What does the term "Excess Charge" refer to in the context of Medicare?

The term "Excess Charge" in the context of Medicare specifically refers to the difference between the Medicare-approved amount for a service and the actual charge that a healthcare provider bills. Medicare sets a standard amount it considers reasonable for various medical services, and if a provider charges more than this approved amount, the additional amount above the approved limit is termed the "excess charge."

When a beneficiary receives a service, Medicare will pay its share based on the approved amount. If the service provider’s actual charge exceeds that approved amount, the beneficiary may be responsible for paying the excess charge. This is particularly relevant for services provided by non-participating providers who may bill patients for the difference rather than accepting the approved amount as full payment. It is important for beneficiaries to be aware of potential excess charges when seeking care from providers who do not accept assignment from Medicare.

Understanding this term helps Medicare beneficiaries better manage their healthcare expenses and be prepared for any additional costs they might incur when services are provided by certain healthcare professionals.