Plain-English definitions for every Medicare term — from ABN to ZIP enrollment. No jargon, no confusion.
Showing 4 results for "Medicare-approved amount" — clear search
An agreement by a doctor, supplier, or provider to accept the Medicare-approved amount as full payment for a covered service. Providers who accept assignment cannot bill you for more than that amount, aside from normal deductibles and coinsurance.
The highest amount a non-participating provider who does not accept assignment is allowed to charge for a Medicare-covered service — capped at 15% above the Medicare-approved amount.
A doctor or supplier who does not accept Medicare assignment but is still enrolled in Medicare. They may charge up to 15% more than the Medicare-approved amount (the limiting charge). Medicare will still pay its share, but you may pay more.
Also known as: Non-par provider
A doctor, hospital, or other health care provider who accepts Medicare assignment — meaning they agree to accept the Medicare-approved amount as full payment for covered services.
Also known as: Par provider
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