Medicare accepting assignment doctors agree to take the Medicare-approved amount as full payment for covered services. That one agreement shapes what you pay at every visit. In Original Medicare, Medicare accepting assignment doctors cannot bill you above the approved amount. You typically owe only your Part B deductible and 20% coinsurance. However, not every provider works this way.
Some doctors see Medicare patients but decline assignment. Others have left Medicare entirely. Each status comes with different costs, paperwork, and protections. Knowing the difference helps you avoid surprise bills. It also helps family caregivers plan for ongoing specialist care and budget with more confidence.
How Medicare Accepting Assignment Doctors Differ From Other Providers
Assignment is an agreement between a provider and Original Medicare. The provider accepts the Medicare-approved amount as payment in full. CMS sets that amount through the Medicare Physician Fee Schedule. The provider then bills Medicare directly, so you never file your own claim. Medicare pays its share straight to the doctor’s office.
Providers fall into three groups. Participating providers sign an agreement to accept assignment on every Medicare claim. The agreement runs for a full calendar year. According to CMS, most physicians and practitioners who bill Medicare are participating providers. KFF research has found that only about 1% of non-pediatric physicians have formally opted out of Medicare.
Non-participating providers still treat Medicare patients. They decide case by case whether to accept assignment for each service. When they decline, they can charge more than the approved amount, up to a legal cap. Opt-out providers have left Medicare completely. They sign private contracts with patients, and Medicare pays nothing toward their bills. Medicare accepting assignment doctors give you the most predictable costs of the three groups.
What You Pay: Participating, Non-Participating, and Opt-Out Providers
Your costs change sharply depending on provider status. With a participating provider, Medicare pays 80% of the approved amount after you meet the Part B deductible. You pay the remaining 20%. The doctor cannot bill you for anything more on covered services. This protection applies to office visits, tests, and most outpatient procedures.
Non-participating providers follow different rules. Medicare sets their approved amount 5% lower than the participating rate. However, when they decline assignment, they can charge up to 15% above that reduced amount. This cap is called the “limiting charge.” As a result, your share can climb well above the usual 20% coinsurance.
For example, imagine a service with a $100 participating rate. At a participating office, you would pay $20 after your deductible. A non-participating doctor’s approved amount would be $95. Their limiting charge would be $109.25. Medicare pays 80% of $95, which is $76. You would owe the remaining $33.25.
Some states set stricter rules. Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont limit or ban these excess charges. New York, for instance, caps them at 5%. Only Medicare accepting assignment doctors protect you from the limiting charge in every state.
| Provider Type | Accepts Approved Amount? | Can Charge Extra? | Who Files the Claim? | Does Medicare Pay? |
|---|---|---|---|---|
| Participating | Always | No | Provider | Yes, 80% after deductible |
| Non-participating (accepts assignment on that claim) | For that service | No | Provider | Yes, 80% of a reduced rate |
| Non-participating (declines assignment) | No | Up to 15% limiting charge | Provider must still file | Yes, but payment may go to you |
| Opt-out | No | No federal limit; set by private contract | No one | No, except certain emergencies |
Payment timing also differs. A non-participating provider who declines assignment may ask you to pay the full bill at the visit. Medicare then reimburses you for its share later. That gap can strain a fixed budget. Even so, the provider must still submit the claim to Medicare for you. They cannot charge you for filing it.
Opt-out providers carry the greatest financial risk. You sign a private contract before receiving care. You pay the full price the doctor sets. Medicare pays nothing, and Medigap policies will not cover those services either. Opt-out status lasts two years and renews automatically unless the provider cancels it.
How to Find Doctors Who Accept Assignment and Protect Your Wallet
Start with the “Find & Compare Doctors” tool on Medicare.gov. Search by name, specialty, or ZIP code. Each profile shows whether the provider accepts Medicare-approved amounts as full payment. This is the fastest way to identify Medicare accepting assignment doctors near you. Check the listing again before major procedures, since status can change each year.
Next, call the office and ask the right question. “Do you take Medicare?” is not enough. Instead, ask “Do you accept Medicare assignment for all services?” A non-participating office may say yes to the first question. Their answer to the second question tells you what you will actually pay.
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Your Medigap choice matters too. Medigap Plan G covers Part B excess charges. Plan F also covers them, but only people eligible for Medicare before January 1, 2020, can buy it. Many other Medigap plans leave excess charges uncovered. Carriers like AARP/UnitedHealthcare, Mutual of Omaha, Aetna, Cigna, and Blue Cross offer these plans in most states. Pricing varies by state and insurer.
Medicare Advantage works another way. Plans from Humana, UnitedHealthcare, Aetna, and others use provider networks. Your costs depend on whether a doctor is in network, not on assignment status. In most cases, out-of-network care in an HMO is not covered except for emergencies. PPO plans typically cover out-of-network care at a higher cost share. Always confirm network status with your plan directly.
Finally, review every Medicare Summary Notice. Original Medicare mails these notices every four months. You can also view claims sooner in your Medicare.gov account. Compare each charge against the limiting charge rules. If a non-participating doctor billed above the limit, they must refund the excess. For billing questions, call 1-800-MEDICARE. You can also contact your State Health Insurance Assistance Program (SHIP) for free, unbiased counseling.
Frequently Asked Questions
Is it better to see a doctor who accepts Medicare assignment?
In most cases, yes. Medicare accepting assignment doctors cannot charge more than the approved amount. You pay only your deductible and 20% coinsurance. That makes your costs lower and far easier to predict.
What is the Medicare limiting charge?
The limiting charge is the most a non-participating provider can bill for a covered service. It equals 15% above their Medicare-approved amount. For example, Medigap Plan G covers these excess charges in full. Some states set even lower limits.
Can a doctor who does not accept assignment make me pay upfront?
Yes, a non-participating provider may ask for full payment at the visit. They must still file your claim with Medicare. Medicare then sends its share of the payment to you. Opt-out doctors are different, since Medicare will not reimburse any part of their bill.
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Official Sources & Resources
For verified information on Medicare regulations and consumer protection:
- Medicare.gov (Official Site): medicare.gov
- CMS (Centers for Medicare & Medicaid Services): cms.gov
- NAIC (National Association of Insurance Commissioners): naic.org
- KFF Medicare Research: kff.org/medicare
- Social Security Administration: ssa.gov
Content last reviewed September 2026. If you notice any outdated information, please contact us.