In short, Part A is your hospital insurance and Part B is your physician insurance. Excess charges falls under what a doctor can bill you for.
If you read an outline of coverage of a plan F or a plan G (whichever carrier’s outline you want to look at doesn’t matter – the plans are standardized so the input is the same regardless of company), you will see that Medicare Part A pays all but specified amounts during a hospital stay (as an inpatient) as follows:
1) First 60 days – Medicare Part A pays for all but $1,260. Medigap plan F and G pay the deductible for you.
2) Days 61-90 – Medicare Part A pays for all but $315 a day. Medigap plan F and G pay the $315 a day for you (30 days totals up to $9,450).
3) Days 91+ (while using 60 lifetime reserve days) – Medicare Part A pays for all but $630 a day. Medigap plan F and G pay the $630 a day (60 reserve days totals up to $37,800).
4) Once lifetime reserve days are used, additional 365 days – Medicare Part A pays $0. Medigap plan F and G pay 100% of Medicare-eligible expenses up to an additional 365 days.
5) Beyond the additional 365 days – Medicare Part A pays $0.
*Note – that’s per benefit period! A benefit period begins on the first day you receive services as an INPATIENT and ends after you’ve been out of the hospital for at least 60 days in a row. It’s possible to have more than one benefit period in the span of a year. Inpatient stay coverage per benefit period includes semi-private room and board, general nursing, and miscellaneous services and supplies.
Please also note, you can be in a hospital for a day or two and still be listed as an outpatient. If you’re unsure, you should ask your doctor if you’re listed as an inpatient or outpatient in their system.
Unless you’re admitted as an inpatient, you’re being treated as an outpatient which is where your Medicare Part B coverage comes into play. Part B pays about 80% of medical expenses leaving you responsible for the other 20% (covered by plans F and G). If a doctor accepts Medicare assignment, they accept the Medicare-approved amount as payment in full. If they do not accept Medicare assignment, they can bill you an excess charge – which are covered by plans F and G.
If you live in Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, or Vermont, you cannot be charged excess charges by a doctor due to the Medicare Overcharge Measure laws.
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.