In most states, healthcare providers who don’t participate in Medicare may charge up to 15% above the Medicare-approved amount of a service. This amount is billed directly to the patient as a Medicare Part B Excess Charge.[1]

It works like this healthcare “providers” (doctors, providers, suppliers, etc) that work with Medicare agree to accept the Medicare-approved amount as full payment for covered services (this is called “assignment“). Using these providers won’t result in an excess charge.

However, you can still use doctors who don’t accept assignment (aka non-participating providers), but these providers can charge up to 15% more for a service. That 15% will be billed directly to you as a Part B Excess Charge.

Meanwhile, “non-participating providers” (those who don’t accept assignment) are paid 95% of the fee schedule amount.

TIP: Some supplemental Medicare plans, like Medicare Part F, can provide coverage for these excess charges.

FACT: The limiting charge applies only to certain Medicare-covered services and doesn’t apply to some supplies and durable medical equipment.

Citations

  1. Lower costs with assignment Medicare.Gov.