Medicare Supplement Excess Charges
What are Medicare “Excess Charges?” With twelve federally mandated plans to choose from, you will most likely find the plan that fits your budget and unique needs. F being the most popular because of how comprehensive it is. Plans C and D are also very popular, although many folks ask about the “Excess Charges” not covered with Plans C and D.
Lets go over “Excess Charges” for a moment.
For example; lets say the Medicare allowable charge for a certain visit or procedure is $100. Medicare Part B pays $80 and the Medicare Supplement pays the remaining $20. If the doctor does not “accept assignment, and the client has Plan D, the client pays the 15% above the allowable Medicare charge.
However, neither Medicare nor the Medicare Supplement will pay the doctor. Why, because he wouldn’t “accept assignment” of the claim. The money goes to the client. So now the doctor has to hope he gets paid the $115 from the client after he does all the billing instead of knowing he’ll receive $100 if he “accepts assignment.”
Let’s assume the net annual premium difference between Plan F and Plan D is $275, after deducting the $135 Part B deductible that is not paid by Plan D. At 15%, that would mean the client would have to incur bills of almost $2,000 from doctors that don’t accept assignment.
Since only 1% of all doctors won’t accept assignment and knowing how much Medicare limits charges, it becomes almost impossible for Plan F to be a money saver. Medicare states that if the doctor does not accept assignment the doctor can add 15% to the amount Medicare approves. However, Medicare reduces the amount they approved by 5% because the doctor does not accept assignment. Now the doctor can only add the 15% to the reduced amount.
If Medicare approves a total of $100 and the doctor does not accept assignment then Medicare reduces the amount by 5% the doctor is really only getting an additional $9.25 and not $15. When the doctor sends a claim to Medicare, Medicare will assign a value to that claim. If the doctor agrees to “accept assignment” then the doctor also agrees to accept that assigned value as 100% payment for his/her services, of which Medicare pays 80% and the Med Supp policy pays the remaining 20%.
If the doctor does not “accept assignment” the claim still goes to Medicare and Medicare will “assign a value.” It makes no difference whether or not the doctor accepts assignment.
Would you like to compare Medicare Supplement plans for yourself? I can help. Feel free to contact me anytime with your questions.
Thanks;
John Conner
800-700-1246 - office
916-240-6422 - cell
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