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Doctor Choice

How can I choose doctors to keep costs low?

Most doctors accept Original Medicare (Parts A and B). Others do not. Some limit the number of Medicare patients they see. Ask if your doctor accepts Medicare assignment. This will affect how much you pay for care.

What does “accepting assignment” mean?

If a doctor “accepts assignment” it means they agree to the amount Medicare pays for a visit or service. This is also called the Medicare-approved amount. If they accept assignment, you would only pay the 20 percent coinsurance when you go to them.

Some providers see people with Medicare, but do not accept assignment. They can charge you up to 15 percent more than the amount Medicare approves. This means you would pay your usual 20 percent coinsurance, plus an extra 15 percent.

Example: Medicare approved $100 for a doctor visit. But your doctor did not accept assignment. He charged you $115 for your visit. You would pay $35. This is 20 percent of the $100 amount Medicare approved, plus the extra $15 Medicare did not cover.

If you have a Medicare Advantage plan, your doctor agrees to accept the terms of the plan. He or she can only charge you the plan's copayment. You would also have to pay your deductible, if the plan charges one.

What does it mean if my doctor “opts out” of Medicare?

Providers can also “opt out” of the Medicare program. This means they do not bill Medicare at all, and they can charge you whatever they like for a service. A Medicare supplemental policy will not pay, either.

Providers who opt out of Medicare must tell you before they treat you. They must give you a written statement that you and the doctor sign, to make sure you understand. You do not have to stay with a doctor who opts out of Medicare.

What portions of Medicare costs do I have to pay?

Most people with Medicare will pay:

  • Monthly fees, called premiums, and
  • A set amount each year, called an annual deductible, and
  • A share of the costs for each visit or service. In Original Medicare this is called coinsurance. In Medicare Advantage, it is called a copayment.

You might pay deductibles before Medicare starts paying its share of each service. The federal government sets costs for Medicare Parts A and B. The private Medicare Advantage plans set their own costs for services and prescription drugs.

Learn more about costs of different parts of Medicare.

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