Does your provider accept Medicare as full payment?
You can get the lowest cost if your doctor or other health care provider accepts the Medicare-approved amount as full payment for a covered service. This is called “accepting assignment.” If a provider accepts assignment, it’s for all Medicare-covered Part A and Part B services.
Using a provider that accepts assignment
Most doctors, providers, and suppliers accept assignment, but always check to make sure that yours do.
If your doctor, provider, or supplier accepts assignment:
- Your out-of-pocket costs may be less.
- They agree to charge you only the Medicare deductible and coinsurance amount, and usually wait for Medicare to pay its share before asking you to pay your share.
- They have to submit your claim directly to Medicare and can't charge you for submitting the claim.
How does assignment impact my drug coverage?
Using a provider that doesn't accept Medicare as full payment
Some providers who don’t accept assignment still choose to accept the Medicare-approved amount for services on a case-by-case basis. These providers are called "non-participating."
If your doctor, provider, or supplier doesn't accept assignment:
- You might have to pay the full amount at the time of service.
- They should submit a claim to Medicare for any Medicare-covered services they give you, and they can’t charge you for submitting a claim. If they refuse to submit a Medicare claim, you can submit your own claim to Medicare. Get the Medicare claim form.
- They can charge up to 15% over the Medicare-approved amount for a service, but no more than that. This is called "the limiting charge."
Does the limiting charge apply to all Medicare-covered services?
Using a provider that "opts-out" of Medicare
- Doctors and other providers who don’t want to work with the Medicare program may "opt out" of Medicare.
- Medicare won’t pay for items or services you get from provider that opts out, except in emergencies.
- Providers opt out for a minimum of 2 years. Every 2 years, the provider can choose to keep their opt-out status, accept Medicare-approved amounts on a case-by-case basis ("non-participating"), or accept assignment.
Private contracts with doctors or providers who opt out
- If you choose to get services from an opt-out doctor or provider you may need to pay upfront, or set up a payment plan with the provider through a private contract.
- Medicare won’t pay for any service you get from this doctor, even if it’s a Medicare-covered service.
What are the rules for private contracts?