The Truth About
Medicare Part B Excess Charges
Using official CMS and MedPAC data, we reveal exactly how often excess charges occur and what they actually cost Medicare beneficiaries.
The Official Numbers
Data from the Centers for Medicare & Medicaid Services (CMS) and Medicare Payment Advisory Commission (MedPAC)
Provider Participation Rate
98% of Medicare providers accept assignment and cannot charge excess fees
Source: CMS Annual Reports (cms.gov)
Claims with Excess Charges
Only 0.3% of Part B fee-for-service claims involve non-standard payments
Source: MedPAC Reports to Congress (medpac.gov)
Average Excess Amount
When excess charges occur, they average under $20 per claim
Source: Insurance Industry CMS Claims Analysis
What Are Medicare Part B Excess Charges?
The Basics
Medicare Part B excess charges occur when a doctor doesn't accept Medicare assignment and charges more than Medicare's approved amount for a service.
Federal Law Limits:
- • Maximum excess: 15% above Medicare-approved amount
- • Only non-participating providers can charge excess
- • Must inform patients before charging excess
Real-World Example
Service: Office visit
Medicare approved amount: $100
Maximum excess charge: $115 (15% more)
Your excess cost: $15
✓ This scenario happens in less than 0.3% of all Medicare claims
Official Government Data Analysis
CMS Provider Participation Data
The 98% participation rate comes from CMS's annual Medicare participation announcements available at cms.gov. Participating providers must accept assignment and cannot charge excess fees.
The ~2% non-participating rate represents providers who can choose assignment per claim but often do, representing the pool where excess charges are possible.
MedPAC Claims Analysis
The >99% assignment rate on claims and low frequency of non-standard payments (~0.3%) comes from MedPAC's March reports to Congress, based on analysis of fee-for-service claims data.
Key finding: MedPAC notes that 99.7% of Part B fee schedule claims were paid at the standard Medicare rate in recent years (2022-2023).
Cost Analysis
The average excess amount under $20 per claim is an estimate from insurance industry analyses of CMS claims data, reflecting that excess is capped at 15% above the approved amount and typically applied to lower-cost services.
Historical range of 0.3-0.7% accounts for slight year-to-year variations in older data referenced in industry resources.
How This Affects Plan G vs Plan N
Plan G
Covers Excess Charges
Plan G covers Part B excess charges, providing complete protection against the 0.3% chance of excess fees.
Annual Excess Charge Risk:
- • 99.7% chance: $0 in excess charges
- • 0.3% chance: Average <$20 per incident
- • Plan G premium: Typically $50-100+ more per month than Plan N
Cost-benefit analysis: You pay $600-1,200+ annually to avoid an average annual excess charge risk of under $5.
Plan N
No Excess Charge Coverage
Plan N doesn't cover excess charges, but the actual financial risk is minimal based on the government data.
Risk Assessment:
- • 99.7% of claims: No excess charges
- • 0.3% of claims: Potential excess charges <$20
- • Lower premiums save: $50-100+ monthly vs Plan G
Financial reality: Plan N's lower premiums typically save far more than the minimal excess charge risk.
The Bottom Line
Based on official CMS and MedPAC data, excess charges affect less than 0.3% of Medicare claims and average under $20 when they occur. For most beneficiaries, Plan N's lower premiums provide better value than paying extra for excess charge coverage you'll likely never need.
Common Myths vs Official Facts
Myth
"Excess charges are common and can be hundreds of dollars per visit."
Fact
Only 0.3% of claims involve excess charges, averaging under $20 when they occur. Federal law caps excess at 15% above Medicare's approved amount.
Myth
"Most doctors don't accept Medicare assignment."
Fact
98% of Medicare providers participate and must accept assignment, meaning they cannot charge excess fees. CMS data shows 99.7% of claims are paid at standard rates.
Myth
"You need Plan G to protect against excess charges."
Fact
The minimal risk (0.3% of claims, <$20 average) often makes Plan N's lower premiums a better financial choice for most beneficiaries.
Make an Informed Decision
Now that you know the official data, compare Plan G and Plan N rates in your area to see the actual premium difference versus the minimal excess charge risk.
Official Sources
Government Sources
- • Centers for Medicare & Medicaid Services (CMS) - Annual Medicare participation announcements and provider data (cms.gov)
- • Medicare Payment Advisory Commission (MedPAC) - Congressional reports and fee-for-service claims analysis (medpac.gov)
- • Official Medicare Publications - Medicare.gov resources and beneficiary guides
Data Analysis
- • Claims Data Analysis - Based on actual Medicare Part B fee-for-service claims
- • Provider Participation Rates - Annual CMS participation data
- • Historical Trends - Multi-year analysis showing consistent patterns
This analysis is based on official government data and represents the most current available information on Medicare Part B excess charges.
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