Medicare part B “excess charges” and Plans F & G

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Medicare supplement plan F looks to be the best plan because although it is primarily the most expensive, it covers everything. It pays your part B deductible and part B “excess charges”.  But what are “excess charges” or “billing balances”? They are the amounts that a doctor charges in excess of what medicare pays. Doctors who accept Medicare patients also must decide whether they will accept the payments which Medicare approves, an agreement known as accepting assignment. In most states if a health care provider does not accept medicare assignment, they are allowed to charge the patient “excess charges” -a maximum of 15%  of what medicare pays for the service. The patient will be responsible for the balance unless they have supplement plans F or G. These two plans pay 100% of part B excess charges.

Ohio is one of the few states that prohibits Medicare providers from charging more than what Medicare allows (This is also known as the MOM law – Medicare Overcharge Measure). So, unless you need to see an out-of-state provider or spend time in a state that allows excess charges, they may not be something to worry about.  With that being said, let us take a closer look at Medicare supplement plans F & G, the two plans that cover these “excess charges”.

Plan F has higher premiums, but pays your part B deductible & 100% excess charges. Plan G does exactly the same thing, but has lower premiums & you have out of pocket costs for your part B deductible.  Most often when dealing with plan G, the money you save on your premiums more than pays the Part B deductible. Even though excess charges are currently prohibited, we believe plan G is “better safe than sorry”.

Request a quote from us here at PledgePoint, Ohio’s Medigap Connection. We are here to find the best plan at the best price!