Medicare Assignment: What does it mean to me?

Medicare assignment is a way to keep costs under control in the Medicare program. Medicare assignment is a way in which costs are determined in advance, with Medicare establishing a certain fee that it will pay for medical procedures and supplies before the procedures are even provided. When a physician, health care provider, or supplier of medical supplies accepts Medicare assignment, they are basically stating that they will take the assigned fee as full payment for a given service with your loved one only paying the deductible and a coinsurance (usually either 20% or 50% depending upon the service rendered) amount.

Current estimates are that more than 70% of doctors (excluding pediatricians and others who do not provide care under Medicare) are "participating physicians", which means that they accept Medicare assignment on their patients.

If a physician does not accept assignment, they can establish the amount of their own charges and your loved one will be responsible for the difference beyond the part that Medicare would normally pay for that specific service and the actual charge. Also, your senior may have to pay the bill in full and then get a partial reimbursement from Medicare.

There are limits to how much doctors can charge for their services. In most cases, the physician cannot add more than 15% to the fees that have been approved by Medicare. For example, if the approved fee for a specific service is $100, the most a doctor can charge is $115. (Of course a doctor can charge whatever he/she wants for services that are not covered under Medicare).

If your parent or loved one is very happy with their doctor, they may be willing to pay whatever the physician chooses to charge, and they may be willing to pay the extra charge. Otherwise, your senior may find a participating physician either by calling doctor's offices and asking if they accept Medicare assignment or by looking in the Participating Physician Directory, which can be found at www.medicare.gov , or at public libraries, Social Security offices and also at your local senior citizens center. Your senior may also call his/her Medicare carrier for a list of participating providers.

Some information from How to Care for Aging Parents by Virginia Morris

Additional information and web page by Paul Susic M.A. Licensed Psychologist Ph.D. Candidate Clinical Director- Senior Care Psychological Consulting