Medicare — Accepting Assignment

When you visit a doctor or healthcare provider as a Medicare beneficiary, one of the most important questions to ask is whether they "accept assignment." This term has a specific meaning under Medicare, and it directly affects how much you pay for services.

A provider who accepts assignment agrees to accept Medicare's approved amount as full payment for covered services. This means they cannot charge you more than the standard 20% coinsurance (after you've met your Part B deductible). Accepting assignment protects you from unexpected, higher out-of-pocket costs.

Providers who do not accept assignment — called "non-participating providers" — can still see Medicare patients, but they may charge up to 15% above the Medicare-approved amount. This is called the "limiting charge." While Medicare will still pay its share, you are responsible for the difference, which can add up quickly for frequent or expensive services.

Opt-out providers have chosen to completely remove themselves from the Medicare system. They can charge any amount they choose, and Medicare will not pay anything for their services (except in emergencies). If you see an opt-out provider, you are responsible for the full cost.

You can verify whether a provider accepts Medicare assignment using the Medicare Care Compare tool at Medicare.gov. It's always a good idea to confirm assignment status before scheduling an appointment, especially for specialists or new providers.

If you have a Medicare Supplement (Medigap) plan, it may cover the 20% coinsurance and even the excess charges from non-participating providers, depending on your plan type. Our advisors can help you choose a Medigap plan that minimizes your exposure to these costs.