Medicare excess charges in Pennsylvania are generally prohibited for Medicare-covered services provided by licensed healthcare practitioners in the state. Pennsylvania law prevents practitioners and the organizations that employ them from balance billing Medicare beneficiaries above the Medicare-approved charge.
This protection makes Medicare Part B excess charges less of a concern for people who receive their care in Pennsylvania. However, excess charges may still matter when receiving care outside Pennsylvania, and the rules are different for providers who have formally opted out of Medicare.
Call or text The DeAngelis Agency at 215-967-8828, or contact us online. We can compare current Plan G and Plan N rates from multiple insurance companies and explain which option may provide the better value for you. There is no charge or obligation.
What Are Medicare Excess Charges?
Medicare excess charges occur when a physician does not accept Medicare assignment and charges more than the Medicare-approved amount for covered services.
Under federal Medicare rules, certain providers in some states may charge up to 15% above the Medicare-approved amount.
These additional costs are known as Medicare Part B excess charges.
Why Are Medicare Excess Charges in Pennsylvania Prohibited?
Pennsylvania is one of Eight states that provide additional protections.
In Pennsylvania, doctors must accept Medicare assignment.
As a result, Pennsylvania Medicare beneficiaries do not face Medicare Part B excess charges.
This is an important distinction because beneficiaries in many other states do have to consider excess charges when choosing Medicare Supplement coverage.
Non-Participating Providers vs. Providers Who Opt Out of Medicare
A non-participating provider still works with Medicare but does not always accept Medicare assignment. In states that permit excess charges, a non-participating provider may charge up to Medicare’s limiting charge.
An opted-out provider is different. An opted-out provider generally does not submit claims to Medicare and usually requires the patient to sign a private contract. Medicare generally does not pay for those services, and Medicare’s excess-charge limits do not apply to the private bill.
Pennsylvania’s excess-charge protections do not make services from an opted-out provider Medicare-covered.
How Medicare Excess Charges in Pennsylvania Affect Plan G and Plan N
Medicare Supplement Plan G covers Medicare Part B excess charges. Plan N does not.
For care received in Pennsylvania from providers who bill Medicare, Pennsylvania’s assignment rules generally prevent excess charges. This reduces one of the practical differences between Plan G and Plan N for many Pennsylvania beneficiaries.
The difference can still matter when you receive care outside Pennsylvania. If a provider is located in a state that permits Medicare excess charges and does not accept assignment, Plan G covers eligible excess charges. Plan N does not.
Because Plan N often has lower premiums, many Pennsylvania beneficiaries may still find it a strong value. The right choice depends on premium savings, copays, travel habits, and how much predictability you want.
Other Differences Between Plan G and Plan N
Plan N may include:
- Up to a $20 copay for certain office visits
- Up to a $50 emergency room copay when you are not admitted
- No coverage for Medicare Part B excess charges
- Lower monthly premiums in many situations
Plan G covers Medicare Part B excess charges and does not include Plan N’s office visit or emergency room copays. However, Plan G usually has a higher monthly premium.
When comparing the plans, consider the annual premium difference, possible Plan N copays, your travel habits, and whether you prefer lower premiums or more predictable out-of-pocket costs.
Frequently Asked Questions
What are Medicare excess charges?
Medicare excess charges are additional amounts certain providers may charge above the Medicare-approved amount.
Can doctors charge Medicare excess charges in Pennsylvania?
Generally, no. Pennsylvania physicians are required to accept Medicare assignment.
Does Plan N cover Medicare excess charges?
No. However, Pennsylvania beneficiaries often do not need to worry about excess charges because of Pennsylvania’s assignment requirements.
Is Plan N a good choice in Pennsylvania?
For many people, yes. Lower premiums and Pennsylvania’s assignment rules make Plan N worth considering.
How much can Plan N save compared to Plan G?
The difference varies by company, age, ZIP code and available discounts. In some Pennsylvania quotes I review, Plan N may cost approximately $500 to $800 less per year than Plan G, but the actual savings must be calculated using current rates.
Related Medicare Topics
- What Are Medicare Part B Excess Charges?
- Do Medicare Excess Charges Actually Happen?
- States That Prohibit Medicare Excess Charges
- Plan G vs. Plan N
- Why I Recommend Medicare Supplement Plan N So Often
Schedule Your Medicare Consultation Today
Medicare can be confusing, but getting answers shouldn’t be.
Whether you’re enrolling for the first time, reviewing your current coverage, considering a plan change, or simply looking for a second opinion, I’m happy to help you understand your options and answer your questions.
I’ve been helping Medicare beneficiaries since 1985, and I’ve built my practice on straightforward advice, long-term relationships, and treating people the way I’d want my own family treated.
If you’d like to discuss your Medicare options, call or text The DeAngelis Agency at 215-967-8828.
There’s no pressure and no obligation—just honest guidance to help you make a confident decision.
