Can Doctors Charge Medicare Excess Charges in Pennsylvania?

One of the questions I hear most often is:

“Can doctors charge Medicare excess charges in Pennsylvania?”

The good news is that Pennsylvania Medicare beneficiaries have protections that many people don’t realize exist.

In Pennsylvania, physicians are required to accept Medicare assignment if they accept your Medicare. That means Medicare Part B excess charges are not a concern for Pennsylvania beneficiaries.

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.

How Is Pennsylvania Different?

Pennsylvania is one of Seven 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.

Why Does This Matter When Comparing Plan N and Plan G?

One of the common concerns people have about Medicare Supplement Plan N is that it does not cover Medicare Part B excess charges.

However, because Pennsylvania physicians accept Medicare assignment, this issue is never a problem for Pennsylvania residents.

I frequently explain it this way:

If excess charges generally aren’t a concern in Pennsylvania, why pay hundreds of dollars more each year just to insure against a risk you may never face?

For many Pennsylvania beneficiaries, this makes Plan N an excellent value.

What Is the Real Difference Between Plan N and Plan G?

For many Pennsylvania Medicare beneficiaries, the practical differences often come down to:

• Up to a $20 copay for certain office visits with Plan N

• A potential $50 emergency room copay if you aren’t admitted

• Lower premiums with Plan N, which can sometimes save $500 to $800 per year compared to Plan G

Many people decide those trade-offs are worth considering.

Should Pennsylvania Beneficiaries Ignore Excess Charges?

No.

It’s still important to understand how Medicare works and how Medicare Supplement plans differ.

However, Pennsylvania residents should know that excess charges generally are not the concern they can be in other states.

That’s one reason why many Pennsylvania beneficiaries feel comfortable considering Plan N.

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?

In some situations, Pennsylvania beneficiaries may save $500 to $800 annually in premiums.

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.

Click here to ask a question.

There’s no pressure and no obligation—just honest guidance to help you make a confident decision.