Once you have Original Medicare, ask your doctor if they accept Medicare assignment before receiving services. However, with over 800,000 doctors taking Medicare, you have the largest provider network.
Whether you want to see the best doctor in New York or Dr. Smith down the road chances are they’re in-network.
What is Medicare Assignment
Medicare assignment is a fee schedule agreement between Medicare and a doctor. Accepting assignment means your doctor agrees to the payment terms of Medicare.
Over 93% of all doctors in America accept Medicare assignment. Before Medicare eligibility, most people use networks and referrals.
Doctors who accept assignment are either a participating doctor, non-participating doctor, or they opt-out.
The 3 categories:
- Participating doctors accept Medicare assignment; the doctor accepts Medicare and only charges up to the amount that Medicare allows
- Non-Participating Doctors choose to accept or not accept Medicare; the doctor takes Medicare but can choose to charge an excess charge
- Doctors that have Opted out of Medicare are the minority. These doctors don’t accept Medicare and you pay 100%
When you go on Medicare you get a lot more freedom when it comes to choosing your doctor; this is because most doctors accept Medicare assignment.
Medicare Assignment of Benefits
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 assignment on an individual claims basis. On item 27 of CMS-1500 claim form non participating doctors need to check “yes” when they agree to accept Medicare assignment for the full charge on the claim.
Doctors Who Accept Medicare Assignment
Before you assume that every doctor accepts assignment, you should know that not all of them agree to the terms. When it comes to Medicare assignment, doctors can choose to opt-out or not participate.
To find doctors that accept Medicare assignment use the Physician Compare tool available on Medicare’s website.
Do All Doctor Accept Medicare Supplement Plans
Having a Medicare Supplement plan gives you access to every doctor in America that accepts Medicare.
You may occasionally get someone behind the desk that tries to tell you they don’t take your plan; however, this is because they have network lists regarding Medicare Advantage Plans.
Simply ask if they accept Medicare and if they do they must accept the supplement plan.
Do Most Doctors Accept Medicare Advantage
Unlike a Medicare Supplement, a Medicare Advantage Plan replaces your Original Medicare. Your health coverage is the insurance company and you don’t have the freedom to simply go to any doctor.
MA plans are subject to plan networks and rules for services. In most cases, if you go to a doctor that takes Medicare but doesn’t take your Medicare Advantage Plan you must pay 100% out of pocket.
Some Medicare Advantage Plans do have Preferred Provider Organization (PPO) allowing you to go out of network; however, you’ll pay a much higher rate.
Does Having Medicaid Impact Your Doctor Network
This can be a more complicated situation. If you’re on Medicare and Medicaid you can always go to any doctor that accepts Original Medicare.
The best practice when dealing with Medicare and Medicaid is to make sure the provider takes both Medicare and Medicaid. This way the Medicaid plan will pay your portion of the bill.
Free Medicare Preventive Services
You get to enjoy the free preventive services through Medicare. This includes services such as colonoscopies, heart disease screening, annual wellness visits, and more.
However, these services are only free if you get them from a doctor who accepts Medicare assignment.
Medicare Assignment Code
This code shows that Medicare has agreed to be to represent you and cover your medical bills. This allows for easy communication between health providers and Medicare when taking care of your medical needs.
What is Medicare Assignment Part B
Medicare Assignment Part B determines if the doctor accepts Medicare for outpatient services. The providers participating type will determine how much you pay for Part B services.
For example, fully participating doctors accept Medicare rates for services; this means 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 to accept Medicare payment altogether; if this is the situation, you’re responsible for 100% of the costs.
What Happens if a Doctor Doesn’t Accept Medicare Assignment
Not all doctors accept assignment, this means you pay for services out of pocket.
You could pay 100% out of pocket, then wait for Medicare reimbursement. Please keep in mind, there’s no reimbursement guarantee.
Then there are doctors who opt out of Medicare charges. This means you pay 100%.
Unlike doctors that accept assignment, these doctors don’t set their fees to Medicare standards. This is why you should always confirm first whether your doctor accepts assignment or not.
After you receive services from a doctor who doesn’t accept assignment but is still part of the Medicare program, you can receive reimbursement. You must file a claim to Medicare asking for reimbursement.
You should fill the CMS-1490S form to ask for payment.
The service provider will likely process the claim. They deal with Medicare so that you get a reimbursement; but if they don’t, then you can.
Medicare Opt-Out Private Contract
Sometimes your doctor may ask you to sign a private contract. This usually happens with doctors who do not have an agreement with Medicare.
A Medicare private contract is for doctors that opt-out of Medicare payment terms. Once you sign a contract, it means that you accept the full amount on your own and Medicare can’t reimburse you.
Signing such a contract is giving up your rights to use Medicare for your health purposes.
Before you sign a private contract, you should know the following:
- Medicare can’t reimburse you
- Medicare can’t pay for services
- You can pay for services whenever you want, without signing a contract
- The service provider sets prices
Lower Costs With Medicare Assignment
You’ll have lower costs by seeing a doctor that accepts Medicare assignment. Beneficiaries with Medigap coverage pay less out of pocket.
Medigap beneficiaries save money on copayment, coinsurance, and deductibles. However, Medigap Premiums are higher than most Medicare Advantage premiums.
To save the most on Medicare Supplement coverage call us at the number above. If you prefer, fill out an online rate form and discover the best rates in your area.