What is Medicare assignment?
Medicare assignment is a policy in which doctors agree to accept a Medicare-approved amount as full payment for services and supplies covered under Part B. Medicare usually pays 80% of the approved amount directly to the physician or supplier after the beneficiary meets the annual Part B deductible of $100.

Always ask your doctors and medical suppliers if they accept assignment. If they do, it means that they will accept as payment the amount Medicare approves for a particular service or supply. You will pay only the deductible and 20 percent coinsurance. Here's how assignment works:

If your doctor accepts assignment

Let's suppose your doctor accepts assignment and that you have already paid the $100 Part B deductible for the year. Let's also assume that Medicare approves $100 for the service you receive from your doctor.

Medicare pays 80 percent of the $100 approved amount, or $80. You are responsible for the other 20 percent, or $20. Medicare pays its share of the bill directly to the doctor after the doctor files your claim. The doctor can ask you to pay the $20 immediately, but could not ask for more.

If your doctor does not accept assignment

Here's what could happen if your doctor does not accept assignment. The doctor could charge $115, which is the $100 charge approved by Medicare, plus the extra 15 percent that doctors who do not accept assignment are permitted to charge.

Medicare would pay 80 percent of $100, or $80 and you would be responsible for the remaining $35. Also, a doctor who does not accept assignment can ask you to pay the entire cost immediately ($115 in this example). Medicare would send you a check for $80 after your doctor files your claim.

Limits on Charges
  • A doctor who does not accept assignment cannot, by federal law, charge more than 15 percent more than Medicare's approved amount.

  • Doctors who do not accept assignment for elective surgery are required to give you a written estimate of your costs before the surgery if the total charge will be $500 or more. If you are not given a written estimate, you are entitled to a refund of any amount you paid in excess of the Medicare-approved amount for the surgery performed.

  • Medicare will not pay for services it judges to be medically unnecessary. Therefore, if your doctor does not participate in Medicare and provides you with a service that he or she has reason to believe will be determined medically unnecessary by Medicare, you must be told that in writing before the service is performed. If you were not given written notice and you did not know that Medicare would not pay, you cannot be held liable for payment for that service. However, if you did receive written notice and signed an agreement to pay for the service, you will be held liable to pay.

The information above summarizes general employee benefit provisions. It is not intended to specify details of any particular employer's plan, nor is it a guarantee of benefits. Contact your benefit representative about specific details regarding your company's employee benefit plan.