Co-Founder, TermInsuranceBrokers.com, Goldenzweig Financial Group, Las Vegas, Nevada
Medicare is a federal government run program - the benefits provided under Medicare Parts A & B are the same in each state.
If a doctor accepts assignment, they are accepting the Medicare approved amount as payment in full and will not bill the insured an excess charge.
When a doctor does not accept assignment, they reserve the right to charge an amount above and beyond the Medicare approved amount, up to 15%. For example, if you have a service done that Medicare says costs $200 and the doctor accepts Medicare, but not assignment, they can charge the insured up to an additional $30 for the service.
A Medicare supplement plan is a great way to cover excess charges. If your primary care physician accepts Medicare, but does not accept assignment, you may want to secure a Medigap plan F. If they do accept assignment, a plan N may be more suitable to your needs. Plans F & G will cover excess charges - the other Medicare supplement plans will not.
The states that do not allow excess charges (due to the Medicare Overcharge Measure Law) are Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island and Vermont. However, this is only a critical item if you have a Medicare Supplement plan that does not cover Part B excess charges. If you have a plan F or plan G, then it wont really matter because the plan would pay the excess charges regardless.
I hope the information is helpful - please feel free to contact me for help with your coverage and if you have any other questions. Thanks very much.
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If a doctor accepts assignment, they are accepting the Medicare approved amount as payment in full and will not bill the insured an excess charge.
When a doctor does not accept assignment, they reserve the right to charge an amount above and beyond the Medicare approved amount, up to 15%. For example, if you have a service done that Medicare says costs $200 and the doctor accepts Medicare, but not assignment, they can charge the insured up to an additional $30 for the service.
A Medicare supplement plan is a great way to cover excess charges. If your primary care physician accepts Medicare, but does not accept assignment, you may want to secure a Medigap plan F. If they do accept assignment, a plan N may be more suitable to your needs. Plans F & G will cover excess charges - the other Medicare supplement plans will not.
The states that do not allow excess charges (due to the Medicare Overcharge Measure Law) are Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island and Vermont. However, this is only a critical item if you have a Medicare Supplement plan that does not cover Part B excess charges. If you have a plan F or plan G, then it wont really matter because the plan would pay the excess charges regardless.
I hope the information is helpful - please feel free to contact me for help with your coverage and if you have any other questions. Thanks very much.