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Costs & IRMAA

Doctors Have Until December 31 to Set Their 2027 Medicare Status, and That Choice Affects Your Bill

The annual window for physicians and suppliers to declare their Medicare participation status is now open. Whether your doctor is participating, non-participating, or opted out determines how much you can be charged above what Medicare approves.

By the Goodsurance editorial teamNovember 12, 2026

The annual Medicare participation decision window opened this month, with a deadline of December 31, 2026 for coverage year 2027. By that date, every physician, practitioner, and supplier enrolled in Medicare must choose how they intend to handle claims next year.

The choice has three levels. Participating providers accept assignment on all Medicare claims. Medicare pays them the full approved fee schedule amount directly, patients owe only their applicable deductible and coinsurance, and no additional billing is permitted.

Doctors have until December 31 to choose their 2027 Medicare participation status, and that choice sets whether patients can be billed above the approved rate.

Non-participating providers do not accept assignment routinely. Medicare reimburses them 5 percent below the standard fee schedule amount. They may still bill patients but are capped at 115 percent of the Medicare-allowed amount, a threshold called the limiting charge. That cap means patients can be billed up to 15 percent more than what Medicare would pay a participating provider for the same service.

Opted-out providers set their own fees entirely. Medicare pays nothing toward their services, and patients bear the full cost out of pocket.

For beneficiaries currently in the fall open enrollment period, a provider's participation status is worth checking, especially for anyone considering a new plan or new providers. CMS publishes participation status for enrolled physicians and suppliers in its online provider directory at Medicare.gov, where enrollees can look up a doctor before scheduling a visit.

The December 31, 2026 deadline applies to all providers; decisions take effect January 1, 2027. The mid-November to December 31 window is the only time during the year when providers may change their participation election.

In plain words

Every year in November and December, doctors and suppliers in Medicare must decide how they want to handle Medicare payments for the next year. This year the deadline is December 31, 2026, for year 2027.

There are three choices. If a doctor is fully participating, Medicare pays the full approved amount straight to the doctor. You pay only your regular deductible and copay, nothing extra.

If a doctor is not fully participating, Medicare pays that doctor 5 percent less. The doctor can then charge you up to 15 percent more than what Medicare approves. That means a higher bill for you.

If a doctor has opted out of Medicare completely, the program pays nothing. You pay the entire bill yourself.

You can look up whether your doctor is participating at Medicare.gov. Checking this before you schedule a visit can tell you what cost rules apply.

Understand the basics first

Source: CMS
Read at the source →

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