An Act to Protect Medicare Beneficiaries from Surprise Bills and to Inform Medicare Beneficiaries About Medicare Part B Excess Charges
Maine Legislature, Session 131, LD 1354
Committee: Health Coverage, Insurance and Financial Services
Sponsors: BELL, ARFORD
Amends: 24-A MRSA §5005, 32 MRSA §2600-G, 32 MRSA §3300-J

Legislative Document
No. 1354
H.P. 868
House of Representatives, March 28, 2023
An Act to Protect Medicare Beneficiaries from Surprise Bills and to 
Inform Medicare Beneficiaries About Medicare Part B Excess 
Charges
Reference to the Committee on Health Coverage, Insurance and Financial Services 
suggested and ordered printed.
ROBERT B. HUNT
Clerk
Presented by Representative BELL of Yarmouth.
Cosponsored by Representative: ARFORD of Brunswick.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  24-A MRSA §5005, sub-§2, as amended by PL 1991, c. 740, §7, is further 
amended to read:
2.  Format; content or outline.  The superintendent shall prescribe the format and 
content of the outline of coverage required by subsection 1. For purposes of this section, 
"format" means style, arrangements and overall appearance, including such items as the 
size, color and prominence of type and the arrangement of text and captions. The outline 
of coverage must include:
A.  A description of the principal benefits and coverage provided in the policy;
C.  A statement of the renewal provisions, including any reservation by the issuer of a 
right to change premiums; and disclosure of the existence of any automatic renewal 
premium increases based on the policyholder's age; and
D.  A statement that the outline of coverage is a summary of the policy issued or applied 
for and that the policy should be consulted to determine governing contractual 
provisions.; and
E.  A statement disclosing whether the standardized Medicare supplement policy or 
certificate provides coverage for Medicare Part B excess charges.
Sec. 2.  32 MRSA §2600-G is enacted to read:
§2600-G.  Balance billing of Medicare beneficiaries prohibited
1. Definitions.  As used in this section, unless the context otherwise indicates, the 
following terms have the following meanings.
A. "Balance bill" means to charge to or collect from a Medicare beneficiary any amount 
in excess of the Medicare-approved amount for a service, procedure or treatment paid 
to a physician.
B. "Medicare" means the federal Health Insurance for the Aged Act, Title XVIII of the 
Social Security Amendments of 1965, as amended. 
C. "Medicare beneficiary" means a person who is a beneficiary of health insurance 
under Medicare.
2.  Balance billing prohibited.  A physician licensed under this chapter may not 
balance bill a Medicare beneficiary for any service, procedure or treatment provided to the 
Medicare beneficiary.
3.  Notice; posting.  A physician who treats Medicare beneficiaries shall post a 
summary of the provisions of this section in a conspicuous place in the physician's office.  
The summary must include the statement that any person aggrieved by a physician's failure 
to comply with the provisions of this section may file a complaint with the board and must 
include toll-free telephone numbers to be used for this purpose.
4.  Complaints; violations.  An individual may file a complaint with the board seeking 
disciplinary action concerning a violation of this section.  The board shall investigate or 
cause to be investigated and shall resolve a complaint on its own motion or upon receipt of 
a written complaint.  The board shall conduct its actions in accordance with the Maine 
Administrative Procedure Act.
Sec. 3.  32 MRSA §3300-J is enacted to read:
§3300-J.  Balance billing of Medicare beneficiaries prohibited
1.  Definitions.  As used in this section, unless the context otherwise indicates, the 
following terms have the following meanings. 
A.  "Balance bill" means to charge to or collect from a Medicare beneficiary any 
amount in excess of the Medicare-approved amount for a service, procedure or 
treatment paid to a physician.
B.  "Medicare" means the federal Health Insurance for the Aged Act, Title XVIII of 
the Social Security Amendments of 1965, as amended.
C.  "Medicare beneficiary" means a person who is a beneficiary of health insurance 
under Medicare.
2.  Balance billing prohibited.  A physician licensed under this chapter may not 
balance bill a Medicare beneficiary for any service, procedure or treatment provided to the 
Medicare beneficiary.
3.  Notice; posting.  A physician who treats Medicare beneficiaries shall post a 
summary of the provisions of this section in a conspicuous place in the physician's office.  
The summary must include the statement that any person aggrieved by a physician's failure 
to comply with the provisions of this section may file a complaint with the board and must 
include toll-free telephone numbers to be used for this purpose.
4.  Complaints; violations.  An individual may file a complaint with the board seeking 
disciplinary action concerning a violation of this section.  The board shall investigate or 
cause to be investigated and shall resolve a complaint on its own motion or upon receipt of 
a written complaint.  The board shall conduct its actions in accordance with the Maine 
Administrative Procedure Act.
SUMMARY
This bill requires an insurer offering Medicare supplement insurance in this State to 
disclose whether the Medicare supplement insurance plan covers the costs of Medicare Part 
B excess charges.
The bill also prohibits physicians from balance billing Medicare beneficiaries for any 
amount in excess of the Medicare-approved amount for a service, procedure or treatment 
paid to that physician under the Medicare program.