What is an excess charge?

Medicare offers what is probably the largest network of doctors and hospitals in the nation. Most physicians are participating doctors who have agreed to “accept Medicare assignment” rates, which essentially just means that they agree to whatever Medicare’s schedule allows for payment of their services, and won’t charge any more than that.

Some doctors, however, are nonparticipating doctors, and these physicians have the right to charge 15% above and beyond the ordinary cost of medical services as outlined in Medicare’s payment value scale. This upcharge is commonly called an “excess charge.” Under Medicare Part B, beneficiaries are generally only responsible for 20% of charges after their annual Part B deductible has been met. However, if a doctor charges an excess charge, then in that circumstance the beneficiary is responsible for 35% of the Medicare-approved rate.

If this concerns you, then you might want to consider Medigap Plan F or Plan G, as these Medicare supplements cover any excess charges that may occur. You can also search the Medicare Provider Directory to find out whether your physician is a participating provider. Our agency can also give you tips on how to verify which Medicare plans your important physicians might be accepting.