If a specialist's bill came in higher than you expected and Medicare only paid part of it, the gap may be a Medicare Part B excess charge. Excess charges are the extra amount, up to about 15% more than what Medicare approves, that a provider who doesn't accept assignment is allowed to bill you.Centers for Medicare & Medicaid Services. (n.d.). Does your provider accept Medicare as full payment?. medicare.gov. Retrieved Aug 22, 2026, from https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare It applies to services under Part B, the medical-services side of 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?
- What to Do If You Already Got a Bill
- 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.Centers for Medicare & Medicaid Services. (n.d.). Medicare.gov — Does your provider accept Medicare as full payment?. medicare.gov. Retrieved Aug 22, 2026, from https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare
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 Aug 22, 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: in many cases, no more than 15% above the Medicare-approved amount.Centers for Medicare & Medicaid Services. (n.d.). Does your provider accept Medicare as full payment?. medicare.gov. Retrieved Aug 22, 2026, from https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare The exact math has two tiers. For services paid under the physician fee schedule, the limiting charge is 115% of the fee schedule amount Medicare sets for non-participating providers, which is where the "15% more" comes from.Centers for Medicare & Medicaid Services. (n.d.). Does your provider accept Medicare as full payment?. medicare.gov. Retrieved Aug 22, 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.
The cap has one big exception, and it is the expensive one to miss. A provider who has opted out of Medicare is not the same as a non-participating provider, and the limiting charge does not bind them at all. They treat you under a private contract, Medicare will not pay for their services except in emergencies, and no 15% cap applies to what they bill, so you may have to pay the full amount upfront or set up a payment plan.Centers for Medicare & Medicaid Services. (n.d.). Does your provider accept Medicare as full payment?. medicare.gov. Retrieved Aug 22, 2026, from https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare Opting out runs in terms of at least two years, and CMS publishes a look-up tool of providers who have opted out. Medicare's own advice before you sign a private contract with any provider is to contact your State Health Insurance Assistance Program (SHIP) for help.Centers for Medicare & Medicaid Services. (n.d.). Does your provider accept Medicare as full payment?. medicare.gov. Retrieved Aug 22, 2026, from https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare
So whether you ever see an excess charge, and whether anything caps it, comes down to which of three billing statuses your provider holds. 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 Sep 4, 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 Aug 22, 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 Sep 4, 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.). Compare Medigap Plan Benefits. medicare.gov. Retrieved Sep 28, 2026, from https://www.medicare.gov/health-drug-plans/medigap/basics/compare-plan-benefits |
| Provider who has opted out of Medicare | No cap applies | The full amount under a private contract; Medicare pays nothing except in emergenciesCenters for Medicare & Medicaid Services. (n.d.). Does your provider accept Medicare as full payment?. medicare.gov. Retrieved Aug 22, 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 Sep 4, 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 Aug 22, 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 Sep 4, 2026, from https://www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles Here is the scale. Say Medicare approves a service at $200. Your 20% coinsurance is $40 once the deductible is met, and a non-participating provider who declines assignment can add up to about $30 on top of that.Centers for Medicare & Medicaid Services. (n.d.). Does your provider accept Medicare as full payment?. medicare.gov. Retrieved Aug 22, 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 Sep 4, 2026, from https://www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles On a cheap visit that extra is a few dollars. 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.
This guide is about Original Medicare. Medicare Advantage plans are private plans with their own networks and rules, so if you have one, ask your plan how it bills out-of-network care.Centers for Medicare & Medicaid Services. (n.d.). Compare Original Medicare & Medicare Advantage - Medicare.gov. medicare.gov. Retrieved Aug 8, 2026, from https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/your-coverage-options/compare-original-medicare-medicare-advantage And if you are enrolled in the Qualified Medicare Beneficiary (QMB) program, federal law bars Medicare providers from billing you for Part A and Part B cost sharing at all.Centers for Medicare & Medicaid Services. (n.d.). Medicare Savings Programs. medicare.gov. Retrieved Jul 17, 2026, from https://www.medicare.gov/basics/costs/help/medicare-savings-programs
Does Medigap Cover a Medicare Part B Excess Charge?
Yes, but only two of the lettered plans do.Centers for Medicare & Medicaid Services. (2025). Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare (2026) — CMS Product No. 02110. medicare.gov. Retrieved Sep 26, 2026, from https://www.medicare.gov/publications/02110-choosing-a-medigap-policy.pdf 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.). Compare Medigap Plan Benefits. medicare.gov. Retrieved Sep 28, 2026, from https://www.medicare.gov/health-drug-plans/medigap/basics/compare-plan-benefits
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.
If you're shopping now, though, Plan F may not be on your menu. It can't be sold to people new to Medicare, which means you turned 65 on or after January 1, 2020 and also got Part A on or after that date. If you had Medicare before 2020 (including through a disability or End-Stage Renal Disease before turning 65), or were eligible before 2020 but never enrolled, you may still be able to buy Plan F. Everyone else gets excess-charge coverage through Plan G.Centers for Medicare & Medicaid Services. (n.d.). Compare Medigap Plan Benefits. medicare.gov. Retrieved Sep 28, 2026, from https://www.medicare.gov/health-drug-plans/medigap/basics/compare-plan-benefits
Do Excess Charges Apply Where You Live?
Assume they do until someone official tells you otherwise. The limiting charge is a federal Medicare rule, and whether a particular state adds limits of its own is a separate question that federal rule doesn't answer.Centers for Medicare & Medicaid Services. (n.d.). Does your provider accept Medicare as full payment?. medicare.gov. Retrieved Aug 22, 2026, from https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare
Be wary of lists online that say your state bans excess charges. Connecticut's SHIP, for one, warns that some websites wrongly say people with Medicare in Connecticut can't be charged them; it says only people enrolled in the Qualified Medicare Beneficiary (QMB) level of the Medicare Savings Program are protected there, and everyone else in Traditional Medicare can be charged excess charges.Centers for Medicare & Medicaid Services. (n.d.). Does your provider accept Medicare as full payment? - Medicare.gov. medicare.gov. Retrieved Oct 2, 2026, from https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare If you want an answer for your own state, ask your SHIP, and keep asking providers about assignment in the meantime.
What to Do If You Already Got a Bill
- Ask the provider's billing office whether they accept assignment.
- If they don't, the provider should still submit the Medicare claim for you and cannot charge for doing so. If they refuse, you can submit your own claim.Centers for Medicare & Medicaid Services. (n.d.). Does your provider accept Medicare as full payment?. medicare.gov. Retrieved Aug 22, 2026, from https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare
- If the bill still doesn't add up, call 1-800-MEDICARE (1-800-633-4227), which people can reach 24 hours a day, 7 days a week, except some federal holidays.Centers for Medicare & Medicaid Services. (n.d.). Contact Medicare — Medicare.gov. medicare.gov. Retrieved Jul 23, 2026, from https://www.medicare.gov/talk-to-someone
- Ask your SHIP to walk through the bill with you.
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.Centers for Medicare & Medicaid Services. (n.d.). Medicare.gov — Does your provider accept Medicare as full payment?. medicare.gov. Retrieved Aug 22, 2026, from https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare
- Ask which status they hold, not just whether they take assignment. Non-participating is capped at the limiting charge; opted out is not capped at all.Centers for Medicare & Medicaid Services. (n.d.). Does your provider accept Medicare as full payment?. medicare.gov. Retrieved Aug 22, 2026, from https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare
- If you already have Medigap Plan F or Plan G, a non-participating provider's excess charge is covered, so you don't need to screen for that. Still ask about opted-out status, because Medicare pays nothing for an opted-out provider's services except in emergencies.Centers for Medicare & Medicaid Services. (n.d.). Compare Medigap Plan Benefits. medicare.gov. Retrieved Sep 28, 2026, from https://www.medicare.gov/health-drug-plans/medigap/basics/compare-plan-benefits,Centers for Medicare & Medicaid Services. (n.d.). Does your provider accept Medicare as full payment?. medicare.gov. Retrieved Aug 22, 2026, from https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare
- Know the cap isn't one formula. For services paid under the physician fee schedule the limiting charge is 115% of the non-participating fee schedule amount; for items Medicare pays outside that schedule it's calculated differently.Centers for Medicare & Medicaid Services. (n.d.). Does your provider accept Medicare as full payment?. medicare.gov. Retrieved Aug 22, 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 Aug 22, 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 Aug 22, 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.Centers for Medicare & Medicaid Services. (2025). Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare (2026) — CMS Product No. 02110. medicare.gov. Retrieved Sep 26, 2026, from https://www.medicare.gov/publications/02110-choosing-a-medigap-policy.pdf 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, a non-participating provider's excess charges are handled, so assignment status stops mattering for that cost (opted-out providers are the exception: Medicare pays nothing for their services except in emergencies); any other letter, and the excess is yours to pay.Centers for Medicare & Medicaid Services. (n.d.). Compare Medigap Plan Benefits. medicare.gov. Retrieved Sep 28, 2026, from https://www.medicare.gov/health-drug-plans/medigap/basics/compare-plan-benefits
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.Centers for Medicare & Medicaid Services. (n.d.). Does your provider accept Medicare as full payment?. medicare.gov. Retrieved Aug 22, 2026, from https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare
Do excess charges apply to every kind of care?
Not uniformly. The limiting charge caps what a non-participating provider may bill, but the formula differs between services paid under the physician fee schedule and items Medicare pays outside it.Centers for Medicare & Medicaid Services. (n.d.). Does your provider accept Medicare as full payment?. medicare.gov. Retrieved Aug 22, 2026, from https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare Whether your state adds any limit of its own is a separate question, so check with your SHIP rather than assuming one applies.Centers for Medicare & Medicaid Services. (n.d.). Does your provider accept Medicare as full payment?. medicare.gov. Retrieved Aug 22, 2026, from https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare
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 Aug 22, 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 Sep 4, 2026, from https://www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles
Learn More
Find personalized help figuring out whether a provider's excess charges will cost you at brevy.com.
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.
Still have questions?
Brevy answers from this guide and every other guide here, and can check what you qualify for.