What it is
A Part B excess charge is the difference between what Medicare approves for a service and what a provider is allowed to bill. It can happen when a provider does not accept assignment. Accepting assignment means agreeing to take the Medicare-approved amount as full payment.
Providers who take Medicare but do not accept assignment are sometimes called non-participating. They may charge up to a limit set by federal rules. You may be asked to pay that extra amount on top of your usual Part B cost-sharing.
Many providers accept assignment, so excess charges do not come up for everyone. They are also tied to Original Medicare. Rules can also differ by state, and a few states restrict or prohibit them. Confirm current details with Medicare.gov, your State Health Insurance Assistance Program (SHIP), or a licensed agent.
How it’s traditionally been approached
People have often handled excess charges by asking a provider up front whether they accept assignment. If the answer is yes, excess charges generally do not apply. Some people choose providers with that in mind.
Others look at Medigap. Certain standardized Medigap plans cover Part B excess charges, while other plans do not. Plan G is one that people commonly ask about. Plans C and F are available only to people who became eligible for Medicare before January 1, 2020.
Medicare Advantage works differently. It has its own network rules and cost-sharing, and excess charges are handled under the plan's terms. Each approach has trade-offs. Medigap offers any provider nationwide that accepts Medicare, but it generally has higher monthly premiums and a separate Part D plan for drugs. Medicare Advantage often has lower premiums and an annual out-of-pocket maximum, but it may have networks, prior authorization and copays.
How the right licensed agent may help
A Medigap agent may help you see how different plan letters treat Part B excess charges. Plans A, B, D, G, K, L, M and N, and high-deductible Plan G, are sold to people newly eligible for Medicare. Plans E, H, I and J were discontinued and are not sold today. An agent may also explain how Massachusetts, Minnesota and Wisconsin standardize Medigap differently.
A visit or call is usually a relaxed conversation. An agent may ask which doctors you see, how you use care, and what matters to you. They may also explain enrollment timing, including open enrollment and guaranteed issue rights, which vary by state.
Good questions to ask include: Does this plan cover Part B excess charges? Is medical underwriting possible for me? How would I add drug coverage? Does my state limit excess charges? Call 1-800-MEDIGAP for more information.
The bigger picture
Unexpected bills can cause stress, and that stress can affect sleep, mood and how willing you are to seek care. Knowing how excess charges work may help you feel steadier about choosing doctors and planning your budget.
Peace of mind looks different for everyone. Some people value predictability, and others value lower premiums. Neither choice is wrong. If you also want help finding care providers, Providers.plus may be a useful place to look.
Keep in mind
- 1-800-MEDIGAP is an independent educational directory, not Medicare, and it is not endorsed by the U.S. government. Official information is at Medicare.gov.
- Excess charges apply only to certain providers and services, and not every Medigap plan covers them.
- Rules on excess charges, open enrollment and guaranteed issue vary by state and change over time, so confirm them before you decide.
- This page is education only. It is not insurance, legal, tax or medical advice, and no plan is guaranteed to fit you.
Take the next step
- Talk with a Medigap agent ↗Jeff Cline on contacts.plus — a person, not a call center.
Not sure where to start? Answer a few gentle questions and choose who you’d like to hear from.
Call 1-800-MEDIGAP for more information
Frequently asked questions
What are Medicare Part B excess charges?
Medicare Part B excess charges are the extra amount a provider who does not accept assignment may bill above the Medicare-approved amount. They are limited by federal rules. They do not apply when a provider accepts assignment.
How can I avoid Part B excess charges?
Ask your provider before a visit whether they accept Medicare assignment. If they do, excess charges generally do not apply. Some Medigap plans may also cover them.
Does Medigap Plan G cover Part B excess charges?
Yes, Medigap Plan G is one of the standardized plans that covers Part B excess charges. High-deductible Plan G works the same way once its deductible is met. Plans A, B, D, M and N do not cover them, so compare plan letters carefully.
Do Medicare Advantage plans have excess charges?
Excess charges are tied to Original Medicare. Medicare Advantage plans have their own rules, networks and cost-sharing instead. Check your plan's materials or ask a licensed agent how a specific plan handles this.
Can I still buy Plan F to cover excess charges?
Only if you became eligible for Medicare before January 1, 2020. Plans C and F, and high-deductible F, are not sold to people newly eligible. Newly eligible people may look at Plan G instead.
Do all states allow Part B excess charges?
No. Some states limit or prohibit them, and rules can change. Confirm current rules with Medicare.gov, your State Health Insurance Assistance Program (SHIP), or a licensed agent. Call 1-800-MEDIGAP for more information.
Educational resource. 1-800-MEDIGAP shares general information and connects people with independent licensed agents. It is not professional advice. Talk with a qualified professional about your own situation.