NJ Life & Health Insurance Group
  • Ken Connolly

What is Medicare Part B Excess?

One of the more common questions we get at NJ Life & Health is “What the heck is Medicare Part B Excess?”. Let’s do a deep dive.

Medicare Part B Excess is an out of pocket cost for people who have Original Medicare. Some similar Medicare costs that may be more familiar to you include copays, coinsurance, and deductibles. Medicare Part B Excess however, is a little more complicated compared to the others.

To understand Medicare Part B Excess we have to understand Medicare Assignment. Medicare Assignment is when a Doctor opts-in to accept patients currently receiving Original Medicare. When they do this, they accept that Medicare is going to pay them a predetermined rate for their services. Roughly 95% of Medicare doctors in the US accept Medicare Assignment.

For the other 5% of Doctors, they may charge you Medicare Part B Excess rates in addition to the standard 20% co-insurance. These providers are often referred to as “Non-Participating Medicare Providers.” While these providers do indeed take Original Medicare, this allows them to charge you 15% more than what they would have received from Medicare having accepted Medicare Assignment. Note that this extra cost doesn’t count towards your Part B Deductible, so YOU will be on the hook for it.

Will I Have to Pay Medicare Excess?

Many people wonder if their plan covers Medicare Part B Excess. If you have a Plan G or Plan F Medicare Supplement, you will not have to worry about Medicare Part B Excess Charges. These plans cover this particular out of pocket expense and many others. If you trade in your Original Medicare for a Medicare Advantage Plan, you will not have to worry about this charge either. If you have a Plan N or any other Medigap plan however, you will have to pay.

Does My State Allow Medicare Excess?

There are currently 8 states that don’t allow or limit Doctors’ ability to charge Medicare Part B Excess for their residents. These states include Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont. So if you live in these states, you’re in luck! You won’t have to worry about this quite as much as residents of other states.

How Can I Be sure I’ve Got The Right Medicare Plan?

The best way to know you have the best coverage for your needs is to speak with a licensed Medicare Specialist that can give you a Medicare Education. Here at NJ Life & Health, we’ve been serving the Medicare needs of New Jersey residents as well as other states for years. To set up your free Medicare Education, give us a call at 848-226-6897 or visit https://www.njlifeandhealth.com/request-an-appointment-1 to request an appointment.

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We Do Not Offer Every Plan Available In Your Area. Any Information We Provide Is Limited To Those Plans We Do Offer In Your Area. Please Contact Medicare.gov Or 1-800-MEDICARE to get information on all of your options.

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