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Contributor ⭐
April 20, 2026

Medicare Plan N

  • April 20, 2026
  • 1 reply
  • 915 views

Has anyone enrolled in Plan N ever been charged the 15% medicare excess charge?

    1 reply

    GailL1
    Community Champion ⭐⭐⭐
    April 20, 2026

    @InessaG960679 

    The ONLY time a beneficiary would encounter them (and it is rare) is if the provider did not accept Medicare Assignment and they are deemed “non-participating” by Medicare.

     

    This Medicare link describes the “non-participating” providers as well as what it means to be a provider that accepts assignment and the ones that work only on a contract basis and thus does NOT accept Medicare at all.

     

    Medicare.gov - Does your provider accept Medicare as full payment? 

    “NON-PARTICIPATING” Providers

    From the link:  [copy/paste]

    Using a provider that doesn't accept Medicare as full payment

    Some doctors, health care providers, and suppliers who don’t accept assignment still choose to accept the Medicare-approved amount for services on a case-by-case basis. These providers are called "non-participating."

    If your doctor, provider, or supplier doesn't accept assignment:

    • You might have to pay the full amount at the time of service.
    • They should submit a claim to Medicare for any Medicare-covered services they give you, and they can’t charge you for submitting a claim. If they refuse to submit a Medicare claim, you can submit your own claim to Medicare. Get the Medicare claim form.
    • They can charge you more than the Medicare-approved amount. In many cases, the charge can't be more than 15% above the Medicare-approved amount for non-participating healthcare providers. This amount is called "the limiting charge."

    end copy/paste - there is more at the link ~

     

    It may also be worth mentioning that some states have outlawed the practice of excess charges for Medicare in their state.  Last I checked (in mid 2025) these states were:  Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont.

     

     

     

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