A limiting charge is the amount above the Medicare-approved amount that non-participating providers can charge. These providers accept Medicare but do not accept Medicare’s approved amount for health care services as full payment. They can charge up to 15% more than the Medicare-approved amount, which you pay in addition to the 20% coinsurance. Some states restrict the limiting charge further. For example, in New York providers can only charge 5% more instead of 15% for most services. Providers who opt out of Medicare are not subject to these limiting charges and can charge as much as they want, if they maintain their opt-out status and give the patient a private contract that meets Medicare’s rules.

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