What does Medicare Assignment Mean?
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What is Concierge Medicine or Opt Out? 

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.
  • 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 once you ask them to call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
    • 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

Opt Out
#Concierge

 

Certain doctors and other health care providers who don’t want to enroll in the Medicare program may “opt out” of Medicare. You can still see these providers, but they must enter into a private contract with you (unless you’re in need of emergency or urgently needed care).

Medicare won’t pay for any services you get under a private contract, so you’ll pay the provider’s entire charge out of your own pocket. You and your provider will set up your own payment terms through the private contract.  Medicare and You  *  Medicare.Gov Assignment * Medicare.Gov Concierge *

Details on how to opt out of Medicare for MD’s – Assoc. of American Physicians & Surgeons – Note the rules on notifying patients

Tell me more about Concierge

Fees run around $1,200 to $5k/year.  For this you get faster service, a closer relationship with your MD, more preventative care and house calls. Kiplinger.comWikipedia  *

Most traditional concierge medicine physicians continue to accept insurance plans and government programs, and patient visits are billed in the traditional manner.

Insurance companies don’t pay for concierge services at this time—the retainer fee is paid out-of-pocket. But it’s not hard to imagine why insurance companies would like the idea—concierge physicians report less payout, fewer hospital admissions, and improved care to prevent chronic conditions, like hypertension, high cholesterol and diabetes, which are costly to treat. Insurance would be used for outside lab tests, X-rays, visits to specialists and hospitalizations.  TheHealthJournals.com *

In DPC direct primary care, the doctor does not accept third party reimbursements, like Medicare. The membership fees paid by the patients cover basic visits, and some services are charged separately.  PhysicianPractise.Com *

Where to find a Concierge MD?

Our FAQ’s 

  • So, does the patient pays a yearly concierge fee plus fees for all services? Medicare pays nothing?
    • It’s not as simple as the question sounds. Depends if the MD opted out of Medicare as he’s a direct primary care doctor. Depends on what service you get and where. Say you just use Concierge for Preventative, but serious things use a Medicare doctor? In the contract in my very brief review, you’re only opting out of the services the Opt Out agreement coverage.

 

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