What Are Medicare Part B Excess Charges?
If you see a health care provider who doesn't use Medicare's set prices, you could be on the hook for excess charges.
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Contributing Writer Medicare Part B excess charges are extra fees charged above the Medicare-approved amount. Most health care providers charge Medicare's set rates. But nonparticipating providers can charge up to 15% more.
While rare, these charges can be steep, and they aren't covered by Medicare. You can avoid these costs by seeing participating providers or enrolling in Medigap Plan G.
What is Medicare assignment?
The most affordable Medicare services generally come from providers who accept assignment. These "participating providers" agree to accept the Medicare-approved amount as full payment . They must agree in writing.
If you see a participating provider, you don't have to worry about submitting a claim to Medicare. The provider will submit your claim. Usually, you don't have to pay anything until Medicare pays the provider. You only owe your Medicare deductible and coinsurance for covered services.
Nonparticipating providers
Excess charges can happen when you see a nonparticipating provider. These are providers who accept Medicare patients but don't accept assignment.
Nonparticipating providers may accept assignment on a case-by-case basis. They may charge the Medicare-approved amount for certain services but not for others. There are usually limits on how much extra they can charge.
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How high can excess charges get?
Often, nonparticipating providers can't charge more than 15% above the Medicare-approved amount . This "limiting charge" only applies to certain covered services and supplies.
There’s no limit on how much nonparticipating suppliers can charge you for durable medical equipment . Before receiving durable medical equipment, make sure your supplier accepts assignment.
When you use nonparticipating providers:
- You may have to pay the whole charge upfront. You’ll get reimbursed after Medicare pays your provider.
- They can charge you more than Medicare’s set price. You don’t get reimbursed for this extra charge.
- Your provider should submit your claim to Medicare. They aren't allowed to charge you for this.
How common are excess charges?
Most Medicare visits won't cost you extra. About 99% of doctors for adults accept Medicare, according to KFF, a health policy nonprofit . And 98% of these doctors are participating providers .
Still, a small number of providers don’t accept assignment, and extra charges can add up. Before you book a visit or order supplies, always ask your provider if they accept assignment.
Are excess charges allowed in all states?
Most states allow excess charges, but some have laws to protect you. Here are a few:
- Connecticut: Most people here can be billed for excess charges. However, if you're in the Qualified Medicare Beneficiary (QMB) program, doctors can't charge you these fees.
- New York: State law places stricter limits on excess charges than federal. Doctors can only charge up to 5% over the Medicare-approved price for most care.
- Massachusetts: Doctors who take Medicare can't bill you for excess charges in Massachusetts.
- Minnesota: Doctors can't bill Minnesota residents for excess charges on most services. Ambulance services and medical equipment are exceptions.
- Ohio: Excess charges are considered balance billing, which is illegal in Ohio.
To find out if your state has similar rules, reach out to your local department of aging.
Does Medigap cover excess charges?
Only two Medicare Supplement Insurance, or Medigap, plans cover Part B excess charges:
- Medigap Plan F: This plan type is only available to those eligible for Medicare before Jan. 1, 2020.
- Medigap Plan G: This plan type is available to new Medicare beneficiaries. It’s almost identical to Plan F, except it doesn’t cover the Part B deductible.
How can I avoid excess charges?
To avoid excess charges, only use doctors and suppliers who accept Medicare assignment. You can also buy a Medigap plan that covers Part B excess charges.
If you have additional questions about Medicare, visit Medicare.gov or call 800-MEDICARE (800-633-4227, TTY 877-486-2048).
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- 1. Centers for Medicare & Medicaid Services. Does your provider accept Medicare as full payment?. Accessed Mar 16, 2026.
- 2. Centers for Medicare & Medicaid Services. Durable medical equipment (DME) coverage. Accessed Mar 16, 2026.
- 3. KFF. How Many Physicians Have Opted Out of the Medicare Program?. Accessed Mar 16, 2026.
- 4. Centers for Medicare & Medicaid Services. Annual Medicare Participation Announcement. Accessed Mar 16, 2026.
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| Insurance company | NerdWallet rating | Plan types offered | NAIC complaint rate | Premium discounts available |
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| A, C, D, F, G and N | Far fewer than expected | Below average | ||
| A, B, C, F, G, K, L and N | Far fewer than expected | Above average | ||
| A, F, G and N | Far more than expected | Above average | ||
| A, F, G and N | Far fewer than expected | Above average |
