If you’re comparing Medicare coverage options—especially when deciding between Medicare Supplement (Medigap) plans like Plan G and Plan N—you’ve likely heard the term Part B excess charges. It sounds like an unpredictable extra cost that may or may not show up without notice.
While excess charges are real, they are not that common and only apply in specific situations. They are also more predictable and avoidable than you think! Understanding how they work can help you make a more educated decision when trying to reduce premium costs between Medicare Supplement plans.
In this article, we breakdown what you need to know about Medicare Part B Excess charges and how to avoid them.
What are Part B Excess Charges?
Medicare Part B covers your outpatient services, including doctor visits, specialists, labs, x-rays, durable medical equipment, etc. For every Part B service, there is a Medicare-approved amount that the provider can charge. This is the payment amount that Original Medicare sets for a covered service or item. It is usually less than the providers’ normal set rates. It is similar to when you have a group plan that has negotiated rates with the providers. When a doctor accepts Medicare assignment, it means they agree to accept the Medicare-approved amount as full payment for covered services.
However, doctors can take Medicare without accepting assignment. A doctor who takes Medicare but doesn’t accept assignment can still treat Medicare patients but they don’t always accept the Medicare-approved amount as payment in full. In this case, Medicare allows them to charge an excess charge of up to 15% more than the Medicare-approved amount. However, they cannot charge more than this 15%!
Example of Medicare Part B Excess Charge with Original Medicare
For this example, we will assume you only have Original Medicare. You visit a doctor that takes Medicare but doesn’t accept assignment. If the Medicare-approved amount for this office visit is $100, then the provider can charge $115. This is $100 plus an excess charge of $15. If you have already met your Part B deductible, then you pay 20% plus $15, so $35 total. If the doctor accepted assignment, then you would only pay $20 in this scenario.
IMPORTANT NOTE: Excess charges are only for Part B! They are not applicable for Part A, which covers in-patient hospital, Skilled Nursing Facilities, and Hospice.
How common are Part B Excess Charges?
You can take some relief from knowing that excess charges are not very common at all. Most Part B healthcare providers in the United States accept Medicare assignment, so the chances of getting hit with an extra charge is very low. How low? Per the Medicare Payment Advisory Commission’s (MedPAC) 2026 report, “98% of clinicians billing Medicare were participating providers, meaning they agreed to accept Medicare’s fee schedule amount as payment in full.” Very few providers do not accept the Medicare assignment.
Also, you may not be paying these excess charges regardless depending on your other coverage options.
How do Medicare Supplements handle excess charges?
Medicare Supplement (Medigap) plans are designed to fill in the “gaps” in Original Medicare. This means they help pay your portion of your Medicare costs, depending on the plan level. But not all Medigap plans cover excess charges. Medigap Plan G and Plan F provide full coverage for Part B excess charges. If you have one of these plans, you will not pay anything extra, even if your provider charges above the Medicare-approved amount. The plan will pay these charges if you’ve met your deductible. However, you will pay a higher premium for these plans. So there is a tradeoff.
With rapidly increasing Medigap premiums, many people are looking at more affordable Medigap plans, such as Plan N. Medigap Plan N has lower premiums but with the potential for excess fees. If you go to a provider that charges the extra 15%, you will be responsible for these payments. However, the premium savings per year may outweigh the small chance of getting an excess charge. If you do choose Plan N, there is a way to ensure you avoid excess fees and save.
How Can I Avoid Excess Charges if my Medigap plan doesn’t cover them?
Remember, excess charges are rare. But if you are not comfortable with the possibility of an extra 15%, no matter how rare, you can proactively avoid them. If you choose Plan N, you can easily check if your doctor accepts assignment before you see them. It is actually very easy! Medicare has an online provider search tool that lets you verify if doctor accepts assignment. It will indicate if the doctor charges the Medicare-approved amount. You can quickly search their provider tool HERE. You can also simply call your doctor and ask. This is a great way to make sure you do not get surprised by any excess charges.
If you live in one of the states below, then Part B charges are not allowed for residents if you get care in your home state. If you get medical care outside of your home state, you can still be charged Part B excess charges.
Here are the 8 states that don’t allow Part B excess charges:
- Connecticut
- Massachusetts
- Minnesota
- New York
- Ohio
- Pennsylvania
- Rhode Island
- Vermont
Does my Medicare Advantage plan cover Part B excess fees?
Another option to avoid Part B excess fees is by enrolling in a Medicare Advantage plan. When you enroll in a Medicare Advantage plan, you simply pay the copays or coinsurance listed in your plan. You will not get hit with any excess charges on top of that. Medicare Advantage is generally a good option for people who want a lower monthly premium and need extra benefits, such as dental, vision, hearing aids, fitness memberships, etc. If you have a Medicare Advantage plan, you will search the plan’s provider network and not the Medicare provider search tool.
Conclusion about Part B excess charges
The possibility of Medicare Part B excess charges can sound alarming. While they are a possibility, they only apply in specific situations and are rarely encountered by most beneficiaries. They are also avoidable if you pick a plan that covers them, or you are proactive and verify doctors accept Medicare assignment. If you need help review your plan options, consider reaching out to one of our local licensed agents. We can help you compare plans and find ways to save!
