California G Medicare Plans  -    Medicare Excess

what is excess with Medicare and do i cover it


What Are Medicare Excess Charges?



Medicare introduces seniors to a whole slew of new terms.

Let's add one to the list.

A very important term.

Medicare Excess

What is it, how does it work, and maybe most importantly, is there a Medicare plan that will take care of it.

It's good to understand how Excess works as we go forward since it will become more important (and costly) with each year.

Let's jump right into it. First, what is it?

What is Medicare Excess?

Here's the simple answer.

 Doctors are allowed to charge up to 15% more than what Medicare allows and still be Medicare providers.


The 15% is Excess.

A little more background.

Medicare has its own list of contracted providers...similar to a PPO.

These doctors agree to certain requirements from Medicare (or CMS really).

The most important of these rules deals with how much they can charge.

For any given medical procedure, there's an agreed upon reimbursement rate.  A schedule of allowed charges.

For example, a doctor visit with a dermatologist (just the consultation itself), Medicare may list a rate of $80 reimbursement back to the doctor in a given area.

The doctor must agree to a list of reimbursements based on different health care codes to be a Medicare doctor.

If not, Medicare will not reimburse the doctor for those services to Medicare members.

Pretty straight forward.

There's a catch (as always)!

 A doctor is allowed to charge up to 15% more than the allowed Medicare rate and STILL remain "in-network" with Medicare.


Some doctors accept the Medicare rate while others choose to charge up to the 15% additional amount.

For example...

If the allowed Medicare rate for an office visit is $100, a doctor can charge up to $115 and still keep their coveted Medicare provider status.

If you only have Medicare (and not a supplement), you will have to pay this 15% in addition to the core benefits of Medicare.


quote supplements that will cover excess like the g plan

15% doesn't seem too bad..what's the big deal?

Why Medicare Excess Is important

Here's the deal...there's no cap to the 15%

15% on $100 is manageable to most people.

15% on $4000 is less so and 15% on $20K will pose issues to many seniors.

That 15% can continue indefinitely.

Your surgeon might accept Medicare's rates but what about the supporting staff or anesthesiologist?  (from actual client experiences!!)

Again, the 15% is not curtailed by your core Part B Medicare coverage.

That's just the start of why Medicare Excess is an important consideration.

The importance will only grow with time.

Get ready for Excess playing a much more important role.

Crystal Balls and Medicare Excess

Excess is going to get much more important.

Maybe critical.

A quick lay of the land.

There's tremendous pressure on Medicare to contain costs as its financial situation worsens.

The biggest bat Medicare can take to its costs is the reimbursement to doctors and hospitals.

It's been an ongoing battle.


Look at what they're facing?:


why medicare alone is an issue


Each year, Congress is faced with an existing mandate to roll back reimbursement to doctors and each year, out of political pressure, they choose to delay for another year.  Understandably!

The issue is that this compounds over time and just shifts the need to the future.

The rate of inflation for doctor reimbursement is already extremely low.

Add to that a slowing birthrate (less workers to support seniors), and it's going to get "interesting".

Why does this matter?

Expect more pressure from Medicare on doctor's reimbursements.

 As a result, expect more doctors to charge "Excess".


Doctors are already under assault from falling reimbursements due to the ACA health law.

It probably won't be unheard of to see most doctors charge excess within 5-10 years.

Alright...we established why Excess is important and how it will grow in importance.

What can we do about it?

Enter the G plan - Excess Killer!

We help many Seniors find the best Medicare supplement plan for their situation and budget.  Check out our Picking the Best Medicare Guide or Insider's Guide to Medicare Supplements.


One note..excess isn't an issue with Advantage plans since you have to remain in network and they by definition, agree to medicare rates.  See our big review on the trade-off between Advantage and Supplements.

Without fail, the G plan is the plan of choice and for good reason.

Aside from the comprehensive nature of the G plan in regards to the major holes of Medicare (deductibles, 20% coinsurance, etc), it's the only supplement plan that addresses...



 That's right. The G Medigap plan will cover Excess when doctors charge more than what Medicare allows.

 It's the only true supplement plan (as oppose to Advantage plans which force networks) that covers Excess.  We have a massive review on the G medigap plan.


By definition, a doctor must accept Medicare if they participate in an Advantage plan.


You can quickly quote all the major carriers for Medicare supplements including the G plan.


quote california medicare carriers and plans online


We're happy to walk through any questions on how the plans work and differ from each other.

The Medicare Excess Wrap-up

  • Doctors can choose to charge more than 15% above what Medicare allows and still be Medicare providers.
  • Core Part A and Part B do not cover this 15% - the member will be responsible
  • The financial impact from Excess will only grow with time due to Medicare pressure on costs.
  • The G Plan supplement is the only Supplement plan (as opposed to Advantage plan) that covers this 15% Excess charge.


Really...figuring out the excess piece and Part D (for medication) rounds out the decision making.


Finally, let us help you! There's no cost for our services and we have helped 1000's of California Seniors find the best supplement plan values.


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Call us at 800-320-6269 and we can go through any questions or run your instant Quote including G plan with Excess coverage here.  Thanks!