Medicare Assignment: What Does it Mean?

Medicare Assignment means that your doctor or medical provider has signed an agreement with Medicare to accept Medicare's approved amount as the full amount they will charge for services or supplies. A doctor or provider can enroll with Medicare without agreeing to accept assignments. Before you receive care or supplies it is always best to check with your provider to see if they accept Assignment or not. Using a doctor or provider that accepts Assignment will keep your co-pay and out of pocket expenses down because Medicare's Assignment amounts are low. For example, a doctor may charge $75.00 for an office visit but if he has agreed to Assignment and the Medicare Assignment amount for an office visit is $65.00 that is the amount he is agreeing to charge you and Medicare for the service. Assignments are beneficial to providers too because they are assured of receiving payment from Medicare.

Auntie Lou says, "Don't forget to use doctors that accept assignment, those that don't are ***ingment folks and hard on the wallet."

Unassigned providers can charge you more than the Medicare-approved amount for certain items or services but their participation in the Medicare program prohibits them from charging more than 15% more than the approved Medicare amount. Some types of durable medical equipment and services are excluded from this 15% limit also known as the "limiting charge."

Assignment is beneficial for the patient because the Assignment agreement stipulates that the provider is responsible for the billing process and filing a claim for payment with Medicare. By participating in assignment the provider is also agreeing to charge you only the deductible and co-insurance amount. Moreover, your payment won't usually be billed until Medicare has paid its share of the bill. This leaves you with no risk of overpayment and trying to get reimbursed. Furthermore, the provider is responsible for submitting the claim into Medicare and handling all the necessary paperwork. A provider can't charge you for filing the claim.

Occasionally a provider may refuse to submit a Medicare claim and insist you pay him/her directly. If this happens you may be able to get reimbursed from Medicare using form CMS-1490S. This form is available at http://www.medicare.gov/medicareonlineforms/. Or by calling 1-800-MEDICARE (1-800-633-4227).

Assignment also gives you greater recourse for dealing with fraud or providers who are refusing to file paperwork. If you encounter either of these things with a Medicare Assignment provider you can call 1-800-MEDICARE (1-800-633-4227) and for TTY users: 1-800-486-2048.