Frequently Asked Questions
What are Medicare Part B excess charges?
Part B excess charges are additional amounts that non-participating Medicare providers can charge above the Medicare-approved rate. When a doctor 'accepts assignment,' they agree to Medicare's approved rate as payment in full. When they don't, they can charge up to 15% more than the Medicare rate. Example: if Medicare approves $200 for a service, a non-participating doctor could charge up to $230. Medicare still pays its 80% of the approved $200, leaving you responsible for the 20% coinsurance plus the $30 excess charge.
Do most doctors charge excess charges?
No — approximately 97% of Medicare providers accept Medicare assignment and cannot charge excess charges. However, certain specialties are more likely to have non-participating providers: some psychiatrists, certain surgical specialists, and some concierge or direct-pay practices. In most routine situations with primary care and common specialists, you won't encounter excess charges.
Which Medigap plans cover excess charges?
Medigap Plan G and Plan F cover 100% of Medicare Part B excess charges — meaning you pay $0 in excess charges regardless of what the doctor bills. Plans C and F also covered this (Plan F is no longer available to new enrollees after 2020, but existing Plan F holders retain coverage). Medigap Plans A, B, D, K, L, M, and N do NOT cover excess charges — you pay the excess out of pocket.
How do I know if my doctor accepts Medicare assignment?
Ask the doctor's office directly: 'Do you accept Medicare assignment?' This is the clearest approach. You can also search Medicare's physician directory at medicare.gov to see a provider's participation status. Always verify before your appointment, especially when seeing a specialist for the first time.
Are excess charges capped?
Yes — the limiting charge law caps excess charges at a maximum of 15% above the Medicare-approved rate. Providers cannot charge more than this. Some states have additional protections — Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, Connecticut, and Vermont prohibit excess charges entirely for state residents.
Part B excess charges are one of the least-known Medicare cost risks — and knowing about them influences both your Medigap plan choice and how you verify your providers' participation status. While the vast majority of Medicare providers accept assignment, those who don't can legally bill you up to 15% above what Medicare approves.
How Excess Charges Work
Every Medicare Part B service has a Medicare-approved amount — the maximum Medicare considers appropriate for that service in your area. Providers who accept Medicare assignment agree to this amount as payment in full. Non-participating providers can bill up to 115% of the Medicare rate — the additional 15% is the excess charge.
Example: Specialist Visit
Medigap Protection Against Excess Charges
Medigap Plan G covers 100% of excess charges — this is one of Plan G's key benefits. With Plan G, your total out-of-pocket in the example above is $0 (after meeting the $283 annual deductible). Plan F also covered excess charges but is no longer available to new enrollees after 2020. Plans A, B, D, K, L, M, N do NOT cover excess charges.
This distinction matters when choosing between Medigap plans. If you live in an area with many non-participating providers or if you frequently see specialist physicians, excess charge protection is meaningful coverage.
States That Ban Excess Charges
Eight states prohibit Medicare excess charges entirely — residents of these states pay no excess charges regardless of their Medigap plan:
- Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, Vermont
If you live in one of these states, excess charge coverage is less important as a Medigap selection factor.
How to Verify Before Your Appointment
- Call the provider's office and ask: "Do you accept Medicare assignment?"
- A "yes" means you won't face excess charges
- A "no" or "non-participating" means you may owe up to 15% extra beyond your coinsurance
- For elective procedures, ask for the estimated charge in writing before the appointment
- Ask every new provider: "Do you accept Medicare assignment?" before your first appointment
- If your Medigap plan is not Plan G or F, excess charges are your out-of-pocket responsibility
- Residents of 8 states (CT, MA, MN, NY, OH, PA, RI, VT) are protected by state law — no excess charges
- For high-cost procedures, request cost estimates in writing from non-participating providers
→ Medigap Plan G — Full Coverage Details
→ 10 Ways to Lower Medicare Costs
→ Part B Costs 2026 — Complete Breakdown