Medicare assignment means that your doctor accepts the Medicare-approved amount as full payment for covered services. Most doctors accept Medicare assignment, but some do not. Check to make sure that your doctor participates in Medicare AND accepts assignment – it will keep your costs down and make life easier. Consider the following scenarios.
Your doctor accepts Medicare assignment
Doctors accepting assignments are known as participating doctors. Here what happened if you are visiting the participating provider:
- Participating doctors agree to accept the Medicare approved amount as payment in full. You may be only charged for the Medicare deductible and coinsurance amount (typically 20%). Medicare typically pays its share before you are asked to pay your share.
- Doctors submit your claim directly to Medicare.
- Your out-of-pocket costs are minimized.
Your doctor accepts Medicare but does not accept Medicare assignment
Doctors who accept Medicare, but do not take assignment are called non-participating doctors. Here what happened if you are visiting the non-participating doctor:
- Doctors may charge you more than the Medicare-approved amount, but the extra charge is limited to 15% of the amount paid to the participating providers. In addition, the non-participating providers are paid only 95% of the fee scheduled amount. In some states like Pennsylvania, the extra charges are illegal.
- You might have to pay the full charge at the time of service. Your doctor will submit a claim to Medicare, but sometimes you have to submit your own claim to Medicare to get paid back.
Your doctor does not accept Medicare
Some doctors do NOT accept Medicare at all. They are called opt-out doctors. The opt-out doctors can charge you any amount for their health services, but they must provide you with a private contract with the specifics of their services, and you are asked to sign it. By signing the contract, you acknowledge that:
- Medicare will not pay any amount of the services you get from the opt-out doctor, even if it is Medicare-covered services.
- You suppose to pay the full amount the provider charges you.
- Your provider must tell you if Medicare would pay for the service if you got it from another provider who accepts Medicare.
As you see from the above the differences between doctors accepting Medicare assignment and not accepting it are quite significant. Therefore, always confirm that your provider participates in Medicare AND accepts the assignment.
US Government Sources
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