Glossary · Costs
What is balance billing?
Balance billing is when a provider bills you for the difference between the provider's charge and the plan's allowed amount. If the charge is $100 and the allowed amount is $70, the provider may bill you $30.
Definition and figures from HealthCare.gov glossary, Medicare.gov, checked October 23, 2026. This page explains the term; it does not recommend a plan.
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Balance billing: the facts
| Item | Fact | Source |
|---|---|---|
| Example from HealthCare.gov | $100 charge, $70 allowed amount, $30 balance bill | HealthCare.gov glossary: Balance billing |
| Preferred providers | May not balance bill you for covered services | HealthCare.gov glossary: Balance billing |
| Medicare non-participating providers | Can charge up to 15% above the Medicare-approved amount (the limiting charge) | Medicare.gov: Does your provider accept Medicare as full payment? |
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Questions
What does balance billing mean in health insurance?
Balance billing is when a provider bills you for the difference between the provider's charge and the plan's allowed amount. If the charge is $100 and the allowed amount is $70, the provider may bill you $30.
Does balance billing count toward the out-of-pocket maximum?
No. HealthCare.gov lists costs above the allowed amount among the charges the out-of-pocket limit does not include.