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Medicare Assignment

Once you have Original Medicare, ask your doctor if they accept Medicare assignment before receiving services. This is because doctors who accept Medicare assignment are agreeing to the terms of the Medicare program, and those who don’t can leave you paying higher costs for your healthcare.

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The good news is that there are more than 800,000 doctors nationwide who accept Medicare assignment, making it the largest provider network in the United States. Whether you want to see the best doctor while on vacation or your local healthcare provider, chances are they’re in-network.

When it comes to healthcare facilities, knowing which accepts Medicare assignment and how you’re affected by such designation is essential. The difference can mean hundreds if not thousands of dollars in healthcare costs or savings. Learn more about doctors who accept Medicare assignment, how the system works, and the status maintained by many popular healthcare facilities.

What is Medicare Assignment?

Medicare assignment is a fee schedule agreement between the federal government’s Medicare program and a doctor or facility. When Medicare assignment is accepted, it means your doctor agrees to the payment terms of Medicare.

Doctors that accept Medicare assignment fall under one of three designations: a participating doctor, a non-participating doctor, or they opt-out of the program altogether. Let’s break down the various designation of Medicare assignment providers below:

  1. Participating Providers: Providers that accept Medicare assignment and agree to accept what Medicare establishes per procedure, or visit, as payment in full.
  2. Non-Participating Providers: Providers who accept Medicare benefits, but do not accept the amount Medicare says a procedure or visit should cost. These providers reserve the right to charge an excess charge of up to 15% more than the Medicare-approved amount in states that allow it.
  3. Opt-Out Providers: The minority of healthcare providers that do not accept Medicare. Fortunately for beneficiaries, this group represents less than 3% of adult healthcare providers in the United States.

How To Find Out if a Doctor Accepts Medicare Assignment

Since not every doctor accepts Medicare assignment, it’s important to know whether or not your doctor does. You can easily pinpoint and compare doctors that accept Medicare assignment of benefits with the Care Compare Tool. The tool allows you to personalize results for doctors and hospitals in your area. Also, the tool is available on smartphones and tablets.

Using the Care Compare Tool provides you with much more information than which providers who do not accept assignment of Medicare benefits or do accept it. You can also find out important information such as contact info, quality ratings, and directions to healthcare facilities.

Furthermore, you can also use the Care Compare Tool to find out information on nursing homes, hospices, dialysis centers, rehab care, and Long-Term care facilities.

Do All Doctors Accept Medicare Supplement Plans?

All doctors who accept Original Medicare will accept Medicare Supplement plans. However, not all doctors accept the federal government’s Medicare program.

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Also known as Medigap, your Medicare Supplement benefits are there to help you cover the leftover costs that can occur when using Original Medicare benefits alone. Therefore, while you have access to every doctor in America that accepts Medicare, if they don’t, you’ll need to pay for your healthcare costs out of your own pocket.

One common mistake you may encounter is receiving healthcare services only to be told at the desk that the facility doesn’t accept your Medigap plan. There are 12 lettered Medicare Supplement plans available, but all are accepted at any healthcare facility accepting Medicare assignment. The misconception can occur when workers confuse the idea of networks. Medigap doesn’t have networks, but Medicare Advantage plans do.

Overall, if you encounter such issues, simply ask if the facility accepts Medicare. If the answer is yes, you’ll be covered by your Medicare Supplement benefits also. However, if you are enrolled in a Medicare Advantage plan, you’ll need to also be sure that the facility is within your plan’s network. While out-of-network healthcare providers may still be used by Medicare Advantage beneficiaries, the cost will be higher.

Do Most Doctors Accept Medicare Assignment?

An overwhelming majority of doctors are healthcare providers which adhere to Medicare assignment rules. Around 98% of all doctors providing healthcare to adults are either participating or non-participating providers. Remember, even non-participating providers accept Medicare. They simply reserve the right to charge as much as 15% more through Medicare Part B excess charges in states that allow them.

This is great news for beneficiaries enrolled in Medicare because it provides more options for healthcare and benefits. Rather than facing expensive, rising healthcare costs alone, you can enjoy benefits that help you cover the costs of approved services.

But it’s important to understand that different Medicare benefits may have some restrictions. Specifically, when enrolled in Medicare Advantage plans, you’ll need to ensure that they are in your plan’s network.

For many, this can be a restriction that only allows healthcare services near one’s home. Meaning if you’re known to travel, it may not be the best choice for you. Because Medicare Supplement plans don’t have a network, all you’ll need to worry about is whether or not your healthcare provider accepts Medicare assignments or not to be covered, regardless of location within the United States.

What Happens if a Doctor Doesn’t Accept Medicare Assignment?

Providers who do not accept Medicare Assignment may require you to pay higher costs for services out-of-pocket. You could pay up to an additional 15% of the Medicare-approved amount out-of-pocket, then wait for Medicare reimbursement, but there’s no reimbursement guarantee.

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If you are receiving healthcare from doctors who opt-out of Medicare services, you’ll pay 100% of the costs. But unlike Medicare assignment doctors, these healthcare providers don’t set their fees to Medicare standards. This means you may pay more as a result, and that is exactly why you should always confirm first whether your doctor accepts the assignment or not.

After you receive services from a doctor who doesn’t accept the assignment but is still part of the Medicare program, you can receive reimbursement. But you must file a claim to Medicare asking for reimbursement by filling out the CMS-1490S form to ask for payment. The service provider will likely process the claim, then deal with Medicare to help you get reimbursement. Alternatively, if they do not, then you also have the option to process your claim.

Medicare Opt-Out Private Contract

A Medicare opt-out private contract may come to be if your doctor does not have an agreement with Medicare and asks you to sign a private contract. Once you sign a contract, you accept the total amount of your healthcare costs on your own, and Medicare can’t reimburse you. Signing such a contract gives up your right to use Medicare for your health purposes.

Before you sign a private contract, you should know the following:

  • Medicare can’t reimburse you for healthcare services.
  • Medicare can’t pay for your services.
  • You can pay for services whenever you want without signing a Medicare opt-out private contract.
  • The service provider sets the prices for your healthcare.

These considerations are important because the cost of handling your healthcare costs alone can be monumental for anyone. While each situation is different, avoiding Medicare opt-out private contracts and using providers who accept Medicare assignment instead can help you receive the services you deserve while protecting your finances.

Explaining the difference between opt-out and non-participating providers.

Do Hospitals Accept Medicare Assignment?

Most hospitals accept Medicare assignment. For general purposes, hospitals are similar to Medicare doctors who accept assignment, meaning the following:

  • Most facilities are going to accept Medicare.
  • Because hospitals accept Medicare assignment, you’re covered for both your Part A and Part B services.
  • Although a large majority of hospitals accept Medicare assignment, not all do, and you’re going to need to check with a facility before receiving healthcare from them to understand where they stand.
  • Excess charges can still exist in states that allow them, allowing for Part B costs to be elevated by as much as 15%.
  • If you have Medicare Advantage benefits, you’re going to need to receive services from hospitals within your network or pay for your healthcare yourself. Alternatively, if you have a Medicare PPO plan, you may be able to use an out-of-network hospital, but you’ll pay a lot more.

Remember, if Original Medicare benefits are accepted, so too is your Medigap coverage. Therefore, you’ll need to take into consideration your lifestyle, finances, travel plans, and other personal factors before enrolling in either a Medicare Advantage or Medigap plan. Speaking with a licensed Medicare agent can help you navigate Medicare assignment and your coverage.

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Does Cleveland Clinic Accept Medicare Assignment?

Yes, Cleveland Clinic accepts Medicare assignment at most of its 22 hospitals and 275 outpatient locations. This means if you have benefits from Original Medicare, Medicare Supplement, and/or Medicare Advantage, they are accepted so long as the facility is within the United States of America. Furthermore, you’ll still need to determine whether or not a specific location is within your plan’s network for Medicare Advantage benefits.

Does CVS Accept Medicare Assignment?

Yes, the various CVS Health businesses, including MinuteClinic, all accept Medicare assignment in the United States. Again, you’ll still need to ensure that specific locations are a part of your Medicare Advantage plan before using your benefits. While Medicare assignment is unrelated to Medicare Part D, you will find that most Part D plans are also accepted by CVS Pharmacy, though this may vary by location with America’s largest pharmacy retailer.

Does Labcorp Accept Medicare Assignment?

Yes, Labcorp accepts Medicare assignment throughout its more than 2,000 locations found within the U.S. The same guidelines apply. Both Original Medicare and Medigap benefits are accepted, along with Medicare Advantage. But your Advantage benefits will also consider whether or not the location you are going to is a part of your plan’s network.

Does Mayo Clinic Accept Medicare Assignment?

No, while Mayo Clinic does accept Medicare benefits within the 44 communities in which they are present, the campuses do not accept Medicare assignment. This means if you receive healthcare at a Mayo Clinic location, you’ll be billed, and you may be charged a higher rate due to excess charges. Of course, the best way to understand a specific location’s billing is to contact your local campus directly. This is especially important for those with Medicare Advantage plans who will also need to make sure their local Mayo Clinic is within their Advantage plan’s network.

Does MD Anderson Accept Medicare Assignment?

Yes, MD Anderson consists of hospitals that accept Medicare assignment, meaning you can use your benefits at its 13 hospital systems throughout 11 states. What you need to realize is that while benefits for Original Medicare and Medigap are accepted, MD Anderson’s Medicare Advantage options are quite limited. Furthermore, it is advised that you speak with your plan provider before receiving healthcare from the Houston-based healthcare provider.

Does Walgreens Accept Medicare Assignment?

Yes, Walgreens accepts Medicare assignment, allowing its customers to find affordable healthcare solutions near their homes. As the second-largest pharmacy brand in the U.S., you can also take advantage of your Medicare Part D benefits, along with many services covered by Part B coverage. Featuring more than 9,000 stores nationwide, remember to check your plan’s network if you have Medicare Advantage coverage to ensure that you are covered before you go.

What is Medicare Assignment of Benefits?

The assignment of benefits is when the insured authorizes Medicare to reimburse the provider directly. In return, the provider agrees to accept the Medicare charge as the full charge for services. Non-participating providers can accept assignments on an individual claims basis. On item 27 of the CMS-1500 claim form, Medicare assignment of benefits requirements dictate that non-participating doctors check “yes” when they agree to accept Medicare assignment for the full charge on the claim.

What are Medicare Assignment Codes?

The Medicare assignment code is what shows proof that Medicare has agreed to represent you and cover your medical bills. This method allows for easy communication between health providers and Medicare when caring for your medical needs.

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Participating healthcare providers file for service reimbursement with a Medicare assignment of benefits form. Formally known as a CMS-1500 form, this is used by non-institutional providers and suppliers for reimbursement from Medicare and, in some cases, Medicare State Agencies.

What is Medicare Part B Assignment?

Medicare Part B assignment is when your doctor accepts the preassigned costs for Medicare outpatient services. Participating providers determine how much you pay for Part B services. For example, fully participating doctors accept Medicare rates for services, meaning you only pay 20% of the bill with Original Medicare. However, if a provider is not participating, you could be responsible for an excess charge of 15%.

Some providers refuse Medicare assignment altogether. If this is the situation, you’re responsible for 100% of the costs not only for Medicare Part B but also for Part A services if they apply.

What Is the Difference Between Medicare Participation and Assignment?

Being a participant in Medicare assignment varies from accepting assignment because non-participating providers can still accept but charge more. Remember, this is where excess charges come into play unless you are in Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, or Vermont, which all prevent such charges.

An excess charge means that a healthcare provider can charge you as much as 15% more than Medicare for approved services. Therefore, just because a healthcare provider accepts Medicare assignment, doesn’t mean they are a Par Provider, and you may face higher rates even with coverage.

What Is a Par Provider?

A Par Provider is the same as a Participating Provider. These healthcare providers have accepted assignment from Medicare and agree to charge the amount allowable according to the federal government’s program for approved services. If you receive care from Par Physicians, you may still have out-of-pocket costs, which can be covered partially or entirely by Medicare Supplement plans.

How To Navigate Medicare Assignment and Your Benefits

The best way to avoid excess charges if you live in one of the many states that allow them is by visiting a provider who accepts Medicare and participates in Medicare assignment. But as you can see, additional considerations come into play.

Keeping your healthcare costs in check while receiving the right services is a delicate balancing act. Original Medicare is a robust coverage, but covering additional costs can often be tricky. Many options are available, and you can only have Medigap or Medicare Advantage, so how do you know which is best for your needs?

Luckily, we can help. Our expert team of licensed Medicare agents is here to help you enroll in the best coverage for your personal healthcare and budget needs so that you pay less for the services you require. When it comes to covering excess charges, Medicare Supplement plans that cover these expenses are available, and we can help you identify the best option for you.

Call us today to compare Medigap plans in your area that cover excess charges when providers don’t accept Medicare assignment. You can also fill out our online rate form for plan comparison.

Kayla Hopkins

Kayla Hopkins

Content Editor
Kayla Hopkins is an accomplished writer and Medicare guru serving as the Editor of MedicareFAQ.com. Upon completing her Communications degree from Ohio University, Kayla dedicated her time to understanding the ever-evolving landscape of healthcare. With her extensive background as a Licensed Insurance Agent, she brings a wealth of knowledge and expertise to her writing.
Ashlee Zareczny

Ashlee Zareczny

Compliance Manager
Ashlee Zareczny is the Compliance Manager for MedicareFAQ. As a licensed Medicare agent in all 50 states, she is dedicated to educating those eligible for Medicare by providing the necessary resources and tools. Additionally, Ashlee trains new and tenured Medicare agents on CMS compliance guidelines. Ashlee is a Medicare expert who specializes in Medicare Supplement, Medicare Advantage, and Medicare Part D education.

17 thoughts on "Medicare Assignment"

  1. I have just reached 65 and am now covered by Medicare part A and B. I have made an appointment on my own with my local Diagnostic Center for a yearly mammogram that I have not had in years. Do I need my doctor to make that referral on my behalf for Medicare to pick up the cost? Is the total cost covered by Medicare or is it subject to the Medicare deductible being met and then they pay their 80%? Is the 3D mammogram covered which is more comprehensive since I have had a biopsy in the past and need the more comprehensive xray? Thank you for your assistance!

    1. Hello! Your coverage will be determined by the type of mammogram you receive. If the mammogram is diagnostic, you will be subject to the 20% co-payment. If this is a preventative mammogram, you will receive 100% coverage as long as your provider accepts Original Medicare.

  2. I think there are procedures which Medicare does not cover. If doctor which accept assignment who orders non-Medicare approved procedure, is patient responsible for that procedure that was ordered by doctor and not covered by Medicare. Or is doctor legally obligated to inform the patient that the procedure is not covered?

    1. Bill, it is up to you to know what is and is not covered by your insurance. However, the doctor should inform you that it will not be covered by Medicare and you will be required to sign an Advanced Beneficiary Notice. This waiver informs you that Medicare may not cover the services and you will pay out-of-pocket if Medicare denies the claim.

  3. We accept Medicare but claims were denied because it’s under capitation what does it means. Who’s is payer insurance of the services. This is a solo medical practice

  4. Hello Lindsay,

    I work for a provider that accepts Medicare, however we do balance bill. Is there a difference between Medicare and Medicare assigment? Are they in fact 2 different programs? We have conflicting information and want to clear this up.

    1. Hi Amy! You can accept Medicare, but be a non-participating provider. This means you do accept Medicare, but you do not accept the Medicare-approved amount for a service. Non-participating providers can balance bill up to 15% of the Medicare-approved amount for the service. I wouldn’t say it’s two different programs but one of three billing arrangement options for providers who accept Medicare. I hope this helped clarify!

      1. Hi! So how does the non participation but accepting Medicare work for Annual Wellness Visits? Is it still appropriate to have non-par providers who accept assignment billing for AWVs? Also, do Medicare Advantage companies allow for non-par/accepting assignment providers to bill as well? Last question….do these providers still need to be fully credentialed if they are non par for Medicare? Assume yes, but wasn’t sure how Medicare and even insurance companies view this. For example if I am using a vendor to arrange for providers to help complete AWV’s and those providers are non par but accept assignment is that acceptable for a MA plan where providers do need PTAN’s.

        Thanks!

    2. Hey Jagger, I will be starting Medicare soon. The chiropractor. I see can’t accept Medicare because he can’t find anyone to do Medicare billing. He has been my god sent for adjustments for over 10 years. I would gladly pay him out of my own pocket, before switching to someone I don’t know, and doesn’t know my needs. Is it possible to stay with my doc? Linda

      1. Hi Linda – if your doctor doesn’t accept Medicare but is still part of the Medicare program, you can fill out Form CMS 1490S to request medical payment. Otherwise, you can pay out-of-pocket while still being on Medicare.

  5. Hi, Lindsay, my wife received a Medicare Claim Notice for care she received from a non-participating provider (my wife paid the entire claimed amount at the time of the appointment). One note on the claim notice said, “Under federal law, your doctor cannot charge more than $38.34. If you have already paid more than this amount, you are entitled to a refund from the provider.” The provider refuses to refund us the $61.66 overpayment my wife paid. I called Medicare, and they don’t care. Who can we report this to?

    1. Hi William! Your best bet is to call Medicare. However, since you’ve already gone that route and had no luck, I would contact your carrier directly. Have them put in writing & document what their responsibility is and the overpayment to provide to the doctor. Hopefully, that will get their attention.

    1. Hi Elizabeth! If they accept Medicare Assignment, the doctor can only bill the amount Medicare has approved. If you don’t have any supplemental insurance, Medicare will bill you the remaining amount after they cover their portion of the costs. If the doctor does not accept Medicare Assignment, they can bill you up to 15% in excess charges for each service.

  6. Hello Lindsay. My doctors office says they accept medicaid. Does that mean they accept medicare? I have plan N with Cigna.

    1. Hi Thomas! Medicare & Medicaid are two different types of health coverage. However, I would imagine if your doctor accepts Medicaid, they probably accept Medicare. I would just give them a call to verify.

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