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Are there really Medicare excess charges? Understanding what they are and what you can do about them.

Medicare is a program run by the federal government. It provides health insurance for over 44 million Americans, many of whom might not otherwise have access to insurance and healthcare. The largest group of Medicare enrollees are people age 65 or older, followed by people with disabilities who receive Social Security Insurance, and individuals suffering from End-Stage Renal Disease who require dialysis or a kidney transplant.

Medicare is an amazing program, but it can be overwhelming and confusing, especially when it comes to the plans, the costs, and who pays for what. Instead of doing a lot of legwork yourself, we have put together this handy guide to Medicare plans, including excess charges, where they come from, and what you can do about them. Take a look.

Medicare Plans and Coverage

Medicare includes a bundled package of plans to fit the needs of most of its subscribers. They look like this:

Medicare Part A

This is the hospital coverage for your Medicare plan. It includes inpatient care at hospitals, skilled nursing facilities, long-term care hospitals, mental health care facilities, and hospice care facilities

Medicare Part B

Part B is the standard health insurance coverage. It covers medically necessary services and preventative care, including:

  • Medically necessary services:
    • Durable medical equipment
    • Ambulance service
    • Clinical research
    • Mental health care
    • Services necessary to diagnose illness or injury
    • Services or supplies necessary to treat a medical condition
  • Preventative services:
    • Annual wellness visit or physical
    • Bone density testing
    • Cardiovascular disease screenings
    • Doctor’s visits
    • Blood work and lab tests
    • Well-woman exams, including mammograms and screenings for cervical and vaginal cancer
    • Colonoscopies and colorectal cancer screenings
    • Depression screening
    • Diabetes screening
    • Glaucoma testing
    • Hepatitis screening
    • Lung cancer screening
    • Nutrition therapy
    • Prostate cancer screening
    • Preventative vaccines including flu, hepatitis B, and pneumococcal shots

Medicare Part C

Also called the Medicare Advantage Plan, Part C is a supplement plan that you can buy through a private insurance provider to help cover costs that arise that are not covered by your Original Medicare bundle of plans.

Medicare Part D

The prescription drug coverage plan. This part of the plan covers prescription drugs not covered by the medical insurance portion, Part B. Part D coverage includes prescription medications you take yourself not in a doctor’s office, outpatient facility, hospital, or clinical environment.

When are There Excess Charges?

Medicare is funded by a combination of Social Security and Medicare taxes, as well as some government funding. Individuals are, however, also responsible for some of the costs of their own healthcare. These costs include monthly premiums should they apply to you, annual deductibles, and a percentage of the cost of certain treatments, care, and medication. This percentage is usually 20%. You can find details about these Medicare costs on the Medicare website.

There’s also the possibility you will be responsible for Part B excess charges that come from Part B-covered medical expenses. If you’re responsible for paying them, they can get to the point where you might avoid seeking care to avoid paying these excess charges. But there are some plans in place to help cover these costs.

What are Medicare Part B Excess Charges?

Part B excess charges are more than just overages on your treatment. These are charges that doctors in some states have the option of adding to your bill. Medicare has a predetermined cost associated with medical care and services. They have these costs associated with each type of service or procedure. These fees vary by location, and they are subject to change over time.

When a doctor feels like the associated cost Medicare is willing to pay for a procedure or service is too low to cover their own costs, they have the option of charging an additional 15% above the Medicare predetermined cost. The only states that currently prohibit the excess charges are Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont. If you live outside of these states, you could be subject to these additional charges.

Help Covering Excess Charges

The excess charges some doctors apply can be too much for some individuals to manage, especially if they need frequent care from their healthcare professionals. That’s where the Medicare Advantage and Medicare Parts F and G come in. These are supplement plans, also called Medigap plans that you can purchase through a private insurance company to help cover these excess charges as well as other additional costs.

Supplement plans can help pay for these expenses, so you don’t have to. While you do pay for the plans themselves, they can be a huge cost saving over trying to manage deductibles, copayments, over the counter medications, additional services not covered by your bundle, and the excess charges some doctors choose to bill to you.

Who should take advantage of these types of plans? Currently, more than 81% of Medicare enrollees have some type of supplemental insurance. The cost of medical care can be significant, should you need long-term care, long-term treatment for an illness or condition, or want to take advantage of the additional benefits available with Medicare Advantage plans. Adding one of these plans can create more comprehensive coverage for you, which becomes increasingly important as you move into your golden years.

Where to Buy the Right Plans at the Right Price

Your health is important, and so is your financial well-being. If you’re starting to consider your Medicare enrollment, it’s time to look at what you need to complete your coverage. Adding the right supplement plan can make a huge difference in your out-of-pocket costs every year. Instead of worrying about how you will cover your medical expenses, including extra services, your deductibles and premiums, and any Part B excess charges, talk to our team of experts at Norgard Insurance Group about the right Medicare Advantage plan for your needs.

Everyone is different and has different requirements when it comes to healthcare and insurance. You can count on us to review your needs, your budget, and what you want your care to look like now and in the future. Call us today at 813-454-5072 for a free evaluation of your Medicare and health insurance needs.

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