What Is Medicare Assignment?

There are many terms and acronyms when you start learning about Medicare, and “Medicare assignment” is one that may come up for you.

If you don’t find a doctor that accepts Medicare assignment, your costs for medical care could be higher, even with a Medicare Supplement. Here’s what you need to know about Medicare assignment and non-participating providers.

What does Medicare assignment mean?

Have you ever noticed on an Explanation of Benefits that the price a doctor charges is not what you actually end up paying?

For example, your doctor may charge $350 for an office visit, but the insurance company may re-price that to $95. When the doctor decided to accept this insurance, they agreed to accept the lower payment amount.

Medicare does the same thing.  

Every year, Medicare sets the amounts they’ll agree to pay for covered services. If a doctor, provider, or supplier accepts “assignment,” it means they agree to accept the Medicare-approved amount as full payment for covered services.

What does it mean when a doctor does not accept Medicare assignment?

Any provider that doesn’t sign an agreement to accept assignment for all Medicare-covered services is called a non-participating provider.

These providers can still choose to accept assignment for individual services. As an example, a provider may accept Medicare assignment for a preventative office visit, but not for a diagnostic office visit.  

In these situations, a non-participating provider is allowed to charge you more than the Medicare-approved amount. However, there’s a limit called a “limiting charge” or “excess charge.” The provider is only allowed to charge up to 15% over the Medicare-approved amount.

If a provider chooses to completely opt-out of Medicare, that means they don’t want to work with the Medicare program at all. In these cases, you’d be paying out of pocket for any services you receive, except in the case of an emergency.

What if I have a Medicare Supplement?

If you have a Medicare Supplement, you are still allowed to see non-participating providers. Plus, if you have a Plan F or Plan G, the potential limiting charge – or excess charge – is covered by your supplemental plan.

If you have a Plan N, you would be responsible for that excess charge, which is up to 15% over the Medicare-approved amount.

For all individuals with a Medicare Supplement, you’ll want to avoid seeing providers who have opted out of Medicare. If you do see a provider who has opted out, you’d be responsible for all medical bills unless it’s an emergency.  

How do I know if my doctor accepts Medicare assignment?

Most doctors accept Medicare assignment, so rest easy! It’s pretty rare to come across a doctor that doesn’t accept Medicare.

However, finding out is easy: just ask. Plus, if a provider does not accept Medicare, they are required to have you sign a form stating that you understand this.

Finally, you can use Medicare’s Care Compare tool to double-check if your provider, doctor, or supplier accepts Medicare. We still recommend double-checking with a quick phone call, though.

What percentage of doctors accept Medicare assignment?

Depending on which source you use, anywhere from 93-99% of physicians accept Medicare assignment. If you’re going to run into a provider that doesn’t accept Medicare assignment, they’re most likely to be a specialist, such as a psychiatrist or neurologist (Kaiser Family Foundation report).

In general, dealing with a non-participating provider or a provider who has completely opted out of Medicare will be rare.

However, if you do run into this situation or want extra help, don’t hesitate to reach out to our office at 217-423-8000. Our licensed insurance agents can assist you with your questions.

Conclusion

There’s always something new to learn about Medicare! If you ever come across the term “Medicare assignment,” we hope this article helps clear things up.

As always, you do not need to learn everything about the confusing Medicare program. Please remember you can lean on our team of Medicare experts to help answer your questions and clear up the complexities.

We read the fine print so you don’t have to.