Excess Charges

by David Bynon, last updated

What are Medicare Part B Excess Charges?

A Medicare Part B excess charge is the difference between a healthcare provider’s actual charge and Medicare’s approved amount for payment. Medicare allows providers who do not accept assignment to charge up to 15% more than Medicare’s approved rates.

Most healthcare providers participate in the Medicare program in one form or another. Only a small percentage don’t. But, not all providers participate in the same way, which often leads to excess charges.

Medicare Part B is the portion of

Medicare has a fee schedule agreement for doctors called Medicare assignment. When a doctor accepts Medicare assignment it simply means they agree to Medicare’s payment terms for services provided.

Medicare assignment has several categories:

  1. Participating Doctors — The doctor accepts Medicare and only charges up to the amount that Medicare allows.
  2. Non-Participating Doctors — The doctor takes Medicare but can choose to charge an excess charge (up to 15%).
  3. Doctors Opted Out — These doctors do not accept Medicare and you pay 100% if you use their services.

There is also a tool that Medicare beneficiaries can use called Medicare Assignment of Benefits.  This allows a beneficiary to authorize Medicare to reimburse a provider directly.

Non-participating providers can charge up to 15-percent more for their services than participating providers. The additional amount that Medicare allows non-participating providers to charge is a Medicare Part B Excess Charge, and it is the beneficiary’s responsibility to pay.

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