What are Medicare excess charges?


Quick Answer

Medicare excess charges are fees that exceed the amount the Medicare fee schedule allows. Physicians who accept Medicare assignment cannot charge these fees. However, physicians who have not signed a contract with Medicare but bill the agency for some services can charge the patient an additional amount, says Medicare.gov.

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Full Answer

Medicare limits the amount of excess fees a health care provider may charge. Called a "limiting charge," this limit is 15 percent above the amount Medicare pays nonparticipating providers, which is 95 percent of the allowable amount. However, the limiting charge does not apply to all covered services or all durable medical equipment, explains Medicare.gov.

Most physicians and other health care suppliers who accept Medicare are participating providers, which means they have agreed to accept Medicare's fee schedule as payment for their services, states Medicare.gov. These providers bill Medicare directly, and Medicare reimburses them 80 percent of the allowable amount, less any deductible that the patient owes. The patient is responsible for paying the remaining 20 percent of the amount allowed by Medicare and nothing more.

Some doctors and health care suppliers do not work with Medicare in any way, Medicare.gov explains. These providers cannot bill Medicare for a person's health care even if Medicare usually covers the service they provide.These providers typically require that Medicare-eligible patients sign a written contract agreeing to pay the full amount of the bill. However, they must inform the patient that the service would be covered if the patient received care from a provider who accepts Medicare. Patients cannot be forced to sign a contract for urgent or emergency medical care.

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