Medicare and Medicare Assignment and Medicare Supplements

Nobody likes to be presented with surprise charges at the doctor’s office, right? As an agent, it’s your job to ensure your client understands these charges and how they may affect them. Educating your clients on how excess fees work will help prevent any surprises they may encounter when dealing with Medicare, Medicare Assignment, and Medicare Supplements.

Insurance Companies can offer up to 10 different policies labeled A, B, C, D, F, G, K, L, M, and N. Each lettered policy is standard across all carriers. Each labeled policy with the same letter has the same benefits, no matter which company provides the product. Companies are not required to offer all Medicare Supplements, also called Medigap.

Beyond the basics included in Medicare Supplements, each standardized plan covers a different amount of your Medicare cost-sharing. Depending on which policy a client chooses, they can get coverage for additional expenses such as paying the Excess Charges, which a physician that DOES NOT accept Medicare Assignment but does accept Medicare can charge over the Medicare-approved amount.

“Doctors can accept Medicare AND accept Medicare Assignment
OR
Doctors can accept Medicare AND NOT accept Medicare Assignment.”

Medicare Assignment is directly related to the Medicare Part B Excess Fees that a Doctor can charge over the Medicare regulated fee structure by CMS. Doctors who do not accept Medicare Assignment may charge this 15% excess fee. Excess Fees relate only to Medicare Supplement Plans.

For example, a doctor’s appointment that costs $100 may cost $115 when a Doctor DOES NOT accept Medicare Assignment. It does not seem outrageous until you have a major surgery and you are looking at possibly thousands of dollars or more.

When talking with a client, remember that if they are having major surgery, some of the Doctors involved, i.e., The anesthesiologist, may not accept Medicare Assignment even though your surgeon does.

You can look up the doctors on Medicare.gov under the ‘Find Care Provider’ tab and search your location.

Medicare Supplement Plan F and Plan G are the only supplements that cover Excess Charges.

As of 2020, some states do not allow any excess charges billed to the Medicare beneficiary. These states include Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont.

If you have any questions about excess charges and how they could affect your client, don’t hesitate to get in touch with your Broker Sales Specialist.