Can Doctors Charge Medicare Excess Charges in Pennsylvania?

Medicare excess charges in Pennsylvania are prohibited, so doctors cannot add them to the Medicare-approved amount.

“Can doctors charge Medicare excess charges in Pennsylvania?”

Medicare excess charges by state can vary because some states prohibit doctors from adding these charges to Medicare-approved costs.

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.

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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.

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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?

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.

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