Medicare acceptance

Medicare acceptance means a healthcare provider or facility agrees to take Medicare’s approved amount as full payment for covered services. Providers accepting Medicare assignment agree not to bill patients more than the Medicare deductible and coinsurance, supported by CMS data showing 98% of doctors participate in Medicare as of 2023.

Facilities like hospitals or clinics indicate their Medicare acceptance status on their websites and via CMS.Gov’s Care Compare tool. Pharmacies accepting Medicare Part D must adhere to plan network agreements and accept set copays for prescription drugs.

Providers may decline Medicare assignment, which allows them to charge up to 15% above Medicare’s fee schedule, known as the limiting charge, according to the Social Security Act §1848(g)(1)(B). Insurance carriers assess provider networks for Medicare acceptance before offering Medicare Advantage (Part C) plans, per CMS requirements.

Patients verify a provider’s Medicare acceptance by checking with the provider directly or consulting official directories on medicare.Gov. Out-of-network providers typically do not accept original Medicare assignment, resulting in higher out-of-pocket costs for beneficiaries, as detailed by MedPAC reports.

Durable medical equipment suppliers accepting Medicare must have CMS accreditation and publicly list their status, as tracked through the National Supplier Clearinghouse. Mental health professionals show varying rates of Medicare acceptance; 55% of psychiatrists accepted new Medicare patients in 2022, based on AMA survey findings.

Dentists rarely accept traditional Medicare because it generally excludes dental coverage, confirmed by American Dental Association statistics showing less than 1% participation nationwide, per YourInsurance.info (Your Insurance Info).