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What Is "Assignment" and Why Is it Important?

Assignment is an agreement between you (the person with Medicare), doctors, other health care suppliers or providers, and Medicare. You "assign" Medicare to pay your doctor, supplier, or provider directly for care. Most doctors, suppliers, and providers accept assignment.
If a doctor, other health care supplier, or provider accepts assignment, it means they
  • agree to be paid by Medicare.
  • agree to receive only the amount Medicare approves for their services.
  • can only charge you, or other insurance you have, the Medicare Deductible or Coinsurance amount.

In some cases, doctors, other health care suppliers, and providers must accept assignment. For example, assignment must be accepted if you receive Medicare-covered physician assistant's services. Doctors, other health care suppliers, and providers have to submit your claim to Medicare directly and can't charge you for submitting the claim (this includes claims for glucose test strips).

If the doctor, other health care supplier, or provider, doesn't agree to accept assignment, they may charge you more than the Medicare-approved Amount; however, for most services, there is a limit to what they can charge you. The highest amount you can be charged is called the "limiting charge." The limiting charge is 15% over the Medicare-approved amount (but may be lower in your state). The limiting charge applies only to certain services and doesn't apply to supplies and other durable medical equipment. In addition, you might have to pay the entire charge at the time of service. Medicare will send you payment for its share of the charge when the claim is processed.

To get more information about assignment, visit www.medicare.gov on the web and select "Search Tools" at the top of the page. Then select "Find a Doctor." You can also call 1-800-MEDICARE (1-800-633-4227).

(Primary Source: Centers for Medicare and Medicaid Services - Medicare and You Handbook. This content may have been enhanced by Q1Group LLC to include further examples, explanations, and links.)



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