Can doctors charge Medicare excess charges in Pennsylvania? Yes. Pennsylvania allows Medicare excess charges, although many doctors who accept Medicare assignment never bill them. Understanding how excess charges work can help you choose the right Medicare Supplement coverage.
If you have Original Medicare and live in Pennsylvania, you may wonder whether your doctors can charge more than Medicare’s approved amount. The answer is yes—but only in certain situations.
Understanding how excess charges work can help you avoid unexpected medical bills and choose the Medicare Supplement coverage that’s right for you.
What Are Medicare Excess Charges?
Medicare Part B typically pays 80% of approved outpatient medical expenses after you’ve met your annual deductible. Doctors who accept Medicare assignment agree to accept Medicare’s approved amount as full payment.
However, some providers are considered non-participating providers. These doctors can choose not to accept Medicare assignment on a case-by-case basis.
When they do, they can charge up to 15% more than Medicare’s approved amount. This additional amount is called a Medicare excess charge.
If you’re new to this topic, What Are Medicare Part B Excess Charges? explains how these charges work and who may be affected.
Can Doctors Charge Medicare Excess Charges in Pennsylvania?
Yes.
Pennsylvania does not prohibit Medicare excess charges. This means that doctors who do not accept Medicare assignment may legally bill up to 15% above Medicare’s approved amount.
The good news is that most doctors in Pennsylvania do accept Medicare assignment. As a result, many Medicare beneficiaries never encounter excess charges.
However, it’s still important to understand your options—especially if you see specialists or travel frequently.
How Can You Avoid Medicare Excess Charges?
One of the easiest ways to avoid excess charges is to ask your provider:
“Do you accept Medicare assignment?”
If the answer is yes, the provider agrees to accept Medicare’s approved amount and cannot bill you excess charges.
Another option is choosing a Medicare Supplement plan that covers these costs.
Which Medicare Supplement Plans Cover Excess Charges?
One of the biggest differences between Medicare Supplement plans involves protection against excess charges.
Medicare Supplement Plan G
Plan G covers Medicare Part B excess charges in full. If your doctor bills excess charges, Plan G pays them for you.
Medicare Supplement Plan N
Plan N does not cover Medicare excess charges. Although excess charges are relatively uncommon, beneficiaries enrolled in Plan N could be responsible if they receive care from a provider who does not accept Medicare assignment.
Before deciding between these plans, read Medicare Plan G vs. Plan N: Which Is Right for You? to understand the trade-offs.
Should Pennsylvania Medicare Beneficiaries Be Concerned?
For many people, excess charges never become an issue. Most physicians participate in Medicare and accept assignment.
However, you may want to consider coverage for excess charges if you:
- Visit multiple specialists
- Travel outside your local area
- Prefer predictable healthcare costs
- Want additional peace of mind
If you’re evaluating your Medigap options, How to Choose a Medicare Supplement Plan can help you narrow down the right fit.
Need Help Choosing a Medicare Supplement Plan?
Choosing the right Medicare Supplement plan isn’t always straightforward. As an independent Medicare broker serving Bucks County, Montgomery County, and surrounding communities, I help people compare their options and understand the differences between Plan G, Plan N, and other Medigap plans.
Call 215-967-8828 to discuss your options or click here to request a Medicare consultation.
Before you enroll, using these Questions to Ask a Medicare Agent Before Enrolling can help you make a confident decision.
Frequently Asked Questions
Can Pennsylvania doctors charge Medicare excess charges?
Yes. Pennsylvania allows non-participating Medicare providers to charge up to 15% above Medicare’s approved amount.
How common are Medicare excess charges in Pennsylvania?
They’re relatively uncommon because most Pennsylvania providers accept Medicare assignment.
Does Medicare Supplement Plan G cover excess charges?
Yes. Plan G pays Medicare Part B excess charges in full.
Does Medicare Supplement Plan N cover excess charges?
No. Plan N beneficiaries may have to pay excess charges if they see providers who do not accept Medicare assignment.
How can I avoid Medicare excess charges?
Ask whether your provider accepts Medicare assignment or consider a Medicare Supplement plan that includes excess charge coverage.
Related Medicare Topics
- What Are Medicare Part B Excess Charges?
- Medicare Plan G vs. Plan N: Which Is Right for You?
- How to Choose a Medicare Supplement Plan
- Questions to Ask a Medicare Agent Before Enrolling
- Best Medicare Supplement Plans for Pennsylvania Seniors
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