Ritter Insurance Marketing, Craig Ritter

Information on Medicare Excess Charges

How Medicare plans cover excess charges and which States do not allow providers to charge more than Medicare allows.

Posted by filed under Medicare Supplement .

  • Anonymous

    Its ridiculous why arent all states prohibited from part b excess charges thought obamacare was going to address this . So maybe we should be able to buy care across state lines.

  • Anonymous

    Living in PA is great. With the new N Plan, I had a $180,000 procedure and payed only $162.00 out of pocket (Medicare Part B deductible).

  • Anonymous

    A few of our agents are also looking for specifics on which states allow excess. I searched online for a while and couldn’t find anything so I though I’d try here.

    BGA Insurance

    • All the states except for the ones listed allow excess charges.

    • States which DO NOT allow excess charges are: Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island and Vermont.

      All others will allow.

  • Rhonda K West

    I am trying to find the list. I see a comment thanking Kim for the list. Can you tell me how to retrieve the list?

    • There are several states which have mandated that Medicare providers are not able to charge more than what Medicare allows (This is the MOM Law or Medicare Overcharge Measure). In these states, the Part B excess charge coverage is not necessary. The states are: Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island and Vermont.

  • Steven

    Where did you come up with the states not allowing excess charges? I’ve got another broker telling my client that this info is all wrong. The client then called Medicare and was told it had nothing to do with the states, that it was solely dependent on the doctor accepting assignment and could be in any state. Can your information be sited?


    • Steven:

      Are you just looking for a citation in OH?


    • See page 23 of this document: http://www.insurance.ohio.gov/Consumer/OCS/CompleteGuides/CompleteMedSupGuide.pdf

      Note: Most Ohio residents do not need
      excess charges coverage because of
      the state’s balance bill ban. Call OSHIIP
      for details: 1-800-686-1578.

      Some OH residents who spend time outside of Ohio, may want to consider a plan with excess charges since there are many other states which allow physicians to excess charge your clients.

  • G. Avery


    Law of the state you’re visiting.

  • OK. Please clarify…..If I were traveling out of state and had to visit an emergency room for medical care, how would I be charged….based on PA law re: excess billing or the law of the state where I received treatment?

    • Agreed. Thus a Plan F may prove useful in a “Mom Law” state for a Beneficiary who might travel out of state. By the way, I wanted to say thanks to Kim for providing the list. I had it at one time years ago and lost it and I wanted to have it documented someplace.


      • Rhonda K West

        Craig, how do I find the list of states?

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