Medicare Accept Assignment Discovery Education Student Assignment

Non-participating providers must submit claims to Medicare on behalf of their Medicare patients, but Medicare reimburses the patient, rather than the nonparticipating provider, for its portion of the covered charges.

A small share (4%) of providers who provide Medicare-covered services are non-participating providers.

Under current law, Medicare has several financial protections in place that are designed to safeguard Medicare beneficiaries—seniors and people with permanent disabilities—from unexpected and confusing charges when they seek care from doctors and other practitioners.

These protections include the participating provider program, limitations on balance billing, and conditions on private contracting.

Also, participating providers may collect Medicare’s reimbursement amount directly from Medicare, in contrast to non-participating providers who may not collect payment from Medicare and typically bill their Medicare patients upfront for their charges.

This issue brief describes these three protections, explains why they were enacted, and examines the implications of modifying them for beneficiaries, providers, and the Medicare program.

Under current law, physicians and practitioners have three options for how they will charge their patients in traditional Medicare.

Opt-out providers, privately contracting: Physicians and practitioners who choose to enter into private contracts with their Medicare patients “opt-out” of the Medicare program entirely.

These opt-out providers may charge Medicare patients any fee they choose.

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