What does Medicare Assignment Mean?

• Medicare Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services.
•  Medicare Assignment and Costs FACT Sheet  pdf 10-19-23  CA Health Care Advocates HI Cap
  • Hi Cap Web Site
• If your doctor, provider, or supplier accepts assignment:
  • Your out-of-pocket costs may be less.
  • They agree to charge you only the Medicare deductible and coinsurance amount and usually wait for Medicare to pay its share before asking you to pay your share.
  • They have to submit your claim directly to Medicare and can’t charge you for submitting the claim.
• Non-participating providers haven’t signed an agreement to accept assignment for all Medicare-covered services, but they can still choose to accept assignment for individual services. These providers are called “non-participating.”
• Here’s what happens if your doctor, provider, or supplier doesn’t accept assignment:
  • You might have to pay the entire charge at the time of service.
  • Your doctor, provider, or supplier is supposed to submit a claim to Medicare for any Medicare-covered services they provide to you.
    • If they don’t submit the Medicare claim Form
      • 
  • They can charge you more than the Medicare-approved amount, but there’s a limit called “the limiting charge.”
    • The provider can only charge you up to 15% over the amount that non-participating providers are paid.
    • Non-participating providers are paid 95% of the fee schedule amount (Medicare Physician Fee Schedules (MPFS)) (How to Use the MPFS Lookup Tool)  . ^{Medicare.Gov Assignment} * 
  • Note that Medi Gap plans will pay the excess charge
  • Medicare Advantage – doesn’t really apply, as you have to use that Insurance Companies physicians list

Bibliography, Resources & Links

• Medicare.Gov Assignment Explanation
  • See Opt Out – Concierge Rules below
  • CA Health Care Advocates on assignment Fact Sheet
• Medicare Provider Finder
• Epoch Times – When MD no longer accepts Medicare – Patients left holding the bag.
• Kaiser Foundation – Primary Care MD’s accepting Medicare
• Our webpage on negotiated fees & surprise billing

💡 What an Excess Charge Is

If a doctor or provider accepts Medicare but does not accept Medicare “assignment,” they may bill more than the Medicare-approved amount for a service — up to 15% extra. This extra is called a Part B excess charge (sometimes also referred to as the limiting charge). (Humana)

Example:

• Medicare “approved amount” for a visit: $200

• Provider doesn’t accept assignment and charges full 15% excess:
  → Excess charge = $30
  → You would normally owe: Part B coinsurance (20% of $200 = $40) + $30 excess = $70 total out-of-pocket for that visit. (Humana)

📍 How Often It Happens in Los Angeles (and the U.S. Generally)

Here’s what data and industry info suggest:

🧑‍⚕️ Rare for Most Doctors

• Most doctors accept Medicare assignment and do not bill excess charges — often cited as about 98% of physicians, meaning less than 2% of doctors bill excess charges. (MedigapSeminars)

• Common specialties where excess billing is slightly more likely include:

  • Mental health/psychiatry

  • Certain surgical consultants or out-of-network specialists
    (because they negotiate differently or don’t take assignment) — but it’s still a small percentage. (Reddit)

So in Los Angeles, too, the vast majority of clinicians (e.g., primary care, most specialists) accept Medicare assignment and won’t bill excess charges. If you see a non-participating provider, only that visit is at risk of an excess charge.

🩺 Common Scenarios Where You Might See an Excess Charge

1. Visiting a Specialist Who Doesn’t Accept Assignment

Some specialists in LA may accept Medicare but not assignment — e.g., some dermatologists, mental health professionals, or anesthesiologists at outpatient clinics.
In such a case, you could be billed up to 15% above Medicare’s approved rate for an outpatient service. (Humana)

Example:
A dermatologist procedure with a Medicare approved rate of $1,000 could have up to $150 extra added if the doctor bills excess.

2. Out-of-Network Diagnostic or Outpatient Procedures

Providers you didn’t choose (e.g., anesthesiologist in a hospital or imaging provider at a clinic) sometimes don’t take assignment — making excess charges possible. (Reddit)

3. Low-Utilization Services with Non-Participating Providers

If you see a provider infrequently who doesn’t take assignment, you might incur an excess charge — but still not very often, given most providers accept assignment. (MedigapSeminars)

💳 How Often a Medicare Plan G Pays for It

📌 Medigap Plan G covers Part B excess charges at 100%.
That means if a doctor bills an excess charge, Plan G will pay that extra amount — after your Medicare Part B deductible is met — so you would not pay the 15% yourself. (Humana)

So in a scenario like:

• Provider bills 15% over Medicare approved amount

• You have Medigap Plan G
  → Plan G pays those excess charges — you don’t. (Humana)

Even if that happens rarely, Plan G protects you from having any surprise out-of-pocket on excess charges.

🧠 Bottom Line: Likelihood + Plan G’s Protection

👉 Most doctors you see in LA will not bill excess charges — but if they do, Plan G will pay it for you.

📌 Tips to Avoid Excess Charges Altogether

• Ask before your appointment whether the provider “accepts Medicare assignment.”

• Use the Federal Medicare provider lookup tool to check assignment status.

• Rarely, emergency or hospital-based providers may not accept assignment — Plan G still protects you. (Medicare)

If you want, I can also help estimate how much excess charges might cost annually for common services in Los Angeles (like office visits, imaging, or outpatient surgery).

Medi Gap Plans from Anthem Blue Cross –
Click for Information and ONLINE enrollment