Most doctors accept Medicare as full payment for their services. But some accept it only for certain services, and others don’t accept it at all.
What does this mean for you?
If you have Original Medicare, it means you should try to use doctors, hospitals, medical equipment suppliers, and other healthcare providers that participate or “accept assignment” in Medicare. Such providers have signed agreements to take Medicare as payment in full for their services.
If your doctor or other provider accepts assignment:
• Your out-of-pocket costs may be less.
• The provider agrees to charge you only the Medicare deductible and coinsurance amount, and usually waits for Medicare to pay its share before asking you to pay your share.
• The provider has to submit your claim directly to Medicare and can’t charge you for submitting the claim.
Some doctors and other providers haven’t signed an agreement to accept assignment for all Medicare-covered services, but they can still choose to accept assignment for some services. These providers are called “non-participating” providers.
If your doctor or other provider doesn’t accept assignment:
• You may have to pay the entire bill at the time of service. Your provider is supposed to submit a claim to Medicare for any Medicare-covered services they provide to you.
• The provider can’t charge you for submitting a claim. If they don’t submit the Medicare claim once you ask them to, call 1‑800‑MEDICARE.
• In some cases, you might have to submit your own claim to Medicare using Form CMS-1490S to get paid back.
• The provider can charge you more than the Medicare-approved amount, but there’s a limit. Non-participating providers are paid 95 percent of the Medicare-approved amount. They can only charge you up to 15 percent over the amount that non-participating providers are paid.
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