What Is Medicare Assignment?

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When you have Original Medicare, you should ask your doctor if they accept Medicare assignment before getting services. But there are more than 800,000 doctors who take Medicare. So no matter if you want to see the local specialist or the top doctor in a big city, it’s likely they’re in-network. Today, we’re going to define Medicare assignment and explain what doctors accept it.

Medicare Assignment Defined 

It’s an agreement between Medicare and a physician. Accepting assignment means your doc agrees to Medicare’s payment terms for covered services. Did you know that over 93% of all physicians in America accept Medicare assignment?

Before people are eligible for Medicare, most use networks and referrals.  

Related Post: Medicare Terms You Should Know

Categories for Medicare Assignment

There are three categories:

  1. Participating doctors accept Medicare assignment. The doc takes Medicare and only charges up to the Medicare-approved amount. 
  1. Non-Participating doctors decide to accept or not accept Medicare. The doc takes Medicare but can charge an excess fee. 
  1. Doctors that have opted out are the minority. These physicians don’t take Medicare and you pay 100% of the costs.

Again, since MOST doctors accept Medicare assignment, you’ll have more freedom with choosing your doctor (when you get Medicare). BUT you should always confirm first whether or not your doctor accepts the assignment.

Related Post: Should I Be Worried About Medicare Excess Charges?

What Doctors Accept Medicare Assignment?

Not everyone agrees to the terms. Doctors may choose to opt-out or not participate in Medicare. 

Doctors who accept Medicare will also accept Medicare Supplement (Medigap) coverage. However, not all doctors that accept Medicare will take a Medicare Advantage plan. 

What If a Doctor Doesn’t Accept Medicare Assignment?

This means you pay for medical services out of pocket. You might pay 100%, then wait for reimbursement. Medicare reimbursement isn’t guaranteed. 

Medicare Opt-Out Private Contract

Sometimes doctors ask their patients to sign a private contract. This usually occurs with physicians who won’t have an agreement with Medicare. In other words, they’ve opted-out of Medicare payment terms. If you sign a contract, you accept the full amount by yourself, and Medicare can’t repay you. 

Does Having Medicaid Affect Your Doctor Network?

This can be a complex situation. If you’re on Medicare and Medicaid, you can visit any doctor that accepts Original Medicare (A and B). The best thing you can do is ensure that the provider takes both. Then, the Medicaid plan will pay your share of the bill.  

You Can Lower Costs with Medicare Assignment

By seeing a doctor that accepts Medicare assignment, you’ll have lower costs. Medicare recipients with Medigap insurance pay less out-of-pocket, and they can save money on deductibles, copays, and coinsurance. Just know that Medigap plans have higher premiums than most Medicare Advantage programs. 

Whether you’re interested in Medicare Advantage, Medicare Supplements, or prescription drug coverage, we can help. Bobby Brock Insurance will find you the right plan — at the best rate — in your area. Contact an agent online or call (662) 844-3300. 

Justin Brock

Justin Brock

The CEO and President of Bobby Brock Insurance. A nationally syndicated Medicare advisor, best-selling author of Medicare Breakdown: The Alphabet Soup of Medicare, and pacesetter for over 20,000 senior market insurance agents. Featured in many insurance-related publications for his Medicare and Health insurance... Read More »

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