigap policies that provided coverage for the Part B deductible are also no longer available for new enrollees.
Monthly premiums may vary depending on the private insurance provider, the state in which a person lives, and when an individual becomes eligible for Medicare. Remember, if you have Medicare Advantage (Medicare Part C), you cannot legally buy Medigap insurance.
In conclusion, understanding the coverage provided by different Medigap plans is essential for making informed decisions about your healthcare. By knowing which plans cover Medicare Part B excess charges, you can make the best choice for your needs and budget.
- Two particular plans, Plan F and Plan G, guard against Medicare Part B excess charges by paying for the full amount of any excess charges (up to 15% more than the Medicare-approved amount) when a healthcare provider doesn't accept Medicare assignment.
- In eight specific states – Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont – providers are prohibited by law from charging Part B excess charges, shielding residents from these extra costs regardless of their Medigap plan.
- In contrast, Medigap plans such as Plan N, Plan K, Plan L, and all others do not cover Part B excess charges, leaving the onus on patients to pay these charges out of pocket if they visit a provider who doesn't accept Medicare assignment.
- To evade Part B excess charges, it's advisable to select healthcare providers who accept Medicare assignment, or enroll in Medigap Plan F or Plan G if the coverage for excess charges is a top priority.
