How Many Doctors Accept Medicare Assignment?
The vast majority of physicians accept Medicare assignment, but understanding the details is crucial for beneficiaries. While exact figures fluctuate, generally more than 90% of doctors accept Medicare assignment at least some of the time, though this doesn’t always mean they accept it for all services or all patients.
Understanding Medicare Assignment
Medicare assignment is a crucial concept for Medicare beneficiaries. It determines how much you pay out-of-pocket for covered healthcare services. A doctor who accepts assignment agrees to accept the Medicare-approved amount as full payment for covered services. This means you’ll typically pay only your deductible and coinsurance.
Benefits of Seeing a Doctor Who Accepts Assignment
Choosing a doctor who accepts assignment offers several advantages:
- Lower out-of-pocket costs: You only pay your deductible and coinsurance amounts.
- Predictable costs: You know upfront what Medicare will pay and what you’ll be responsible for.
- Simplified billing: The doctor bills Medicare directly, reducing your paperwork.
- Peace of mind: You avoid the possibility of balance billing (being charged more than the Medicare-approved amount).
The Medicare Assignment Process
The process is relatively straightforward:
- Doctor provides services: You receive covered healthcare services from a participating doctor.
- Doctor submits claim to Medicare: The doctor’s office submits a claim to Medicare for the services rendered.
- Medicare processes claim: Medicare reviews the claim and determines the approved amount.
- Medicare pays doctor: Medicare pays the doctor 80% of the approved amount (after you’ve met your deductible).
- You pay coinsurance: You’re responsible for the remaining 20% coinsurance.
Potential Drawbacks for Doctors
While many doctors accept Medicare assignment, some may choose not to, citing reasons such as:
- Lower reimbursement rates: Medicare reimbursement rates are often lower than those from private insurance companies.
- Administrative burden: Dealing with Medicare claims and paperwork can be time-consuming.
- Perceived control over fees: Some doctors prefer to set their own fees.
Understanding Non-Participating Providers
If a doctor doesn’t accept assignment, they’re considered a non-participating provider. This means they can charge up to 15% more than the Medicare-approved amount. This extra charge is known as an excess charge. It’s important to ask your doctor if they accept assignment before receiving services to avoid unexpected costs.
Factors Influencing Acceptance Rates
Several factors influence how many doctors accept Medicare assignment, including:
- Geographic location: Acceptance rates may vary depending on the state or region.
- Specialty: Some specialties have higher acceptance rates than others.
- Payment models: The shift toward value-based care may influence doctors’ willingness to accept Medicare assignment.
Finding Doctors Who Accept Medicare Assignment
Here are some ways to find doctors who accept Medicare assignment:
- Medicare’s Physician Compare tool: This online tool allows you to search for doctors and filter by whether they accept assignment.
- Your Medicare plan: Contact your Medicare plan (Original Medicare or a Medicare Advantage plan) for a list of participating providers.
- Doctor’s office: Simply ask the doctor’s office directly if they accept Medicare assignment.
Understanding “Opt-Out” Physicians
A small percentage of physicians have opted out of Medicare entirely. These doctors don’t bill Medicare at all. If you see an opt-out physician, you’re responsible for paying the full amount charged, and Medicare won’t reimburse you. Be certain to ascertain the billing situation before your appointment.
Common Mistakes to Avoid
- Assuming all doctors accept assignment: Always confirm with the doctor’s office.
- Failing to understand excess charges: Know that non-participating providers can charge up to 15% more than the Medicare-approved amount.
- Not comparing prices: If possible, compare prices from different doctors, especially if you’re seeing a non-participating provider.
- Neglecting to use Medicare’s resources: Utilize Medicare’s Physician Compare tool and contact your plan for assistance.
Conclusion
While how many doctors accept Medicare assignment remains high overall, understanding the nuances is crucial. Knowing your rights and responsibilities can help you avoid unexpected costs and ensure you receive the healthcare you need. Always verify acceptance status before receiving treatment.
Frequently Asked Questions (FAQs)
Will a doctor who accepts assignment always accept it for all services?
No. While most doctors who accept assignment do so for the vast majority of their services, some may choose not to accept assignment for certain procedures or services. Always clarify with the doctor’s office beforehand.
If my doctor doesn’t accept assignment, can I still submit the claim to Medicare?
Generally, if a doctor does not accept assignment, they are responsible for submitting the claim to Medicare. However, it is always best to confirm this with the provider.
What happens if I can’t afford the coinsurance even when my doctor accepts assignment?
Medicare offers programs like Medicare Savings Programs (MSPs) that can help individuals with limited income and resources pay for their Medicare costs, including deductibles, coinsurance, and premiums.
Are there different rules for Medicare Advantage plans regarding assignment?
Yes. Medicare Advantage plans have their own networks of participating providers. You typically need to see doctors within the plan’s network to receive coverage, and those doctors are expected to accept the plan’s payment terms.
How do I report a doctor who is charging me more than the allowed amount under Medicare?
You can report a doctor who is charging you improperly to Medicare. Contact your local State Health Insurance Assistance Program (SHIP) for guidance.
What is the Medicare limiting charge?
The Medicare limiting charge is the maximum amount that a non-participating provider can charge you. This is 15% above the Medicare-approved amount.
Are there any states with laws that restrict or prohibit excess charges?
Yes, a few states have laws that prohibit or limit excess charges by non-participating providers. Check with your state’s Department of Insurance or Medicaid agency.
Does accepting Medicare assignment affect the quality of care a doctor provides?
There is no evidence to suggest that accepting Medicare assignment negatively affects the quality of care a doctor provides.
Can a doctor selectively accept assignment, choosing to accept it for some patients but not others?
While uncommon, a doctor can technically choose to accept assignment on a case-by-case basis. However, this practice can be confusing and is generally discouraged. Transparency is key.
Does Medicare negotiate the fees that doctors can charge?
Yes. Medicare negotiates payment rates with providers. These rates are often lower than those charged by private insurance companies.
What should I do if I receive a bill from a doctor that I don’t understand?
Contact the doctor’s billing office immediately to clarify the charges. You can also contact Medicare for assistance.
How can I find out if a doctor has opted out of Medicare entirely?
The doctor’s office is required to inform you if they have opted out of Medicare. This information should be readily available when you schedule an appointment. If you are unsure, always ask.