What Are Medicare Part B Excess Charges?

Medicare can feel like a puzzle, and one of the most confusing pieces for many people is the idea of Part B Excess Charges. These charges don't come up often, but when they do, they can leave you with an unexpected bill. The good news is with the right understanding and planning, you can avoid them altogether. Let's break down what Part B Excess Charges are, when they apply, and how you can protect yourself.

What are Medicare Part B Excess Charges?

Medicare Part B covers outpatient medical services, such as doctor visits, lab work, preventive screenings, and durable medical equipment. Medicare sets an "approved amount" for each service. Most providers who accept Medicare agree to accept this approved amount as full payment, but some doctors don't. An Excess Charge is when a provider bills you more than Medicare's approved amount, up to a legal limit.

Under federal law, providers who do not accept Medicare "assignment" can charge up to 15% more than the Medicare-approved amount. This 15% is what's known as the Part B Excess Charge.

For example:

• Medicare-approved amount: $200
• Doctor who doesn't accept assignment charges 15% extra: $230
• Medicare pays 80% of $200 = $160
• You owe: $40 coinsurance + $30 excess charge = $70 total

That $30 is the Part B Excess Charge.

Who Can Bill Excess Charges?

Not every provider can tack on excess charges. Here's how it works:

• Medicare-Participating Providers - Accept Medicare assignment for all patients, cannot bill excess charges.
• ​Non-Participating Providers - Accept Medicare patients but not assignment for eery service. They can bill up to 15% more than the Medicare-approved amount.
• Opt-Out Providers - Do not accept Medicare at all. You pay the full cost (this is separate from excess charges).

Most doctors in the U.S. are participating providers, meaning they accept assignment and don't bill excess charges. Still, it's smart to check before scheduling care.

State Exceptions: When excess Charges Are Not Allowed

Some states have special laws that protect beneficiaries from Part B Excess Charges. These states ban or restrict them:
Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, Vermont.
If you live in these states, you don't need to worry about excess charges. In other states, the 15% rule applies.

How Medicare Supplement (Medigap Plans) Help

Excess charges are one reason some people chooses specific Medicare Supplement (Medigap) plans. Plan F covers all Medicare cost-sharing, including excess charges. (Only available if you were eligible for Medicare before January 1, 2020).  Plan G covers everything plan F does except the Part B deductible, and it also covers excess charges. Most other Medigap plans do not cover excess charges. That means if avoiding excess charges is important to you, Plan G may be your best option.

Medicare Advantage Plans and Excess Charges

If you're on a Medicare Advantage (Part C) plan, excess charges generally do not apply. That's because you're using the plan's provider network, not Original Medicare's. Instead, your costs are determined by your plan's copayments and coinsurance. However, you must stay in-network for most services (except emergencies).
 
Are Excess Charges Common?

You might be wondering how often this actually happens. The truth is Part B Excess Charges are relatively rare. Most providers accept Medicare assignment  because it's easier for billing and guarantees payment. Still, the risk isn't zero. Excess charges tend to show up more often with certain specialists (like psychiatrists or dermatologists), providers in high-cost urban areas, and out-of-network providers if you have Medicare Advantage (though technically this isn't an "excess charge").

💡 Quick Tips: Medicare Part B Excess Charges

• Check Before You Go – Always ask if your provider accepts Medicare assignment.
• Consider Plan G – Covers all excess charges, giving you peace of mind.
• ​Remember It’s Rare – Most providers accept Medicare assignment, but it pays to know the rules.

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Final Thoughts

Part B Excess Charges aren't something most Medicare beneficiaries deal with often, but when they do appear, the costs can add up.
The best protection is knowledge. Check your providers, understand your Medigap options, and make sure you are not caught off guard.

At Prairie Grove Insurance, we help Wisconsin residents understand Medicare rules, compare plans, and choose coverage that fits their health and budget. Whether you’re considering a Supplement plan like Plan G or looking at Medicare Advantage, we’re here to help you make the best decision for your needs.
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To Get Help Now, Call Our Office!

​Rob and Carrie Davies
Prairie Grove Insurance
800-254-5200
​608-839-0275