Medicare assignment is an agreement that your health care provider (doctor) has made to be paid by Medicare for the services they deliver. An important part of this agreement is that your provider won’t charge you anything more than a Medicare deductible and coinsurance. This can keep your out-of-pocket costs lower and ensure that your provider submits claims directly to Medicare. Accepting assignment refers to Original Medicare only, since Medicare Part C and D plans may have their own corresponding network of providers that they have agreements with.
What If a Doctor Doesn’t Take Assignment?
Medicare is not accepted universally and not all health care providers accept Medicare assignment.
A health care provider that doesn’t accept assignment is considered non-participating. This means they haven’t agreed to accept assignment for all Medicare-covered services. They can still take assignment on some services, though this shouldn’t be assumed. Some doctors may also choose to opt out, which means they won’t accept assignment for Medicare covered services. When a provider opts out, the services provided aren’t covered by Medicare at all, and you would be responsible for all costs out of your own pocket.
When a provider opts out, the services provided aren’t covered by Medicare at all, and you would be responsible for all costs out of your own pocket.
If a health care provider is non-participating, you’ll most likely be expected to pay for the full services up front. Afterward, the provider should submit a claim to Medicare for you. Since this isn’t required, it’s wise to request that they submit the claim and follow up so that Medicare can reimburse their portion of the bill. If they don’t submit the claim, you can contact 1-800-MEDICARE or, in some cases, submit your own claim. You should also know that they cannot charge you for submitting this claim.
One reason that a doctor may not accept assignment is because they wish to charge more for services than Medicare allows. When the fee is reimbursed, Medicare will cover the portion that they would have paid for with a participating provider. You’ll be expected to pay for the rest out of pocket. In some cases, Medicare will enforce what’s called a limiting charge, which caps how much a service can cost by up to 15 percent extra. This is known as an excess charge. A limiting charge is only available for some services, however. In these instances, you’ll still be responsible for the additional 15 percent.
How to Know If Your Doctor Accepts Assignment
It’s very important to determine if your doctor or provider has agreed to accept Medicare assignment. The whole point of Medicare is to help seniors attain affordable health care. If you need a service normally covered under Medicare, only to find that you’ll need to front the money or that it costs 15 percent more, it may become infeasible.
Luckily, there are ways you can find out who accepts Medicare assignment quickly and easily. If you already have a physician, you can simply ask them. They should be able to give you an idea if they accept all Medicare assignments, some, or choose to opt out.
If you already have a physician, you can simply ask them. You can also explore your options online.
You can also explore the Medicare Physician Compare tool. The tool allows you to search by your area, by the doctor’s name, or even by their specialty. If you want to get really specific, you can even limit the search to your area and a particular issue you’re experiencing.
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Medicare is a powerful service that can help Americans pay for the health care they need. Getting a necessary service only to find out that you owe money, or that it wasn’t properly covered, is a shock nobody wants. The sooner you know if your health care provider accepts Medicare assignment, the better.