Medicare-Approved Amount is the amount a doctor or supplier that accepts assignment can be paid. Which statement is true?

Medicare-Approved Amount is the amount a doctor or supplier that accepts assignment can be paid. Which statement is true?

• A. Medicare pays the entire cost, with no balance due
• B. The provider receives no payment if assignment is accepted
• C. The patient is always responsible for the full bill
• D. The patient or recipient pays the difference between the approved amount and what Medicare pays

Answer: (D)

The key idea is how assignment affects who pays what when Medicare is involved. When a doctor or supplier accepts assignment, they agree to take Medicare’s approved amount as payment in full for covered services. Medicare then pays its share of that approved amount, and the patient is responsible for the remaining portion—that is, the difference between the Medicare-approved amount and what Medicare pays. This difference is the patient’s cost share (coinsurance and any deductible), so there’s no extra balance billed by the provider for covered services. Non-covered charges or services not paid by Medicare would be handled separately.

The key idea is how assignment affects who pays what when Medicare is involved. When a doctor or supplier accepts assignment, they agree to take Medicare’s approved amount as payment in full for covered services. Medicare then pays its share of that approved amount, and the patient is responsible for the remaining portion—that is, the difference between the Medicare-approved amount and what Medicare pays. This difference is the patient’s cost share (coinsurance and any deductible), so there’s no extra balance billed by the provider for covered services. Non-covered charges or services not paid by Medicare would be handled separately.