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If you enroll in
the Original Medicare Plan, the amount of money you pay for services and
supplies is determined by whether your doctor, provider, or supplier is
a participating provider.
Participating
Provider
A participating provider agrees to accept assignment, which means he or
she agrees to accept the Medicare-approved amount as payment in full for
Part B services and supplies. You pay the coinsurance and deductibles.
Non-Participating
Provider
A non-participating provider is a provider that does not accept assignment.
His or her charges are often higher, which means you will pay more.
In many cases, you are required to pay the entire amount at the time
of service. Medicare will then send you its share of the charge. Non-participating
providers are subject to a "limiting charge," which means
they cannot charge more than 115% of the Medicare-approved amount.
The limiting charge
is the highest amount you can be charged for a covered service by doctors
and other health care providers who don't accept assignment. The limiting
charge do not apply to all services, including suppliers
of equipment.
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