MEDICARE EXCESS CHARGES EXPLAINED

Michael T. Braden January 6, 2026 MEDICARE 101

WHAT ARE MEDICARE EXCESS CHARGES

Medicare provides healthcare to millions of Americans every day, and it is truly world-class. But, as good as Medicare is, it does not cover everything.

When people first approach age 65, many realize they need to learn about Medicare. So they do research, attend seminars, and engage friends and family members in discussions. They learn about Premiums, Deductibles, Co-Insurance, Co-Payments, Medicare Advantage, and Medigap. But there is one important piece of the Medicare Puzzle they miss entirely: Medicare Excess Charges. While many beneficiaries are aware of deductibles and copayments, another hidden cost that often catches people off guard is what we call Medicare excess charges, specifically, Medicare Part B Excess Charges.

Thankfully, there are options available to every Medicare beneficiary to avoid these potentially expensive add-on costs altogether and forever. This is where Medicare Supplement plans, or Medigap plans as some people refer to them, step in to help you.

Both Medicare Supplement/Medigap Plan G and Plan F, specifically, Medigap Plan F and Plan G, protect you from these additional, unnecessary fees and costs. BY eliminating Medicare Part B Excess Charges, your medicare bills stay predictable, and you can rest easy without fear of having a big surprise Healthcare bill.

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UNDERSTANDING MEDICARE EXCESS CHARGES

So what are MEdicare Part B Excess charges, and how can you avoid them? Medicare excess charges are additional amounts a healthcare provider can charge a Medicare beneficiary. These Medicare Part B Excess Charges are over and above the amount Medicare has approved for health services. Medicare-approved amount for a service. These charges apply only to Medicare Part B services. Most Part B Excess charges involve doctor office visits, Outpatient Care, and Durable Medical Equipment (DME).

Around 93.6% of all physicians accept Medicare. When a doctor accepts Medicare, they are agreeing to honor Medicare's Fee Schedule.

The largest majority of doctors who do not accept Medicare have traditionally been:

• Pediatricians.

• Psychologists.

• Psychiatrists.

• Naturopathic Doctors.

• Homeopathic Doctors.

• Doctors who specialize in "Alternative Therapies or Alternative Medicine, many of which are associated with taking a holistic, natural approach to Cancer Treatments.

  
  

If you only received one Excess Charge, it may be manageable, but it still irritates you. And, if you have received a Cancer diagnosis, these Medicare Part B Excess Charges can add up, and they can easily become quite expensive for you.

WHY SOME DOCTORS CHARGE MORE THAN MEDICARE

Doctors, Physicians, and healthcare providers have one of three options for their relationship with Medicare.

1. Participating Providers:

   These doctors accept “assignment,” meaning they agree to accept the Medicare-approved amount as full payment. They cannot bill you for excess charges.

   
   

2. Non-Participating Providers:

   These doctors accept Medicare but do not accept assignment. They can choose to charge you up to 15% more than the Medicare-approved amount.

   
   

3. Opt-Out Providers:

   These doctors have opted out of Medicare entirely. Medicare does not pay for their services, and you are responsible for the full cost.

   
   

Excess charges originate from the second group: non-participating providers. They accept your insurance, but they require higher compensation than the standard Medicare reimbursement rates.

HOW MUCH MORE CAN SOME DOCTORS CHARGE YOU?

If you do not own a Medicare Supplement Plan F or Plan G policy, you are responsible for paying the full excess charge out of your own pocket.

Consider a scenario where you require a surgery that has a Medicare-approved cost of $2,000. If your surgeon is a non-participating provider, they can add a 15% excess charge to that amount:

• Medicare Approved Amount: $2,000

• Maximum Excess Charge (15%): $300

• Total Bill: $2,300

Using the example above, Medicare would pay its required amount (80%) of the $2,000. Once Medicare has paid their 80% share, you would be responsible for your 20% share ($400) plus 100% of any/all Medicare Part B Excess Charges, which in the example we used is $300. Your total out-of-pocket cost for that single procedure would be $700. If you see the same specialist regularly, these costs canbecome an ongoing financial burden.

WHICH MEDICARE SUPPLEMENT/MEDIGAP PLANS COVER EXCESS CHARGES?

The best way to hedge your bet and protect yourself is to enroll in a Medigap or Medicare Supplement plan that will cover 100% of all Medicare Part B excess charges. Currently, two main plans offer this specific benefit:

• Medicare Supplement/Medigap Plan F

• Medicare Supplement/Medigap Plan G

  
  

Both plans are excellent choices for comprehensive coverage, though eligibility rules differ between them.

MEDICARE SUPPLEMENT PLAN G & PLAN F BOTH COVER MEDICARE EXCESS CHARGES

Medigap Plan F has long been considered the “gold standard” of Medicare supplements because it covers 100% of the gaps in Original Medicare. When you have Plan F, you have zero out-of-pocket costs for Medicare-covered services. The plan pays your deductibles, your coinsurance, and yes, it pays 100% of any Medicare excess charges you incur. But there is a catch with Plan F: unless you were 65 prior to January 1, 2020, you are not eligible to enroll in Plan F.

For those new to Medicare, or for anyone looking to save on monthly premiums, Medigap Plan G is widely considered the best choice available today. Plan G provides nearly identical coverage to Plan F. It covers your Part A deductible, your Part B coinsurance, skilled nursing facility coinsurance, and it covers 100% of Medicare Part B excess charges.

The only difference is that Plan G does not cover the Part B annual deductible ($283 in 2026). Once you pay that small deductible at the start of the year, your Plan G coverage operates just like Plan F, paying for all covered services for the rest of the calendar year.

With Plan G, your monthly premiums are often significantly lower than Plan F. In many cases, the annual premium savings outweigh the cost of the Part B deductible, allowing you to keep more money in your pocket while still protecting you from Medicare Part B excess charges.

WHAT IF YOU CHOOSE MEDIGAP PLAN N?

If you choose a plan that does not cover excess charges, such as Plan N, you are accepting a certain amount of Financial risk.

Medicare Supplement/Medigap Plan N is an excellent option for filling the gaps in Original Medicare coverage. The absolute best thing that those with a Plan N can do to avoid Medicare Part B Excess fees is to ask every doctor you have if they accept Medicare assignment. This is not always practical.

In emergency situations, you cannot choose your provider. You might be taken to a hospital where the anesthesiologist or the on-call specialist is a non-participating provider. Without coverage, you will receive a bill for those excess charges weeks later. And those bills are not inexpensive.

Additionally, if you happen to live in or travel to a state that does not prohibit excess charges (most states allow them), you are exposed to these costs. Having a plan like Plan F and Plan G eliminates the need to stress or worry about which doctor you see or where you travel within the United States.

WHEN EXCESS CHARGES MATTER THE MOST

Coverage for excess charges becomes critical when you need specialized care. Specialists, surgeons, and psychiatrists are statistically more likely to be non-participating providers than general practitioners.

It also matters if you want to be the only person in charge of your own healthcare. With Plan G or Plan F, you can see any doctor in the United States who accepts Medicare. You do not need to ask if they accept the assignment because your insurance plan handles the difference. This peace of mind is invaluable when you are dealing with a health concern.

WRAPPING THINGS UP

Medigap Plan F is awesome, but most Medicare Beneficiaries who have had Plan F realize their premiums are typically $60-$100 a month higher than Plan G. And, that the convenience of Plan F automatically paying your deductible for you is nice, but the math just does not add up to Plan F being the best value.

Medicare Supplement Plan G honestly is the new Platinum Standard for Medicare. Medical expenses are unpredictable, but your insurance coverage does not have to be. By choosing a Medicare Supplement plan like Plan G, you ensure that excess charges never impact your retirement savings.

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If you still have questions about Medicare Part B Excess Charges, Plan F, Plan G, or Plan N, or anything else related to Medicare, please drop me a line or give me a call anytime. You can email me directly at mike@bradenmedicare.com, online at www.bradenmedicare.com, or by calling or texting me at (480) 225-1393.