Health & Benefits

Medicare assignment is when a health care provider accepts Medicare and has agreed not to charge more than the cost for services approved by Medicare.

By using a provider who accepts assignment, you will not have to pay more than any deductible and coinsurance amount under your Medicare plan. Also, the provider is responsible for submitting a bill for the services you receive directly to Medicare. 

Providers who do not accept assignments for all services rendered are called "non-participating." Non-participating providers may accept Medicare but can charge you more than the cost for services approved by Medicare. You are responsible for any amount that is more than what Medicare approves, along with any deductible and coinsurance due under your Medicare plan. However, non-participating providers cannot charge above the "limiting charge" for certain services. The limiting charge cannot exceed 115% of Medicare’s approved charge.

Also, non-participating providers can require that you pay the entire bill at the time of service. Then you would ask Medicare to reimburse you using Form CMS-1490S. Medicare will reimburse you at only 80% of the Medicare-approved charge.

Providers who “opt-out” do not accept Medicare at all and can charge whatever they want for services, even above the limiting charge. Medicare will not cover any amount of non-emergency services you receive from a provider who opts out. You are responsible for paying the full amount charged and will not be reimbursed by Medicare. In an emergency, Medicare may cover services from a provider who opts out.

You should always check whether your provider accepts Medicare assignment.  

Example: You pay a 20% coinsurance under your Medicare plan. You see a doctor and the Medicare-approved charge for their service is $100. If the doctor accepts assignment, Medicare will pay them $80. The doctor can require you to immediately pay $20, the amount of your coinsurance, but nothing more. 

If the doctor does not accept assignment and is non-participating, the doctor could charge up to $115. The doctor could require that you pay the entire amount at once. Medicare will reimburse you $80, and you would be liable for the remaining $35.