Medicare Part B Excess Charges
Medicare Part B Excess Charges FAQ
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Excess charges occur when a doctor who does not accept Medicare assignment bills up to 15% more than the Medicare-approved amount. This only applies under Original Medicare, not Medicare Advantage plans.
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Only when:
• You are on Original Medicare (with or without a Medigap plan)
• You visit a provider who does not accept assignment (Medicare’s approved rate)
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Doctors can bill up to 15% above Medicare’s approved amount.
Example:
• Medicare approves $200 for a service
• Doctor may bill $230 (if they do not accept assignment)
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Yes — but it depends on your plan:
• Plan G: Pays the full excess charge. You owe $0.
• Plan N: Does not cover excess charges. You pay the extra 15% out-of-pocket if charged.
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They are very rare:
• 97–99% of Medicare doctors accept assignment and do not charge excess fees
• In 2022, 99.7% of Medicare claims were paid at the standard rate (MedPAC, 2024)
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Yes — as of 2025, these states ban excess charges:
• Connecticut
• Massachusetts
• Minnesota
• New York
• Ohio
• Pennsylvania
• Rhode Island
• Vermont
In these states, Plan N functions like Plan G when it comes to excess charges — doctors are not allowed to bill more than the Medicare-approved rate.
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Usually not. But if you live in a state without a ban and want complete protection, Plan G may be safer.
If you want to save on premiums and are okay with minimal risk, Plan N may still be a great choice.
