Alert
Close

Watch the NASCAR race on Sunday at the Atlanta Motor Speedway. Join the Drive to End Hunger!

HIGHLIGHTS

Close

2014 NATIONAL EVENT

Health & Wellness
AARP Auto Buying Program

DRIVER SAFETY

Piggy bank on the road - AARP Driver Safety

Take the new AARP Smart Driver Course!

Contests and
Sweeps

Safe Driving in 2014 Sweepstakes

Learn how AARP Driver Safety can help you stay safe—and enter for a chance to win $1,000. See official rules. 

Download the ipad App

AARP-iPad-ePub-app

KEEP BRAIN ACTIVE!

AARP Games - Play Now!

AARP Books

Medicare for Dummies book cover

Get the answers you need, from Patricia Barry, AARP's Ask Ms. Medicare

Most Popular

Viewed

share your Thoughts

Reader stories help us fine-tune our education efforts and strengthen our calls for action on issues that matter most to you. We read and learn from every story and may use yours (with permission) to brief legislators, inspire other readers and more. Please share your story with us. Do

Ask Ms. Medicare

Seeing a Doctor 'on Assignment' can lower your Medicare costs

What Medicare pays, what you pay when you see a doctor 'on assignment' versus other scenarios

pill identifier tool

Pill Identifier

Avoid a medication mix-up. Use our tool to identify pills by color, shape and markings.

Q. What does seeing a doctor “on assignment” mean?

A.  When you’re enrolled in traditional Medicare and go to any new doctors for the first time, always ask whether they accept Medicare patients and, if so, whether they accept assignment. Their answers to these questions affect how much you pay:

  • A doctor who accepts assignment is agreeing to charge you no more than the amount Medicare pays for the service you receive. Medicare pays 80 percent of this amount, and you pay 20 percent (after you’ve met your annual Part B deductible). The doctor bills Medicare directly, as you are “assigning” Medicare to pay the doctor for your care.

  • The preventive services that Medicare now provides for free (such as mammograms, colonoscopies, heart disease screenings and many others) are free of charge only if they’re provided by a doctor or other qualified health provider who accepts assignment. 

  • A doctor who does not accept assignment can charge you up to a maximum of 15 percent more than Medicare pays for the service you receive.

  • A doctor who has opted out of Medicare cannot bill Medicare for services you receive and is not bound by Medicare’s limitations on charges. You enter into a private contract with the doctor, agreeing to pay his or her bills directly. You cannot claim reimbursement from Medicare under this arrangement.

The chart shows an example of what Medicare pays and what you pay under each of these scenarios:

Doctor accepts assignment Doctor does not
accept assignment
Doctor has opted out of Medicare
Doctor’s bill $120 $120 $120
Amount Medicare approves $100 $100 NA
Medicare pays $80 (80%) $80 (80%) $0
You pay $20 (20%) $20 (20%) $120
Additional charge above Medicare-approved amount $0 $15 (maximum
15% in excess of amount Medicare approves)
NA
You pay in total $20 $35 $120


The same rules apply not just to doctors but also to most other outpatient providers. However, suppliers of durable medical equipment (such as wheelchairs and oxygen equipment) that don’t accept assignment are not bound by Medicare’s limits rule on charges and are allowed to bill you more than 15 percent above the Medicare-approved amount.

These rules affect you only if you’re in traditional Medicare. If you’re enrolled in a Medicare private health plan, you pay what your plan requires, as explained in the plan’s information packet and on its website.

To find doctors in your area who participate in Medicare (including those who accept assignment on all claims), go to Medicare's "Physician Compare" website. Or call the Medicare help line at 1-800-633-4227.

Patricia Barry is a senior editor for AARP Integrated Media and the author of “Medicare For Dummies” (Wiley/AARP, October 2013).

Also of interest: How would you strengthen Medicare?

Topic Alerts

You can get weekly email alerts on the topics below. Just click “Follow.”

Manage Alerts

Processing

Please wait...

progress bar, please wait

Tell Us WhatYou Think

Please leave your comment below.

Discounts & Benefits

From companies that meet the high standards of service and quality set by AARP.

Woman trying on glasses in optometrists shop

Members save up to 60% on eye exams and 30% on glasses at JCPenney Optical.

Prescription medication spilling out of bottle

Members get a free Rx card from AARP® Prescription Discounts provided by Catamaran.

AngiesList

Members can save 25% to 45% on their Angie's List membership.

Caregiving walking

Caregiving can be a lonely journey, but AARP offers resources that can help.