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Medicare Part B Excess Charges and How to Avoid Them

Some Medicare providers charge 15% more than the Medicare-approved amount for covered Part B services. These additional charges are called Part B excess charges.

Part B excess charges can be a financial burden as many Medicare beneficiaries do not know they exist. In this post, we break down Medicare Part B charges and how you can avoid paying them.


What are Medicare Part B excess charges?

Medicare has a predetermined amount they pay to service providers called Medicare assignment.

Healthcare professionals in the Medicare network, also called participating providers, accept Medicare assignments. This means that they won’t charge you above the Medicare-approved amount.

However, some healthcare professionals who are non-participating are not required to accept Medicare assignment and can charge you up to 15% more than the Medicare-approved amount, which you’ll have to pay out of your own pocket.



How Part B excess charges work

Let’s say you visited a participating provider to receive diagnostic screenings for diabetes that cost $300. Medicare will pay 80% of the bill, which amounts to $240, while you only have to pay the remaining 20%. Your total out-of-pocket expense would be $60.

If the doctor doesn’t accept Medicare assignment, they can charge you an extra 15% more than the participating provider. So your bill would be $345.

Medicare would cover 80% of the approved amount of $300, which is $240, while you pay the 20% co-insurance and the extra 15% charge of $45. Your total out-of-pocket expenses would be $105.


What to do to avoid Part B excess charges

There are two ways you can avoid Part B excess charges.

The most obvious and easiest is to visit only participating healthcare providers. Before you book an appointment with a provider, you should always ask if they accept Medicare assignment. Using Medicare’s physician finder tool will help speed up the process of finding a participating provider.

Alternatively, you can buy Medigap plans that’ll help you pay the Part B excess charges. The two Medigap plans currently offering this benefit are Plan F and Plan G.


States that don’t allow Medicare Part B excess charges

In some states, it is illegal for a provider to charge above the Medicare-approved amount. So you have to worry about paying additional charges if you live in:

  • Vermont

  • Rhode Island

  • Pennsylvania

  • Ohio

  • New York

  • Minnesota

  • Massachusetts

  • Connecticut

If you receive medical services outside your state, it’s important to ask if they accept Medicare assignment as you can be charged Part B excess charges.

If you have questions about Medicare or need help enrolling in a Medicare plan, we’ll be happy to help. Contact us today to get started.