Certain doctors and other health care providers who don’t want to work with the Medicare program may “opt out” of Medicare. Medicare doesn’t pay for any covered items or services you get from an opt out doctor or other provider, except in the case of an emergency or urgent need. If you still want to see an opt out provider, you and your provider can set up payment terms that you both agree to through a private contract.  

What does assignment mean?

Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services.  

If your doctor, provider, or supplier accepts assignment:  

• Your out-of-pocket costs may be less.  

• They agree to charge you only the Medicare deductible and coinsurance amount and usually wait for Medicare to pay its share before asking you to pay your share.  
• They have to submit your claim directly to Medicare and can’t charge you for submitting the claim.  

Some providers haven’t agreed and aren’t required by law to accept assignment for all Medicare-covered services, but they can still choose to accept assignment for individual services. The providers who haven’t agreed to accept assignment for all services are called “non-participating.” You might have to pay more for their services if they don’t accept assignment for the care they provide to you. Here’s what happens if your doctor, provider, or supplier doesn’t accept assignment: 

• You might have to pay the entire charge at the time of service. Your doctor, provider, or supplier is supposed to submit a claim to Medicare for any Medicare-covered services they provide to you.  

• They can charge you more than the Medicare-approved amount. In many cases, the charge can’t be more than an amount called “the limiting charge.”  

Is your doctor eligible to accept Medicare? 

Next : Medicare Advantage Plans Benefits