What are Medicare Part B excess charges?

Medicare Part B, also known as medical insurance, is the second part of Original Medicare. (Part A is the other.) Part B offers coverage for doctor visits and outpatient care. Some examples of what Part B covers include: 

• Medically necessary doctor services
  
• Outpatient care (even if received in a hospital)
• Chiropractic care, if medically necessary
• Home health services  
• Mental health services  
• Ambulance services 

There’s no set price for Part B excess charges. The cost will depend on the service you receive and how much your doctor charges you. However, you can only be charged up to 15% of the Medicare-approved amount for a service.¹

For example—Let’s say you get a service that Medicare pays $500 to perform. If your doctor doesn’t accept Medicare assignment and bills you the full 15%, your excess charge will be $75. 

Here are the 8 states that don’t allow Part B excess charges:

• Connecticut
• Massachusetts
• Minnesota
• New York
• Ohio
• Pennsylvania
• Rhode Island
• Vermont

If you live in 1 of these states, you’re protected from excess charges if you get medical care in your home state. If you get medical care outside of your home state, you can still be charged Part B excess charges. 

Yes, in some cases. As with any Medicare billing appeal, be sure to have all your documentation ready. This includes the excess charge, the Medicare-approved amount and the code for the service you received. Then, contact your Medicare carrier to file an appeal. 

A Medicare Supplement Insurance plan, also known as Medigap, can help pay out-of-pocket costs that Original Medicare doesn’t cover. There are 2 Medigap plans that cover Part B excess charges—Plan F and Plan G. Plan F is only available to Medicare beneficiaries who were eligible for Medicare before Jan. 1, 2020.

The best way to avoid Part B excess charges is to only get care from Medicare-approved providers who accept assignment. Ask if they accept assignment before scheduling your service to be 100% sure.

Overall, Part B excess charges aren’t common and can be avoided. To learn more about deductibles, premiums and common out-of-pocket costs, check out these articles on Medicare costs.