- Participating doctors are those who accept the set Medicare assignment (maximum amount a doctor can charge for a specific service).
- Non-participating doctors are allowed to go above the Medicare assignment, up to a federal maximum of an additional 15% (for NY, the maximum is 5%)
- Opt-out doctors are those doctors who have fully opted out of Medicare. This means that if you go to such a doctor, Medicare will not cover your claim and you are advised to follow your normal claim process. Please note that opt-out doctors may still be within your medical insurance plan’s network.
Additionally, please note that being enrolled in Medicare Part B does not restrict your choice of doctors under a UN plan and you will still be reimbursed as before if the doctor has “opted-out” of Medicare. Your claims have to be accompanied by a letter from your doctor indicating he/she has opted out of Medicare before sending claims to insurance carrier.