Medicare Part B Excess Charges — What You Need to Know in 2026

If you have Original Medicare, you may have heard the term excess charges, but most people don’t fully understand what they are until they receive an unexpected bill. At Craig Smith Insurance Group, we help seniors across Queens, Long Island, the Bronx, Westchester, and New Jersey avoid costly Medicare surprises every day. Here’s everything you need to know about Medicare Part B excess charges and how to protect yourself.

What Are Medicare Part B Excess Charges?

Medicare Part B excess charges occur when a doctor or healthcare provider does not accept Medicare assignment and charges more than the Medicare-approved amount for a service.

Here’s how it works:

• Medicare-approved amount: The amount Medicare has agreed to pay for a specific service
• Medicare assignment: When a provider agrees to accept the Medicare-approved amount as full payment
• Excess charge: The additional amount a non-participating provider can charge above the Medicare-approved amount

Under federal law, non-participating providers can charge up to 15% above the Medicare-approved amount. This 15% is the excess charge, and in Original Medicare without a supplement plan, you are responsible for paying it out of pocket.

A Simple Example of How Excess Charges Work

Let’s say you visit a specialist who does not accept Medicare assignment. The Medicare-approved amount for your visit is $200.

Item	Amount
Medicare-approved amount	$200.00
Maximum excess charge (15%)	$30.00
The provider can charge a total	$230.00
Medicare pays (80% of the approved amount)	$160.00
Your responsibility without supplement	$70.00

Without a Medicare Supplement plan, you would owe the $40 coinsurance (20% of $200) plus the $30 excess charge, a total of $70 out of pocket for a single visit.

Medicare Part B Excess Charges vs. Coinsurance — What’s the Difference?

Many people confuse excess charges with coinsurance. Here’s how they differ:

Cost Type	What It Is	Who Pays It
Part B Coinsurance	20% of the Medicare-approved amount	You, unless you have a Medigap plan
Part B Excess Charge	Up to 15% above the Medicare-approved amount	You, unless you have Plan G or Plan F

Which Medicare Supplement Plans Cover Excess Charges?

Not all Medicare Supplement (Medigap) plans cover Part B excess charges. Here’s what you need to know:

Medigap Plan	Covers Excess Charges?
Plan G	✅ Yes — fully covered
Plan F	✅ Yes — fully covered (only if eligible before 2020)
High Deductible Plan G	✅ Yes — after deductible is met
Plan N	❌ No — you pay excess charges
Plan K	❌ No — you pay excess charges
All other plans	❌ No — you pay excess charges

This is one of the most important reasons why Medicare Supplement Plan G is the most popular Medigap plan for New York seniors. Plan G covers excess charges in full, so you will never receive an unexpected bill from a non-participating provider.

How Common Are Medicare Part B Excess Charges?

The good news is that the vast majority of doctors and healthcare providers accept Medicare assignment. According to CMS data, approximately 97% of Medicare claims are submitted by participating providers who accept Medicare assignment.

However, the 3% of providers who do not accept assignment tend to be concentrated in certain specialties and geographic areas, including some major metropolitan areas like New York City. This makes excess charge protection especially important for seniors living in the NYC metro area.

How to Find Out if Your Doctor Accepts Medicare Assignment

Before your appointment, you can verify whether your doctor accepts Medicare assignment in several ways:

• Visit Medicare.gov and use the “Find doctors, hospitals & other providers” tool
• Call your doctor’s office directly and ask: “Do you accept Medicare assignment?”
• Ask your independent Medicare broker to verify before you enroll in a plan

At Craig Smith Insurance Group, we verify provider participation for every client before recommending a Medicare plan. This ensures you never face unexpected excess charges from your preferred doctors.

New York State and Excess Charges

New York State has additional consumer protections regarding Medicare excess charges. New York law limits the amount providers can charge Medicare beneficiaries beyond the Medicare-approved amount. If you are a New York resident and believe you have been incorrectly billed for excess charges, contact the New York State Department of Health, or call our office, and we will help you navigate the situation.

Medicare Advantage and Excess Charges

If you are enrolled in a Medicare Advantage plan rather than Original Medicare, excess charges work differently:

• Medicare Advantage plans have their own networks of providers
• In-network providers have agreed to accept the plan’s approved amounts
• Out-of-network costs vary by plan type. PPO plans may allow out-of-network care at higher cost-sharing
• HMO plans generally do not cover out-of-network care except in emergencies

The concept of “excess charges” as it applies to Original Medicare does not typically apply to Medicare Advantage plans in the same way.

How to Protect Yourself From Medicare Part B Excess Charges

There are several strategies to protect yourself from unexpected excess charges:

1. Choose Medicare Supplement Plan G — the most comprehensive protection against excess charges available in 2026
2. Verify provider participation before every appointment, especially with new specialists
3. Ask upfront — always ask “Do you accept Medicare assignment?” before receiving care
4. Work with an independent broker — a broker can verify your preferred doctors accept Medicare before you enroll

Frequently Asked Questions About Medicare Part B Excess Charges

Can a doctor charge more than 15% above the Medicare-approved amount?

No. Federal law caps excess charges at 15% above the Medicare-approved amount. Any provider charging more than this limit is violating federal law.

What is a Medicare limiting charge?

The Medicare limiting charge is the maximum amount a non-participating provider can legally charge a Medicare beneficiary. It is set at 115% of the Medicare-approved amount, meaning the provider can charge no more than 15% above what Medicare has approved.

Does Plan N cover excess charges?

No. Medicare Supplement Plan N does not cover Part B excess charges. If you choose Plan N, you are responsible for paying any excess charges billed by non-participating providers. This is an important consideration when comparing Plan G vs Plan N.

Are excess charges common in New York City?

Excess charges are more common in certain metropolitan areas, including New York City, where some specialists and physicians opt out of Medicare assignment. This makes excess charge protection especially valuable for NYC-area Medicare beneficiaries.

How do I dispute an incorrect excess charge?

If you believe you have been incorrectly billed for excess charges, contact Medicare at 1-800-MEDICARE or contact your State Health Insurance Assistance Program (SHIP). In New York, you can also call the New York State Office for the Aging at 1-800-342-9871.

Talk to a Local Medicare Expert About Excess Charge Protection

Medicare Part B excess charges may seem complicated, but protecting yourself is straightforward. Choose the right Medicare Supplement plan and verify your providers accept Medicare assignment. At Craig Smith Insurance Group, we do this work for every client at no cost to you.

As an independent Medicare broker serving Queens, Long Island, the Bronx, Westchester, Rockland County, and New Jersey, I compare all available Medicare Supplement plans and verify your doctors accept Medicare before recommending any plan. You’ll always speak directly with Craig, never a call center.

📞 Call (917) 740-1895
✉️ craigsmith@csmedicare.net
🌐 csmithinsurancegroup.com
🕐 Monday–Friday 9 AM–8 PM | Saturday 10 AM–1 PM

We are not connected with or endorsed by the United States Government or the federal Medicare program. We do not offer every plan available in your area. Contact Medicare.gov or 1-800-MEDICARE for information on all your options.