Medicare assignment means that the provider, or medical supplies vendor or retailer, has agreed to accept Medicare’s reimbursement amount as payment in full, and that reimbursement comes to them directly from Medicare. “Participating providers” have agreed to submit all their Medicare claims on an “assigned” basis, whereas “non-participating providers” may choose whether to accept assignment on each individual claim. A provider who accepts assignment usually does not require the beneficiary to pay their share up front. And in the event the claim is denied, the beneficiary may be protected from liability if the provider accepted assignment. 

Medicare Assignment:

The supplier (retailer) must:
1.  Be a Medicare approved Provider;

2.  Accept the Medicare Allowable as Payment in Full;

3.  Submit claims to Medicare and get directly reimbursed 80% of the allowable fee;

4. Make an attempt to collect the remaining 20% of the allowable fee from the beneficiary

(and the remaining portion, if any, of their yearly Part B deductible); and

5.  Shall not attempt to collect any additional monies from the beneficiary for this transaction.

The amounts the beneficiary is liable for can change if they have already met their deductible and have a secondary insurance coverage plan (supplemental insurance).

And note that if the beneficiary receives their Medicare benefits through a Medicare Advantage Health Plan, they may owe little or nothing depending on the plan’s benefits.

Now let’s look at Medicare Non-Assignment:

If the supplier does not “take assignment”, the supplier (retailer) must meet the following criteria:

1.  Be a Medicare approved Provider;

2.  The beneficiary must purchase their products at the supplier’s retail price as a “cash” transaction;

3.  The supplier (retailer) is obligated to submit a claim to Medicare on behalf of the beneficiary;

4.  The claim must be filed within one year of the date of service;

5.  Medicare issues a check for 80% of the allowable fee directly to the beneficiary;

6.  The beneficiary’s total expense is the difference between the “cash” transaction price and 80% of the allowable fee amount; and

7.  The supplier (retailer) cannot collect a fee for filing the claim.

Generally speaking, Medicare beneficiaries will save money if they use a Medicare approved provider to purchase their medical supplies.

Additionally, Medicare approved providers must meet strict standards to qualify as a Medicare supplier, and will have a Medicare supplier number. Another advantage is that the beneficiary may buy their supplies from any store that sells them.

However, the supplier must be enrolled in Medicare, or the claim will be denied.

Also note that Medicare approved providers who choose not to participate can charge more than the Medicare-approved amount (but they are limited to not charging more than 15% above the Medicare-approved amount). They can also require the beneficiary to pay the entire bill when they pick up their order (or when the items are delivered). If this is the case, Medicare will send the reimbursement directly to the beneficiary, but the usual delay will still exist.