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If you are enrolled in Original Medicare (Part A and Part B), you may be concerned about managing your out-of-pocket expenses. One way to lower costs and get more from your Medicare benefits is to receive care from health-care providers who have signed an agreement with Medicare. Here’s how to find a doctor who accepts Medicare assignment.
What does it mean to “accept Medicare assignment?”
Medicare Part B (medical insurance) covers medically-necessary services (or certain preventive tests) from doctors and other health-care providers. When doctors, hospitals, or medical suppliers accept Medicare assignment, it means that they agree to accept the Medicare-approved amount as full payment for whatever services or equipment they provide. Also, you enjoy these advantages when you see a doctor or health-care provider who accepts Medicare assignment:
- Your out-of-pocket costs are usually lower than if you saw a non-Medicare provider.
- Your provider usually waits for Medicare to pay its share before asking you to pay, and agrees to charge only the Medicare deductible and coinsurance amounts.
- The provider bills Medicare directly at no charge to you.
Typically, you pay 20% of the Medicare-approved amount (except for certain preventive services, which may be offered at no cost if the provider accepts assignment). The Medicare Part B deductible will apply. Please confirm with the health-care provider if you wish to know how much your specific test or service will cost.
What happens if I find a doctor who doesn’t accept assignment?
Whether a provider will always accept Medicare assignment depends on whether she or he “participates” in Medicare or not. Medicare-participating providers always accept Medicare assignment. Non-participating providers do not have to accept Medicare assignment for your care, although they have the option to choose to accept assignment on a case-by-case basis (for individual services).
Here’s what you can expect from a provider who does not accept Medicare assignment for all Medicare-covered services but may accept it sometimes (non-participating providers):
- You may be asked to pay the entire bill for your care at the time of service.
- For any Medicare-covered services they provide to you, providers should still submit a claim to Medicare. They can’t charge you for submitting a claim.
- You may be charged more than the Medicare-approved amount (up to the “limiting charge”) for your care. The “limiting charge” (typically 15% more than the Medicare-approved amount) is the highest amount you can be charged for a Medicare-covered service by providers who don’t accept assignment. Please note that the limiting charge applies only to certain Medicare-covered services and won’t apply to some supplies and equipment.
If you choose to see a provider who does not participate at all with the Medicare program, you may be asked to sign a private contract. Keep in mind that in most cases, you can find another doctor who does accept Medicare assignment, and do not have to sign the contract. If you do sign the contract, however, Medicare will not pay anything for any services you receive from this provider, even if it is a service normally covered by Medicare. Find out more about assignment and private contracts on Medicare.gov.
Are there resources to find a doctor who accepts Medicare?
Fortunately, Medicare makes it easy to find a doctor who participates in the program and accepts assignment. The Physician Compare tool from Medicare.gov helps you search for doctors, hospitals, and medical suppliers in your area that accept Medicare assignment. You can also contact your local State Health Insurance Assistance Program (SHIP) if you need help finding Medicare-approved providers. The licensed insurance agents at eHealth are also available to help you find a doctor or hospital in your area that accept Medicare assignment and to answer any other questions you may have about Medicare plan options.