Glossary
Medicare Assignment
A provider's agreement to accept Medicare's approved amount as full payment for a covered service.
Also known as: accepts assignment, assignment, Medicare-approved amount
Quick answer
Medicare assignment is the formal agreement between a provider and Medicare in which the provider accepts the Medicare-approved amount as payment in full. Providers fall into three buckets: participating (always accept assignment), non-participating (may or may not, claim by claim), and opt-out (do not bill Medicare at all and require a private contract).
Why it matters
Assignment status controls how much you can be billed and whether TRICARE For Life will pay anything as the secondary payer.
Why this matters at age 65
MTF physicians always accepted whatever Medicare-like rate the DoD set. Once you transition to civilian care at 65, you become responsible for verifying assignment status before every new provider relationship — this single check protects you from balance billing and from claims TFL will not process.
When you'll encounter it
Whenever you choose a new doctor, specialist, lab, imaging center, or hospital. Also stamped on every Medicare Summary Notice.
Impact on Medicare
Medicare pays 80% of the Medicare-approved amount after you meet the Part B deductible — the approved amount is roughly 5% lower at non-participating providers.
Impact on TRICARE For Life
TFL pays the Medicare cost-share ONLY at providers who accept assignment or are non-opt-out. At opt-out providers, Medicare pays $0 and TFL pays $0 — you are 100% responsible.
Impact on Medicare Advantage
Assignment is a Part B concept; under MA, the plan's own network and contracted rates apply instead. Always verify a provider is in the plan's network.
Military-specific context
Concierge medicine and many psychiatrists opt out of Medicare. Retirees moving from MTF care often discover this only after a $500 office visit — verify first.
Common misconceptions
- "All doctors take Medicare." — About 1% of physicians (and a much higher share of psychiatrists and concierge practices) have opted out entirely.
- "If a provider bills Medicare, they accept assignment." — Non-participating providers can bill Medicare and still charge the 15% limiting charge on top.
Common mistakes to avoid
- Booking a 'Medicare provider' without confirming they actually accept assignment for your specific service.
- Signing a 'private contract' at a concierge clinic without realizing it permanently waives Medicare and TFL for that provider for two years.
- Assuming TFL will rescue you from an opt-out provider — it won't.
Real-world scenario: A retired Master Sergeant sees a new dermatologist who 'takes Medicare' but is non-participating.
Medicare's approved amount is $190. Medicare pays 80% of $180.50 (the reduced non-par rate). The dermatologist legally charges 115% of that — $207.58. TFL still pays the cost-share between Medicare's payment and the limiting-charge amount, but only because the doctor did not opt out.
What should I do?
- 1Before any first visit, ask: 'Do you accept Medicare assignment?' — if the answer is unclear, ask 'Are you a Medicare opt-out provider?'
- 2Verify the provider in Medicare Care Compare at medicare.gov/care-compare/.
- 3If you must use a non-participating provider, confirm TFL is on file so the limiting-charge balance is reimbursed.
- 4Never sign a private contract without understanding it waives Medicare and TFL coverage for that provider.
Questions people commonly ask
Continue learning
— suggested by the knowledge graph- What is Medicare? A complete overview for retired militaryA plain-English, handbook-grounded overview of the federal health insurance program for people 65 and older, written specifically for retired service members and their families.
- Understanding Original Medicare (Parts A & B) for veteransExactly what Part A and Part B cover, what they cost in 2026, and why both are required to keep TRICARE For Life.
- How Medicare and TRICARE For Life work togetherThe exact mechanics of who pays first, who pays second, and what you owe — for every common care scenario.
- How Medicare and TRICARE For Life claims are paidThe mechanics of the Medicare-to-TFL crossover system — what providers do, what WPS does, and what to do if a claim gets stuck.
- Benefit Period (Part A)The Part A timeframe used to measure hospital deductibles and coinsurance — it resets after 60 days out of the hospital.
- Coordination of Benefits (COB)The federal and contractual rules that determine which insurer pays first when you have more than one health plan.
- Durable Medical Equipment (DME)Medically necessary, reusable equipment for home use — covered by Part B at 80% after the deductible.
- IRMAA (Income-Related Monthly Adjustment Amount)An income-based surcharge added to your Medicare Part B and Part D premiums when your modified adjusted gross income exceeds CMS thresholds.
- Late Enrollment Penalty (Part B and Part D)A permanent monthly surcharge added to your Part B (10% per 12 months delayed) or Part D (1% per month delayed) premium for as long as you have Medicare.
- What should be on my 90-day checklist before turning 65?Apply for Medicare A and B, verify DEERS, build a civilian care team, transfer prescriptions if leaving an MTF pharmacy, and review FEDVIP for dental/vision.
- Who pays first, Medicare or TRICARE For Life?Medicare pays first for any service it covers. TFL pays second. The claim usually crosses over automatically — you should never pay out of pocket up front.
- Should I pay the doctor's office up front?Almost never. Medicare and TFL pay providers directly. If a Medicare-participating provider asks for payment beyond a known small copay, ask them to bill Medicare first.
- How much does Medicare Part B cost?Most people pay the standard Part B premium (roughly $202.90/month in 2026). Higher-income retirees pay IRMAA on top. Lower-income retirees may qualify for help paying it.
- I'm turning 65. What should I do first?About 3 months before your 65th birthday, sign up for Medicare Parts A and B at SSA.gov. TRICARE For Life activates automatically once both are effective and DEERS is current.
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Continue learning straight from the source. Every link below goes to an official government or DoD resource.
Last reviewed January 2026 against the 2026 Medicare & You and TRICARE For Life handbooks.