What is Medicare Assignment?

What is Medicare Assignment
Once you’re enrolled in Original Medicare, it’s important to ask your doctor if they accept Medicare assignment prior to receiving medical 
services. Doctors who accept assignment are categorize as either a participating doctor, non-participating doctor or an opted out doctor.

What does Medicare Assignment Mean?

Medicare Assignment is a form of payment agreement where your doctor accepts the amount paid by Medicare as full payment for his/her services. Medicare assignment is a set amount agreed by Medicare and the doctor, all the services you get from them should be fully covered by Medicare. 

What is Medicare Assignment of Benefits?

These are the benefits that you get when Medicare and your doctor have an agreement. The agreement allows the doctor to only charge you the amount agreed with Medicare on certain services. You get the benefits because Medicare covers 80% of all the services you get from your doctor and you only pay the remaining 20%. 

Free Preventative Services

You also get to enjoy the free preventive services provided by Medicare. This includes services such as colonoscopies, heart disease screening, etc. However, these services are only free if you get them from a doctor who is approved and accepts Medicare assignment. 

What is Medicare Assignment Code?

This code shows that Medicare has agreed to be signed to represent you and cover your medical bills. This allows easy communication between health providers and Medicare when taking care of your medical needs.

Who Accepts Medicare Assignment?

Before you assume that every doctor accepts assignment, you should know that not all of them agree to it. When it comes to Medicare assignment, doctors fall into the following categories as follows.

  1. Participating doctors: These are doctors who accept Medicare assignment. They have been approved to accept whatever Medicare has to offer for the services they provide to you. These doctors only charge you what is approved by Medicare. You only pay 20% while your Medicare covers the remaining 80%. The bill is sent directly to Medicare after your visit. 
  2. Non-participating doctors: These are doctors who might or might not accept Medicare assignment. At times they might agree, but other times you may need to cover up to 35% of the services. However, the doctor is limited to 15% above what Medicare covers. That means they cannot charge you any higher than 35% of what Medicare is willing to pay. 
  3. Ones who have opted out on Medicare: These doctors set their charges, and you’re responsible for paying everything. When you visit such a doctor, you’re on your own. The agreement is between you and them. Whatever they decided to charge you, you have to pay. After paying for the full services, Medicare is not obligated to reimburse you. Everything should come from you and Medicare is not responsible.

My doctor doesn’t accept Medicare assignment, what does this mean?

As stated above, not all doctors accept assignment. This means you can use your Medicare, but must pay whatever is not covered with your own money. You could possibly have to pay the full cost with your own money, then wait to be reimbursed the difference by Medicare. Please keep in mind, there’s no guarantee that Medicare will reimburse you.

Then there’s doctors who have opted out of Medicare charges. This means that whatever services they offer you, you need to pay them in full. Unlike doctors that accept assignment, these doctors set their fee that the patient has to pay and not what Medicare states. You’re required to pay the full amount without help from Medicare. This is why you should always confirm first whether your doctor accepts assignment or not. 

How do I get reimbursed if my doctor doesn’t accept Medicare assignment?

After you receive services from a doctor who doesn’t accept assignment, but is still part of the Medicare program, you can be paid back. You’re required to file a claim to Medicare asking for reimbursement. You should fill the CMS-1490S form to ask for your payment. However, most of the times the service provider processes the claim for you. They deal with Medicare so that you can be paid back, but if they don’t do it, then you can do it yourself by filling out this form.

What does it mean to sign a private contract?

Sometimes your doctor may ask you to sign a private contract. This usually happens with doctors who do not have any agreement with Medicare. Once you sign a private contract, it means that you have accepted to pay the doctor the full amount on your own and Medicare cannot 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 cannot reimburse you after such an agreement.
  • Medicare cannot pay for any services you get through such a contract even if they are Medicare covered.
  • You can pay for full services whenever you want to even without signing such a contract.
  • The service provider sets their prices and charges that you must pay. 

How do I find a doctor that accepts Medicare assignment?

To find doctors approved by Medicare you can visit the Medicare website tool to search for a doctor. Here you can find all the doctors who accept assignment near your area. You can narrow down your search to find a doctor who offers all the services you need near you and accepts Medicare assignment. 

What if I can’t afford the 20% Medicare doesn’t pay?

If you need coverage for the remaining 20% that Medicare doesn’t pay for, you can enroll in a Medicare Supplement plan, also known as Medigap. These policies cover the remaining 20%, as well as any additional out of pocket costs like copays, deductibles and coinsurance. There’s ten letter plans to choose from, lettered from A-N. The rates depend on many factors such as your location, the carrier you choose to go with, your age, etc. Call of our our licensed advisers today at the number above, or you can use our online rate comparison tool here to see the rates in your area now!

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