Part B excess charges in Washington

What an excess charge is

Every Medicare service has an approved amount. A provider who accepts assignment agrees to take that amount as full payment. A provider who doesn't accept assignment on a claim can bill you up to 15% more than the approved amount. That extra 15% is the Part B excess charge.

Example: Medicare approves $200 for a specialist visit. If the doctor doesn't accept assignment, the most they can charge is $230 ($200 + 15%, the "limiting charge"). Medicare pays its share of the approved amount; your Medigap plan pays the 20% coinsurance; the $30 excess charge is left over.

• Plan G and Plan F pay that $30.
• Plan N, K, L, A, B and D don't. You do.

How common are they in Washington?

CMS publishes whether each clinician accepts Medicare assignment. Across Washington, 4.5% of clinician practice listings are marked as only sometimes accepting assignment; the rest always accept it. That's low, but it isn't spread evenly. Some towns have none; some have several times the state rate, usually because of a few specialty groups.

Every city page on this site shows the local rate for clinicians within 8 miles, and every county page shows the county rate.

Washington doesn't ban them

Some states (Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island and Vermont) limit or prohibit excess charges by law. Washington doesn't, and neither do Oregon or Idaho. If you live near either border and use providers there, the same 15% rule applies.

How to protect yourself on Plan N

1. Ask each doctor's office: "Do you accept Medicare assignment for all services?" Participating providers always do.
2. Check the provider on Medicare.gov's care compare tool, which shows assignment status.
3. If a provider doesn't accept assignment, you can ask them to accept it for your visit, or choose another provider.
4. Remember that hospitals, labs and most outpatient facilities accept assignment; excess charges come almost entirely from individual clinicians.

What this means for choosing a plan

If your doctors all accept assignment and you rarely see specialists, excess charges are unlikely to cost you anything, and that's a point for Plan N. If you use specialists, travel for care or simply don't want to check, Plan G removes the question. Our Plan G vs Plan N guide shows the break-even math.