Each year, Medicare publishes a list of the amounts it will pay for hospital and medical services. This is known as “Medicare assignment.” Doctors that accept Medicare assignment will charge you only the Medicare-approved amount, once you have met the yearly deductible. There is no yearly limit for what you pay out of pocket. You may also purchase a Medigap policy to help cover these expenses.

If you go to a doctor or another health provider that accepts assignment:

• The amount you pay will probably be less.
• The doctor will agree to charge you only the Medicare deductible and the amount of your co-insurance. Most of the time you will not receive a bill until Medicare pays its portion.
• You do not have the hassle of submitting claims. The doctor will send the claim directly to Medicare.

Doctors that Don’t Accept Assignment

If your doctor does not accept assignment, they will charge you more than the Medicare-allowed amount (up to a maximum of 15 percent). You must pay any deductible or co-insurance amount, plus the difference between the billed amount and the Medicare-allowed amount. If your doctor does not accept assignment, you can switch to a doctor that does.

If you go to a doctor or another health provider that does not accept assignment:

• You may be required to pay for the entire cost of the services at the time you receive them.
• Your doctor is supposed to submit a claim to Medicare for the covered services they provide you. You cannot be charged for submitting claims on your behalf.
• In some cases, you may have to submit your own claim to Medicare. If so, use Form CMS-1490S.
• As mentioned above, the doctor cannot charge you more than 15 percent of the Medicare-allowed amount. This only applies to health care services, not supplies and durable medical equipment.

Help is Available

If you’re wondering if your doctor accepts Medicare assignment, give us a call at 1-877-470-3108, TTY 711. We will be happy to check for you.

Medicare has neither reviewed nor endorsed this information.