Medicare Part B And Excess Charges: What To Know And Avoiding Them
Maybe your like
- Health Conditions
Health Conditions
- Alzheimer's & Dementia
- Anxiety
- Asthma & Allergies
- Atopic Dermatitis
- Breast Cancer
- Cancer
- Cardiovascular Health
- COVID-19
- Diabetes
- Endometriosis
- Environment & Sustainability
- Exercise & Fitness
- Eye Health
- Headache & Migraine
- Health Equity
- HIV & AIDS
- Human Biology
- Leukemia
- LGBTQIA+
- Men's Health
- Mental Health
- Multiple Sclerosis (MS)
- Nutrition
- Parkinson's Disease
- Psoriasis
- Sexual Health
- Ulcerative Colitis
- Women's Health
- Health Products
Health Products
All- Nutrition & Fitness
- Vitamins & Supplements
- CBD
- Sleep
- Mental Health
- At-Home Testing
- Men’s Health
- Women’s Health
- Discover
News
- Latest News
- Medicare 2026 Costs
Original Series
- Medical Myths
- Honest Nutrition
- Through My Eyes
- New Normal Health
Podcasts
All- Artificial sweeteners and brain aging: What we know so far
- Does the Mediterranean diet hold the key to longevity?
- AMA: Registered dietitian answers 5 key questions about fiber and weight loss
- Health misinformation and disinformation: How to avoid it
- Brain health, sleep, diet: 3 health resolutions for 2025
- 5 things everyone should know about menopause
- Tools
General Health
- Drugs A-Z
- Health Hubs
- Newsletter
- Medicare Plans by State
Health Tools
- Find a Doctor
- BMI Calculators and Charts
- Blood Pressure Chart: Ranges and Guide
- Breast Cancer: Self-Examination Guide
- Sleep Calculator
Quizzes
- RA Myths vs Facts
- Type 2 Diabetes: Managing Blood Sugar
- Ankylosing Spondylitis Pain: Fact or Fiction
- Connect
About Medical News Today
- Who We Are
- Our Editorial Process
- Content Integrity
- Conscious Language
Find Community
- Bezzy Breast Cancer
- Bezzy MS
- Bezzy Migraine
- Bezzy Psoriasis
Follow Us
- Parts
- Coverage
- Costs
- Eligibility
- Enrollment Periods
- Disability and Benefits
- Financial Assistance
- Caregiver Guide
- State Guide
Related Topics
Parts
PartsRelated Articles
- Parts Overview
- Part A
- Part B
- Part C
- Part D
- Medigap
- SNPs
- C-SNPs
- D-SNPs
- I-SNPs
Coverage
CoverageRelated Articles
- Coverage Overview
- Part A Coverage
- Part B Coverage
- Part C Coverage
- Part D Coverage
- Drug Coverage
Costs
CostsRelated Articles
- Costs Overview
- Part A Cost
- Part B Cost
- Part C Cost
- Part D Cost
- Copay
- Reimbursement
Eligibility
EligibilityRelated Articles
- Eligibility Overview
- Medicare Checklist
- Eligibility Age
- Part A Eligibility
- Part B Eligibility
- Part C Eligibility
- Part D Eligibility
- Spouse Coverage
- Dual Eligibility
- Not Eligible
Enrollment Periods
Enrollment PeriodsRelated Articles
- Enrollment Overview
- Medicare Advantage Open Enrollment Period
- Special Enrollment Period
- Application Status
- Deferring Enrollment
- Medigap Open Enrollment Period
- Enroll Now
Disability and Benefits
Disability and BenefitsRelated Articles
- Disability Overview
- Eligibility Before 65
- Disability Coverage
- Age Disability Benefits
Financial Assistance
Financial AssistanceRelated Articles
- Assistance Program Overview
- Extra Help Program
- QDWI Program
- QI Program
- QMB Program
- SLMB Program
Caregiver Guide
Caregiver GuideRelated Articles
- Caregiver Overview
- Caregiver Requirements
- Choosing a Plan
- Enrolling Your Parents
- Getting Medical Records
State Guide
State GuideRelated Articles
- State Overview
- Travel Coverage
- Moving States
- California
- Florida
- Maryland
- New Jersey
- Arizona
- New York
- North Carolina
- Texas
Medically reviewed by Alisha D. Sellers, BS Pharmacy, PharmD — Written by Sherri Ledbetter — Updated on September 26, 2024- About Part B
- About Medigap
- Medigap eligibility
- Medigap options
- Medigap plans F and G
- Summary
Medicare Part B excess charges are any costs higher than those approved by Medicare. A person is usually required to settle these costs themselves, but help may be available.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Medicare Part B provides coverage for outpatient services, such as visits to a doctor’s office or appointments with a specialist.
Medicare has set amounts that it will pay for specific treatments and services. If a healthcare professional charges more than the Medicare-approved amount, the patient is required to pay the difference out of pocket.
The difference between the higher cost the provider charges for a service and the Medicare-approved amount is known as an excess charge.
Help is available to cover out-of-pocket expenses, and sometimes this includes Part B excess charges.
This article looks at Medicare Part B excess charges and the additional help that may be available.
Glossary of Medicare terms
- Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money someone pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
What are Medicare Part B excess charges?
Share on PinterestMedicare Part B provides medical coverage for non-hospital visits such as to a primary care physician, a specialist, or another healthcare professional.
Medicare has a pre-approved amount that it will pay a healthcare professional for eligible treatment and services.
Providers can bill the Medicare-approved amount only for services that they accept assignment for. However, they are allowed to charge up to 15% more than the Medicare-approved amount for other services. This limit cap is known as the limiting charge.
Providers that do not fully participate only receive 95% of the Medicare-approved amount when Medicare reimburses them for the cost of care.
In turn, the provider can charge the patient up to 15% more than this reimbursement amount. Medicare will not cover this extra charge, which causes Medicare recipients to incur greater out-of-pocket costs.
Excess charges must be paid by an individual, and these costs do not usually count toward an annual deductible.
The list below is a summary of Part B covered services:
- Healthcare provider services: health services a person receives from a licensed medical professional
- Durable medical equipment (DME): the purchase or rental of DME, such as a wheelchair or walker, from a Medicare-approved supplier — a doctor must confirm that the item is medically necessary
- Home health services: skilled nursing or therapy care if a person is unable to leave home
- Ambulance services: emergency transportation, usually to and from a hospital
- Non-emergency ambulance: transportation when no safe alternative is available for medically necessary treatment or services
- Preventive services: screenings and counseling intended to maintain health, prevent illness, and detect health conditions
- Therapy services: outpatient services, including speech, physical, and occupational therapy provided by a Medicare-approved therapist
- Mental health services: group and family therapies, activity therapies, substance use disorder therapy, and some medications that must be administered by a doctor
- Limited prescription drugs: immunosuppressants, cancer drugs, antiemetic drugs, dialysis drugs, and medications from a physician
Diagnostic tests and limited chiropractic care are also usually available with Part B coverage.
What is Medigap?
Private insurance companies offer Medigap plans, also known as Medicare supplement insurance. Medigap plans aim to fill some of the gaps left by Original Medicare’s out-of-pocket expenses.
Some plans even offer additional benefits, including emergency care provided outside the United States and excess charges.
Medigap eligibility
To be eligible for a Medigap plan, a person must have Original Medicare parts A and B.
A separate monthly premium is payable to the private insurance company selling the Medigap plan.
If a person has Medicare Advantage (Medicare Part C), they cannot legally buy Medigap insurance.
Other Medigap eligibility requirements may apply, depending on the state in which an individual resides.
Medigap options
Each Medigap policy offers different benefits and levels of coverage.
Monthly premiums may vary depending on:
- the private insurance provider
- the state in which a person lives
- when an individual becomes eligible for Medicare
With these considerations in mind, a person may have up to 10 different Medigap policies to compare, including plans A, B, C, D, F, G, K, L, M, and N.
It is important to note that Medigap policies in the states of Massachusetts, Minnesota, and Wisconsin may differ from those available in other states and may also be subject to different rules.
Medigap plans F and G
Medigap plans F and G may cover Part B excess charges. High deductible versions of both of these plans are available in some states.
However, as of January 1, 2020, Plan F is not available to those newly eligible for Medicare. Medigap policies that provided coverage for the Part B deductible are also no longer available for new enrollees as of January 1, 2020.
If a person needs help choosing a Medigap policy, they can contact their State Health Insurance Assistance Program (SHIP).
For more information on state Medigap policies, an individual can contact the State Department of Insurance.
Summary
Excess charges are treatment or service costs that exceed Medicare-approved amounts.
Some Medigap policies cover Medicare Part B excess charges, and a person can compare plans to choose the most suitable coverage for their needs.
Private insurance companies offer Medigap policies, and, as such, benefits may vary. There may also be different benefits and rules according to the state in which a person lives.
The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.
- Health Insurance / Medical Insurance
- Medicare / Medicaid / SCHIP
How we reviewed this article:
SourcesMedical News Today has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.- Does your provider accept Medicare as full payment? (n.d.). https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare
- How to compare Medigap policies. (n.d.). https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies#
- Local Medicare help. (n.d.). https://www.shiptacenter.org/
- Map: States & jurisdictions. (n.d.). http://www.naic.org/state_web_map.htm
- Medicare Advantage & other health plans. (n.d.). https://www.medicare.gov/health-drug-plans/health-plans
- Medicare Part B covered services. (n.d.). https://www.medicareinteractive.org/get-answers/medicare-covered-services/medicare-coverage-overview/summary-of-part-b-covered-services
- Medigap in Massachusets. (n.d.) https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies/medigap-in-massachusetts
- Medigap in Minnesota. (n.d.). https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies/medigap-in-minnesota
- Medigap in Wisconsin. (n.d.). https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies/medigap-in-wisconsin
- Medigap overview. (n.d.). https://www.medicareinteractive.org/get-answers/medicare-health-coverage-options/supplemental-insurance-for-original-medicare-medigaps/medigap-overview
- What's Medicare supplement insurance (Medigap)? (n.d.). https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap
- What Part B covers. (n.d.)https://www.medicare.gov/what-medicare-covers/what-part-b-covers
Share this article
Medically reviewed by Alisha D. Sellers, BS Pharmacy, PharmD — Written by Sherri Ledbetter — Updated on September 26, 2024Latest news
- Diabetes-fighting gut molecule may help lower insulin resistance
- Polyphenol-rich cocoa, coffee, and berries may help support heart health
- GLP-1s may have little to no impact on breast, thyroid cancer risk, research says
- Cheese was linked to lower dementia risk in a new study but there's a catch
- Lower-calorie diet could help keep the brain young, animal study says
Related Coverage
- Who is eligible for Medicare Part B?Medically reviewed by Jennie Olopaade, PharmD, RPH
A person becomes eligible for Medicare when they turn 65. Eligibility can also occur sooner due to certain medical conditions. Read on for more…
READ MORE - Medicare Plan G: Helping fill the MedigapMedically reviewed by Debra Sullivan, Ph.D., MSN, R.N., CNE, COI
Medicare Plan G supplement insurance helps cover the out-of pocket "gap" that includes Medicare Part A deductible, copayments and coinsurance for…
READ MORE - How does Medigap work?
Medicare helps with healthcare expenses, but there are still out-of-pocket costs to consider. Medigap plans can help cover these costs. Learn more.
READ MORE - Getting to know Medigap Plan A
Medigap Plan A can cover some of Original Medicare's out-of-pocket costs, although it offers the fewest benefits of all current Medigap plans. Read…
READ MORE - Does Medicare cover Taltz?
Medicare may cover Taltz (ixekizumab) from Part B or Part D, depending on where it is administered. Read more.
READ MORE
Tag » What Are Part B Excess Charges
-
Medicare Part B Excess Charges Explained & How You Can Avoid ...
-
What Are Medicare Part B Excess Charges?
-
What Are Medicare Part B Excess Charges? - NerdWallet
-
What Are Medicare Part B Excess Charges? How Can You Avoid ...
-
What Are Medicare Part B Excess Charges - MedicareFAQ
-
What Are Medicare Part B Excess Charges?
-
How To Avoid Medicare Part B Excess Charges
-
Medicare Part B Excess Charges - What Are They?
-
What Are Medicare Part B Excess Charges? - Boomer Benefits
-
[PDF] Part B Excess Charges In Connecticut
-
Medicare Part B Excess Charges: What They Are, How To Avoid ...
-
What Are Medicare Part B Excess Charges? | Considerable
-
Understanding Medicare's Excess Charges
-
What Are Medicare Part B Excess Charges? - GoMedigap