What are Part B Excess Charges?

I had a great question today from a MSS… I was asked to give an example of what “Part B excess charges” would be.

This led me to a search.

I have always explained Part B excess charges as “charges above Medicare approved amounts,” but what does that actually mean? So I dug a little deeper…i.e. I called the Anthem broker line. :-)

After giving my broker number I explained to Linda at broker services that I was being asked to give examples of what some part B excess charges could be. Her answer was – “They could be anything.”

She went on to look up the technical definition of Part B excess charges:

They are the difference between what a client’s doctor charges & what Medicare allowed amounts are in situations where a client sees a physician who does not take a Medicare assignment.

In other words if your client sees a doctor who doesn’t take Medicare, then the plan, that covers part B excess charges, would cover the difference in what Medicare’s allowed reimbursement rates are & what the physician’s bill actually is.

 

Federal law also dictates what that difference can be. It says that a physician, who has not taken Medicare assignment, can charge up to 15% more than Medicare allowed amounts.

So what are some situations where a client would need coverage for part B excess charges? Simple- any time a client sees a doctor that doesn’t take Medicare they could incur these charges . Many will argue to just instruct your clients to only see physicians that take Medicare to avoid these charges. While this is a good practice keep in mind in many hospital and emergency situations you end up seeing the doctor on call… Who is to say if they accept Medicare or not?

So if you want to protect your clients from a possible 15% rate up on their medical services sign them up for a plan that covers part B excess charges. These plans would be Plan F, High Deductible Plan F, & Plan G.

Happy selling everyone!