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What are Medicare Excess Charges?
Medicare excess charges are additional costs that may occur when a healthcare provider charges more for a medical service than the amount approved by Medicare. In the United States, Medicare sets a specific payment amount for each covered service or procedure, known as the Medicare-approved amount (also called Medicare assignment). This amount is based on a fee schedule established by Medicare. When a healthcare provider accepts Medicare assignment, they agree to accept the Medicare-approved amount as full payment for the service provided and will reduce the bill to that amount. However, some healthcare providers may choose not to accept Medicare assignment and can charge more than the Medicare-approved amount. These additional charges are referred to as Medicare excess charges.
If your doctor does not accept assignment, then they may charge up to 15% more than the approved amount.
Comparing Doctor's Bills with & without Assignment
Doctor that Accepts Assignment
Does NOT Accept Assignment
Doctor's Bill
Approved Amount
Medicare Pays 80%
Your Coinsurance 20%
Your Total Bill
$1500
$1000
$800
$200
$200
Doctor's Bill
Approved Amount
Medicare Pays 80%
Your Coinsurance 20%
Excess Charges
(15% of approved amount)
Your Total Bill
$1500
$1000
$800
$200
$150
$350
*Note on deductibles: The annual deductible was excluded from this example. The deductible amount would have to be met first before benefits begin.
**Note on Supplements: If you have a supplement plan, it may cover the cost of your annual deductible, coinsurance, and/or excess charges depending on your supplement plan (meaning your bill could be as low as $0).
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