Physician Acceptance of 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.