What Is Medicare With Assignment?

The original Medicare plan is a pay-for-service type of insurance, also an 80/20-plan meaning Medicare pays 80 percent and the patient pays 20 percent. However, Medicare places an assignment, or amount they will pay, for each service.

Features

• When a physician decides to accept Medicare patients, they must also decide to accept the Medicare assignment, which outlines the amount Medicare pays for specific services.

Medicare Assignment

• Since the physician agrees to Medicare’s approved amount as payment in full, they cannot require the patient pay the difference. The patient is required to pay 20 percent of Medicare’s assignment, rather than the full amount of the services.

Assignment Opt-Out

• Physicians can in fact accept Medicare but not agree to the Medicare assignment of benefits. In that case, the beneficiary must pay the difference. For instance, if the physician charges $120 and Medicare approves $100, the patient pays 20 percent of the $100 plus the additional $20 Medicare did not cover.

Medicare Acceptance

• Since physicians and clinics make less on each Medicare beneficiary patient, they can choose to opt out and not accept Medicare at all. Doctors practicing in rural communities, poorer areas or those with a higher elderly population usually accept Medicare.

Final Thoughts

• When visiting any physician or facility, ask them if they accept assignment from Medicare, since this most often means less out-of-pocket expenses for the patient.