How Excess Charges May Effect Your Medicare Coverage in MD

How Excess Charges May Effect Your Medicare Coverage in MD

Last updated on: November 10, 2022

Medicare can be challenging to navigate with all of the different plans that offer varying levels of coverage at different costs in Maryland. The complexity can leave you quite confused about which plan is the best fit. You also have to take into account which charges are covered by your desired plan and which expenses you will be required to pay out-of-pocket. An example of these charges is excess charges. This article aims to give you information on excess charges and how they may affect your Medicare coverage in Maryland.

What Are Excess Charges?

Excess charges are fees that a beneficiary is required to pay apart from the Medicare-approved payment. These charges in MD come into play with Original Medicare Part B, which covers medically necessary outpatient services such as doctor visits, lab tests, imaging tests, operations, durable medical equipment (such as wheelchairs and walkers), ambulance services, and preventive services (like cancer screening and diabetes screening). 

Participating providers in MD who offer their services under Medicare Part B and who accept Medicare Assignment will not charge you excess charges. They will accept the Medicare-approved bill as full payment. On the other hand, non-participating providers in MD who don’t accept Medicare Assignment have the right to bill you up to 15% above the Medicare-approved amount. This is why it’s vital that you figure out whether your provider in MD accepts Medicare assignment, before you go to them for treatment, medical equipment, or other healthcare services.

How Do Excess Charges Work in Maryland?

Excess charges are only implemented on Medicare Part B services in Maryland. We’ve provided a detailed example below to show you how excess charges come into play if you visit a non-participating provider in Maryland:

Example: Suppose you visit a doctor who is not working under Medicare Assignment in Maryland. The treatment you receive amounts to $100. Since they reserve the right to charge you up to an excess of 15% more than the Medicare-approved bill, the doctor chooses to add on excess charges of 15%, totaling your bill to $115. 

If you’ve already reached your deductible amount, you are only required to pay 20% of the treatment cost, plus the 15% excess charges. Medicare will pay the remaining 80%. So your bill will require you to pay $35 in total (20% of $100 + $15 in excess charges).

While this example illustrates the case of a relatively small bill, in which case the excess charges might not amount to much, keep in mind the rare possibility of larger medical bills and how significant excess charges could add up. For instance, if you’re receiving chemotherapy for a cancer diagnosis in MD, the cost of treatment is likely very high, so the excess charges might wind up being extremely costly as well.

How Concerned Should I Be About Excess Charges in Maryland?

Excess charges are rarer than you think. Very few physicians and healthcare providers in the US will implement excess charges on top of the Medicare-approved bill. According to national statistics, 95% of providers accept Medicare Assignment and therefore do not ask for any excess charges. Aetna, a leading health insurance company, recently stated that only 1% of their clients’ bills have excess charges, and the average excess charges amount to only $20. So not only are you unlikely to encounter excess charges when using services under Part B, those charges are not exorbitantly high. There are also a few states that have made it illegal for providers to demand excess charges. 

How To Avoid Excess Charges in Maryland

If you wish to avoid paying excess charges for Medicare Part B healthcare services, try the following measures:

  • Only use the services of those doctors, healthcare service providers, and medical equipment suppliers who accept Medicare Assignment because they are the ones who do not bill you for excess charges. You can search providers on medicare.gov to see which professionals fit this category, and you can also double-check with hospitals. Always be sure to confirm with your doctor beforehand about whether or not they bill excess charges so that you avoid inadvertently paying more than the Medicare-approved payment.
  • Know the law and use Part B services in states where excess charges are illegal. These states implement the Medicare Overcharge Measure, or MoM Law: Connecticut, Massachusetts, Minnesota, Ohio, Rhode Island, New York, Vermont, and Pennsylvania. Providers in these eight states are strictly prohibited from billing excess charges. 
  • Shop for a Medicare Supplement Plan (Medigap Plan), which covers excess charges. Plan F and Plan G - along with their high deductible versions - cover 100% of excess charges. This means you can visit any provider anywhere in the country without having to concern yourself with whether they accept Medicare Assignment or not.

However, given how low and rare excess charges tend to be, most beneficiaries do not consider the coverage of excess charges when deciding which healthcare plan to opt for. Actually, one of the most popular Medigap plans is Plan N, despite the drawback that it does not cover excess charges. Plan N has very low monthly premiums compared to Medicare Supplement Plan F and Plan G. Therefore, Plan N is more economical for people in the long run.

Contact Enroll Medicare Maryland Today

We hope this article helped you understand the concept of excess charges and how they work so that you’re not caught unaware the next time you receive your Medicare bill in MD. We have experts on our staff who can help you determine if you will be charged excess charges or not and what to do about it if you are. Additionally, if you are already on a Medicare Supplement Plan and wish to change, we can help you with that as well. We can answer all of your Medicare questions. Please don’t hesitate to contact our Maryland-based agents today! 


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