What Are Medicare Part B Excess Charges?
Medicare Part B excess charges occur when a provider does not accept Medicare assignment and bills up to 15% more than the Medicare-approved amount. While uncommon, these charges can add unexpected costs to your medical bills.
Most providers accept assignment, meaning they take Medicare’s approved amount as full payment. In that case, Medicare pays 80% of the approved cost, and you owe the standard Part B coinsurance (usually 20%).
Example of an Excess Charge
Suppose a covered test has a Medicare-approved cost of $100:
- Provider accepts assignment: Medicare pays $80, you owe $20 coinsurance.
- Provider does not accept assignment: The provider may add up to 15% ($15). Medicare still pays $80, leaving you responsible for $35 out of pocket.
Excess charges do not count toward your annual Part B deductible ($257 in 2025).
Where Are Excess Charges Prohibited?
Eight states ban Part B excess charges:
- Connecticut
- Massachusetts
- Minnesota
- New York
- Ohio
- Pennsylvania
- Rhode Island
- Vermont
If you live in one of these states, providers cannot bill excess charges locally — though charges may still apply if you receive care out of state.
How to Avoid Medicare Excess Charges
- Ask before every visit. Confirm that your provider accepts Medicare assignment. Policies can change, even with familiar doctors.
- Choose a Medigap plan that covers excess charges. Only Plan F and Plan G cover all excess charges. Plan F is closed to new beneficiaries after January 1, 2020, but Plan G remains available to everyone.
Medigap Coverage for Excess Charges
Beneficiaries with Plan F or Plan G will never pay Medicare Part B excess charges, even with a non-participating provider. Other Medigap plans do not offer this protection.
Compare Plans That Cover Excess Charges
Benefits offered by each Medigap plan
Compare the benefits of each lettered plan to help you find one that meets your needs now and in the future. You might not be able to switch Medigap policies later.
✔ = Plan covers 100% ✘ = Plan doesn’t cover % = Amount the plan covers
| Benefits | A | B | C | D | F | G | K | L | M | N |
|---|---|---|---|---|---|---|---|---|---|---|
| Part A coinsurance & hospital costs | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Part B copays/coinsurance | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | 50% | 75% | ✔ | ✔ |
| Blood (first 3 pints) | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | 50% | 75% | ✔ | ✔ |
| Part A hospice | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | 50% | 75% | ✔ | ✔ |
| Skilled nursing facility | ✘ | ✘ | ✔ | ✔ | ✔ | ✔ | 50% | 75% | ✔ | ✔ |
| Part A deductible | ✘ | ✔ | ✔ | ✔ | ✔ | ✔ | 50% | 75% | 50% | ✔ |
| Part B deductible | ✘ | ✘ | ✔ | ✘ | ✔ | ✘ | ✘ | ✘ | ✘ | ✘ |
| Part B excess charges | ✘ | ✘ | ✔ | ✘ | ✔ | ✔ | ✘ | ✘ | ✘ | ✔ |
| Foreign travel emergency | ✘ | ✘ | 80% | 80% | 80% | ✘ | ✘ | ✘ | 80% | 80% |
| $7,220 | $3,610 | |||||||||
Next Steps
Compare Medigap plans, check rates in your area, and decide whether excess charge protection matters for you. Start with Compare Plans and Compare Rates, or explore options by state. For one-on-one help, contact us to speak with a licensed agent.