What are non-participating providers in Medicare?

Non-participating providers in Medicare are those who do not accept Medicare assignments. This means they have the option to charge their patients more than the Medicare-approved amount for their services. These providers can indeed bill patients for any amount over the Medicare fee schedule, although there are limitations on how much extra they can charge above the Medicare-approved amount.

By not accepting assignment, these providers may also receive a lower reimbursement rate from Medicare when they do bill for covered services. Patients often encounter higher out-of-pocket costs when seeing non-participating providers, as they may be responsible for paying the excess charges not covered by Medicare. Non-participating providers still have the ability to see Medicare beneficiaries, but the financial arrangement differs significantly from those who participate fully in the Medicare program.