En español | If you’re enrolled in the original Medicare program, it’s important to ask any doctor you see whether he or she accepts “assignment” — before you receive care — because this can have an impact on what you pay.
- A doctor who accepts assignment has agreed to accept the Medicare-approved amount as full payment for any covered service provided to a Medicare patient. The doctor sends the whole bill to Medicare. Medicare pays the 80 percent of the cost that it has decided is appropriate for the service, and you are responsible for the remaining 20 percent.
- A doctor who doesn’t accept assignment can charge up to 15 percent above the Medicare-approved amount for a service. You are responsible for the additional charge, on top of your regular 20 percent share of the cost. The doctor is supposed to submit your claim to Medicare, but you may have to pay the doctor at the time of service and then claim reimbursement from Medicare.
If you have Medigap insurance, all policies cover Part B’s 20 percent copays in full or in part. Two policies (F and G) cover excess charges from doctors who don’t accept assignment.
Note that these rules apply only to the original Medicare program. If you’re enrolled in a Medicare Advantage plan, such as an HMO or PPO, you pay the specific copays for doctors’ services that your plan requires.