Medicare Part B Excess Charges Explained: What They Are and How to Avoid Them

If you have Original Medicare, there's a little-known cost that can catch you off guard: Medicare Part B excess charges. While most Medicare beneficiaries never encounter them, those who do can face bills significantly higher than expected.

Here's a complete explanation of what excess charges are, when they apply, and -- most importantly -- how to protect yourself.

Medicare sets an "approved amount" for every covered service -- the maximum it will pay for a procedure, office visit, or test. When a provider accepts Medicare assignment, they agree to accept this approved amount as payment in full (minus your 20% coinsurance).

Excess charges occur when a provider does NOT accept Medicare assignment and charges more than the Medicare-approved amount. Federal law allows non-participating providers to charge up to 15% above the Medicare-approved amount.

Say Medicare's approved amount for a specialist visit is $200.

• Participating provider (accepts assignment): Bills $200. Medicare pays $160, you pay $40 (20%).
• Non-participating provider (doesn't accept assignment): Can bill up to $230 ($200 × 1.15). Medicare still pays based on $200, so you pay $40 + $30 excess = $70 total.

That 15% excess charge is entirely your responsibility -- unless you have a Medigap plan that covers it.

The good news: the vast majority of Florida doctors and providers do accept Medicare assignment. According to CMS data, over 95% of Medicare-participating providers accept assignment.

However, certain specialties have higher rates of non-participating providers:

• Psychiatrists and mental health providers -- higher rates of non-participation
• Some surgeons -- particularly in high-cost metro areas
• Certain specialists -- dermatologists, ophthalmologists in some markets

In Florida, excess charges are relatively uncommon but not unheard of, particularly in South Florida markets.

Some states have passed laws prohibiting Medicare excess charges entirely:

• Connecticut
• Massachusetts
• Minnesota
• New York
• Ohio
• Pennsylvania
• Rhode Island
• Vermont

Florida is NOT on this list. Florida providers can legally charge up to 15% above the Medicare-approved amount.

Before scheduling an appointment, always ask: "Do you accept Medicare assignment?"

You can also check online:

1. Go to medicare.gov/care-compare
2. Search for the provider
3. Look for "Accepts Medicare Assignment: Yes" on their profile

If a provider is listed as "participating," they accept assignment. If "non-participating," they may charge excess fees.

The most effective protection is a Medicare Supplement (Medigap) plan that covers excess charges.

Plan G covers Medicare Part B excess charges in full. This means even if you see a non-participating provider who charges the maximum 15% excess, your Plan G picks up that extra cost.

Plan G also covers:

• Part A hospital coinsurance and costs up to 365 days after Medicare benefits are exhausted
• Part B coinsurance (20%) after you meet the annual deductible
• Part A deductible
• Skilled nursing facility coinsurance
• Foreign travel emergency (up to plan limits)

The only thing Plan G doesn't cover is the Part B deductible ($283 in 2026).

Plan F was the gold standard -- it covered everything including the Part B deductible AND excess charges. However, Plan F is no longer available to people who became eligible for Medicare on or after January 1, 2020.

If you enrolled in Medicare before 2020 and have Plan F, you can keep it. But new Medicare enrollees cannot purchase Plan F.

This is an important distinction: Plan N does not cover Part B excess charges. Plan N is a popular, lower-premium option, but if you see a non-participating provider, you're responsible for the excess charge.

If you're considering Plan N, make sure your doctors all accept Medicare assignment.

If you're enrolled in a Medicare Advantage plan, excess charges work differently. Medicare Advantage plans have their own fee schedules and network agreements. When you see an in-network provider, excess charges generally don't apply.

However, if you see an out-of-network provider with a Medicare Advantage plan, your cost-sharing can be significantly higher -- and some plans don't cover out-of-network care at all (HMO plans).

For most Florida seniors, excess charges are a minor concern because most providers accept assignment. But there are scenarios where they matter:

1. Seeing a specialist in a high-cost area -- South Florida specialists are more likely to be non-participating
2. Emergency situations -- You may not have time to verify assignment status
3. Mental health care -- Psychiatrists have higher non-participation rates
4. Traveling -- Providers in other states may not accept assignment

If you travel frequently or live part of the year in another state, excess charge protection becomes more valuable.

Plan G typically costs more per month than Plan N. Whether the excess charge protection is worth the premium difference depends on:

• Your health status and how often you see specialists
• Whether your current doctors accept assignment
• Your risk tolerance for unexpected bills
• Your travel habits

For most Florida seniors who want comprehensive coverage and peace of mind, Plan G is the recommended choice -- it's the most popular Medigap plan in Florida for good reason.

Medicare Part B excess charges are a real but manageable risk. Understanding how they work helps you make informed decisions about your Medicare coverage.

If you want to eliminate excess charge risk entirely, Medigap Plan G is your best option. If you're comfortable with the risk and want lower premiums, Plan N may work -- just make sure your providers accept assignment.

I help Florida seniors compare Medigap plans from 20+ carriers to find the best combination of coverage and price. Call me at (386) 871-3858 or schedule a free consultation at calendly.com/themedicaredude/75.

William Gray is an independent Medicare specialist licensed in Florida (License #W690237). He represents 60+ carriers and helps Florida seniors find the right coverage for their individual needs.