Medicare Assignment is an agreement between healthcare providers who accept Medicare payments and the government to accept the approved Medicare reimbursement as full payment for their services. This means that healthcare providers cannot charge patients more than the Medicare-approved amount for a covered service.

Medicare Assignment Explanation

Medicare Assignment is a voluntary agreement between healthcare providers and the government to accept the Medicare-approved amount as full payment for their services. This means that patients with Medicare will not be charged more than the approved amount, and healthcare providers cannot bill patients for any excess charges.

How Does Medicare Assignment Work?

As stated above, Medicare Assignment is an agreement between healthcare providers who accept Medicare payments and the government. When healthcare providers agree to accept Medicare Assignment, they agree to accept the Medicare-approved amount as full payment for their services. This means that patients with Medicare who receive care from these providers will not be charged more than the approved amount, and healthcare providers cannot bill patients for any excess charges

For example, let’s say a patient with Medicare visits a healthcare provider who has agreed to accept Medicare Assignment. If the approved amount for the service is $100, the healthcare provider will accept this amount as payment in full, and the patient will not have to pay anything out of pocket beyond their normal Medicare copayment or coinsurance. However, if the healthcare provider did not accept Medicare Assignment and charged $150 for the same service, the patient would be responsible for paying the excess charges, which Medicare would not cover.

When doctors agree to Medicare Assignment, they can be classified into one of three categories: Participating Providers, Non-Participating Providers, or Opt-Out Providers. Participating Providers accept the amount established by Medicare as payment in full for a procedure or visit. Non-Participating Providers accept Medicare benefits but can charge an excess of up to 15% more than the Medicare-approved amount in some states. Opt-Out Providers do not accept Medicare and represent less than 3% of adult healthcare providers in the United States.

Will All Doctors Accept Medicare Assignment?

Not all doctors accept Medicare assignments. While the vast majority of doctors in the United States participate in Medicare, some may choose not to accept assignments, which means they may charge more than the Medicare-approved amount for their services. These doctors are considered “non-participating” and may charge up to 15% more than the Medicare-approved amount. Additionally, some doctors do not accept Medicare at all. Before making an appointment, it’s important to check with your doctor’s office to confirm their participation in Medicare and whether they accept assignments.

Do All Doctors Accept Medigap Plans?

While most doctors and healthcare providers who accept Original Medicare will also accept Medigap plans, there is no legal requirement for them to do so. 

If a doctor accepts Medicare assignment, they are legally required to accept Medicare Supplement Insurance, also known as Medigap, if they have one. Medigap plans are optional insurance policies that can help cover some out-of-pocket costs associated with Original Medicare, such as copayments, coinsurance, and deductibles. When you have a Medigap plan, your doctor will bill Medicare for your services and then bill your Medigap plan for any additional costs that are covered under your plan.

If you have a Medigap plan that covers excess charges but the doctor does not accept Medicare assignments, you may still be able to receive care from that doctor. However, you will be responsible for paying the Part B Excess Charges out of pocket. The Medigap plan will then cover those excess charges as per the policy terms.

Are Medicare Assignment and Part B Excess Charges the Same?

Although related, Medicare Assignment and Part B Excess Charges are not the same things. Medicare Assignment refers to the agreement between a healthcare provider and Medicare to accept the Medicare-approved amount as full payment for their services, meaning the provider cannot charge the patient more than the approved amount, and any excess charges are waived. In contrast, Part B Excess Charges are additional fees that healthcare providers may charge if they do not accept Medicare Assignment, allowing them to bill patients up to 15% more than the Medicare-approved amount. However, not all healthcare providers charge Part B Excess Charges, and some may choose to accept Medicare Assignment voluntarily. Patients should always confirm with their healthcare provider whether they accept Medicare Assignment and whether they charge Part B Excess Charges before receiving any services to avoid unexpected costs.

How to Find Doctors Which Accept Medicare Assignments?

Finding doctors who accept Medicare assignments can be relatively straightforward. One option is to use the Medicare Provider Directory, which lists all the healthcare providers in a given area who accept Medicare assignments. This directory is available on the Medicare website, and you can search by zip code, city, or state to find providers. You can also contact your state health insurance assistance program (SHIP) for assistance in finding doctors who accept Medicare assignments. Additionally, you can contact your doctor’s office directly to confirm whether they accept Medicare assignments. Some doctors may also display the Medicare assignment logo or note it on their website or office materials. When searching for a doctor, it’s important to confirm whether they accept Medicare assignments, as this can impact the cost of services and out-of-pocket expenses.

Ways To Avoid Part B Excess Charges

There are several ways to avoid Part B Excess Charges. One option is to choose a healthcare provider who accepts Medicare Assignment, meaning they agree to accept the Medicare-approved amount as full payment for their services, and cannot charge you more than that amount. Another option is to enroll in a Medicare Advantage plan, which often has a network of healthcare providers who have agreed to accept the plan’s payment terms, and therefore do not charge Part B Excess Charges. Alternatively, you can consider switching to a Medigap plan that covers Part B Excess Charges, which can help reduce or eliminate out-of-pocket expenses related to excess charges. It’s important to note that not all healthcare providers charge Part B Excess Charges, so it’s always a good idea to confirm with your provider before receiving any services. If you do receive a bill for Part B Excess Charges, it’s important to review it carefully and contact Medicare or your insurance provider if you have any questions or concerns.