The Truth About Medicare Part B Excess Charges

In this post I will explain why you shouldn’t worry about Medicare Part B excess charges when shopping for a Medicare Supplement.  An Excess Charge is defined as the difference between Medicare’s approved billing amount for a service and what your doctor actually charges. Currently, the very popular Medigap Plan G and Medigap Plan F are the only plans that cover excess charges when a doctor bills you above the Medicare allowable.

Doctors who accept Medicare Assignment are called participating.

A participating doctor has a signed agreement with Medicare to accept their approved amount for services. This approved amount is known as the Medicare allowable. Participating physicians can not bill you above the Medicare allowable.

Non-participating doctors have different agreements with Medicare.

At their discretion, on a case-by-case basis, they can bill you above the Medicare allowable. This amount is called an excess charge. There are rules regarding how much above the allowable non-participating doctors can charge you. In fact, in some states, billing for any excess charges is illegal. In the remaining states, the limit is 9.25% (based on a 15% legal limit applied to Medicare’s reduced allowable of 5% to non-participating providers).