When you start Medicare, you may hear the phrase “accepts Medicare assignment.” It sounds technical, but it can be an important detail when choosing doctors and managing your health care costs.
In simple terms, Medicare assignment is an agreement between a doctor, hospital, or other health care provider and Medicare. The provider agrees to accept Medicare’s approved payment amount for a covered service. This can make your costs more predictable when you use Original Medicare.
Assignment is most relevant for people with Original Medicare, which includes Part A and Part B. It can also matter if you have a Medicare Supplement plan, also called Medigap, because these plans generally help pay their share of Medicare-approved costs.
What does it mean when a provider accepts Medicare assignment?
Medicare sets an approved amount for many covered medical services. When a provider accepts assignment, they agree to accept that approved amount as full payment for the service, aside from your deductible, coinsurance, or copayment.
For example, under Original Medicare, Medicare Part B generally pays 80% of the Medicare-approved amount after you meet your Part B deductible. You are generally responsible for the remaining 20% unless you have other coverage that helps pay it, such as a Medicare Supplement plan, retiree coverage, or Medicaid.
A provider who accepts assignment usually sends the claim to Medicare directly. Medicare processes the claim and pays its share. Then you or your supplemental coverage may pay the remaining approved amount.
This process can be simpler than paying the full bill yourself and waiting for reimbursement.
Why Medicare assignment can matter
Choosing providers who accept assignment may help you avoid unexpected charges above Medicare’s approved amount. It can also make billing easier, since the provider generally files the Medicare claim for you.
Here are a few reasons people often look for providers who accept assignment:
- More predictable bills: The provider agrees to Medicare’s approved amount for covered services.
- Less paperwork: The provider generally submits the claim to Medicare.
- Helpful with Medigap: Medicare Supplement plans are designed to work with Original Medicare-approved costs. Your plan’s benefits may vary by plan, carrier, and state.
- Broader doctor choice: With Original Medicare, you can generally see any provider nationwide who accepts Medicare and is accepting new patients.
Accepting assignment does not mean every service is free. You may still owe deductibles, coinsurance, or costs for services Medicare does not cover. The amount you pay can depend on your coverage and the service you receive.
Do all doctors who take Medicare accept assignment?
Not always. There are a few ways providers may work with Medicare.
Participating providers agree to accept assignment for all Medicare-covered services. These providers are often the most straightforward choice for someone using Original Medicare.
Non-participating providers can still see Medicare patients, but they may choose whether to accept assignment on a case-by-case basis. For some services, they may charge more than Medicare’s approved amount. This is different from a provider who has opted out of Medicare entirely.
Opt-out providers do not bill Medicare for their services. You may sign a private contract with them and pay the provider directly. In many cases, Original Medicare and Medicare Supplement insurance will not pay for services received under that private contract.
Before making an appointment, it is wise to ask the provider’s office how they work with Medicare. Provider status can change, so checking ahead may prevent confusion later.
What is the difference between assignment and a Medicare Advantage network?
Medicare assignment applies to Original Medicare. Medicare Advantage plans work differently because they are offered by private insurance companies that contract with Medicare.
Many Medicare Advantage plans have provider networks. Depending on the plan type, you may need to use in-network doctors and hospitals to receive the lowest costs, or to have coverage for non-emergency care. Some plans may offer out-of-network coverage, while others may not except for emergencies.
Original Medicare with a Medicare Supplement plan generally does not use a plan-specific network. Instead, you can generally use providers that accept Medicare. This flexibility is one reason some people consider Medigap coverage, especially if they travel often or want a wider choice of providers.
Medicare Advantage can be a good fit for people who are comfortable following a plan’s network and coverage rules. The right choice may depend on your budget, preferred doctors, prescriptions, travel habits, and comfort with out-of-pocket costs.
How can you find doctors who accept Medicare assignment?
You can use Medicare’s official provider search tool to look for doctors, hospitals, and other providers in your area. The search results may show whether a provider accepts Medicare assignment.
You can also call the provider’s office and ask a few clear questions:
- Do you accept Medicare?
- Do you accept Medicare assignment for all Medicare-covered services?
- Are you accepting new Medicare patients?
- Will you file my Medicare claim?
- Do you work with my Medicare Supplement plan, if I have one?
If you are scheduling a test, procedure, or surgery, consider asking about every provider involved. A hospital may accept Medicare assignment, while an anesthesiologist, radiologist, or other specialist may bill separately.
Does assignment guarantee that Medicare will pay?
No. Assignment does not guarantee payment for every service. Medicare still has coverage rules, and some services may need to be medically necessary or meet other requirements. Your provider may recommend a service that Medicare does not cover, or Medicare may cover only part of it.
When a service may not be covered by Medicare, your provider may ask you to sign a notice explaining that you could be responsible for the cost. Ask questions before receiving non-emergency care if you are unsure about coverage.
Understanding Medicare assignment is one small but useful step in building a health care plan that fits your needs. If you would like free, no-pressure help comparing how Original Medicare and Medicare Supplement coverage may work for you, reach out to Eric. With 25 years of experience, he can help you sort through your options in plain English.