Understanding Medicare Part B Excess Charges in Pennsylvania

If you are shopping for a Medicare Supplement plan, you may hear the term “Medicare excess charges.” Many people are confused by what they are, how they happen, and whether they should worry about them.

At MyMedicareQuotes.com, we help people throughout Bucks County, Montgomery County, Hunterdon County, and all across Pennsylvania understand how Medicare works and how to avoid unexpected medical bills.

What Is a Medicare Excess Charge?

A Medicare excess charge happens when a doctor or healthcare provider does not accept Medicare assignment and charges more than the Medicare-approved amount for a service.

Under federal law, providers who do not accept Medicare assignment can charge up to 15% more than Medicare’s approved amount for Part B services.

For example:

Medicare-approved amount: $100
Provider charges 15% extra: $115
The additional $15 is called an excess charge

These charges apply to outpatient and physician services covered under Medicare Part B.

Which Medicare Plans Cover Excess Charges?

Medicare Supplement Plan G

Medicare Supplement Plan G covers Medicare Part B excess charges in full.

If your doctor charges above the Medicare-approved amount, Plan G pays the excess charge for you.

This is one reason why many people choose Plan G for more predictable coverage and fewer surprise bills.

Medicare Supplement Plan N

Medicare Supplement Plan N does NOT cover Medicare excess charges.

With Plan N:

You may pay small copays for doctor visits and ER visits
You are also responsible for any excess charges billed by providers

Because of this, it is important to ask doctors whether they accept Medicare assignment before enrolling in Plan N.

Are Excess Charges Common?

In Pennsylvania, excess charges are generally less common than many people think.

Most doctors and hospitals accept Medicare assignment, meaning they agree to accept Medicare’s approved amount as payment in full.

However, excess charges can still occur with:

Certain specialists
Out-of-network providers
Some surgical practices
Providers in high-demand areas

Even though excess charges are not extremely common, some people prefer the peace of mind of knowing they are fully covered under Plan G.

Can Medicare Advantage Plans Have Excess Charges?

Medicare Advantage plans work differently than Medicare Supplement plans.

Medicare Advantage plans typically use provider networks and set copays rather than Medicare excess charge rules.

However, you may still face:

Higher out-of-pocket costs
Out-of-network expenses
Referral requirements
Prior authorization delays

This is why many people compare Medicare Advantage plans carefully against Medicare Supplement coverage before enrolling.

Should You Choose Plan G or Plan N?

The answer depends on:

Your budget
How often you see doctors
Whether your providers accept Medicare assignment
Your comfort level with potential out-of-pocket costs

Plan N may save money on monthly premiums.

Plan G may provide more predictable coverage and protection from excess charges.

A good independent Medicare broker can help compare both options side-by-side.

Frequently Asked Questions About Medicare Excess Charges

Do all doctors charge Medicare excess charges?

No. Most doctors accept Medicare assignment and do not charge excess fees.

Does Plan G cover excess charges?

Yes. Plan G covers Medicare Part B excess charges completely.

Does Plan N cover excess charges?

No. Plan N does not cover excess charges.

What states prohibit excess charges?

Some states prohibit Medicare excess charges entirely. Pennsylvania does prohibit them.

How much can a doctor charge above Medicare rates?

Providers who do not accept Medicare assignment can generally charge up to 15% above the Medicare-approved amount.

Is Plan G worth it because of excess charges?

For many people, yes. Some beneficiaries prefer the predictable coverage and peace of mind offered by Plan G.

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.