Medicare assignment is a term used to describe how a healthcare provider agrees to accept the Medicare-approved amount. Depending on how you get your Medicare coverage, it could be essential to understand what it means and how it can affect you.

Understanding the Medicare-approved Amount

Medicare sets a fixed cost to pay for every benefit they cover. This amount is called Medicare assignment.

You have the largest healthcare provider network with over 800,000 providers nationwide on Original Medicare. You can see any doctor nationwide that accepts Medicare.

Understanding the differences between your cost and the difference between accepting Medicare and accepting Medicare assignment could be worth thousands of dollars.

Healthcare Providers Accepting Medicare

Your healthcare provider can fall into one of three categories:

  1. Accepts Medicare assignment
  2. Takes Medicare but doesn’t accept Medicare assignment
  3. Doesn’t accept Medicare

More than 97% of healthcare providers nationwide accept Medicare. Because of this fact, you can see almost any provider throughout the United States without needing referrals.

Let’s discuss the three categories the healthcare providers fall into.

Accepts Medicare and Medicare Assignment

Participating providers are doctors or healthcare providers who accept Medicare assignment. This means they will never charge more than the Medicare-approved amount.

Accepts Medicare But Doesn’t Accept Medicare Assignment

There are non-participating providers that accept Medicare but not Medicare assignment. This means that you can see them the same way you see a provider that accepts Medicare assignment.

You need to understand that since they don’t take Medicare assignment, they can charge up to 15% more than the Medicare-approved amount.

Since Medicare will only pay the Medicare-approved amount, you’ll be responsible for these charges. The 15% overcharge is called an excess charge. A few states do not allow or limit the amount or services of the excess charges. Only about 5% of providers charge excess charges.

Doesn’t Accept Medicare

Opt-out providers don’t accept Original Medicare, and these healthcare providers are in the minority in the United States. If healthcare providers don’t accept Medicare, they won’t be paid by Medicare.

This means choosing to see a provider that doesn’t accept Medicare will leave you responsible for 100% of what they charge you. These providers may be in-network for a Medicare Advantage plan in some cases.

Avoiding Additional Charges

Excess charges could be large or small depending on the service and the Medicare-approved amount. Avoiding these is easy. The simplest way is to ask your provider before service if they accept Medicare assignment.

If they say yes, they do not issue excess charges. Or, on Medicare.gov, there’s a provider search tool that’ll allow you to look up your healthcare provider, and it’ll show if they accept Medicare assignment or not.

Medicare Supplement and Medicare Assignment

Medigap plans are additional insurance that helps cover your Medicare cost-share. If you are on specific plans, they’ll pay any extra costs from healthcare providers that accept Medicare but not Medicare assignment. Most Medicare Supplement plans don’t cover the excess charges.

Medicare Advantage and Medicare Assignment

Medicare assignment has no effect on Medicare Advantage plans since Medicare Advantage is just another way to receive your Medicare benefits. Since your Medicare Advantage plan is now handling your healthcare benefits, they set the terms.

Most Medicare Advantage plans require you to use network providers. If you go out of the network, you may pay more. If you’re on an HMO, you’d be responsible for the entire charge of the provider not being in the network.

FAQs

What is a Medicare assignment?

The Medicare assignment means that the healthcare provider has agreed to only charge the amount Medicare has approved for procedure and services.

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

The doctor can change more than the Medicare-approved amount for procedures and services. You could be responsible for up to a 15% excess charge.

How many doctors accept Medicare assignment?

About 97% of doctors agree to accept Medicare assignment.

Is accepting Medicare the same as accepting Medicare assignment?

No. If a doctor accepts Medicare and accepts Medicare assignment, they’ll take what Medicare approves as payment in full.

If they accept Medicare but not Medicare assignment, they can charge up to 15% more than the Medicare-approved amount. You could be responsible for this excess charge.

What is the Medicare-approved amount?

The Medicare-approved amount is Medicare’s charge as the maximum for any given medical service or procedure.

Can doctors balance bill patients?

Yes, if that doctor takes Medicare but does not accept Medicare assignment. The provider may bill up to 15% more than the Medicare-approved amount.

Getting Help With Your Medicare Needs

Whether it’s Medicare assignment, or anything related to Medicare, we have licensed agents that specialize in this field standing by to assist.

Give us a call, or fill out our online request form. We are happy to help answer questions, review options, and guide you through the process.

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by Lindsay Malzone, Lindsay Malzone is the Medicare expert for Medigap.com. She's been contributing to many well-known publications as an industry expert since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.