What Are Medicare Part B Excess Charges?
Short answer
A Part B excess charge is an amount certain nonparticipating Original Medicare providers can legally bill above the Medicare-approved amount when they do not accept assignment, subject to Medicare’s limiting-charge rules and any stronger state protections.
Coverage
Participating providers cannot impose Part B excess charges because they accept assignment. The issue arises with certain enrolled nonparticipating providers.
Not Automatic
Excess charges are not the same as every balance bill, a noncovered-service charge or an opted-out private-contract fee.
Costs And Ma
Some Medigap plans cover legally billed Part B excess charges. State rules can also matter. Medicare Advantage billing follows plan-network rules instead.
Practical Example
A beneficiary seeing a nonparticipating Original Medicare physician may owe a permitted excess amount if assignment is declined and the charge is legal in that state.
Questions to verify
- Does the provider accept assignment?
- Does my state restrict excess charges?
- Does my Medigap policy cover them?