Medigap Monday: What are Medicare Part B excess charges?

If you are enrolled in Medicare, you may be familiar with Medicare Part B Excess Charges. Some doctors accept what is called the “assigned” rate for their work. Others charge a higher rate, but they cannot charge more than 15 percent more than the assigned rate.

For example, Medicare might decide that the fair “assigned” rate for a specific procedure should be $400. A doctor who accepts the Medicare assignment would bill at or below that rate.

However, your doctor may decide that $400 is not a sufficient reimbursement. Doctors are allowed to charge up to an additional 15% over and above what Medicare has approved. Therefore, in this case, your doctor could charge you $460 and you would be responsible for paying the additional $60 “excess” charge out-of-pocket ($400 X 15% = $60 excess charge) in addition to any deductible and co-pay.

Here are two ways to avoid Part B excess charges:

  1. Use doctors who accept Medicare Assignment. There is a database maintained at Medicare.gov that attempts to keep track of all doctors who accept Medicare and tells if they accept the assigned rate. You should always confirm with your doctor’s office if they accept the Medicare assignment or if they charge excess charges, just to be sure.
  1. Buy a Medicare Supplement policy that pays for excess Part B charges. Medicare Supplements Plan F and Plan G are the only Medicare Supplements that provide coverage for excess charges. Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island and Vermont do NOT allow Part B excess charges.