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Your Out-of-Pocket Costs and “Assignment” in the Original Medicare Plan

Original Medicare Plan Assignment is an agreement between you (the person with Medicare), Medicare, and doctors, other health care suppliers, or providers. You “assign” Medicare to pay your doctor, supplier, or provider directly for services. Most doctors, suppliers, and providers accept assignment. Getting treatment from a doctor, provider, or supplier who is enrolled in Medicare and who accepts assignment can reduce your out-of-pocket costs.

If a doctor, provider, or supplier accepts assignment, they agree to the following conditions:

• To be paid by Medicare
• To accept only the amount Medicare approves for their services
• To only charge you, or other insurance you have, the Medicare deductible or coinsurance amount

In some cases, doctors, providers, and suppliers must accept assignment. For example, assignment must be accepted if you get Medicare-covered physician assistant services.

Doctors, providers, and suppliers have to submit your claim to Medicare directly. They can’t charge you for submitting the claim (this includes claims for glucose test strips).

What if Your Health Care Provider Doesn’t Accept Assignment?

If your doctor, provider, or supplier doesn’t agree to accept assignment, they are required to submit a claim to Medicare and they may charge you more than the Medicare-approved amount. However, there is a limit to what they can charge you for most services. The highest amount you can be charged is called the “limiting charge.” The limiting charge is 15% over the Medicare-approved amount (but may be lower in your state). The limiting charge applies only to certain services and doesn’t apply to some supplies and durable medical equipment. In addition, you might have to pay the entire charge at the time of service, and then submit your claim to Medicare to get reimbursed. To find doctors and suppliers who accept assignment, visit www.medicare.gov on the web. Under “Search Tools,” select “Find a Doctor.” You can also call 1-800-MEDICARE (1-800-633-4227, 24 hours, 7 days a week, including some federal holidays.  TTY/TDD users can call 1-877-486-2048. However, the interactive phone system is available 24 hours every day of the year.