Physician Acceptance of Medicare Assignment

Christian Worstell
In this article...
  • Medicare assignment pertains to an agreement between Medicare and participating doctors. Learn more about the physicians that accept Medicare assignment.

Medicare assignment, or Medicare assignment of benefits, is the process in which a Medicare beneficiary authorizes Medicare to directly reimburse health care providers for services. To ensure all services are charged at Medicare-determined rates, recipients should verify whether their primary physicians fall under the accept assignment definition prior to scheduling services. 

What Is the Medicare Accept Assignment Definition?

The Medicare accept assignment definition pertains to physicians, medical suppliers and medical providers that agree to accept Medicare-approved charges as total and full payment for all covered services without adding extra charges. These providers also agree to charge only the allowed Medicare deductible and coinsurance charges to patients. Medicare-approved providers who accept Medicare assignment are referred to as participating providers. 

Non-participating providers may accept Medicare and provide Medicare-covered services. However, as non-participating providers, they are not required to accept Medicare's pre-determined costs for procedures and office visits. Additionally, non-participating providers are legally allowed to charge up to 15% above Medicare-approved amounts. That extra amount is billed to the patient.

In addition to participating and non-participating providers, some providers choose not to accept Medicare in any capacity. These providers are referred to as opt-out providers. Only a small percentage (under 2%) of providers choose to completely opt out.

What Are Some Benefits of Medicare Assignment? 

Medicare recipients who receive primary care through Medicare assignment providers may have lower out-of-pocket costs than recipients who utilize the services of non-participating providers. Providers who accept Medicare assignment must submit all claims directly to Medicare, so recipients can't be charged anything for claim submission. In most cases, Medicare assignment providers wait to charge recipients for their share in costs (when applicable) until after Medicare pays its share, which may help make medical expenses more manageable. 

What May Happen When a Provider Doesn't Accept Assignment? 

In addition to possibly being charged up to an additional 15% for procedures and services, individuals who use non-participating providers may be required to pay full costs for services upfront. Recipients may also need to submit their own insurance claims to Medicare to receive reimbursements. Medicare recipients who receive services through providers who are completely opted out are generally required to pay for all services and procedures, even if they would normally be covered by Medicare. Recipients who prefer to use opt-out providers may be able to set up payment plans through private contracts. 

What Is Part B Medicare Assignment?

Medicare assignment Part B pertains to outpatient services. Recipients who work with participating providers are generally required to pay 20% of allowed amounts out of pocket. Those who choose providers defined as non-participating may be required to pay excess charges of up to 15%. Recipients with health care providers who are completely opted out may be responsible for 100% of costs for services and procedures.

Christian Worstell
About the Author

Christian Worstell is a senior Medicare and health insurance writer with He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

While at HelpAdvisor, Christian has written hundreds of articles that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. You can find Christian’s most recent articles in our blog.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at

Read More
Smiling couple outdoors with sun in the background
How do Medigap plans and Medicare Advantage plans differ? How can you decide which type of plan is ...
A woman uses her computer while reviewing paper copies of bills
Some people may think Medicare Advantage (Part C) plans are bad because some plans have provider network ...
Man uses laptop computer at home in his kitchen is an important resource for Medicare enrollees. Learn about some of the features the ...