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Medicare Part B Excess Charges

No-obligation Medigap QuoteWhat are excess charges?  They are charges above that approved by Medicare if your doctor or hospital does not accept assignment.  Although most physicians and hospitals will accept assignment, some specialists, and specialty hospitals do not.  Let us say that the example below illustrates a procedure requiring a specialist who doesn't accept assignment.  As you can see plans A-D, M and N can leave you vulnerable to excess charges.
The following examples assume a Medicare Approved amount of $100,000
 

First take the example if you have a Medigap Plan A, B, C, D, M or Plan N which does not cover any Part B excess charges if your caregiver does not accept assignment.  In the examples below you may be responsible for excess charges above the Medicare approved amount.
  This example applies to a Plan A, B, C, D, M, and N when provider accepts assignment.
$100,000 Medicare approved amount for procedure.
 - $80,000 Medicare pays 80% of the approved amount.
- $20,000 Your Medigap plan pays 20% of the approved amount.
$0 You pay.
   
  This example applies to a Plan A, B, C, D, M, and N when provider DOES NOT accept assignment.
$115,000 Medicare approved amount plus 15% is the maximum a provider can charge if they don't accept assignment.
- $80,000 Medicare pays 80% of the approved amount.
- $20,000 Your Medigap plan pays 20% of the approved amount.
$15,000 Amount you may be required to pay.

 

Now take the same example if you have a Medigap Plan F or Plan G which covers 100% of any Part B excess charges if your caregiver does not accept assignment.  In the examples below you would pay $0.00 with a Plan F or Plan G.
  This example applies to a Plan F or G when provider accepts assignment.
$100,000 Medicare approved amount for procedure.
 - $80,000 Medicare pays 80% of the approved amount.
- $20,000 Your Medigap plan pays 20% of the approved amount.
$0 You pay.
   
  This example applies to a Plan F or G when provider DOES NOT accept assignment.
$115,000 Medicare approved amount plus 15% is the maximum a provider can charge if they don't accept assignment.
- $80,000 Medicare pays 80% of the approved amount.
- $20,000 Your Medigap plan pays 20% of the approved amount.
$0 You pay nothing because your Plans F or G cover the excess charges.

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