- An excess charge is a charge for a Medicare-covered service or item that is above the amount that is approved by Medicare. Medicare excess charges are generally not allowed under the Medicare program, with a few exceptions.
- If a Medicare beneficiary receives a service or item that is covered by the program, they are generally required to pay the Medicare approved amount for the service or item. This is known as the “Medicare-approved amount” or the “Medicare rate.” If a beneficiary receives a service or item that is covered by Medicare and
they are charged more than the Medicare-approved amount, they may be responsible for paying the excess charge out-of-pocket. - There are a few exceptions to the rule against Medicare excess charges. For example, if a beneficiary sees a healthcare provider who does not accept assignment (meaning that the provider does not agree to accept the Medicare-approved amount as payment in full), the provider may charge up to 15 percent more than the Medicare-approved amount for a service. In this case, the beneficiary may be responsible for paying the excess charge
out-of-pocket. - It is important to note that Medicare excess charges can vary depending on the type of service or item a beneficiary is receiving, and the specific Medicare plan they have. If a beneficiary has any questions about their Medicare coverage or about excess charges, it is recommended that they contact their Medicare plan or speak with a Medicare representative. The beneficiary may also want to discuss their coverage with their healthcare provider to ensure that they understand what is covered and what they may be responsible for paying.
