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Medicare and Providers

A: Before enrolling, compare Marketplace plans and projected costs at HealthCare.gov/see-plans. You can look up your preferred doctors and medical facilities when comparing plans networks before enrolling.

A: Also known as a non-participating provider, it indicates they have agreed to accept the Medicare approved amount for services rendered on a case by case basis. Depending on the services and provider, you may:

  • Pay the full amount at the time of the service rendered.
  • Have to submit a Medicare claim form if they refuse to bill for services rendered.
  • Pay an additional 15% over the Medicare-approved amount, but not more than that (also known as “the limiting charge”).

A: You can choose to continue to see that doctor and pay for everything yourself, but this may be costly. The most cost-effective option is to conduct independent research to find a doctor that accepts Medicare, ask your doctor for a recommendation to a different healthcare professional who accepts Medicare, or go to an urgent care center. Before seeing a new Doctor, you should confirm that they accept Medicare if you have Original Medicare Parts A and B only. If you have a Medicare Advantage plan, you should confirm that the doctor is participating with your plan.

A: Participating healthcare providers always take the assignment and accept Medicare insurance. Accepting assignment signifies that the practitioner accepts full payment from Medicare for all medical services.

Non-participating providers has agreed to accept Medicare insurance, however, they do not accept assignment (they may accept it on a case-by-case basis). This indicates that, despite signing up to accept Medicare insurance, non-participating providers do not accept Medicare’s approved amount for health care services as full payment.

Opt-out providers have agreed to be excluded from the Medicare program and do not accept any form of Medicare insurance. They can charge whatever they choose for services, but they must abide by certain guidelines.

A: Ask your doctor or supplier to submit a claim by contacting Medicare. You also can call 1-800-MEDICARE (1-800-633-4227) TTY: 1-877-486-2048 if they don’t submit a claim. Request the precise deadline for submitting a Medicare claim for the service or item you received.

(855) 922-5051 TTY 711

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1-855-922-5051  |  TTY 711

We’re here Monday - Friday, 9am - 6pm Central.