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Summary: If a provider accepts Medicare assignment, they accept the Medicare-approved amount for a covered service. Though most providers accept assignment, not all do. In this article, we’ll explain the differences between participating, non-participating, and opt-out providers. You’ll also learn how to find physicians in your area who accept Medicare assignment. Estimated Read Time: 5 min

What is Medicare Assignment

Medicare assignment is an agreement by your doctor or other healthcare providers to accept the Medicare-approved amount as the full cost for a covered service. Providers who “accept assignment” bill Medicare directly for Part B-covered services and cannot charge you more than the applicable deductible and coinsurance.

Most healthcare providers who opt-in to Medicare accept assignment. In fact, CMS reported in its Medicare Participation for Calendar Year 2024 announcement that 98 percent of Medicare providers accepted assignment in 2023.

Providers who accept Medicare are divided into two groups: Participating providers and non-participating providers. Providers can decide annually whether they want to participate in Medicare assignment, or if they want to be non-participating.

Providers who do not accept Medicare Assignment can charge up to 15% above the Medicare-approved cost for a service. If this is the case, you will be responsible for the entire amount (up to 15%) above what Medicare covers.

Below, we’ll take a closer look at participating, non-participating, and opt-out physicians.

Medicare Participating Providers: Providers Who Accept Medicare Assignment

Healthcare providers who accept Medicare assignment are known as “participating providers”. To participate in Medicare assignment, a provider must enter an agreement with Medicare called the Participating Physician or Supplier Agreement. When a provider signs this agreement, they agree to accept the Medicare-approved charge as the full charge of the service. They cannot charge the beneficiary more than the applicable deductible and coinsurance for covered services.

Each year, providers can decide whether they want to be a participating or non-participating provider. Participating in Medicare assignment is not only beneficial to patients, but to providers as well. Participating providers get paid by Medicare directly, and when a participating provider bills Medicare, Medicare will automatically forward the claim information to Medicare Supplement insurers. This makes the billing process much easier on the provider’s end.

Medicare Non-Participating Providers: Providers Who Don’t Accept Assignment

Healthcare providers who are “non-participating” providers do not agree to accept assignment and can charge up to 15% over the Medicare-approved amount for a service. Non-participating Medicare providers still accept Medicare patients. However they have not agreed to accept the Medicare-approved cost as the full cost for their service.

Doctors who do not sign an assignment agreement with Medicare can still choose to accept assignment on a case-by-case basis. When non-participating providers do add on excess charges , they cannot charge more than 15% over the Medicare-approved amount. It’s worth noting that providers do not have to charge the maximum 15%; they may only charge 5% or 10% over the Medicare-approved amount.

When you receive a Medicare-covered service at a non-participating provider, you may need to pay the full amount at the time of your service; a claim will need to be submitted to Medicare for you to be reimbursed. Prior to receiving care, your provider should give you an Advanced Beneficiary Notice (ABN) to read and sign. This notice will detail the services you are receiving and their costs.

Non-participating providers should include a CMS-approved unassigned claim statement in the additional information section of your Advanced Beneficiary Notice. This statement will read:

“This supplier doesn’t accept payment from Medicare for the item(s) listed in the table above. If I checked Option 1 above, I am responsible for paying the supplier’s charge for the item(s) directly to the supplier. If Medicare does pay, Medicare will pay me the Medicare-approved amount for the item(s), and this payment to me may be less than the supplier’s charge.”

This statement basically summarizes how excess charges work: Medicare will pay the Medicare-approved amount, but you may end up paying more than that.

Your provider should submit a claim to Medicare for any covered services, however, if they refuse to submit a claim, you can do so yourself by using CMS form 1490S .

Opt-Out Providers: What You Need to Know

Opt-out providers are different than non-participating providers because they completely opt out of Medicare. What does this mean for you? If you receive supplies or services from a provider who opted out of Medicare, Medicare will not pay for any of it (except for emergencies).

Physicians who opt-out of Medicare are even harder to find than non-participating providers. According to a report by KFF.org, only 1.1% of physicians opted out of Medicare in 2023. Of those who opted out, most are physicians in specialty fields such as psychiatry, plastic and reconstructive surgery, and neurology.

How to Find A Doctor Who Accepts Medicare Assignment

Finding a doctor who accepts Medicare patients and accepts Medicare assignment is generally easier than finding a provider who doesn’t accept assignment. As we mentioned above, of all the providers who accept Medicare patients, 98 percent accept assignment.

The easiest way to find a doctor or healthcare provider who accepts Medicare assignment is by visiting Medicare.gov and using their Compare Care Near You tool . When you search for providers in your area, the Care Compare tool will let you know whether a provider is a participating or non-participating provider.

If a provider is part of a group practice that involves multiple providers, then all providers in that group must have the same participation status. As an example, we have three doctors, Dr. Smith, Dr. Jones, and Dr. Shoemaker, who are all part of a group practice called “Health Care LLC”. The group decides to accept Medicare assignment and become a participating provider. Dr. Smith decides he does not want to accept assignment, however, because he is part of the “Health Care LLC” group, he must remain a participating provider.

Using Medicare’s Care Compare tool, you can select a group practice and see their participation status. You can then view all providers who are part of that group. This makes finding doctors who accept assignment even easier.

To ensure you don’t end up paying more out-of-pocket costs than you anticipated, it’s always a good idea to check with your provider if they are a participating Medicare provider. If you have questions regarding Medicare assignment or are having trouble determining whether a provider is a participating provider, you can contact Medicare directly at 1-800-633-4227. If you have questions about excess charges or other Medicare costs and would like to speak with a licensed insurance agent, you can contact us at the number above.

Announcement About Medicare Participation for Calendar Year 2024, Centers for Medicare & Medicaid Services. Accessed January 2024

https://www.cms.gov/files/document/medicare-participation-announcement.pdf

Annual Medicare Participation Announcement, CMS.gov. Accessed January 2024

https://www.cms.gov/medicare-participation

Does Your Provider Accept Medicare as Full Payment? Medicare.gov. Accessed January 2024

https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare

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If you have Original Medicare , your Part B costs once you have met your deductible can vary depending on the type of provider you see. For cost purposes, there are three types of provider, meaning three different relationships a provider can have with Medicare . A provider’s type determines how much you will pay for Part B -covered services.

• These providers are required to submit a bill (file a claim ) to Medicare for care you receive. Medicare will process the bill and pay your provider directly for your care. If your provider does not file a claim for your care, there are troubleshooting steps to help resolve the problem .
• If you see a participating provider , you are responsible for paying a 20% coinsurance for Medicare-covered services.
• Certain providers, such as clinical social workers and physician assistants, must always take assignment if they accept Medicare.
• Non-participating providers can charge up to 15% more than Medicare’s approved amount for the cost of services you receive (known as the limiting charge ). This means you are responsible for up to 35% (20% coinsurance + 15% limiting charge) of Medicare’s approved amount for covered services.
• Some states may restrict the limiting charge when you see non-participating providers. For example, New York State’s limiting charge is set at 5%, instead of 15%, for most services. For more information, contact your State Health Insurance Assistance Program (SHIP) .
• If you pay the full cost of your care up front, your provider should still submit a bill to Medicare. Afterward, you should receive from Medicare a Medicare Summary Notice (MSN) and reimbursement for 80% of the Medicare-approved amount .
• The limiting charge rules do not apply to durable medical equipment (DME) suppliers . Be sure to learn about the different rules that apply when receiving services from a DME supplier .
• Medicare will not pay for care you receive from an opt-out provider (except in emergencies). You are responsible for the entire cost of your care.
• The provider must give you a private contract describing their charges and confirming that you understand you are responsible for the full cost of your care and that Medicare will not reimburse you.
• Opt-out providers do not bill Medicare for services you receive.
• Many psychiatrists opt out of Medicare.

Providers who take assignment should submit a bill to a Medicare Administrative Contractor (MAC) within one calendar year of the date you received care. If your provider misses the filing deadline, they cannot bill Medicare for the care they provided to you. However, they can still charge you a 20% coinsurance and any applicable deductible amount.

Be sure to ask your provider if they are participating, non-participating, or opt-out. You can also check by using Medicare’s Physician Compare tool .

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What is Medicare assignment and how does it work?

Kimberly Lankford,

​Because Medicare decides how much to pay providers for covered services, if the provider agrees to the Medicare-approved amount, even if it is less than they usually charge, they’re accepting assignment.

A doctor who accepts assignment agrees to charge you no more than the amount Medicare has approved for that service. By comparison, a doctor who participates in Medicare but doesn’t accept assignment can potentially charge you up to 15 percent more than the Medicare-approved amount.

That’s why it’s important to ask if a provider accepts assignment before you receive care, even if they accept Medicare patients. If a doctor doesn’t accept assignment, you will pay more for that physician’s services compared with one who does.

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How much do I pay if my doctor accepts assignment?

If your doctor accepts assignment, you will usually pay 20 percent of the Medicare-approved amount for the service, called coinsurance, after you’ve paid the annual deductible. Because Medicare Part B covers doctor and outpatient services, your $240 deductible for Part B in 2024 applies before most coverage begins.

All providers who accept assignment must submit claims directly to Medicare, which pays 80 percent of the approved cost for the service and will bill you the remaining 20 percent. You can get some preventive services and screenings, such as mammograms and colonoscopies , without paying a deductible or coinsurance if the provider accepts assignment. 

What if my doctor doesn’t accept assignment?

A doctor who takes Medicare but doesn’t accept assignment can still treat Medicare patients but won’t always accept the Medicare-approved amount as payment in full.

This means they can charge you up to a maximum of 15 percent more than Medicare pays for the service you receive, called “balance billing.” In this case, you’re responsible for the additional charge, plus the regular 20 percent coinsurance, as your share of the cost.

How to cover the extra cost? If you have a Medicare supplement policy , better known as Medigap, it may cover the extra 15 percent, called Medicare Part B excess charges.

All Medigap policies cover Part B’s 20 percent coinsurance in full or in part. The F and G policies cover the 15 percent excess charges from doctors who don’t accept assignment, but Plan F is no longer available to new enrollees, only those eligible for Medicare before Jan. 1, 2020, even if they haven’t enrolled in Medicare yet. However, anyone who is enrolled in original Medicare can apply for Plan G.

Remember that Medigap policies only cover excess charges for doctors who accept Medicare but don’t accept assignment, and they won’t cover costs for doctors who opt out of Medicare entirely.

Good to know. A few states limit the amount of excess fees a doctor can charge Medicare patients. For example, Massachusetts and Ohio prohibit balance billing, requiring doctors who accept Medicare to take the Medicare-approved amount. New York limits excess charges to 5 percent over the Medicare-approved amount for most services, rather than 15 percent.

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How do I find doctors who accept assignment?

Before you start working with a new doctor, ask whether he or she accepts assignment. About 98 percent of providers billing Medicare are participating providers, which means they accept assignment on all Medicare claims, according to KFF.

You can get help finding doctors and other providers in your area who accept assignment by zip code using Medicare’s Physician Compare tool .

Those who accept assignment have this note under the name: “Charges the Medicare-approved amount (so you pay less out of pocket).” However, not all doctors who accept assignment are accepting new Medicare patients.

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What does it mean if a doctor opts out of Medicare?

Doctors who opt out of Medicare can’t bill Medicare for services you receive. They also aren’t bound by Medicare’s limitations on charges.

In this case, you enter into a private contract with the provider and agree to pay the full bill. Be aware that neither Medicare nor your Medigap plan will reimburse you for these charges.

In 2023, only 1 percent of physicians who aren’t pediatricians opted out of the Medicare program, according to KFF. The percentage is larger for some specialties — 7.7 percent of psychiatrists and 4.2 percent of plastic and reconstructive surgeons have opted out of Medicare.

Keep in mind

These rules apply to original Medicare. Other factors determine costs if you choose to get coverage through a private Medicare Advantage plan . Most Medicare Advantage plans have provider networks, and they may charge more or not cover services from out-of-network providers.

Before choosing a Medicare Advantage plan, find out whether your chosen doctor or provider is covered and identify how much you’ll pay. You can use the Medicare Plan Finder to compare the Medicare Advantage plans and their out-of-pocket costs in your area.

Return to Medicare Q&A main page

Kimberly Lankford is a contributing writer who covers Medicare and personal finance. She wrote about insurance, Medicare, retirement and taxes for more than 20 years at  Kiplinger’s Personal Finance  and has written for  The Washington Post  and  Boston Globe . She received the personal finance Best in Business award from the Society of American Business Editors and Writers and the New York State Society of CPAs’ excellence in financial journalism award for her guide to Medicare.

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What Is Medicare Assignment?

Written by: Rachael Zimlich, RN, BSN

Reviewed by: Eboni Onayo, Licensed Insurance Agent

Key Takeaways

Medicare assignment describes the fee structure that your doctor and Medicare have agreed to use.

If your doctor agrees to accept Medicare assignment, they agree to be paid whatever amount Medicare has approved for a service.

You may still see doctors who don’t accept Medicare assignment, but you may have to pay for your visit up front and submit a claim to Medicare for reimbursement.

You may have to pay more to see doctors who don’t accept Medicare assignment.

How Does Medicare Assignment Work?

What is Medicare assignment ?

Medicare assignment simply means that your provider has agreed to stick to a Medicare fee schedule when it comes to what they charge for tests and services. Medicare regularly updates fee schedules, setting specific limits for what it will cover for things like office visits and lab testing.

When a provider agrees to accept Medicare assignment, they cannot charge more than the Medicare-approved amount. For you, this means your out-of-pocket costs may be lower than if you saw a provider who did not accept Medicare assignment. The provider acknowledges that the amount Medicare set for a particular service is the maximum amount that will be paid.

You may still have to pay a Medicare deductible and coinsurance, but your provider will have to submit a claim to Medicare directly and wait for payment before passing any share of the costs onto you. Doctors who accept Medicare assignment cannot charge you to submit these claims.

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How Do I Know if a Provider Accepts Medicare Assignment?

There are a few levels of commitment when it comes to Medicare assignment.

• Providers who have agreed to accept Medicare assignment sign a contract with Medicare.
• Those who have not signed a contract with Medicare can still accept assignment amounts for services of their choice. They do not have to accept assignment for every service provided. These are called non-participating providers.
• Some providers opt out of Medicare altogether. Doctors who have opted out of Medicare completely or who use private contracts will not be paid anything by Medicare, even if it’s for a covered service within the fee limits. You will have to pay the full cost of any services provided by these doctors yourself.

You can check to see if your provider accepts Medicare assignment on Medicare’s website .

Billing Arrangement Options for Providers Who Accept Medicare

Doctors that take Medicare can sign a contract to accept assignment for all Medicare services, or be a non-participating provider that accepts assignment for some services but not all.

A medical provider that accepts Medicare assignment must submit claims directly to Medicare on your behalf. They will be paid the agreed upon amount by Medicare, and you will pay any copayments or deductibles dictated by your plan.

If your doctor is non-participating, they may accept Medicare assignment for some services but not others. Even if they do agree to accept Medicare’s fee for some services, Medicare will only pay then 95% of the set assignment cost for a particular service.

If your provider does plan to work with Medicare, either the provider or you can submit a claim to Medicare, but you may have to pay the entire cost of the visit up front and wait for reimbursement. They can’t charge you for more than the amount approved by Medicare, but they can charge you above the Medicare-approved amount. This is called the limiting charge, and can be up to 15% more than Medicare-approved amount for non-participating providers.

What Does It Mean When a Provider Does Not Accept Medicare Assignment?

Providers who refuse Medicare assignment can still choose to accept Medicare’s set fees for certain services. These are called non-participating providers.

There are a number of providers who opt out of participating in Medicare altogether; they are referred to as “opt-out doctors”. This means they have signed an opt-out agreement with Medicare and can’t be paid by Medicare at all — even for services normally covered by Medicare. Opt-out contracts last for at least two years. Some of these providers may only offer services to patients who sign contracts.

You do not need to sign a contract with a private provider or use an opt-out provider. There are many options for alternative providers who accept Medicare. If you do choose an opt-out or private contract provider, you will have to pay the full cost of services on your own.

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Do providers have to accept Medicare assignment?

No. Providers can choose to accept a full Medicare assignment, or accept assignment rates for some services as a non-participating provider. Doctors can also opt out of participating in Medicare altogether.

How much will I have to pay if my provider doesn't accept Medicare assignment?

Some providers that don’t accept assignment as a whole will accept assignment for some services. These are called non-participating providers. For these providers and providers who have completely opted out of Medicare, you will pay the majority of or the full amount for your care.

How do I submit a claim?

If you need to submit your own claim to Medicare, you can call 1-800-MEDICARE or use Form CMS-1490S .

Can my provider charge to submit a claim?

No. Providers are not allowed to charge to submit a claim to Medicare on your behalf.

Lower Costs with Assignment. Medicare.gov.

Fee Schedules . CMS.gov.

This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

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What You Need to Know About Medicare Assignment

If you are one of the more than 63 million Americans enrolled in Medicare and are on the lookout for a new provider, you may wonder what your options are. A good place to start? Weighing the pros and cons of choosing an Original Medicare plan versus a Medicare Advantage plan—both of which have their upsides.

Let’s say you decide on an Original Medicare plan, which many U.S. doctors accept. In your research, however, you come across the term “Medicare assignment.” Cue the head-scratching. What exactly does that mean, and how might it affect your coverage costs?

What is Medicare Assignment?

It turns out that Medicare assignment   is a concept you need to understand before seeing a new doctor. First things first: Ask your doctor if they “accept assignment”—that exact phrasing—which means they have agreed to accept a Medicare-approved amount as full payment for any Medicare-covered service provided to you. If your doctor accepts assignment, that means they’ll send your whole medical bill to Medicare, and then Medicare pays 80% of the cost, while you are responsible for the remaining 20%.

A doctor who doesn’t accept assignment, however, could charge up to 15% more than the Medicare-approved amount for their services, depending on what state you live in, shouldering you with not only that additional cost but also your 20% share of the original cost. Additionally, the doctor is supposed to submit your claim to Medicare, but you may have to pay them on the day of service and then file a reimbursement claim from Medicare after the fact.

Worried that your doctor will not accept assignment? Luckily, 98% of U.S. physicians who accept Medicare patients also accept Medicare assignment, according to the U.S. Centers for Medicare & Medicaid Services (CMS). They are known as assignment providers, participating providers, or Medicare-enrolled providers.

It can be confusing. Here’s how to assess whether your provider accepts Medicare assignment, and what that means for your out-of-pocket costs:

The 3 Types of Original Medicare Providers

1. participating providers, or those who accept medicare assignment.

These providers have an agreement with Medicare to accept the Medicare-approved amount as full payment for their services. You don’t have to pay anything other than a copay or coinsurance (depending on your plan) at the time of your visit. Typically, Medicare pays 80% of the cost, while you are responsible for the remaining 20%, as long as you have met your deductible.

2. Non-participating providers

“Most providers accept Medicare, but a small percentage of doctors are known as non-participating providers,” explains Caitlin Donovan, senior director of public relations at the National Patient Advocate Foundation (NPAF) in Washington D.C. “These may be more expensive,” she adds. Also known as non-par providers, these physicians may accept Medicare patients and insurance, but they have not agreed to take assignment Medicare in all cases. That means they’re not held to the Medicare-approved amount as payment in full. As a reminder, a doctor who doesn’t accept assignment can charge up to 15% more than the Medicare-approved amount, depending on what part of the country you live in, and you will have to pay that additional amount plus your 20% share of the original cost.

What does that mean for you? Besides being charged more than the Medicare-approved amount, you might also be required to do some legwork to get reimbursed by Medicare.

• You may have to pay the entire bill at the time of service and wait to be reimbursed 80% of the Medicare-approved amount. In most cases, the provider will submit the claim for you. But sometimes, you’ll have to submit it yourself.
• Depending on the state you live in, the provider may also charge you as much as 15% more than the Medicare-approved amount. (In New York state, for example, that add-on charge is limited to 5%.) This is called a limiting charge—and the difference, called the balance bill, is your responsibility.

There are some non-par providers, however, who accept Medicare assignment   for certain services, on a case-by-case basis. Those may include any of the services—anything from hospital and hospice care to lab tests and surgery—available from any assignment-accepting doctor, with a key exception: If a non-par provider accepts assignment for a particular service, they cannot bill you more than the regular Medicare deductible and coinsurance amount for that specific treatment. Just as it’s important to confirm whether your doctor accepts assignment, it’s also important to confirm which services are included at assignment.

3. Opt-out providers

A small percentage of providers do not participate in Medicare at all. In 2020, for example, only 1% of all non-pediatric physicians nationwide opted out, and of that group, 42% were psychiatrists. “Some doctors opt out of providing Medicare coverage altogether,” notes Donovan.“In that case, the patient would pay privately.” If you were interested in seeing a physician who had opted out of Medicare, you would have to enter a private contract with that provider, and neither you nor the provider would be eligible for reimbursement from Medicare.

How do I know if my doctor accepts Medicare assignment?

The best way to find out whether your provider accepts Medicare assignment is simply to ask. First, confirm whether they are participating or non-participating—and if they are non-participating, ask whether they accept Medicare assignment for certain services.

Also, make sure to ask your provider exactly how they will be billing Medicare and what charges you might expect at the time of your visit so that you’re on the same page from the start.

Is seeing a non-participating provider who accepts Medicare assignment more expensive?

The short answer is yes. There are usually out-of-pocket costs after you’re reimbursed. But it may not cost as much as you think, and it may not be much more than if you see a participating provider. Still, it could be challenging if you’re on a fixed income.

For example, let’s say you’re seeing a physical therapist who accepts Medicare patients but not Medicare assignment. Medicare will pay $95 per visit to the provider; but your provider bills the service at $115. In most states, you’re responsible for a 15% limiting charge above $95. In this case, your bill would be 115% of $95, or $109.25.

Once you get your $95 reimbursement back from Medicare, your cost for the visit—the balance bill—would be $14.25 (plus any deductibles or copays) .

In some states, the maximum cap on the limiting charge is less than 15%. As mentioned earlier, New York state, for instance, allows only a 5% surcharge, which means that physical therapy appointment would cost you just $4.75 extra.

Bottom line: Medicare assignment providers and non-participating providers who agree to accept Medicare assignment are both viable options for patients. So if you want to see a particular provider, don’t rule them out just because they’re non-par.

While seeing a non-participating provider may still be affordable, ultimately, the biggest headache may be keeping track of claims and reimbursements, or simply setting aside the right amount of money to pay for your visit up front.

Before you schedule a visit, be sure to ask how much the service will cost. You can also estimate the payment amount based on Medicare-approved charges. A good place to start is this  out-of-pocket expense calculator  provided by the CMS.

What if I see a provider who opts out of Medicare altogether?

An opt-out provider will create a private contract with you, underscoring the terms of your agreement. But Medicare will not reimburse either of you for services.

Seeing a provider who does not accept Medicare will likely be more expensive. And your visits won’t count toward your deductible. But you may be able to work out paying reduced fees on a sliding scale for that provider’s services, all of which would be laid out in your contract.

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• Medicare Assignment

Home / Medicare101 / How Much Does Medicare Cost / Medicare Assignment

• Updated on March 31, 2023
• Written By: David Haass
• Reviewed By: Ashlee Zareczny

Once you have Original Medicare, ask your doctor if they accept Medicare assignment before receiving services. This is because doctors who accept Medicare assignment are agreeing to the terms of the Medicare program, and those who don’t can leave you paying higher costs for your healthcare.

The good news is that there are more than 800,000 doctors nationwide who accept Medicare assignment, making it the largest provider network in the United States. Whether you want to see the best doctor while on vacation or your local healthcare provider, chances are they’re in-network.

When it comes to healthcare facilities, knowing which accepts Medicare assignment and how you’re affected by such designation is essential. The difference can mean hundreds if not thousands of dollars in healthcare costs or savings. Learn more about doctors who accept Medicare assignment, how the system works, and the status maintained by many popular healthcare facilities.

What is Medicare Assignment?

Medicare assignment is a fee schedule agreement between the federal government’s Medicare program and a doctor or facility. When Medicare assignment is accepted, it means your doctor agrees to the payment terms of Medicare.

Doctors that accept Medicare assignment fall under one of three designations: a participating doctor, a non-participating doctor, or they opt-out of the program altogether. Let’s break down the various designation of Medicare assignment providers below:

• Participating Providers: Providers that accept Medicare assignment and agree to accept what Medicare establishes per procedure, or visit, as payment in full.
• Non-Participating Providers: Providers who accept Medicare benefits, but do not accept the amount Medicare says a procedure or visit should cost. These providers reserve the right to charge an excess charge of up to 15% more than the Medicare-approved amount in states that allow it.
• Opt-Out Providers: The minority of healthcare providers that do not accept Medicare. Fortunately for beneficiaries, this group represents less than 3% of adult healthcare providers in the United States.

How To Find Out if a Doctor Accepts Medicare Assignment

Since not every doctor accepts Medicare assignment, it’s important to know whether or not your doctor does. You can easily pinpoint and compare doctors that accept Medicare assignment of benefits with the Care Compare Tool . The tool allows you to personalize results for doctors and hospitals in your area. Also, the tool is available on smartphones and tablets.

Using the Care Compare Tool provides you with much more information than which providers who do not accept assignment of Medicare benefits or do accept it. You can also find out important information such as contact info, quality ratings, and directions to healthcare facilities.

Furthermore, you can also use the Care Compare Tool to find out information on nursing homes, hospices, dialysis centers, rehab care, and Long-Term care facilities.

Do All Doctors Accept Medicare Supplement Plans?

All doctors who accept Original Medicare will accept Medicare Supplement plans. However, not all doctors accept the federal government’s Medicare program.

Also known as Medigap, your Medicare Supplement benefits are there to help you cover the leftover costs that can occur when using Original Medicare benefits alone. Therefore, while you have access to every doctor in America that accepts Medicare, if they don’t, you’ll need to pay for your healthcare costs out of your own pocket.

One common mistake you may encounter is receiving healthcare services only to be told at the desk that the facility doesn’t accept your Medigap plan. There are 12 lettered Medicare Supplement plans available, but all are accepted at any healthcare facility accepting Medicare assignment. The misconception can occur when workers confuse the idea of networks. Medigap doesn’t have networks, but Medicare Advantage plans do.

Overall, if you encounter such issues, simply ask if the facility accepts Medicare. If the answer is yes, you’ll be covered by your Medicare Supplement benefits also. However, if you are enrolled in a Medicare Advantage plan, you’ll need to also be sure that the facility is within your plan’s network. While out-of-network healthcare providers may still be used by Medicare Advantage beneficiaries, the cost will be higher.

Do Most Doctors Accept Medicare Assignment?

An overwhelming majority of doctors are healthcare providers which adhere to Medicare assignment rules. Around 98% of all doctors providing healthcare to adults are either participating or non-participating providers. Remember, even non-participating providers accept Medicare. They simply reserve the right to charge as much as 15% more through Medicare Part B excess charges in states that allow them.

This is great news for beneficiaries enrolled in Medicare because it provides more options for healthcare and benefits. Rather than facing expensive, rising healthcare costs alone, you can enjoy benefits that help you cover the costs of approved services.

But it’s important to understand that different Medicare benefits may have some restrictions. Specifically, when enrolled in Medicare Advantage plans, you’ll need to ensure that they are in your plan’s network.

For many, this can be a restriction that only allows healthcare services near one’s home. Meaning if you’re known to travel, it may not be the best choice for you. Because Medicare Supplement plans don’t have a network, all you’ll need to worry about is whether or not your healthcare provider accepts Medicare assignments or not to be covered, regardless of location within the United States.

What Happens if a Doctor Doesn’t Accept Medicare Assignment?

Providers who do not accept Medicare Assignment may require you to pay higher costs for services out-of-pocket. You could pay up to an additional 15% of the Medicare-approved amount out-of-pocket, then wait for Medicare reimbursement, but there’s no reimbursement guarantee.

If you are receiving healthcare from doctors who opt-out of Medicare services, you’ll pay 100% of the costs. But unlike Medicare assignment doctors, these healthcare providers don’t set their fees to Medicare standards. This means you may pay more as a result, and that is exactly why you should always confirm first whether your doctor accepts the assignment or not.

After you receive services from a doctor who doesn’t accept the assignment but is still part of the Medicare program, you can receive reimbursement. But you must file a claim to Medicare asking for reimbursement by filling out the CMS-1490S form to ask for payment. The service provider will likely process the claim, then deal with Medicare to help you get reimbursement. Alternatively, if they do not, then you also have the option to process your claim.

Medicare Opt-Out Private Contract

A Medicare opt-out private contract may come to be if your doctor does not have an agreement with Medicare and asks you to sign a private contract. Once you sign a contract, you accept the total amount of your healthcare costs on your own, and Medicare can’t reimburse you. Signing such a contract gives up your right to use Medicare for your health purposes.

Before you sign a private contract, you should know the following:

• Medicare can’t reimburse you for healthcare services.
• Medicare can’t pay for your services.
• You can pay for services whenever you want without signing a Medicare opt-out private contract.
• The service provider sets the prices for your healthcare.

These considerations are important because the cost of handling your healthcare costs alone can be monumental for anyone. While each situation is different, avoiding Medicare opt-out private contracts and using providers who accept Medicare assignment instead can help you receive the services you deserve while protecting your finances.

Do Hospitals Accept Medicare Assignment?

Most hospitals accept Medicare assignment. For general purposes, hospitals are similar to Medicare doctors who accept assignment, meaning the following:

• Most facilities are going to accept Medicare.
• Because hospitals accept Medicare assignment, you’re covered for both your Part A and Part B services.
• Although a large majority of hospitals accept Medicare assignment, not all do, and you’re going to need to check with a facility before receiving healthcare from them to understand where they stand.
• Excess charges can still exist in states that allow them, allowing for Part B costs to be elevated by as much as 15%.
• If you have Medicare Advantage benefits, you’re going to need to receive services from hospitals within your network or pay for your healthcare yourself. Alternatively, if you have a Medicare PPO plan, you may be able to use an out-of-network hospital, but you’ll pay a lot more.

Remember, if Original Medicare benefits are accepted, so too is your Medigap coverage. Therefore, you’ll need to take into consideration your lifestyle, finances, travel plans, and other personal factors before enrolling in either a Medicare Advantage or Medigap plan. Speaking with a licensed Medicare agent can help you navigate Medicare assignment and your coverage.

Does Cleveland Clinic Accept Medicare Assignment?

Yes, Cleveland Clinic accepts Medicare assignment at most of its 22 hospitals and 275 outpatient locations. This means if you have benefits from Original Medicare, Medicare Supplement, and/or Medicare Advantage, they are accepted so long as the facility is within the United States of America. Furthermore, you’ll still need to determine whether or not a specific location is within your plan’s network for Medicare Advantage benefits.

Does CVS Accept Medicare Assignment?

Yes, the various CVS Health businesses, including MinuteClinic, all accept Medicare assignment in the United States. Again, you’ll still need to ensure that specific locations are a part of your Medicare Advantage plan before using your benefits. While Medicare assignment is unrelated to Medicare Part D , you will find that most Part D plans are also accepted by CVS Pharmacy, though this may vary by location with America’s largest pharmacy retailer.

Does Labcorp Accept Medicare Assignment?

Yes, Labcorp accepts Medicare assignment throughout its more than 2,000 locations found within the U.S. The same guidelines apply. Both Original Medicare and Medigap benefits are accepted, along with Medicare Advantage. But your Advantage benefits will also consider whether or not the location you are going to is a part of your plan’s network.

Does Mayo Clinic Accept Medicare Assignment?

No, while Mayo Clinic does accept Medicare benefits within the 44 communities in which they are present, the campuses do not accept Medicare assignment. This means if you receive healthcare at a Mayo Clinic location, you’ll be billed, and you may be charged a higher rate due to excess charges. Of course, the best way to understand a specific location’s billing is to contact your local campus directly. This is especially important for those with Medicare Advantage plans who will also need to make sure their local Mayo Clinic is within their Advantage plan’s network.

Does MD Anderson Accept Medicare Assignment?

Yes, MD Anderson consists of hospitals that accept Medicare assignment, meaning you can use your benefits at its 13 hospital systems throughout 11 states. What you need to realize is that while benefits for Original Medicare and Medigap are accepted, MD Anderson’s Medicare Advantage options are quite limited. Furthermore, it is advised that you speak with your plan provider before receiving healthcare from the Houston-based healthcare provider.

Does Walgreens Accept Medicare Assignment?

Yes, Walgreens accepts Medicare assignment, allowing its customers to find affordable healthcare solutions near their homes. As the second-largest pharmacy brand in the U.S., you can also take advantage of your Medicare Part D benefits, along with many services covered by Part B coverage. Featuring more than 9,000 stores nationwide, remember to check your plan’s network if you have Medicare Advantage coverage to ensure that you are covered before you go.

What is Medicare Assignment of Benefits?

The assignment of benefits is when the insured authorizes Medicare to reimburse the provider directly. In return, the provider agrees to accept the Medicare charge as the full charge for services. Non-participating providers can accept assignments on an individual claims basis. On item 27 of the CMS-1500 claim form, Medicare assignment of benefits requirements dictate that non-participating doctors check “yes” when they agree to accept Medicare assignment for the full charge on the claim.

What are Medicare Assignment Codes?

The Medicare assignment code is what shows proof that Medicare has agreed to represent you and cover your medical bills. This method allows for easy communication between health providers and Medicare when caring for your medical needs.

Participating healthcare providers file for service reimbursement with a Medicare assignment of benefits form. Formally known as a CMS-1500 form , this is used by non-institutional providers and suppliers for reimbursement from Medicare and, in some cases, Medicare State Agencies.

What is Medicare Part B Assignment?

Medicare Part B assignment is when your doctor accepts the preassigned costs for Medicare outpatient services. Participating providers determine how much you pay for Part B services. For example, fully participating doctors accept Medicare rates for services, meaning you only pay 20% of the bill with Original Medicare. However, if a provider is not participating, you could be responsible for an excess charge of 15%.

Some providers refuse Medicare assignment altogether. If this is the situation, you’re responsible for 100% of the costs not only for Medicare Part B but also for Part A services if they apply.

What Is the Difference Between Medicare Participation and Assignment?

Being a participant in Medicare assignment varies from accepting assignment because non-participating providers can still accept but charge more. Remember, this is where excess charges come into play unless you are in Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, or Vermont, which all prevent such charges.

An excess charge means that a healthcare provider can charge you as much as 15% more than Medicare for approved services. Therefore, just because a healthcare provider accepts Medicare assignment, doesn’t mean they are a Par Provider, and you may face higher rates even with coverage.

What Is a Par Provider?

A Par Provider is the same as a Participating Provider. These healthcare providers have accepted assignment from Medicare and agree to charge the amount allowable according to the federal government’s program for approved services. If you receive care from Par Physicians, you may still have out-of-pocket costs, which can be covered partially or entirely by Medicare Supplement plans.

How To Navigate Medicare Assignment and Your Benefits

The best way to avoid excess charges if you live in one of the many states that allow them is by visiting a provider who accepts Medicare and participates in Medicare assignment. But as you can see, additional considerations come into play.

Keeping your healthcare costs in check while receiving the right services is a delicate balancing act. Original Medicare is a robust coverage, but covering additional costs can often be tricky. Many options are available, and you can only have Medigap or Medicare Advantage.

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David Haass

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17 thoughts on " medicare assignment ".

I have just reached 65 and am now covered by Medicare part A and B. I have made an appointment on my own with my local Diagnostic Center for a yearly mammogram that I have not had in years. Do I need my doctor to make that referral on my behalf for Medicare to pick up the cost? Is the total cost covered by Medicare or is it subject to the Medicare deductible being met and then they pay their 80%? Is the 3D mammogram covered which is more comprehensive since I have had a biopsy in the past and need the more comprehensive xray? Thank you for your assistance!

Hello! Your coverage will be determined by the type of mammogram you receive. If the mammogram is diagnostic, you will be subject to the 20% co-payment. If this is a preventative mammogram, you will receive 100% coverage as long as your provider accepts Original Medicare.

I think there are procedures which Medicare does not cover. If doctor which accept assignment who orders non-Medicare approved procedure, is patient responsible for that procedure that was ordered by doctor and not covered by Medicare. Or is doctor legally obligated to inform the patient that the procedure is not covered?

Bill, it is up to you to know what is and is not covered by your insurance. However, the doctor should inform you that it will not be covered by Medicare and you will be required to sign an Advanced Beneficiary Notice. This waiver informs you that Medicare may not cover the services and you will pay out-of-pocket if Medicare denies the claim.

We accept Medicare but claims were denied because it’s under capitation what does it means. Who’s is payer insurance of the services. This is a solo medical practice

Hi Ray! You can read more on Capitated Model here .

Hello Lindsay,

I work for a provider that accepts Medicare, however we do balance bill. Is there a difference between Medicare and Medicare assigment? Are they in fact 2 different programs? We have conflicting information and want to clear this up.

Hi Amy! You can accept Medicare, but be a non-participating provider. This means you do accept Medicare, but you do not accept the Medicare-approved amount for a service. Non-participating providers can balance bill up to 15% of the Medicare-approved amount for the service. I wouldn’t say it’s two different programs but one of three billing arrangement options for providers who accept Medicare. I hope this helped clarify!

Hi! So how does the non participation but accepting Medicare work for Annual Wellness Visits? Is it still appropriate to have non-par providers who accept assignment billing for AWVs? Also, do Medicare Advantage companies allow for non-par/accepting assignment providers to bill as well? Last question….do these providers still need to be fully credentialed if they are non par for Medicare? Assume yes, but wasn’t sure how Medicare and even insurance companies view this. For example if I am using a vendor to arrange for providers to help complete AWV’s and those providers are non par but accept assignment is that acceptable for a MA plan where providers do need PTAN’s.

Hey Jagger, I will be starting Medicare soon. The chiropractor. I see can’t accept Medicare because he can’t find anyone to do Medicare billing. He has been my god sent for adjustments for over 10 years. I would gladly pay him out of my own pocket, before switching to someone I don’t know, and doesn’t know my needs. Is it possible to stay with my doc? Linda

Hi Linda – if your doctor doesn’t accept Medicare but is still part of the Medicare program, you can fill out Form CMS 1490S to request medical payment. Otherwise, you can pay out-of-pocket while still being on Medicare.

Hi, Lindsay, my wife received a Medicare Claim Notice for care she received from a non-participating provider (my wife paid the entire claimed amount at the time of the appointment). One note on the claim notice said, “Under federal law, your doctor cannot charge more than $38.34. If you have already paid more than this amount, you are entitled to a refund from the provider.” The provider refuses to refund us the $61.66 overpayment my wife paid. I called Medicare, and they don’t care. Who can we report this to?

Hi William! Your best bet is to call Medicare. However, since you’ve already gone that route and had no luck, I would contact your carrier directly. Have them put in writing & document what their responsibility is and the overpayment to provide to the doctor. Hopefully, that will get their attention.

If a doctor accepts assignment, can they balance bill the patient?

Hi Elizabeth! If they accept Medicare Assignment, the doctor can only bill the amount Medicare has approved. If you don’t have any supplemental insurance, Medicare will bill you the remaining amount after they cover their portion of the costs. If the doctor does not accept Medicare Assignment, they can bill you up to 15% in excess charges for each service.

Hello Lindsay. My doctors office says they accept medicaid. Does that mean they accept medicare? I have plan N with Cigna.

Hi Thomas! Medicare & Medicaid are two different types of health coverage. However, I would imagine if your doctor accepts Medicaid, they probably accept Medicare. I would just give them a call to verify.

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