Medicare 2026

What "Accepting Medicare Assignment" Really Means — and When a Doctor Can Legally Charge You More

If you're new to Medicare, you've probably seen the phrase "accepts Medicare assignment" and wondered what it actually means for your wallet. The short version: it determines how much a doctor can charge you beyond what Medicare pays. Here's a plain-English walk-through of how assignment works, the three ways a provider can relate to Medicare, and how Medigap and your enrollment choices fit in.

The three ways a doctor can relate to Medicare

When you look at a provider under Part B (doctor and outpatient services), one of three situations applies.

1. Participating providers (accept assignment on all Medicare claims). These providers have an agreement with Medicare to accept the Medicare-approved amount as payment in full for every covered service. Medicare pays its share, and you're responsible only for your Part B deductible and the usual coinsurance (typically 20% of the approved amount after you've met the deductible). You won't be billed extra beyond those standard cost-sharing amounts. This is the most predictable arrangement for budgeting.

2. Non-participating providers (may or may not accept assignment, case by case). These providers still take Medicare, but they haven't signed the participation agreement. For any given service, they can decide whether to accept assignment. When they don't, Medicare law lets them charge up to 15% more than the Medicare-approved amount for that service. That extra amount is called the Part B excess charge, and the maximum total — the Medicare-approved amount plus up to 15% — is called the limiting charge. Some states further restrict or prohibit excess charges, so your protection may be stronger depending on where you live.

A couple of practical notes:

• Non-participating providers may ask you to pay the full bill at the visit and then wait for Medicare to reimburse its share to you.
• Excess charges only apply to Part B services from non-participating providers who don't accept assignment on that claim. They don't apply to Part A hospital services.

3. Opt-out providers (private contract). A smaller group of clinicians have formally opted out of Medicare. If you see one of them, you'll typically sign a private contract agreeing to pay the full fee yourself. Medicare won't pay anything toward that care (with narrow exceptions for emergencies), and a Medigap policy generally won't help either. Before scheduling with a new doctor, especially specialists, it's worth asking directly: "Do you accept Medicare, and do you accept assignment?"

Where Medigap fits in

If you have Original Medicare, a Medigap (Medicare Supplement) policy helps pay some of the out-of-pocket costs Medicare leaves behind — things like coinsurance and the Part A hospital deductible. Among the standardized Medigap plans sold today, Plans F and G are the ones that cover Part B excess charges. (Plan F is generally only available to people who became eligible for Medicare before 2020.) Other lettered Medigap plans do not pay excess charges, so if you see non-participating providers, you'd owe those amounts yourself.

How this looks under Medicare Advantage

If you're enrolled in a Medicare Advantage plan instead of Original Medicare, the "assignment" framework works differently. Advantage plans operate through their own provider networks and contracts, with set copays and an annual out-of-pocket maximum for in-network care. The 15% limiting-charge rule from Original Medicare generally isn't how costs are calculated in an Advantage plan — but network rules, prior authorization, and referral requirements may apply.

Neither path is universally "better." Original Medicare plus a Medigap policy (and usually a stand-alone Part D plan) tends to offer broad provider access and predictable supplemental coverage, but Medigap carries its own premium. Medicare Advantage often bundles Part D and extras into one plan with lower upfront premiums, but you work within a network. It's a trade-off worth weighing based on your doctors, your travel patterns, and how you prefer to handle costs.

A few 2027 program facts worth knowing

• Part D out-of-pocket cap: $2,400 in 2027 (up from $2,100 in 2026). Once you hit that cap on covered drugs, you pay $0 for the rest of the year.
• Maximum Part D deductible any plan can charge in 2027: $700.
• Part D base beneficiary premium for 2027: $41.33 — a national figure used to calculate the late-enrollment penalty. Actual plan premiums vary.
• Annual Enrollment Period: October 15 – December 7, 2026, for coverage starting January 1, 2027.
• Social Security COLA: 3.6% for benefits payable beginning January 2027, announced October 14, 2026.

The 2027 Part B standard premium and deductible, and the IRMAA income brackets, had not been announced at the time of writing. CMS typically releases those figures in the fall, usually November — check Medicare.gov for the official numbers.

If you have Medicaid or Extra Help

Since 2025, people with Medicaid or Extra Help (the Part D Low Income Subsidy) have a monthly Special Enrollment Period to move from Medicare Advantage to Original Medicare with a stand-alone Part D plan, or to switch stand-alone Part D plans. Separately, full-benefit dual-eligible individuals can join an integrated Dual Eligible Special Needs Plan (D-SNP) in any month. These options give lower-income enrollees meaningful flexibility throughout the year.

Before you book: ask three questions

1. Do you accept Medicare? 2. Do you accept assignment on Medicare claims? 3. If not, what will my out-of-pocket cost be?

Those three questions, asked up front, can prevent surprise bills.

Where to learn more

For the official rules, provider look-up tools, and current figures, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, available 24/7. This article is for general education only and isn't a recommendation of any particular plan or provider.