What is the "Limiting Charge" in Medicare?

Original Medicare costs and savings make healthcare a more affordable option for people 65 years and older, or those under 65 who qualify for Medicare due to certain disabilities.

Because there are many facets to Original Medicare’s benefits, careful understanding of what consumers are expected to pay or are being charged is an ongoing and significant learning opportunity. 

Medicare Benefits Solutions

Oct 19, 2021

timer 3 minutes read

Seek Original Medicare providers who accept assignment

An Original Medicare provider “assignment” is a legal and binding agreement between Original Medicare and health care providers. Those providers who accept assignment are held liable to work within Medicare’s financial terms of provider charges. Because not all healthcare providers accept assignment and agree to Medicare’s terms, it is wise to confirm your provider’s position before accepting medical care or treatment.

What is a limiting charge?

Being a part of Original Medicare has its perks. A limiting charge, or limiting charge cap is the highest Medicare-approved payment charge a Medicare recipient can be charged by a physician, supplier or provider who does not accept Medicare assignment for covered services. That cap generally reflects up to a 15% overage of Medicare’s top approved charge of services performed.

It also means those who have accepted assignment will accept Medicare’s limiting charge terms-of-payment amount as payment in full for covered services rendered. This is one big, money-saving advantage Medicare benefits can provide.

How Medicare’s limiting charge can help

Finding ways to save even more money with Medicare benefits and limiting charge assignments helps keep medical service costs lower. The limiting charge assignment agreement can assist in lowering out-of-pocket expenses while leveraging the consumer’s position of payment protocols. 

For example, you may be able to prolong out-of-pocket expenses and defer claim submission charges by only being charged upfront for Medicare’s deductible, and coinsurance costs (if applicable). Once a claim is finally filed, your remaining out-of-pocket expenses may be paid directly to the service provider.

Use caution when choosing providers

There are a lot of great providers out there who have chosen to “opt-out” of working with Medicare. It is important to understand, however, that receiving healthcare services from a private provider, physician or facility that has chosen to “opt-out” means you receive little-to-no Medicare benefits or coverage. There are exceptions where emergency circumstances may allow some coverage. 

Providers opting to work independently from Medicare must do so for two years. After two years, they may continue to opt-out or become a Medicare assigned resource upon request.

SELECT * from wp_posts p INNER JOIN wp_term_relationships tr ON tr.object_id = p.ID INNER JOIN wp_terms tm ON tm.term_id = tr.term_taxonomy_id INNER JOIN wp_term_taxonomy tx ON tx.term_id = tr.term_taxonomy_id where p.post_type='post' and p.post_status='publish' and tx.taxonomy ='category' and tm.term_id in (22) and p.ID NOT IN (1636) group by p.ID ORDER BY p.post_date DESC LIMIT 9

Find a new Medicare plan

Get a plan recommendation based on what's important to you.

Find a new Medicare plan

Get a plan recommendation based on what's important to you.

Got questions?

Call a licensed sales agent at

or TTY 711

Mon to Fri 5 am - 8 pm PT | Sat 5 am - 5 pm PT | Sun closed

Send us a message

We aim to reply within 24 hours.

    Medicare Benefits Solutions is a non-government website. By submitting information on this site, I am providing my written consent for Medicare Benefits Solutions, herein after referred to as “Medicare Benefits”, which is a brand operated by HealthCompare Insurance Services Inc., its agents, or affiliates to contact me (even if I’m on a state or national do not call registry) at the phone number or email address listed to provide me with quotes or information about Medicare products. I further consent to such calls or texts sent via autodialer, automated technology, prerecorded message and/or artificial voice. I understand my consent is not a condition of purchase and that I can revoke my consent at any time via medicarebenefits.com/about-us/contact-us. Additional charges may apply to SMS, call, or Internet usage depending on your data providers.

    Find a plan

    find a plan
    Get plan recommendations

    Compare your current Medicare plan to our recommendations – then choose the plan that gives you more of the things you want.