You got a bill from a specialist that was higher than you expected, and Medicare only paid part of it. That gap may be a Medicare Part B excess charge. Medicare Part B excess charges are the extra amount a provider who doesn't accept Medicare assignment is allowed to add on top of what Medicare approves, up to about 15% more.Centers for Medicare & Medicaid Services. (n.d.). Does your provider accept Medicare as full payment?. medicare.gov. Retrieved Jul 17, 2026, from https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare
In This Guide
- Key Takeaways
- What Is a Medicare Part B Excess Charge?
- Who Pays Medicare Part B Excess Charges, and How Much?
- Does Medigap Cover a Medicare Part B Excess Charge?
- Do Excess Charges Apply Where You Live?
- How to Avoid Medicare Part B Excess Charges
- Frequently Asked Questions
- Learn More
What Is a Medicare Part B Excess Charge?
Start with how doctors bill Medicare. When a provider accepts what's called assignment, they agree to accept the Medicare-approved amount as full payment. You pay your normal share, and that's the end of it. Most doctors do this.
But not all of them have to. A provider can be non-participating, which means they treat Medicare patients but don't always accept assignment. When one of those providers chooses not to accept assignment on your visit, they're allowed to bill you more than the approved amount, and that extra slice is the excess charge.Centers for Medicare & Medicaid Services. (n.d.). Does your provider accept Medicare as full payment?. medicare.gov. Retrieved Jul 17, 2026, from https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare
There's a ceiling on it, though. The provider can't bill whatever they want. Medicare caps the total at what it calls the limiting charge: no more than about 15% above the Medicare-approved amount for most Part B services.Centers for Medicare & Medicaid Services. (n.d.). Does your provider accept Medicare as full payment?. medicare.gov. Retrieved Jul 17, 2026, from https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare The exact math is a little quieter than the headline. Medicare pays non-participating providers off a slightly reduced fee schedule, and the limiting charge is 115% of that reduced amount, which is where the "roughly 15% more" comes from.Centers for Medicare & Medicaid Services. (n.d.). Does your provider accept Medicare as full payment?. medicare.gov. Retrieved Jul 17, 2026, from https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare Either way, if Medicare approves a service, a non-participating provider who doesn't take assignment can add up to that 15% and hand you the difference.
So whether you ever see an excess charge comes down to one thing: does the provider accept assignment for your care? Here's how the situations line up.
| Your situation | Excess charge? | What you pay |
|---|---|---|
| Provider accepts assignment | No | The 20% coinsurance after your $283 deductible, and nothing moreCenters for Medicare & Medicaid Services. (2026). 2026 Medicare Parts A & B Premiums and Deductibles. cms.gov. Retrieved Jul 23, 2026, from https://www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles |
| Non-participating provider, no Medigap | Yes, up to about 15% | Your 20% coinsurance plus the excess charge, out of pocketCenters for Medicare & Medicaid Services. (n.d.). Does your provider accept Medicare as full payment?. medicare.gov. Retrieved Jul 17, 2026, from https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare,Centers for Medicare & Medicaid Services. (2026). 2026 Medicare Parts A & B Premiums and Deductibles. cms.gov. Retrieved Jul 23, 2026, from https://www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles |
| Non-participating provider, Medigap Plan F or G | Yes, but covered | Your normal share; the plan pays the excess chargeCenters for Medicare & Medicaid Services. (n.d.). Does your provider accept Medicare as full payment?. medicare.gov. Retrieved Jul 17, 2026, from https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare |
Who Pays Medicare Part B Excess Charges, and How Much?
You do, out of pocket, unless a supplement picks it up. An excess charge isn't a separate program cost with its own rules. It stacks on top of what you'd normally owe under Part B.
Start with the normal part. For most outpatient Part B services, you pay the annual Part B deductible, which is $283 in 2026, and then 20% of the Medicare-approved amount as coinsurance.Centers for Medicare & Medicaid Services. (2026). 2026 Medicare Parts A & B Premiums and Deductibles. cms.gov. Retrieved Jul 23, 2026, from https://www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles That 20% is your regular share, and it applies no matter who you see.
The excess charge is added onto that. When a non-participating provider doesn't accept assignment, you're responsible for your usual 20%, plus up to about 15% more of the approved amount as the excess.Centers for Medicare & Medicaid Services. (n.d.). Does your provider accept Medicare as full payment?. medicare.gov. Retrieved Jul 17, 2026, from https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare,Centers for Medicare & Medicaid Services. (2026). 2026 Medicare Parts A & B Premiums and Deductibles. cms.gov. Retrieved Jul 23, 2026, from https://www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles On a single routine visit the extra dollars may be small. On a bigger procedure, or across a year of appointments with the same specialist, it adds up in a way that's easy to miss until the bills arrive.
Does Medigap Cover a Medicare Part B Excess Charge?
Yes, but only two of the lettered plans do. If you have Medigap Plan F or Plan G, your policy covers Part B excess charges, so a non-participating provider's extra billing is paid by the plan and you're not stuck with it.Centers for Medicare & Medicaid Services. (n.d.). Does your provider accept Medicare as full payment?. medicare.gov. Retrieved Jul 17, 2026, from https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare
That's one real reason people weighing supplement plans care about this line item. If you see specialists often, or you like the freedom to see any doctor without checking their billing status first, excess-charge coverage is one of the things Plan F and Plan G buy you. If your plan letter doesn't include it, the excess is yours to pay.
Do Excess Charges Apply Where You Live?
Not everywhere. Some states prohibit Part B excess charges entirely, which means a provider in those states can't bill you above the Medicare-approved amount even if they don't accept assignment.Centers for Medicare & Medicaid Services. (n.d.). Does your provider accept Medicare as full payment?. medicare.gov. Retrieved Jul 17, 2026, from https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare If you live in one of them, this whole question is mostly moot, because no provider can add the extra 15% regardless of their billing status.
The specific list is worth confirming directly rather than assuming, because whether a ban applies turns entirely on where you live. The reliable move is to call your state's department of insurance and ask whether excess charges are allowed for Medicare patients in your state. If the answer is that they're banned, you can stop screening providers for assignment status on cost grounds.
How to Avoid Medicare Part B Excess Charges
The simplest protection is a question you ask before the appointment, not after the bill: does this provider accept Medicare assignment? If the answer is yes, no excess charge can appear, full stop.
A few practical angles:
- Ask when you schedule. A front-desk staffer can usually tell you whether the provider accepts assignment. Most do.
- If you already have Medigap Plan F or Plan G, you're covered either way and don't need to screen for it.Centers for Medicare & Medicaid Services. (n.d.). Does your provider accept Medicare as full payment?. medicare.gov. Retrieved Jul 17, 2026, from https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare
- Know the limit doesn't cover everything. The limiting charge applies to most Part B services, but not to some supplies and durable medical equipment, so those follow different rules.Centers for Medicare & Medicaid Services. (n.d.). Does your provider accept Medicare as full payment?. medicare.gov. Retrieved Jul 17, 2026, from https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare
None of this means avoiding a good doctor who happens to be non-participating. It just means going in knowing whether an extra 15% is on the table, so the bill isn't a surprise.Centers for Medicare & Medicaid Services. (n.d.). Does your provider accept Medicare as full payment?. medicare.gov. Retrieved Jul 17, 2026, from https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare
Frequently Asked Questions
How much is a Medicare Part B excess charge?
It scales with the price of the service, since the cap is a percentage rather than a flat fee. Say Medicare approves a service at $200: a non-participating provider who declines assignment can add up to about $30, so you'd owe roughly $30 beyond your usual coinsurance. On a cheap visit that extra is a few dollars; on an expensive procedure the same 15% is a much bigger number.Centers for Medicare & Medicaid Services. (n.d.). Does your provider accept Medicare as full payment?. medicare.gov. Retrieved Jul 17, 2026, from https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare
Does Medigap cover Part B excess charges?
Only Plan F and Plan G do; no other lettered plan includes it. The quickest way to know whether you're covered is to check the plan letter on your Medigap card or policy summary. If it's an F or a G, excess charges are handled and a provider's assignment status stops mattering for your costs; any other letter, and the excess is yours to pay.Centers for Medicare & Medicaid Services. (n.d.). Does your provider accept Medicare as full payment?. medicare.gov. Retrieved Jul 17, 2026, from https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare
How do I know if a doctor will charge me extra?
Ask whether they accept Medicare assignment before your visit. A provider who accepts assignment can't add an excess charge. A non-participating provider who declines assignment can, up to the limiting charge.
Do excess charges apply to every kind of care?
No. The limiting charge applies to most Part B services, but not to some supplies and durable medical equipment, which are billed under different rules. And in states that ban excess charges outright, they don't apply at all.
Is the excess charge on top of my normal costs?
Yes. It's an add-on, not a replacement. Your baseline stays the same as any Part B service: the $283 deductible in 2026, then 20% coinsurance. The excess charge is an extra layer that shows up only when a non-participating provider declines assignment, stacked on top of that baseline rather than folded into it.Centers for Medicare & Medicaid Services. (n.d.). Does your provider accept Medicare as full payment?. medicare.gov. Retrieved Jul 17, 2026, from https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare,Centers for Medicare & Medicaid Services. (2026). 2026 Medicare Parts A & B Premiums and Deductibles. cms.gov. Retrieved Jul 23, 2026, from https://www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles
Learn More
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The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.