What are Medicare Excess Charges?

Excess charges with Medicare refer to additional fees that healthcare providers may charge beyond the Medicare-approved amount for a particular medical service or procedure.

Medicare Supplement plans; F and G pay for the Excess charges not covered by Medicare.

Under original Medicare, healthcare providers are typically required to accept the Medicare-approved amount as full payment for covered services. However, some healthcare providers may choose to opt-out of this agreement and charge more than the Medicare-approved amount for their services. These additional charges are called excess charges.

Excess charges can occur when you see a healthcare provider who does not accept Medicare assignment, which means they do not agree to accept the Medicare-approved amount as full payment for their services. In these cases, you may be responsible for paying the excess charges out-of-pocket.

Medicare states that if the doctor does not accept assignment the doctor can add 15% to the amount Medicare approves.  However, Medicare reduces the amount they approve by 5% because the doctor does not accept assignment.  Now the doctor can only add the 15% to the reduced amount.

It is important to note that not all healthcare providers are allowed to charge excess charges. Healthcare providers who participate in Medicare and accept assignment are not allowed to charge excess charges. Additionally, some states have laws that restrict or prohibit excess charges.

John Conner

Medicare Plan Options ... Medicare Supplement, Medicare Advantage, Medicare Part D Rx