does quest diagnostics accept medicare assignment

Does your provider accept Medicare as full payment?

You can get the lowest cost if your doctor or other health care provider accepts the Medicare-approved amount  as full payment for a covered service. This is called “accepting assignment.” If a provider accepts assignment, it’s for all Medicare-covered Part A and Part B services.

Using a provider that accepts assignment

Most doctors, providers, and suppliers accept assignment, but always check to make sure that yours do.

If your doctor, provider, or supplier accepts assignment:

• Your out-of-pocket costs may be less.
• They agree to charge you only the Medicare deductible and coinsurance amount, and usually wait for Medicare to pay its share before asking you to pay your share.
• They have to submit your claim directly to Medicare and can't charge you for submitting the claim.

How does assignment impact my drug coverage?

Using a provider that doesn't accept Medicare as full payment

Some providers who don’t accept assignment still choose to accept the Medicare-approved amount for services on a case-by-case basis. These providers are called "non-participating."

If your doctor, provider, or supplier doesn't accept assignment:

• You might have to pay the full amount at the time of service.
• They should submit a claim to Medicare for any Medicare-covered services they give you, and they can’t charge you for submitting a claim. If they refuse to submit a Medicare claim, you can submit your own claim to Medicare. Get the Medicare claim form .
• They can charge up to 15% over the Medicare-approved amount for a service, but no more than that. This is called "the limiting charge."  

Does the limiting charge apply to all Medicare-covered services?

Using a provider that "opts-out" of Medicare

• Doctors and other providers who don’t want to work with the Medicare program may "opt out" of Medicare.
• Medicare won’t pay for items or services you get from provider that opts out, except in emergencies.
• Providers opt out for a minimum of 2 years. Every 2 years, the provider can choose to keep their opt-out status, accept Medicare-approved amounts on a case-by-case basis ("non-participating"), or accept assignment.

Find providers that opted out of Medicare.

Private contracts with doctors or providers who opt out

• If you choose to get services from an opt-out doctor or provider you may need to pay upfront, or set up a payment plan with the provider through a private contract.
• Medicare won’t pay for any service you get from this doctor, even if it’s a Medicare-covered service.

What are the rules for private contracts?

You may want to contact your  State Health Insurance Assistance Program (SHIP) for help before signing a private contract with any doctor or other health care provider.

What do you want to do next?

• Next step: Get help with costs
• Take action: Find a provider
• Get details: How to get Medicare services

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Does Medicare Cover Quest Diagnostics?

A health care provider’s most valuable diagnostic tools include laboratory exams. Whether it is a blood test, urinalysis, tissue sample biopsy, or another type of screening test, the exam results may help your physician diagnose, or rule out, suspected illness, disease, or other conditions.

Any time you visit your health care provider, he or she may suggest getting lab work done. Because this sort of diagnostic testing is so common, it is important to have insurance coverage. It is also important for Medicare recipients to have knowledge about which exams are paid for and what diagnostic laboratories are included in your Medicare benefits.

Private laboratories like Quest Diagnostics may be included in your Medicare insurance network. This allows you to have your lab work done in one of their laboratories. Quest has over 2200 labs across the country and perform over 3500 types of tests. You can find out if there is a Quest Diagnostics lab in your area on their website.

Your Medicare benefits may cover the expense of laboratory tests done at Quest labs, but it depends on which state you live in, and what tests your health care provider has ordered. Here is more information on your Medicare coverage of Quest Diagnostics.

Does Medicare Cover Quest Diagnostics? Whenever your health care provider orders medically necessary clinical diagnostic laboratory services, your Medicare Part B (medical insurance), or Medicare Advantage (Part C) plan covers the expense. In most cases, you do not pay for any clinical diagnostic lab tests that are Medicare-covered.

These lab tests include certain blood tests, urinalysis, tests on tissue specimens, and some screening tests that are meant to help prevent, discover, or manage a suspected medical problem.

Medicare recipients have coverage for these exams if the laboratory providing them meets Medicare requirements. Every state in the U.S. has its own list of Medicare Coverage Policies for tests or test group coverage. They also have a list of laboratories that are Medicare-approved.

Before you visit a Quest Diagnostics laboratory for your lab work, make sure that you discuss coverage with your insurance provider.

If you have a Medicare Advantage (Part C) policy, it may include Quest Diagnostic labs in its network of accepted health care providers. You have the responsibility of verifying whether your policy includes Quest in its network before you have your lab work done there. Be certain to read your policy or ask a licensed representative of your insurance provider if you have such coverage.

If you chose a provider that is outside your plan’s network, you may have a higher out-of-pocket cost for the services you receive.

What Tests and Screenings Are Covered by Medicare at Quest? Because Medicare has limited coverage policies for certain lab tests and some also have frequency limitations, be sure to discuss these details with your health care provider.

Beyond routine blood and urine testing, Quest Diagnostic labs offer preventive services and screenings that are covered by your Medicare benefits. These tests ay be associated with Medicare’s annual Wellness Visit or screenings for the following conditions:

• Cardiovascular
• Colorectal cancer
• Hepatitis B and C
• Cervical cancer

Having all your blood tests, screenings, and other lab services done in one place is convenient. You can make appointments online, get your results swiftly and easily, either online or from your health care provider, and you can cover your costs with your Medicare insurance.

If you wish to take advantage of the convenience that Quest Diagnostics offers, you must ensure that you have Medicare coverage first. You can get more information about your personal coverage by speaking to a representative of your private health insurance provider.

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Does Medicare Cover Quest Diagnostics? Exploring Medicare Coverage for Diagnostic Testing

Understand the importance of comprehensive healthcare coverage for Medicare beneficiaries. This article delves into the topic of Medicare coverage for Quest Diagnostics, a leading provider of diagnostic testing services. We aim to provide you with detailed information regarding the coverage options available through Medicare, ensuring that you make informed decisions about your healthcare needs.

Understanding Medicare Coverage for Diagnostic Testing

Medicare part b coverage.

Medicare Part B, also known as Medical Insurance, typically covers a wide range of outpatient services, including diagnostic tests. When it comes to Quest Diagnostics, Medicare Part B provides coverage for various laboratory tests performed by Quest Diagnostics or any other accredited laboratory. These tests are essential for diagnosing, preventing, or monitoring diseases.

Medicare Coverage Criteria for Diagnostic Testing

Medicare covers diagnostic tests when they are deemed medically necessary by a healthcare provider. The tests must be ordered by a qualified physician or other eligible healthcare professionals. It is crucial to note that Medicare only covers tests that are deemed reasonable and necessary for the diagnosis or treatment of a specific medical condition.

Quest Diagnostics and Medicare Assignment

Quest Diagnostics accepts Medicare assignment. This means that they agree to accept the Medicare-approved amount as full payment for covered services. As a result, you will only be responsible for your Medicare deductible and coinsurance, without any additional charges beyond the Medicare-approved amount.

Diagnostic Testing Services Provided by Quest Diagnostics

Quest Diagnostics offers a wide range of diagnostic testing services, including but not limited to:

Blood Tests

Quest Diagnostics performs various blood tests to assess overall health, identify specific conditions, and monitor the effectiveness of treatments. These tests may include complete blood count (CBC), lipid panel, blood glucose tests, liver function tests, kidney function tests, and more.

Genetic Testing

Genetic testing provided by Quest Diagnostics helps identify genetic disorders, predict the risk of developing certain diseases, and determine appropriate treatment plans. Examples of genetic tests include carrier screening, hereditary cancer testing, and pharmacogenetics testing.

Infectious Disease Testing

Quest Diagnostics conducts a wide range of tests to detect and diagnose infectious diseases. These tests encompass screenings for sexually transmitted infections (STIs), respiratory infections, gastrointestinal infections, and viral infections such as COVID-19.

Cancer Testing

Quest Diagnostics offers an array of cancer testing services, including tumor marker tests, genetic testing for hereditary cancers, and liquid biopsy testing. These tests aid in the early detection, diagnosis, and treatment planning for various types of cancers.

Hormone Testing

Hormone testing helps assess hormone levels in the body, providing insights into conditions such as thyroid disorders, reproductive disorders, and hormonal imbalances. Quest Diagnostics offers a comprehensive range of hormone tests to support accurate diagnosis and treatment.

In conclusion, Medicare Part B covers diagnostic testing services provided by Quest Diagnostics, as long as the tests are deemed medically necessary and meet Medicare’s coverage criteria. Quest Diagnostics is committed to accepting Medicare assignments, ensuring that you are only responsible for the Medicare-approved amount. With its extensive range of diagnostic testing services, Quest Diagnostics plays a crucial role in diagnosing and monitoring various medical conditions.

• Medicare Part B covers diagnostic testing services provided by Quest Diagnostics if they meet Medicare’s coverage criteria.
• Quest Diagnostics accepts Medicare assignment, reducing out-of-pocket costs for beneficiaries.
• Quest Diagnostics offers a wide range of diagnostic tests, including blood tests, genetic testing, infectious disease testing, cancer testing, and hormone testing.

Useful Links:

• Medicare.gov – Diagnostic tests
• National Institutes of Health (NIH) – Diagnostic Tests
• American Association for Clinical Chemistry (AACC) – Patient Resources

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What is Medicare assignment and how does it work?

Kimberly Lankford,

​Because Medicare decides how much to pay providers for covered services, if the provider agrees to the Medicare-approved amount, even if it is less than they usually charge, they’re accepting assignment.

A doctor who accepts assignment agrees to charge you no more than the amount Medicare has approved for that service. By comparison, a doctor who participates in Medicare but doesn’t accept assignment can potentially charge you up to 15 percent more than the Medicare-approved amount.

That’s why it’s important to ask if a provider accepts assignment before you receive care, even if they accept Medicare patients. If a doctor doesn’t accept assignment, you will pay more for that physician’s services compared with one who does.

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How much do I pay if my doctor accepts assignment?

If your doctor accepts assignment, you will usually pay 20 percent of the Medicare-approved amount for the service, called coinsurance, after you’ve paid the annual deductible. Because Medicare Part B covers doctor and outpatient services, your $240 deductible for Part B in 2024 applies before most coverage begins.

All providers who accept assignment must submit claims directly to Medicare, which pays 80 percent of the approved cost for the service and will bill you the remaining 20 percent. You can get some preventive services and screenings, such as mammograms and colonoscopies , without paying a deductible or coinsurance if the provider accepts assignment. 

What if my doctor doesn’t accept assignment?

A doctor who takes Medicare but doesn’t accept assignment can still treat Medicare patients but won’t always accept the Medicare-approved amount as payment in full.

This means they can charge you up to a maximum of 15 percent more than Medicare pays for the service you receive, called “balance billing.” In this case, you’re responsible for the additional charge, plus the regular 20 percent coinsurance, as your share of the cost.

How to cover the extra cost? If you have a Medicare supplement policy , better known as Medigap, it may cover the extra 15 percent, called Medicare Part B excess charges.

All Medigap policies cover Part B’s 20 percent coinsurance in full or in part. The F and G policies cover the 15 percent excess charges from doctors who don’t accept assignment, but Plan F is no longer available to new enrollees, only those eligible for Medicare before Jan. 1, 2020, even if they haven’t enrolled in Medicare yet. However, anyone who is enrolled in original Medicare can apply for Plan G.

Remember that Medigap policies only cover excess charges for doctors who accept Medicare but don’t accept assignment, and they won’t cover costs for doctors who opt out of Medicare entirely.

Good to know. A few states limit the amount of excess fees a doctor can charge Medicare patients. For example, Massachusetts and Ohio prohibit balance billing, requiring doctors who accept Medicare to take the Medicare-approved amount. New York limits excess charges to 5 percent over the Medicare-approved amount for most services, rather than 15 percent.

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How do I find doctors who accept assignment?

Before you start working with a new doctor, ask whether he or she accepts assignment. About 98 percent of providers billing Medicare are participating providers, which means they accept assignment on all Medicare claims, according to KFF.

You can get help finding doctors and other providers in your area who accept assignment by zip code using Medicare’s Physician Compare tool .

Those who accept assignment have this note under the name: “Charges the Medicare-approved amount (so you pay less out of pocket).” However, not all doctors who accept assignment are accepting new Medicare patients.

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What does it mean if a doctor opts out of Medicare?

Doctors who opt out of Medicare can’t bill Medicare for services you receive. They also aren’t bound by Medicare’s limitations on charges.

In this case, you enter into a private contract with the provider and agree to pay the full bill. Be aware that neither Medicare nor your Medigap plan will reimburse you for these charges.

In 2023, only 1 percent of physicians who aren’t pediatricians opted out of the Medicare program, according to KFF. The percentage is larger for some specialties — 7.7 percent of psychiatrists and 4.2 percent of plastic and reconstructive surgeons have opted out of Medicare.

Keep in mind

These rules apply to original Medicare. Other factors determine costs if you choose to get coverage through a private Medicare Advantage plan . Most Medicare Advantage plans have provider networks, and they may charge more or not cover services from out-of-network providers.

Before choosing a Medicare Advantage plan, find out whether your chosen doctor or provider is covered and identify how much you’ll pay. You can use the Medicare Plan Finder to compare the Medicare Advantage plans and their out-of-pocket costs in your area.

Return to Medicare Q&A main page

Kimberly Lankford is a contributing writer who covers Medicare and personal finance. She wrote about insurance, Medicare, retirement and taxes for more than 20 years at  Kiplinger’s Personal Finance  and has written for  The Washington Post  and  Boston Globe . She received the personal finance Best in Business award from the Society of American Business Editors and Writers and the New York State Society of CPAs’ excellence in financial journalism award for her guide to Medicare.

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Medicare Assignment

Home / Medicare 101 / Medicare Costs / Medicare Assignment

Summary: If a provider accepts Medicare assignment, they accept the Medicare-approved amount for a covered service. Though most providers accept assignment, not all do. In this article, we’ll explain the differences between participating, non-participating, and opt-out providers. You’ll also learn how to find physicians in your area who accept Medicare assignment. Estimated Read Time: 5 min

What is Medicare Assignment

Medicare assignment is an agreement by your doctor or other healthcare providers to accept the Medicare-approved amount as the full cost for a covered service. Providers who “accept assignment” bill Medicare directly for Part B-covered services and cannot charge you more than the applicable deductible and coinsurance.

Most healthcare providers who opt-in to Medicare accept assignment. In fact, CMS reported in its Medicare Participation for Calendar Year 2024 announcement that 98 percent of Medicare providers accepted assignment in 2023.

Providers who accept Medicare are divided into two groups: Participating providers and non-participating providers. Providers can decide annually whether they want to participate in Medicare assignment, or if they want to be non-participating.

Providers who do not accept Medicare Assignment can charge up to 15% above the Medicare-approved cost for a service. If this is the case, you will be responsible for the entire amount (up to 15%) above what Medicare covers.

Below, we’ll take a closer look at participating, non-participating, and opt-out physicians.

Medicare Participating Providers: Providers Who Accept Medicare Assignment

Healthcare providers who accept Medicare assignment are known as “participating providers”. To participate in Medicare assignment, a provider must enter an agreement with Medicare called the Participating Physician or Supplier Agreement. When a provider signs this agreement, they agree to accept the Medicare-approved charge as the full charge of the service. They cannot charge the beneficiary more than the applicable deductible and coinsurance for covered services.

Each year, providers can decide whether they want to be a participating or non-participating provider. Participating in Medicare assignment is not only beneficial to patients, but to providers as well. Participating providers get paid by Medicare directly, and when a participating provider bills Medicare, Medicare will automatically forward the claim information to Medicare Supplement insurers. This makes the billing process much easier on the provider’s end.

Medicare Non-Participating Providers: Providers Who Don’t Accept Assignment

Healthcare providers who are “non-participating” providers do not agree to accept assignment and can charge up to 15% over the Medicare-approved amount for a service. Non-participating Medicare providers still accept Medicare patients. However they have not agreed to accept the Medicare-approved cost as the full cost for their service.

Doctors who do not sign an assignment agreement with Medicare can still choose to accept assignment on a case-by-case basis. When non-participating providers do add on excess charges , they cannot charge more than 15% over the Medicare-approved amount. It’s worth noting that providers do not have to charge the maximum 15%; they may only charge 5% or 10% over the Medicare-approved amount.

When you receive a Medicare-covered service at a non-participating provider, you may need to pay the full amount at the time of your service; a claim will need to be submitted to Medicare for you to be reimbursed. Prior to receiving care, your provider should give you an Advanced Beneficiary Notice (ABN) to read and sign. This notice will detail the services you are receiving and their costs.

Non-participating providers should include a CMS-approved unassigned claim statement in the additional information section of your Advanced Beneficiary Notice. This statement will read:

“This supplier doesn’t accept payment from Medicare for the item(s) listed in the table above. If I checked Option 1 above, I am responsible for paying the supplier’s charge for the item(s) directly to the supplier. If Medicare does pay, Medicare will pay me the Medicare-approved amount for the item(s), and this payment to me may be less than the supplier’s charge.”

This statement basically summarizes how excess charges work: Medicare will pay the Medicare-approved amount, but you may end up paying more than that.

Your provider should submit a claim to Medicare for any covered services, however, if they refuse to submit a claim, you can do so yourself by using CMS form 1490S .

Opt-Out Providers: What You Need to Know

Opt-out providers are different than non-participating providers because they completely opt out of Medicare. What does this mean for you? If you receive supplies or services from a provider who opted out of Medicare, Medicare will not pay for any of it (except for emergencies).

Physicians who opt-out of Medicare are even harder to find than non-participating providers. According to a report by KFF.org, only 1.1% of physicians opted out of Medicare in 2023. Of those who opted out, most are physicians in specialty fields such as psychiatry, plastic and reconstructive surgery, and neurology.

How to Find A Doctor Who Accepts Medicare Assignment

Finding a doctor who accepts Medicare patients and accepts Medicare assignment is generally easier than finding a provider who doesn’t accept assignment. As we mentioned above, of all the providers who accept Medicare patients, 98 percent accept assignment.

The easiest way to find a doctor or healthcare provider who accepts Medicare assignment is by visiting Medicare.gov and using their Compare Care Near You tool . When you search for providers in your area, the Care Compare tool will let you know whether a provider is a participating or non-participating provider.

If a provider is part of a group practice that involves multiple providers, then all providers in that group must have the same participation status. As an example, we have three doctors, Dr. Smith, Dr. Jones, and Dr. Shoemaker, who are all part of a group practice called “Health Care LLC”. The group decides to accept Medicare assignment and become a participating provider. Dr. Smith decides he does not want to accept assignment, however, because he is part of the “Health Care LLC” group, he must remain a participating provider.

Using Medicare’s Care Compare tool, you can select a group practice and see their participation status. You can then view all providers who are part of that group. This makes finding doctors who accept assignment even easier.

To ensure you don’t end up paying more out-of-pocket costs than you anticipated, it’s always a good idea to check with your provider if they are a participating Medicare provider. If you have questions regarding Medicare assignment or are having trouble determining whether a provider is a participating provider, you can contact Medicare directly at 1-800-633-4227. If you have questions about excess charges or other Medicare costs and would like to speak with a licensed insurance agent, you can contact us at the number above.

Announcement About Medicare Participation for Calendar Year 2024, Centers for Medicare & Medicaid Services. Accessed January 2024

https://www.cms.gov/files/document/medicare-participation-announcement.pdf

Annual Medicare Participation Announcement, CMS.gov. Accessed January 2024

https://www.cms.gov/medicare-participation

Does Your Provider Accept Medicare as Full Payment? Medicare.gov. Accessed January 2024

https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare

Thomas Liquori

Ashlee Zareczny

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What You Need to Know About Medicare Assignment

If you are one of the more than 63 million Americans enrolled in Medicare and are on the lookout for a new provider, you may wonder what your options are. A good place to start? Weighing the pros and cons of choosing an Original Medicare plan versus a Medicare Advantage plan—both of which have their upsides.

Let’s say you decide on an Original Medicare plan, which many U.S. doctors accept. In your research, however, you come across the term “Medicare assignment.” Cue the head-scratching. What exactly does that mean, and how might it affect your coverage costs?

What is Medicare Assignment?

It turns out that Medicare assignment   is a concept you need to understand before seeing a new doctor. First things first: Ask your doctor if they “accept assignment”—that exact phrasing—which means they have agreed to accept a Medicare-approved amount as full payment for any Medicare-covered service provided to you. If your doctor accepts assignment, that means they’ll send your whole medical bill to Medicare, and then Medicare pays 80% of the cost, while you are responsible for the remaining 20%.

A doctor who doesn’t accept assignment, however, could charge up to 15% more than the Medicare-approved amount for their services, depending on what state you live in, shouldering you with not only that additional cost but also your 20% share of the original cost. Additionally, the doctor is supposed to submit your claim to Medicare, but you may have to pay them on the day of service and then file a reimbursement claim from Medicare after the fact.

Worried that your doctor will not accept assignment? Luckily, 98% of U.S. physicians who accept Medicare patients also accept Medicare assignment, according to the U.S. Centers for Medicare & Medicaid Services (CMS). They are known as assignment providers, participating providers, or Medicare-enrolled providers.

It can be confusing. Here’s how to assess whether your provider accepts Medicare assignment, and what that means for your out-of-pocket costs:

The 3 Types of Original Medicare Providers

1. participating providers, or those who accept medicare assignment.

These providers have an agreement with Medicare to accept the Medicare-approved amount as full payment for their services. You don’t have to pay anything other than a copay or coinsurance (depending on your plan) at the time of your visit. Typically, Medicare pays 80% of the cost, while you are responsible for the remaining 20%, as long as you have met your deductible.

2. Non-participating providers

“Most providers accept Medicare, but a small percentage of doctors are known as non-participating providers,” explains Caitlin Donovan, senior director of public relations at the National Patient Advocate Foundation (NPAF) in Washington D.C. “These may be more expensive,” she adds. Also known as non-par providers, these physicians may accept Medicare patients and insurance, but they have not agreed to take assignment Medicare in all cases. That means they’re not held to the Medicare-approved amount as payment in full. As a reminder, a doctor who doesn’t accept assignment can charge up to 15% more than the Medicare-approved amount, depending on what part of the country you live in, and you will have to pay that additional amount plus your 20% share of the original cost.

What does that mean for you? Besides being charged more than the Medicare-approved amount, you might also be required to do some legwork to get reimbursed by Medicare.

• You may have to pay the entire bill at the time of service and wait to be reimbursed 80% of the Medicare-approved amount. In most cases, the provider will submit the claim for you. But sometimes, you’ll have to submit it yourself.
• Depending on the state you live in, the provider may also charge you as much as 15% more than the Medicare-approved amount. (In New York state, for example, that add-on charge is limited to 5%.) This is called a limiting charge—and the difference, called the balance bill, is your responsibility.

There are some non-par providers, however, who accept Medicare assignment   for certain services, on a case-by-case basis. Those may include any of the services—anything from hospital and hospice care to lab tests and surgery—available from any assignment-accepting doctor, with a key exception: If a non-par provider accepts assignment for a particular service, they cannot bill you more than the regular Medicare deductible and coinsurance amount for that specific treatment. Just as it’s important to confirm whether your doctor accepts assignment, it’s also important to confirm which services are included at assignment.

3. Opt-out providers

A small percentage of providers do not participate in Medicare at all. In 2020, for example, only 1% of all non-pediatric physicians nationwide opted out, and of that group, 42% were psychiatrists. “Some doctors opt out of providing Medicare coverage altogether,” notes Donovan.“In that case, the patient would pay privately.” If you were interested in seeing a physician who had opted out of Medicare, you would have to enter a private contract with that provider, and neither you nor the provider would be eligible for reimbursement from Medicare.

How do I know if my doctor accepts Medicare assignment?

The best way to find out whether your provider accepts Medicare assignment is simply to ask. First, confirm whether they are participating or non-participating—and if they are non-participating, ask whether they accept Medicare assignment for certain services.

Also, make sure to ask your provider exactly how they will be billing Medicare and what charges you might expect at the time of your visit so that you’re on the same page from the start.

Is seeing a non-participating provider who accepts Medicare assignment more expensive?

The short answer is yes. There are usually out-of-pocket costs after you’re reimbursed. But it may not cost as much as you think, and it may not be much more than if you see a participating provider. Still, it could be challenging if you’re on a fixed income.

For example, let’s say you’re seeing a physical therapist who accepts Medicare patients but not Medicare assignment. Medicare will pay $95 per visit to the provider; but your provider bills the service at $115. In most states, you’re responsible for a 15% limiting charge above $95. In this case, your bill would be 115% of $95, or $109.25.

Once you get your $95 reimbursement back from Medicare, your cost for the visit—the balance bill—would be $14.25 (plus any deductibles or copays) .

In some states, the maximum cap on the limiting charge is less than 15%. As mentioned earlier, New York state, for instance, allows only a 5% surcharge, which means that physical therapy appointment would cost you just $4.75 extra.

Bottom line: Medicare assignment providers and non-participating providers who agree to accept Medicare assignment are both viable options for patients. So if you want to see a particular provider, don’t rule them out just because they’re non-par.

While seeing a non-participating provider may still be affordable, ultimately, the biggest headache may be keeping track of claims and reimbursements, or simply setting aside the right amount of money to pay for your visit up front.

Before you schedule a visit, be sure to ask how much the service will cost. You can also estimate the payment amount based on Medicare-approved charges. A good place to start is this  out-of-pocket expense calculator  provided by the CMS.

What if I see a provider who opts out of Medicare altogether?

An opt-out provider will create a private contract with you, underscoring the terms of your agreement. But Medicare will not reimburse either of you for services.

Seeing a provider who does not accept Medicare will likely be more expensive. And your visits won’t count toward your deductible. But you may be able to work out paying reduced fees on a sliding scale for that provider’s services, all of which would be laid out in your contract.

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Medicare Part B recipients must satisfy an annual deductible. Once the deductible has been met, Medicare pays 80 percent of what Medicare considers a "reasonable charge" for the item or service. The beneficiary is responsible for the other 20 percent.

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However, in most cases what Medicare calls a "reasonable charge" is less than what a doctor or other medical provider normally charges for a service. Whether a Medicare beneficiary must pay part of the difference between the Medicare-approved charge and the provider's normal charge depends on whether or not the provider has agreed to participate in the Medicare program.

If your doctor participates in Medicare, it means that the doctor "accepts assignment." In other words, the doctor agrees that the total charge for the covered service will be the amount approved by Medicare. Medicare then pays the provider 80 percent of its approved amount, after subtracting any part of your annual deductible that has not already been met. The provider then charges you the remaining 20 percent of the approved "reasonable" charge, plus any part of the deductible that has not been satisfied.

If your doctor does not accept assignment, the rules are different. Non-participating doctors can charge beneficiaries 20 percent of the approved amount plus up to an additional 15 percent more than the Medicare-approved amount. Non-participating doctors can also charge you the entire bill for the care upfront and request that you bill Medicare for reimbursement, while doctors who accept assignment cannot. Note that if you have Medigap plans F and G, they will cover the additional 15 percent charges (however, as of January 1, 2020, plan F is no longer sold).

Doctors can also choose to opt out of Medicare altogether. This means the doctor will not submit any claims to Medicare for reimbursement. If your doctor opts out of Medicare, you will be responsible for the full amount of your bill. 

The payment system under Medicare Advantage is different because doctors contract with Advantage’s HMO or PPO plans and agree to the plan’s payment terms. As far as your payment responsibilities go, your plan will require specific copays and deductibles, which will vary plan by plan. Remember that at any time, Medicare Advantage plans can make changes to which doctors they cover, and doctors can choose to join or leave plans, so having a Medicare Advantage plan does not mean your doctor will always be covered. If your doctor leaves your plan’s network and you want to keep your doctor, you may need to switch plans to have your bills covered. 

For more information about Medicare, click here .

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What Does It Mean for a Doctor to Accept Medicare Assignment?

Written by: Malini Ghoshal, RPh, MS

Reviewed by: Malinda Cannon, Licensed Insurance Agent

Key Takeaways

Doctors who accept Medicare assignment are paid agreed-upon rates for services.

It’s important to verify that your doctor accepts assignment before receiving services to avoid high out-of-pocket costs.

A doctor or clinician may be “non-participating” but can still agree to accept Medicare assignment for some services.

If you visit a doctor or clinician who has opted out (doesn’t accept Medicare), you may have to pay for your entire visit cost unless it’s a medical emergency.

Medigap Supplemental insurance (Medigap) plans won’t pay for service costs from doctors who don’t accept assignment.

One of the things that Original Medicare beneficiaries often enjoy about their coverage is that they can use it anywhere in the country. Unlike plans with provider networks, they can visit doctors either at home or on the road; both are covered the same.

But do all doctors accept Medicare patients?

Truth is, this wide-ranging coverage area only applies to doctors who accept Medicare assignment. Fortunately, most do. If you’re eligible for Medicare, it’s important to visit doctors and clinicians who accept Medicare assignment. This will help keep your out-of-pocket costs within your control. Doctors who agree to accept Medicare assignment sign an agreement that they’re willing to accept payment from Medicare for their services.

If you’re a current beneficiary or nearing enrollment, you may have other questions. Do all doctors accept Medicare Advantage plans? What about Medicare Supplement insurance (Medigap)? Read on to learn how to find doctors that accept Medicare assignment and how this keeps your healthcare costs down.

Let’s find your ideal Medicare Advantage plan.

What Is Medicare Assignment of Benefits?

When you’re eligible for Medicare, you have the option to visit doctors and clinicians who accept assignment. This means they are Medicare-approved providers who agree to receive Medicare reimbursement rates for covered services. This helps save you money.

If you have Original Medicare (Part A and B), your doctor visits are covered by your Part B plan. Inpatient services such as hospital stays and some skilled nursing care are covered by Part A .

In order for a participating doctor (or facility) to bill Medicare and be reimbursed, you must authorize Medicare to reimburse your doctor directly for your covered services. This is called the Medicare assignment of benefits. You transfer your right to receive Medicare payment for a covered service to your doctor or other provider.

Note: If you have a Medicare Supplement insurance ( Medigap ) plan to pay for out-of-pocket costs, you may also need to sign a separate assignment of benefits form for Medigap reimbursement. More on Medigap below.

How Can I Find Doctors Near Me That Accept Medicare?

There are several ways to find doctors and other clinicians who accept Medicare assignment close to you.

First, let’s take a look at the different types of Medicare providers.

They include:

Participating providers: Medicare-participating doctors and providers sign a participation agreement stating they will accept Medicare reimbursement rates for their services.

Non-participating providers:  Doctors or providers who are non-participating providers are eligible to accept Medicare assignment but haven’t signed a Medicare agreement. They may choose to accept assignment on a case-by-case basis. If you visit a non-participating provider, make sure to ask if they accept assignment for your particular service. Also get a copy of their fees. They will need to select “yes” on Centers for Medicare & Medicaid Services CMS Form 1500 to accept assignment for the service.

Opt-out providers:  Some doctors and other providers choose not to accept Medicare. If they choose to opt out, the period is two years (based on Medicare guidelines). The opt-out automatically renews if the provider doesn’t request a change in their status. You would be responsible for paying all costs for services received from an opt-out provider. You cannot bill Medicare for reimbursement unless the service was an urgent or emergency medical need. According to a report from KFF , roughly 1% of non-pediatric physicians opted out of Medicare in 2023.

Visiting a doctor who doesn’t accept assignment may cost you more. These providers can charge you up to 15% more than the Medicare-approved rate for a given service. This 15% charge is called the limiting charge. Some states limit this extra charge to a certain percent. This may also be called the Part B excess charge.

Here are some tips for finding doctors and providers who accept Medicare assignment:

• The easiest way to find a doctor who accepts Medicare assignment is to contact their office and ask them directly.
• If you’re looking for a new doctor, you can use the Medicare search tool to find clinicians and doctors that accept Medicare assignment.
• You can also ask a state health insurance assistance program (SHIP) representative for help in locating a doctor that accepts Medicare assignment.
• Don’t assume that having a longstanding relationship with your doctor means nothing will ever change. Check in with them to make sure they still accept Medicare assignment and whether they’re planning to opt out.

Note: Your doctor can choose to become a non-participating provider or opt out of participating in Medicare. It’s important to verify they accept Medicare assignment before receiving any services.

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Do Doctors Who Accept Medicare Have to Accept Supplement Plans?

If your doctor accepts Medicare assignment and you have Original Medicare (Medicare Part A and Part B) with a Medicare Supplement (Medigap) plan, they will accept the supplemental insurance. Depending on your Medigap plan coverage , it may pay all or part of your out-of-pocket costs such as deductibles, copayments and coinsurance.

However, if you have a Medicare Advantage plan (Part C), you may have a network of covered doctors under the plan. If you visit an out-of-network doctor, you may need to pay all or part of the cost for your services.

Keep in mind that you can’t have a Medigap supplemental plan if you have a Medicare Advantage plan.

If you have questions or want to learn more about different Medicare plans like Original Medicare with Medigap versus Medicare Advantage, GoHealth has licensed insurance agents ready to help. They can shop your different options and offer impartial guidance where you need it.

Do Most Doctors Accept Medicare Advantage Plans?

Many doctors accept Medicare Advantage (Part C) plans, but these plans often use provider networks. These networks are groups of doctors and providers in an area that have agreed to treat an insurance company’s customers. If you have a Part C plan, you may be required to see in-network doctors with few exceptions. However, these types of plans are popular options for all-in-one coverage for your health needs. Plans must offer Part A and B coverage, plus a majority also include Part D , or prescription drug coverage. But whether a doctor accepts a Medicare Advantage plan may depend on where you live and the type of Medicare Advantage plan you have.

There are several types of Medicare Advantage plans including:

• Health Maintenance Organization (HMO): These plans have a network of covered providers, as well as a primary care physician to manage your care. If you visit a doctor outside your plan network, you may have to pay the full cost of your visit.
• Preferred Provider Organization (PPO): You’ll probably still have a primary care physician, but these are more flexible plans that allow you to go out of network in some cases. But you may have to pay more.
• Private Fee for Service (PFFS): You may be able to visit any doctor or provider with these plans, but your costs may be higher.
• Special Needs Plan (SNP): This type of plan is only for certain qualified individuals who either have a specific health condition ( C-SNP ) or who qualify for both Medicaid and Medicare insurance ( D-SNP ).

Start your Medicare PlanFit CheckUp today.

What Are Medicare Assignment Codes?

Medicare assignment codes help Medicare pay for covered services. If your doctor or other provider accepts assignment and is a participating provider, they will file for reimbursement for services with a CMS-1500 form and the code will be “assigned.”

But non-participating providers can select “not assigned.” This means they are not accepting Medicare-assigned rates for a given service. They can charge up to 15% over the full Medicare rate for the service.

If you go to a doctor or provider who accepts assignment, you don’t need to file your own claim. Your doctor’s office will directly file with Medicare. Always check to make sure your doctor accepts assignment to avoid excess charges from your visit.

Health Insurance Claim Form . CMS.gov.

Lower costs with assignment . Medicare.gov.

How Many Physicians Have Opted-Out of the Medicare Program? KFF.org.

Joining a plan . Medicare.gov.

This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

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Does Quest Diagnostics Take Medicare?

Roger Clayton

Introducing Roger Clayton, a healthcare maestro with two decades of unparalleled experience in medical insurance. As the visionary behind Medinscoverage, Roger's mission is to demystify... Read more

If you’re a Medicare beneficiary in need of medical testing, you may be wondering if Quest Diagnostics accepts Medicare. Quest Diagnostics is one of the largest diagnostic testing companies in the United States, and it’s important to know if they take Medicare before scheduling an appointment.

The good news is that Quest Diagnostics does accept Medicare. However, it’s important to understand the details of how Medicare covers diagnostic testing and what costs you may be responsible for. In this article, we’ll explore the ins and outs of Quest Diagnostics and Medicare, so you can make informed decisions about your healthcare.

What is Medicare?

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If you’re a Medicare beneficiary, you may be wondering if Quest Diagnostics accepts Medicare. Quest Diagnostics is one of the largest diagnostic testing companies in the world, offering a wide range of medical tests and services. In this article, we’ll explore whether Quest Diagnostics takes Medicare, and what you need to know if you’re a Medicare beneficiary.

Medicare is a federal health insurance program that provides coverage for people who are 65 or older, people with certain disabilities, and people with end-stage renal disease. Medicare is divided into different parts, each of which covers different healthcare services. Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and home health care. Part B covers doctor visits, outpatient services, and preventive care. Part D covers prescription drugs.

Yes, Quest Diagnostics does accept Medicare. If you’re a Medicare beneficiary, you can use Quest Diagnostics for your diagnostic testing needs. Quest Diagnostics is considered a participating provider in the Medicare program, which means they accept Medicare’s approved payment amount for services.

What Does Medicare Cover at Quest Diagnostics?

Medicare covers a wide range of diagnostic tests and services at Quest Diagnostics, including blood tests, urine tests, genetic testing, and imaging services like X-rays and MRIs. However, Medicare coverage can vary depending on the specific test or service you need, so it’s important to check with your doctor or Medicare to make sure the service is covered.

There are several benefits to using Quest Diagnostics for your diagnostic testing needs as a Medicare beneficiary. Some of the benefits include:

• Access to a wide range of diagnostic tests and services
• Convenient locations throughout the United States
• Participation in the Medicare program, which means they accept Medicare’s approved payment amount for services
• High-quality testing services
• Timely and accurate test results

While Quest Diagnostics is a popular choice for diagnostic testing, there are other companies that also accept Medicare and offer similar services. Some of these companies include:

• Sonic Healthcare
• ARUP Laboratories

When deciding which diagnostic testing company to use, it’s important to consider factors like location, cost, and the specific tests or services you need.

Quest Diagnostics is a participating provider in the Medicare program, which means they accept Medicare’s approved payment amount for services. Medicare beneficiaries can use Quest Diagnostics for a wide range of diagnostic tests and services, including blood tests, imaging services, and genetic testing. When choosing a diagnostic testing company, it’s important to consider factors like location, cost, and the specific tests or services you need.

Frequently Asked Questions

Are you wondering if Quest Diagnostics accepts Medicare? Here are some commonly asked questions and answers to help you understand how Quest Diagnostics works with Medicare.

Yes, Quest Diagnostics is a participating provider with Medicare. This means that they accept Medicare insurance and will bill Medicare directly for covered services.

However, it’s important to note that not all Quest Diagnostics services may be covered by Medicare. Some services may require a co-pay or may not be covered at all. It’s always best to check with your healthcare provider and Medicare to confirm coverage before receiving services.

It depends on the type of service you need. For most routine lab tests, you do not need a referral from your healthcare provider to use Quest Diagnostics with Medicare. However, if you need specialized testing or services, your healthcare provider may need to provide a referral and get prior authorization from Medicare.

It’s always best to check with your healthcare provider and Medicare to confirm any referral or authorization requirements before receiving services.

If you have Medicare, you will need to bring your Medicare card with you to Quest Diagnostics. You should also bring any other insurance cards you have, as well as a photo ID and a list of your current medications.

It’s always a good idea to check with your healthcare provider and Medicare to confirm any other documentation or information you may need to bring with you.

It depends on the type of service you receive and your Medicare coverage. Some services may be covered 100% by Medicare, while others may require a co-pay or deductible. The amount you will have to pay out of pocket will depend on your specific Medicare coverage.

It’s always best to check with your healthcare provider and Medicare to confirm any out-of-pocket costs before receiving services.

Yes, Quest Diagnostics is a participating provider with many Medicare Advantage plans. However, it’s important to check with your specific plan to confirm coverage and any referral or authorization requirements before receiving services.

It’s always best to check with your healthcare provider and Medicare Advantage plan to confirm any coverage and requirements before receiving services.

In conclusion, Quest Diagnostics is a leading diagnostic laboratory service provider in the United States. Many people wonder if Quest Diagnostics accepts Medicare, and the answer is yes. Quest Diagnostics is a Medicare-approved provider, and they accept Medicare as well as a wide range of insurance plans.

If you are a Medicare beneficiary and need diagnostic testing services, Quest Diagnostics can be a great option for you. They offer a wide range of tests and services, including blood tests, genetic testing, and drug testing. You can visit any Quest Diagnostics location and receive high-quality testing and results.

In summary, Quest Diagnostics is a reliable and trusted provider of diagnostic testing services that accepts Medicare. Whether you need routine testing or specialized testing, Quest Diagnostics can provide you with the care you need. Don’t hesitate to contact them to schedule an appointment or learn more about their services.

Introducing Roger Clayton, a healthcare maestro with two decades of unparalleled experience in medical insurance. As the visionary behind Medinscoverage, Roger's mission is to demystify the labyrinth of healthcare coverage, empowering individuals to make well-informed decisions about their well-being. His profound industry knowledge has been the cornerstone in crafting the website's exhaustive resources, offering users indispensable guidance and tools for their healthcare needs.

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Quest Diagnostics should be dropped as AARP UHC preferred lab.

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Does Quest Diagnostics Accept Medicare?

• Quest Diagnostics offers many laboratory tests and screening services.
• Medicare covers tests performed at Quest, as long they’re medically necessary and the specific facility accepts Medicare.
• Medicare Part B or Medicare Advantage (Part C) will cover the cost of your tests.
• Most tests will come at no cost to you once you’ve met your plan’s deductible.

Quest Diagnostics is one of the largest providers of outpatient testing in the world. The company has more than 2,000 locations in the United States alone.

Medicare covers many of the services provided by Quest, including blood tests and other preventive screenings.

With Medicare, you usually won’t pay anything out of pocket for most medically necessary tests at Quest Diagnostics. To receive full coverage, both the healthcare provider who orders the test and the Quest location you use must participate in Medicare.

You’ll also need to meet your plan’s annual deductible before Medicare will cover most tests.

Does Medicare cover testing at Quest Diagnostics?

You can use Quest Diagnostics for many tests your doctor might order. If you have original Medicare (parts A and B), Medicare Part B will generally cover your tests.

However, your test must meet some specific criteria:

• It must be ordered by a doctor.
• That doctor must participate in Medicare.
• The test must be for a diagnostic service that Medicare covers.
• The Quest Diagnostics location must participate in Medicare.

In general, this means your doctor suspects you may have a condition or are at risk for one.

This may be due to significant family history or symptoms you’ve been experiencing. If you haven’t had any symptoms and you don’t have a family history of a condition, Medicare might not pay for your test, no matter where you get it.

It’s also important that the Quest Diagnostics location you visit participates in Medicare.

Each state has its own regulations for Medicare facilities. You can check if Medicare covers the Quest Diagnostics near you by using this map . You can also ask the doctor who orders your test or the staff at Quest if your test will be covered.

If you’re still not sure or have additional questions, you can call Medicare directly at 800-MEDICARE (TTY: 877-486-2048).

Medicare Part A coverage

Medicare Part A is hospital insurance. It’ll cover tests ordered by your doctor during your stay in a hospital or skilled nursing facility. But it doesn’t cover testing at outpatient labs, like Quest Diagnostics.

Medicare Advantage coverage

Medicare Advantage (Medicare Part C) offers plans through private insurance companies regulated by Medicare. Medicare requires all these plans to cover the same services as original Medicare.

This means that your Medicare Advantage plan will cover any testing that Medicare Part B does.

Many Medicare Advantage plans have networks, however, and you’ll need to stay in network for any testing to receive full coverage. If you go to an out-of-network doctor or facility, you’ll pay a much higher price — or your test might not be covered at all.

Quest Diagnostics is in network for many major providers of Medicare Advantage plans, including:

• Anthem (most plans)
• BlueCross BlueShield (most plans)
• UnitedHealthcare

You can check with your plan to see if the Quest Diagnostics location near you is part of the network.

How much can I expect to pay?

Medicare parts A and B will cover medically necessary tests at no cost to you. However, both your doctor and the facility you use will need to be Medicare participants that accept Medicare payments for services.

You can find participating doctors in your area on the Medicare website . Check that both the doctor and lab accept Medicare before you get any testing done, so you don’t end up paying any surprise costs.

Medicare Part B costs

Other than possible costs for the test itself, Medicare Part B has a premium. You’ll need to pay it each month to keep your coverage.

In 2020, most people pay $144.60 per month for Part B coverage.

Medicare Part B also has an annual deductible. In 2020, the deductible is $198 . You’ll need to meet your deductible before your test is covered.

Medicare makes an exception, though, for routine testing for heart disease. In this case, Medicare will completely cover the screening once every 5 years, even if you haven’t met your deductible for the year.

For all other tests, you’ll need to meet the $198 deductible first.

Medicare Advantage costs

When you’re using a Medicare Advantage (Part C) plan, your deductible and premium will depend on your specific plan.

You’ll also need to make sure that the Quest Diagnostics near you is part of your plan’s network.

If it’s not and you still wish to go to Quest, you may need to pay for the test completely out of pocket. This applies even if your plan covers the test.

What types of tests are covered?

Medicare will cover many types of tests.

Check out the table below for some of the most common ones. Most tests are only covered once a year, unless otherwise noted.

Not all Quest Diagnostics locations offer every test or screening procedure covered by Medicare. Check with your local Quest to make sure it can provide the test your doctor has ordered.

Your doctor might be able to recommend other local labs if Quest Diagnostics doesn’t offer the test you need.

The takeaway

You can use Medicare at Quest Diagnostics to get coverage for a wide range of tests your doctor might order. Here are a few other points to remember:

• Your doctor and the Quest location you use must participate in Medicare.
• Both Part B and Medicare Advantage plans will cover medically necessary diagnostic tests.
• You won’t pay any out-of-pocket costs for testing if you’ve already met your plan’s annual deductible.
• You can check with your doctor, your local Quest, and Medicare to make sure your test will be covered.

The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthcare Website Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthcare Website Media does not recommend or endorse any third parties that may transact the business of insurance.

Last medically reviewed on August 12, 2020

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