medicare part b excess charges

Medicare Part B excess charges are extra amounts (up to 15% above the Medicare‑approved amount) that some doctors or suppliers can bill you if they do not accept Medicare “assignment.”

What Medicare Part B Excess Charges Are

• An excess charge is the difference between what a provider chooses to charge and the Medicare‑approved amount for a Part B service, up to a legal limit of 15% in most states.

• These charges apply only when you see a “non‑participating” provider who does not agree to accept Medicare’s approved amount as full payment (does not accept assignment).

How the 15% Rule Works (Simple Example)

• Medicare sets an approved amount for each service; for a non‑participating provider, the “limiting charge” is generally 15% above that approved amount.

• After you meet your 2026 Part B deductible (283 dollars), Medicare usually pays 80% of the approved amount and you are responsible for the 20% coinsurance plus any excess charge up to that 15% limit.

Mini scenario

• Suppose the Medicare‑approved amount for a visit is 100 dollars and the provider does not accept assignment; the provider can bill up to 115 dollars, and you can be billed the normal 20% coinsurance plus the 15% excess portion.

• These excess amounts do not reduce your deductible and are separate from any Part B income‑related surcharges you might pay on your premium.

States That Restrict or Ban Excess Charges

• Several states either ban Part B excess charges or restrict the allowed percentage, sometimes below 15%; examples include Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont.

• New York, for instance, limits what would otherwise be a 15% excess to about 5%, while some other listed states prohibit excess charges outright when both you and your provider are in that state.

How to Avoid or Reduce Excess Charges

• Choose providers who accept Medicare assignment; they agree to take the Medicare‑approved amount as full payment, so they cannot bill any Part B excess charges at all.

• Before scheduling care, you can ask the office directly, “Do you accept Medicare assignment?” or use Medicare’s provider search tool to check participating status.

Role of Medigap (Supplement) Plans

• Standardized Medigap Plans F and G are designed to cover Medicare Part B excess charges, in addition to covering your normal 20% coinsurance, so people with those plans typically do not pay excess charges out of pocket.

• Plan F is closed to people who became newly eligible for Medicare after 2020, but Plan G remains widely available and is commonly recommended for those concerned about excess charges today.

Why This Is a Trending Topic Now

• In 2026, the Part B deductible and premiums have risen again, so any extra out‑of‑pocket costs like excess charges feel more painful to people on fixed retirement incomes.

• At the same time, more online forum discussions focus on surprise bills from specialists who do not accept assignment, which has pushed “Medicare Part B excess charges” into the spotlight as people share strategies for avoiding them.

Information gathered from public forums or data available on the internet and portrayed here.