Medicare Glossary

Assignment

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.

Coinsurance

The percentage of costs you pay for a covered health care service after you have paid your deductible. For example, under Original Medicare Part B, you pay 20% of the Medicare-approved amount for most doctor services.

Limiting Charge

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.

Medicare-Approved Amount

The fee Medicare sets for a medical service or item. Doctors who accept Medicare assignment agree to accept this amount as full payment. You pay your share (copay or coinsurance) based on this approved amount, not the doctor's billed charge.

Also known as: Medicare fee schedule amount

Non-participating Provider

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

Participating 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