What Are Medicare Part B Excess Charges?
Doctors who don't accept Medicare assignment can charge up to 15% more than the Medicare-approved amount in many states. Here's how excess charges work and how to avoid them.
Quick answer
A Part B excess charge is the amount a provider who doesn't accept Medicare assignment can bill above the Medicare-approved amount, generally up to 15% more. Some states prohibit or limit excess charges. Providers who accept assignment can't charge them.
Three kinds of providers
| Provider type | What you pay |
|---|---|
| Participating (accepts assignment) | Your deductible and coinsurance on the approved amount |
| Non-participating | May charge up to 15% above the approved amount, plus your coinsurance |
| Opted out of Medicare | Private contract; Medicare doesn't pay |
An example
A hypothetical Medicare-approved amount of $200, Part B deductible already met:
The exact calculation uses a slightly lower fee schedule for non-participating providers, but the key point is that excess charges add cost on top of coinsurance.
How to avoid them
- Ask whether a provider accepts assignment.
- Check whether your state limits excess charges.
- Some Medigap plans cover excess charges; others don't. See Medigap vs. Medicare Advantage.
- Medicare Advantage plans handle provider payment differently and use networks.
See how to read a Medicare Summary Notice.
The takeaway
Excess charges come from providers who don't accept assignment. Ask before your visit, and check whether your supplemental coverage pays them.
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