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How to avoid Medicare Excess Charges

Learn which Medigap plans cover excess charges and where they are not allowed

by Katie Banks+ on Sep 10, 2019 | 2 Comments

Part B Excess charges occur when a doctor charges more than the Medicare-approved amount.  This happens when the healthcare provider does not accept Medicare assignment and decides to charge you extra.  They are legally allowed to do this up to a maximum of 15%. Crazy huh?

How to avoid Medicare Excess Charges

Enroll in Medigap Plan G or Plan F

Medigap plan F and plan G both cover 100% excess charges so your insurance company will pay those extra fees, not you.
Seniors who turn 65 before 2020 can still enroll and keep their Plan F as you can read in our article about all the Plan F changes in 2020.  Medigap Plan G not only covers 100% of your excess charges but because it has a lower premium it is usually a better deal than Plan F, so if you were planning on getting the latter make sure to check the price of Plan G first. 

Needless to say, every variant of Plan G and Plan F like Innovative F or G Extra also cover excess charges.

Some states do not allow excess charges

That means that if you live in one of these states, you will not have to pay these charges. Here is a list:

  • Connecticut
  • Massachusetts
  • Minnesota
  • New York
  • Ohio
  • Pennsylvania
  • Rhode Island
  • Vermont

If you reside in one of these states, you may want to consider a Medigap Plan N.  Medigap N is less expensive than Plan G but doesn’t cover excess charges.  If you live in a state that doesn’t allow excess charges, why pay for a benefit that you will most likely not use?

Enrolling in Medigap with Senior65.com

We at Senior65.com can help you enroll in Medigap at the lowest price allowed by law. That’s right, we charge you absolutely nothing for our services. Give us a call when you are ready to enroll.

Learn More about Medigap Get a Medigap Quote

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Reader Comments and Questions

Click Here if you have a question

By b on October 10, 2019

I live in Ohio, am over 75 years old and presently have an F plan. I do not think I can pass medical underwriting. The company that I am presently with closed the block that I am in. Their rates have gone up significantly. A company (Medical Mutual) is offering guaranteed issue and lower rates through November of this year. I am considering changing to them and purchasing a G or N plan. I am concerned that at some point I may want to move to either Texas or Florida where my sons reside. Doctors in both of those states can charge Medicare excess charges. Ohio doctors cannot charge excess charges. Also I am concerned that the rates for the company that is offering guaranteed issue (Medical Mutual) will go up significantly since that offer is only being made through November. What should I consider in making a decision about choosing a plan and changing companies? Thank you.

Based on the information you shared moving to a plan G would make more sense than an N. We would have to know a bit more before we could recommend a specific plan but overall your thought process is good.
-Chris from Senior65.com


By Ethan on September 21, 2019

I will turn 65 on november 3rd and im from connecticut . when can I get plan n?

Ethan,
You can already enroll! That is because you are in the 9 month period that starts three months before your 65th birthday and allows you to enroll in Medigap with guaranteed issuance.

Give us a call and we can help you enroll right over the phone. We charge nothing for our services.
-Michelle from Senior65.com



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PLEASE NOTE: We cannot comment on specific Medicare claims. Contact Medicare directly if you are trying to see if your issue is covered.




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