assignment to beneficiaries

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Assignments, Disclaimers and Powers of Appointment

          Assignments, Disclaimers and Powers of Appointment can alter the distribution of a decedent’s estate.    

          First what is and who can make an assignment? A person who has a vested — legally enforceable — interest in a decedent’s estate can “assign” – i.e., transfer – part or all of their interest to another. Generally, an inheritance vests upon the decedent’s death.  An assignment is a gift by the assignor making the assignment to the assignee receiving the assigned interest.    Assignments create tax issues for both the assignor and assignee.   

          For example, consider an unmarried father who dies intestate — without a will or trust – and is survived by a son and a daughter — his heirs.  Prior to settling dad’s estate, the son decides to give his one-half share to his sister and signs and notarizes an assignment of inheritance rights.  The assignment is then filed with the Court.  Dad’s estate, less expenses and debts, is distributed entirely to the daughter. 

          If an interest in real property inherited from a parent is assigned then the parent child exclusion from reassessment — for local real property taxes — only applies to the interest(s) belonging to the child(ren) who do not assign their interest(s).  There is no reassessment exclusion for any transfers between siblings.

          Assignments, however, almost never apply to a beneficiary’s interests in a trust.  Usually, a trust prohibits beneficiaries from assigning their interest in the trust before distribution.  The anti-assignment provision protects undistributed trust assets from claims by a beneficiary’s creditors. 

          Next, disclaimers are used when a beneficiary, or heir, refuses to accept a gift or inheritance.  You cannot force someone to receive a gift or an inheritance.  To be valid disclaimers must satisfy the following requirements: be unconditional, be in writing, and be timely (i.e., generally, within nine months of the transfer), and, when real property is involved, also be filed with the county recorder where the real property lies.  Unlike assignments, the person disclaiming their interest cannot say who receives the disclaimed interest.  A disclaimer is not a gift by the person disclaiming.  Lastly, one cannot have accepted any benefits from the property being disclaimed, such as the income from an income producing asset. 

          The person disclaiming their gift or inheritance is treated as if they had predeceased the person who made the gift.  We see who is then entitled to inherit. 

          For example, a decedent’s trust leaves a share of the decedent’s trust estate to a named beneficiary and otherwise, if he does not survive to inherit, to the beneficiary’s descendants by right of representation.  The beneficiary survives and timely disclaims.  The beneficiary’s living descendants would then inherit by right of representation. 

          Unlike assignments and disclaimers, powers of appointment are created within a person’s estate planning, e.g., a trust or will, for future use.  A power of appointment allows the power holder to say who receives a gift/distribution from a trust or an estate.  The power of appointment is either a limited power that allows gifting to certain persons or is a general power that allows gifting to anyone at all, including the power holder, the power holder’s estate and the power holder’s creditors.  Powers of appointment are used for a variety of estate planning reasons. 

          For example, a husband’s and wife’s joint estate planning may give the spouse who survives a limited power of appointment over the deceased spouse’s separate trust estate.  The limited power of appointment might allow the deceased spouse’s estate to be divided equally or unequally amongst the deceased spouse’s children as the surviving spouse sees fit after the deceased spouse’s death.

          Anyone who wants to proceed with making an assignment, a disclaimer or exercise of a power of appointment should consult a qualified attorney.  There are tax and other issues to discuss and drafting requirements to these legal instruments that benefit from the expertise of a qualified attorney. 

“Serving Lake and Mendocino Counties for nineteen years, the Law Office of Dennis Fordham focuses on legacy and estate planning, trust and probate administration, and special needs planning. We are here for you. 870 South Main Street Lakeport, California 95453-4801. Phone: 707-263-3235.”

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Designating a Beneficiary

When you die, the Office of Federal Employees' Group Life Insurance (OFEGLI) will pay life insurance benefits in a particular order set by law. To learn more about this and to learn to designate a particular individual or entity, see the following links below:

• FEGLI Handbook Chapter on Order of Precedence and Designation of Beneficiary
• Who is My Beneficiary?

Designation of Beneficiary

Forms for designations.

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Who is my Beneficiary?

If you are an active employee:.

You need to check with your employing agency.

OPM does not maintain information on FEGLI designations of beneficiary for employees of other agencies. You need to check with the office that maintains your Official Personnel Folder or equivalent at your agency. If you do not know what office that is or how to contact them, please check with your supervisor.

We cannot tell you who your designated beneficiary (if any) is, so please do not email OPM's life insurance office asking this question.

For more information on who will receive life insurance proceeds when an insured person dies, please check out our FAQ pages.

If you are a Federal RETIREE or compensationer:

You need to check with OPM's Retirement Office by email at [email protected] or by writing to: OPM Retirement Operations Center, P.O. Box 45, Boyers, PA 16017-0045. They maintain all of your FEGLI records. You will need to provide your retirement claim number (CSA) or social security number.

Please note: Beneficiary records are not maintained online. Your paper retirement file will need to be retrieved from archives in order to send you a copy of the designation OPM has on file for you. This may take a while. Instead, you may wish to complete a new one . Any Designation you submit will supercede what is on file.

Instead of waiting for a copy of a designation of beneficiary (if any), you may wish to simply submit a new form. That form will take precedence over any FEGLI designation form on file, as long as you sign it, have two witnesses sign, and complete the rest of the form properly.

Related Information

• FEGLI Designation Form (SF 2823)

Are Your Designations of Beneficiary Current?

When was the last time you checked your designations of beneficiary? Most employees and annuitants don't realize that they have several designations to keep current. If you don't have a designation on file, then the funds will be distributed according to the order of precedence. That may be OK with you, but maybe it isn't. Worse yet is an out-of-date designation giving the money to someone that you no longer wish to give it to.

• Order of Precedence

Check the order of precedence for each of these funds

• CSRS Lump Sum Payment Order of Precedence Upon the Death of a Current Employee
• FERS Lump Sum Payment Order of Precedence Upon the Death of a Current Employee
• Thrift Savings Plan
• Payment of Unpaid Compensation upon the Death of a Federal Employee

If you want benefits paid to someone else or in a different order, you must designate a beneficiary. This could well be vital to your family's future welfare.

Federal Employees' Group Life Insurance Program (FEGLI)

Designations Form: Standard Form 2823, Designation of Beneficiary (4/01)

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Designations Form: TSP-3, Thrift Savings Plan Designation of Beneficiary (10/05)

All Thrift Savings Plan designations should be sent to the following address:

Thrift Savings Plan Service Office P.O. Box 385021 Birmingham AL 35238

• Thrift Savings Plan Order of Preference
• Thrift Savings Plan website

Unpaid Compensation - for Employees only

Designations Form: Standard Form 1152, Designation of Beneficiary, Unpaid Compensation of Deceased Civilian Employee (6/02)

• Civil Service Retirement Programs

Use the following two forms to designate who is to receive a lump-sum payment which may become payable under the Civil Service Retirement System (CSRS) or the Federal Employees' Retirement System (FERS). These forms do not affect the right of any person who is eligible for survivor annuity benefits.

Designations Forms:

• Civil Service Retirement System (CSRS) - Standard Form 2808, Designation of Beneficiary (2/99)
• Federal Employees Retirement System (FERS) - Standard Form 3102, Designation of Beneficiary (6/00)

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• Unpaid Compensation — for Employees only
• Designation of Beneficiary Form (SF 2823)
• Designation of Beneficiary Section in FEGLI Handbook
• OPM Designations of Beneficiary Page

Attachments are also available for designating a trust

We recommend that you designate beneficiaries to receive your life insurance benefits. However, if you are happy with the order of precedence , you don't have to do anything.

It is necessary to designate a beneficiary if:

• you want benefits to go to a person, firm, organization, or other legal entity not listed in the order of precedence ;
• you want benefits to be paid differently than the order of precedence ;
• you want benefits to go to a trust, for example, one you have established for your minor children; or

You cannot designate beneficiaries if you have assigned your insurance.

Important Things to Remember about Designations

• Only the insured can sign the designation of beneficiary. Exception : If you assigned your insurance (using an RI 76-10 Assignment form), only the assignee(s) has(have) the right to make a designation.
• Your employing office must receive the completed form before you die. A designation delivered on a weekend or Federal holiday is not "received" and is not valid until the next workday. If you die before your employing office receives the new designation, the Office of Federal Employees' Group Life Insurance will pay benefits according to the next prior designation on file or under the order of precedence , if there is no prior designation.
• Two persons must witness your signature. These witnesses must sign the form and give their addresses.
• A witness cannot be someone you are naming on the form as a beneficiary.
• Be sure to keep your designation up to date. If you marry or divorce, complete a new form. If your beneficiary's address changes, complete a new form.

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12.6: Assignment, Delegation, and Third Party Beneficiaries

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Contracts are by law assignable and delegable. This means that the rights conveyed by the contract may be transferred to another party by assignment , unless an express restriction on assignment exists within the contract, or unless an assignment violates public policy. Likewise, the duties imposed on a party may be transferred to another party by delegation , unless the contract expressly restricts delegation, there is a substantial interest in personal performance by the original party to the contract, or if delegation would violate public policy.

As a general rule, a party may assign contract rights without the consent of the other party. This is common in the construction industry where a general contractor may assign rights and delegate duties to subcontractors for specific work that needs to be performed under the main contract. For example, the general contractor may delegate the duty to perform electrical work to an electrician, as well as assign the right to be paid for the work performed.

In delegation and assignment, the original contracting party is not “off the hook” if it transfers its duties or rights to another party. For instance, a subtenant assumed the rights and duties imposed on the original tenant in a lease. If the subletting tenant does not pay the rent, the original tenant is still liable.

The way to excuse oneself from legal liability under a contract is through novation. Novation is essentially a new contract that transfers all rights and duties to a new party to the contract and releases the previous party from any further obligation. It is the procedure in which one party is dismissed completely from the contract because a third party is substituted. In this situation, the dismissed party no longer has any liability under the original contract. To be effective, all parties must agree to the novation.

Third Party Beneficiaries

Assignment and delegation under a contract should not be confused with rights of third party beneficiaries. A third party beneficiary is someone who is not a party to the contract but stands to benefit from it. Life insurance policies are a classic example of contracts with third party beneficiaries. The insurance company and the insured are parties to the contract. But the person who receives payment upon the death of the insured is the third party beneficiary.

Third party beneficiaries can either be intended or incidental. An intended beneficiary is someone who the parties intend to receive the benefit of the contract. For example, the named beneficiary of a life insurance policy. The beneficiary does not need to know about the contract to have his or her rights vest.

An incidental beneficiary is someone who benefits from a contract but was not intended by the parties to benefit. For example, if a business pays for a professional to landscape its property, the neighbors are incidental beneficiaries to the landscaping contract. They benefit from the improved appearance and property values, but the business did not enter the contract with an intent to benefit them. Incidental beneficiaries do not have a legally enforceable interest in the contract.

How and why to assign beneficiaries

No one  wants  to think about what will happen after they die. And yet, thinking about it—and planning now with that in mind—will ensure that your wishes are met, and your loved ones are protected at the end of your life. Who doesn’t want that?

Assigning beneficiaries is a key step in protecting your assets. Setting up these designations—which say who will inherit your different accounts—allows your loved ones and/or charities to which you’ll give money to obtain your accounts after you have passed away without having to go through the time, expense confusion, and added pain of legal procedures. A beneficiary designation overrides a will, so it’s important to make sure your beneficiaries are clearly and definitively identified.

Here are some terms to know as you think about determining your beneficiaries:

• POD, or “payable on death”:  This agreement between you and your financial institution means your bank assets will be immediately handed over to your beneficiary upon your death.
• TOD, or “transfer on death”:  With TOD, beneficiaries receive stocks, bonds, mutual funds and other assets (for example, more than half of states allow TOD or beneficiary deeds for homes and automobiles) upon your death, without having to go through a legal procedure called probate.
• Probate:  This court-supervised legal procedure serves to prove that a will is indeed a last and final will and that there are no challenges to it or claims against the estate. Probate takes time and money, something you likely won’t want your loved ones to go through when you die.​

You will want to designate a primary and secondary beneficiary for all of your accounts. Your primary beneficiary is the person or entity that first receives the proceeds of your account upon your death. The contingent (secondary) beneficiary is your second choice to receive the benefit, only if the primary beneficiary dies before you.

Choosing a beneficiary or beneficiaries may be straightforward—for example, if a person has a spouse they want as primary beneficiary and an adult child they want as secondary beneficiary. It can get more complicated or confusing if beneficiary determinations aren’t as obvious. Start by thinking about who is financially dependent on you—this person or people might be who you want to choose. A financial consultant can guide you through other questions you should ask and points you might want to consider.

Contact your bank and investment company to set up POD or TOD on all your taxable accounts.  Plan to review your beneficiary designations periodically—at least annually, or when major life changes occur (death, divorce, new marriage or partnership, etc.).  

This material is for informational or educational purposes only and does not constitute fiduciary investment advice under ERISA, a securities recommendation under all securities laws, or an insurance product recommendation under state insurance laws or regulations. This material does not take into account any specific objectives or circumstances of any particular investor, or suggest any specific course of action. Investment decisions should be made based on the investor’s own objectives and circumstances.

Beneficiary Designations: 5 Critical Mistakes to Avoid

You may be surprised at how easy it is to make an expensive mistake with your beneficiary designations. Here's how to help avoid the five most common mistakes.

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Many people might not realize that their will does not control who inherits all of their assets when they die. Many assets pass by beneficiary designation — which is the ability to fill out a form with the financial company holding the asset and name who will inherit the asset upon your death.

Assets such as life insurance, annuities and retirement accounts (401(k)s, IRAs, 403bs and similar accounts) all pass by beneficiary designation. In addition, many financial companies allow you to name beneficiaries on non-retirement accounts, which are known as TOD (transfer on death) or POD (pay on death) accounts.

Don’t Want to Leave Money to Your Kids? You’ll Probably Change Your Mind.

While naming a beneficiary can be an easy way to ensure your loved ones will receive assets directly, beneficiary designations can also cause many problems. It’s your responsibility to make sure your beneficiary designations are properly filled out and given to the financial company — and mistakes can be costly.

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Here are five critical mistakes to avoid when dealing with your beneficiary designations:

1. Not naming a beneficiary at all.

Many people never name a beneficiary for retirement accounts or life insurance. The reason could be people may not realize they can name a beneficiary, or they just never get around to filling out the forms.

If you do not name a beneficiary for life insurance or retirement accounts, then the financial company has it owns rules about where the assets will go after you die. For life insurance, typically the proceeds will be paid to your probate estate. This means that your family will need to hire a lawyer, go to court and probate your estate to claim the proceeds.

For retirement benefits, if you’re married, your spouse will most likely receive the assets. But, if you’re not married, the retirement account will likely be paid to your probate estate, which has unpleasant income tax ramifications. When an estate is the beneficiary of a retirement account, all of the assets will need to be paid out of the retirement account within five years of death. This causes acceleration of the deferred income tax, which must be paid earlier than would have otherwise been necessary.

2. Failing to take into account special circumstances.

Not all loved ones should receive an asset directly. These individuals include minors, individuals with specials needs, or individuals with an inability to manage assets or with creditor issues. Because children are not legally competent, they will not be able to claim the assets. A court-appointed person (known as a conservator) will have to claim and manage the money until the minor turns 18.

Conservatorships can be very costly and require annual accountings to the court. In addition, conservators often need to file a bond with the court, which is typically purchased from an insurance company and can be expensive.

Discussing Family Legacy Plans? 5 Tips to Navigate ‘the Talk’

Individuals with special needs who receive assets directly can lose valuable government benefits , because once they receive the inheritance directly, more than likely, they will own too many assets to qualify. And, individuals with financial issues or creditor problems can lose the asset through mismanagement or debts.

In such instances, it’s preferable to create a Trust to be named as the beneficiary. The Trustee (who is in charge of the Trust) can claim and manage the asset for your intended recipients for a period of time that takes into account each particular situation.

3. Getting the name wrong (or not exactly right).

Sometimes individuals fill out their beneficiary designation forms incorrectly. There can be multiple people in a family with similar names (such Sr., Jr. and III), but the beneficiary designation form may not be specific. Individuals change their names over time through marriage or divorce, or assumptions can be made about a person’s legal name that later prove incorrect.

Not having names match exactly can cause delays in payouts, and in a worst-case scenario of two people with similar names, it can result in litigation.

4. Forgetting to update your beneficiaries over time.

Who you want to or should name as a beneficiary will mostly likely change over time as circumstances change. Naming a beneficiary is part of an overall estate plan. Just as life changes, so should your estate plan.

Beneficiary designations are an important part of that overall plan, so you want to make sure they are updated regularly .

5. Not reviewing your beneficiary choices with legal and financial advisers.

How beneficiary designations should be filled out is part of an overall financial and estate plan. It’s best to involve your legal and financial advisers to determine what is best for your individual situation.

Remember, beneficiary designations are designed to ensure you have the ultimate say over who will get your assets when you are gone. By taking the time to carefully (and correctly) select your beneficiaries and then periodically reviewing those choices and making any necessary updates, you stay in control of your money … and that is what estate planning is all about, after all.

What Happens to Your Crypto Assets When You Die?

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Tracy A. Craig is a partner and chair of Seder & Chandler 's Trusts and Estates Group. She focuses her practice on estate planning, estate administration, prenuptial agreements, guardianships and conservatorships, elder law and charitable giving. She works with individuals in all areas of estate and gift tax planning, from testamentary estate planning and business succession planning to sophisticated lifetime leveraged gifting techniques, such as grantor retained annuity trusts (GRATs), intentionally defective grantor trusts, family limited liability companies and qualified personal residence trusts (QPRTs). Tracy serves in various fiduciary capacities, including trustee and personal representative (formerly known as executor). She also works with clients on issues facing elders.

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What Is an Irrevocable Beneficiary?

Understanding an irrevocable beneficiary, advantages of an irrevocable beneficiary, irrevocable trusts, disadvantages of an irrevocable beneficiary, irrevocable beneficiaries and divorces, how often should i review my beneficiaries, is an irrevocable beneficiary a primary beneficiary, how can i remove an irrevocable beneficiary.

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What Is an Irrevocable Beneficiary? Definition and Rights

Julia Kagan is a financial/consumer journalist and former senior editor, personal finance, of Investopedia.

An irrevocable beneficiary is a person or entity designated to receive the assets in a life insurance policy or a segregated fund contract. What is irrevocable is the beneficiary status. You can’t choose on your own to change the beneficiary or the terms of the policy, and you can’t cancel the policy without the beneficiary’s consent. The beneficiary must agree to any and all changes in the rights to compensation from these entities.

Key Takeaways

• An irrevocable beneficiary is a person or entity designated to receive the assets in a life insurance policy or a segregated fund contract.
• An irrevocable beneficiary is a more ironclad version of a beneficiary. Their entitlements are guaranteed, and they often must approve any changes in the policy.
• Irrevocable beneficiaries cannot be removed once designated unless they agree to it—even if they are divorced spouses.
• Children are often named irrevocable beneficiaries to ensure their inheritance or secure child support payments.
• Naming an irrevocable beneficiary can also have estate-planning benefits, especially if the insurance policy is put in an irrevocable trust.

An irrevocable beneficiary has certain guaranteed rights to assets held in the policy or fund. It’s a more ironclad status than that of a revocable beneficiary , whose right to assets can be denied or amended under certain circumstances. 

With a life insurance policy , the policyholder may designate either an irrevocable or revocable beneficiary to receive a payout in the event of the insured’s death. If someone is listed as an irrevocable beneficiary, then denial of income from the policy after the death of the insured is not possible, nor are any changes made to policy payout terms—unless the beneficiary agrees to them.

For example, a spouse who is an irrevocable beneficiary has the right to a policy payout even after a divorce. The ex-spouse must agree to changes in the policy before or after the death of the insured. Even the insured cannot change the status of an irrevocable beneficiary once they are named. Irrevocable beneficiaries also have to be notified if either the policy lapses or an attempt is made to cancel it.

In some states, an irrevocable beneficiary has the right to veto any changes to an insurance policy, including cancellation. In other states, they may only challenge items that directly affect them, such as a payout.

The main advantage to naming an irrevocable beneficiary is that it ensures that money goes where you want it to go. Difficult to change during your life and virtually impossible to alter after your death, it’s for the bequests that you’re 100% sure of and don’t want to have to worry about keeping up to date.

Children are often named irrevocable beneficiaries. If a parent wanted to guarantee money to a child, then the parent could designate that child as an irrevocable beneficiary, thus ensuring the child will receive death benefits  from the life insurance policy or segregated fund contract. A parent might also make their spouse an irrevocable beneficiary to ensure that they have the means to support their offspring properly and not be dependent on someone else.

As a way to safeguard an inheritance, making a beneficiary irrevocable can be especially important in this era of multiple marriages and blended families. A stepparent can’t cut off a child from a previous marriage or alter or challenge a policy after the death of the insured. In case of a messy divorce, naming a child rather than a spouse as the policy’s irrevocable beneficiary could be preferable.

A beneficiary designation means that the funds in question don’t have to go through probate, so the recipient gets them faster.

Beneficiaries can protect assets in other ways. A beneficiary designation overrides any sort of bequest made in a will, and it doesn’t have to go through probate. The recipient will get funds faster this way.

Irrevocable beneficiaries can also play a role in estate planning. If you name a beneficiary on a life insurance policy and then put that policy in an irrevocable life insurance trust (ILIT) , the proceeds are then considered removed from your estate—thus avoiding potential estate and gift taxes after your death. An appointed trustee can supervise the trust and distribute the assets, which can be helpful in the case of irresponsible beneficiaries or when the beneficiary is a minor.

Although irrevocable beneficiaries are pretty well-shielded to begin with, irrevocable trusts offer an additional layer of protection against legal challenges . A beneficiary can’t be sued by a creditor for these funds because the money is owned by the trust, not the individual, while the beneficiary doesn’t own the money until the payout.

The primary disadvantage of having an irrevocable beneficiary is inflexibility. You can’t make any changes without the beneficiary’s consent. Life has a way of surprising us, so you need to be very sure that circumstances won’t make you regret your choice.

As to irrevocable trusts, an additional disadvantage is that you lose control of the assets in the trust, ceding that control to a trustee. If you suddenly need to access the funds due to an emergency, you don’t have it.

A policyholder can be ordered by a court to designate their ex-spouse as a designated beneficiary. Most often, this is seen in cases where there are dependent children, child support, or alimony involved.

In such a case, the ex-spouse can work with a divorce lawyer to persuade a court to make the policyholder designate the ex-spouse as an irrevocable beneficiary to secure child support. However, the court can also have the policy amended if it’s deemed that the payout is excessive in regard to what is needed to support the child or at a time when the children are no longer seen as dependents. 

It’s important to note, however, that state law ultimately decides the rights of beneficiaries to an insurance policy, whether they are revocable or irrevocable beneficiaries. Policyholders should be clear with any beneficiary as to what the terms and conditions of a life insurance policy will be.

Some financial planners, including insurance companies themselves, recommend that you review your beneficiaries annually. That might be unnecessary, especially if you have named irrevocable beneficiaries. However, whenever a major life change occurs—marriage, divorce, the birth of a child, or death—you definitely should look over your beneficiaries.

Irrevocable beneficiaries will always be primary beneficiaries . They take priority over revocable beneficiaries, forcing those others into secondary or tertiary status. It would be extremely rare for an irrevocable beneficiary to take second place.

You can’t without difficulty. The point of irrevocable beneficiary status is its permanency. Generally speaking, an irrevocable beneficiary can only be removed if the beneficiary agrees to be displaced, voluntarily surrendering their status.

ABA Section of Taxation NewsQuarterly. “ Irrevocable Life Insurance Trusts: An Effective Estate Tax Reduction Technique ,” Page 1.

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This is the fourth post in Health Care Law Today’s series on the final rule. This post addresses how CMS assigns beneficiaries to an ACO participating in the MSSP.

In the MSSP ACO Final Rule, CMS finalized new regulations that govern the assignment of Medicare fee-for-service beneficiaries to an ACO participating in the MSSP.

Assignment Eligibility

CMS finalized its proposal to codify the criteria that a beneficiary must meet in order to be eligible to be assigned to an ACO. Specifically, if a beneficiary meets all of the following criteria, a beneficiary will be eligible to be assigned to an ACO:

Has at least one month of Part A and Part B enrollment and does not have any months of Part A only or Part B only enrollment.

Does not have any months of Medicare group (private) health plan.

Is not assigned to any other Medicare shared savings initiative.

Lives in the US or US territories and possessions.

Defining Primary Care Services

In the proposed rule, CMS attempted to expand the scope of primary care services in order to expand the scope of beneficiaries who receive those primary care services and more accurately assign beneficiaries to those ACO providers who provide primary care services. In the final rule, CMS finalized its proposal to update the definition of “primary care services” to include certain CPT codes associated with transitional care services and critical care management services. Additionally, future revisions to the definition of primary care service codes will be done through the annual Physician Fee Schedule rulemaking process.

ACO Professionals Who Can Provide Primary Care Services

The final rule includes claims for primary care services furnished by nurse practitioners, physician assistants, and nurse specialist under the first step of the assignment process, after having identified beneficiaries who received at least one primary care service by a physician participating in the ACO. In doing so, all primary care services furnished by the entire primary care physician and practitioner team will be considered for purposes of determining whether a beneficiary received the plurality of primary care services under step 1 of the assignment methodology.

CMS also attempts to address concerns of certain specialists who believe they bill for certain evaluation and management services designated as primary care but who do not actually provide primary care services. This affects not only assignment of beneficiaries, but the exclusivity requirements of the MSSP. In the final rule, CMS identifies primary care services more accurately by pairing the CPT codes for primary care services with the specialties of the practitioners that provide them and excludes claims for services provided by certain physician specialties from the beneficiary assignment process. Based on public comment, CMS excludes physician specialties from step 2 that will rarely, if ever, provide primary care to beneficiaries. Such specialties are surgical in nature and include, but are not limited to: general surgery, allergy and immunology, gastroenterology, hospice and palliative medicine, infectious diseases, rheumatology, and interventional cardiology. Services furnished by these physician specialties are also excluded for purposes of determining if a beneficiary has received a primary care service from a physician who is an ACO profession, which is a precondition for assignment to an ACO.

Assignment of Beneficiaries to ACOs that Include FQHCs, RHCs, CAHs, and ETAs

The final rule continues to require FQHCs and RHCs to identify, through an attestation, the physicians that provide direct patient primary care services in their ACO participant FQHCs and RHCs. Previously, the attestation was used both for purposes of determining whether a beneficiary was assignable and also for purposes of assigning a beneficiary. The final rule allows this information to be used only for purposes of determining whether or not a beneficiary is assignable. If the beneficiary is assignable, then claims for primary care services furnished by all ACO professionals submitted by the FQHC or RHC would be used to determine whether the beneficiary received a plurality of primary care services from the ACO.

CMS determined that no changes were necessary to the assignment process for services provided by CAHs. Finally, in the proposed rule, CMS proposed to add ETA hospitals to the list of ACO participants that are eligible to form an ACO to participate in the MSSP. As a result, services provided by ETA hospitals could be considered primary care services for purposes of assignment. CMS will continue to consider the ETA proposal and will address certain issues related to ETA hospitals in future rulemaking, but has not done so in the final rule.

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Medicare Assignment: Everything You Need to Know

Medicare assignment.

• Providers Accepting Assignment
• Providers Who Do Not
• Billing Options
• Assignment of Benefits
• How to Choose

Frequently Asked Questions

Medicare assignment is an agreement between Medicare and medical providers (doctors, hospitals, medical equipment suppliers, etc.) in which the provider agrees to accept Medicare’s fee schedule as payment in full when Medicare patients are treated.

This article will explain how Medicare assignment works, and what you need to know in order to ensure that you won’t receive unexpected bills.

fizkes / Getty Images

There are 35 million Americans who have Original Medicare. Medicare is a federal program and most medical providers throughout the country accept assignment with Medicare. As a result, these enrollees have a lot more options for medical providers than most of the rest of the population.

They can see any provider who accepts assignment, anywhere in the country. They can be assured that they will only have to pay their expected Medicare cost-sharing (deductible and coinsurance, some or all of which may be paid by a Medigap plan , Medicaid, or supplemental coverage provided by an employer or former employer).

It’s important to note here that the rules are different for the 29 million Americans who have Medicare Advantage plans. These beneficiaries cannot simply use any medical provider who accepts Medicare assignment.

Instead, each Medicare Advantage plan has its own network of providers —much like the health insurance plans that many Americans are accustomed to obtaining from employers or purchasing in the exchange/marketplace .

A provider who accepts assignment with Medicare may or may not be in-network with some or all of the Medicare Advantage plans that offer coverage in a given area. Some Medicare Advantage plans— health maintenance organizations (HMOs) , in particular—will only cover an enrollee’s claims if they use providers who are in the plan's network.

Other Medicare Advantage plans— preferred provider organizations (PPOs) , in particular—will cover out-of-network care but the enrollee will pay more than they would have paid had they seen an in-network provider.

Original Medicare

The bottom line is that Medicare assignment only determines provider accessibility and costs for people who have Original Medicare. People with Medicare Advantage need to understand their own plan’s provider network and coverage rules.

When discussing Medicare assignment and access to providers in this article, keep in mind that it is referring to people who have Original Medicare.

How to Make Sure Your Provider Accepts Assignment

Most doctors, hospitals, and other medical providers in the United States do accept Medicare assignment.

Provider Participation Stats

According to the Centers for Medicare and Medicaid Services, 98% of providers participate in Medicare, which means they accept assignment.

You can ask the provider directly about their participation with Medicare. But Medicare also has a tool that you can use to find participating doctors, hospitals, home health care services, and other providers.

There’s a filter on that tool labeled “Medicare-approved payment.” If you turn on that filter, you will only see providers who accept Medicare assignment. Under each provider’s information, it will say “Charges the Medicare-approved amount (so you pay less out-of-pocket).”

What If Your Provider Doesn’t Accept Assignment?

If your medical provider or equipment supplier doesn’t accept assignment, it means they haven’t agreed to accept Medicare’s approved amounts as payment in full for all of the services.

These providers can still choose to accept assignment on a case-by-case basis. But because they haven’t agreed to accept Medicare assignment for all services, they are considered nonparticipating providers.

Note that "nonparticipating" does not mean that a provider has opted out of Medicare altogether. Medicare will still pay claims for services received from a nonparticipating provider (i.e., one who does not accept Medicare assignment), whereas Medicare does not cover any of the cost of services obtained from a provider who has officially opted out of Medicare.

If a Medicare beneficiary uses a provider who has opted out of Medicare, that person will pay the provider directly and Medicare will not be involved in any way.

Physicians Who Have Opted Out

Only about 1% of all non-pediatric physicians have opted out of Medicare.

For providers who have not opted out of Medicare but who also don’t accept assignment, Medicare will still pay nearly as much as it would have paid if you had used a provider who accepts assignment. Here’s how it works:

• Medicare will pay the provider 95% of the amount they would pay if the provider accepted assignment.
• The provider can charge the person receiving care more than the Medicare-approved amount, but only up to 15% more (some states limit this further). This extra amount, which the patient has to pay out-of-pocket, is known as the limiting charge . But the 15% cap does not apply to medical equipment suppliers; if they do not accept assignment with Medicare, there is no limit on how much they can charge the person receiving care. This is why it’s particularly important to make sure that the supplier accepts Medicare assignment if you need medical equipment.
• The nonparticipating provider may require the person receiving care to pay the entire bill up front and seek reimbursement from Medicare (using Form CMS 1490-S ). Alternatively, they may submit a claim to Medicare on behalf of the person receiving care (using Form CMS-1500 ).
• A nonparticipating provider can choose to accept assignment on a case-by-case basis. They can indicate this on Form CMS-1500 in box 27. The vast majority of nonparticipating providers who bill Medicare choose to accept assignment for the claim being billed.
• Nonparticipating providers do not have to bill your Medigap plan on your behalf.

Billing Options for Providers Who Accept Medicare

When a medical provider accepts assignment with Medicare, part of the agreement is that they will submit bills to Medicare on behalf of the person receiving care. So if you only see providers who accept assignment, you will never need to submit your own bills to Medicare for reimbursement.

If you have a Medigap plan that supplements your Original Medicare coverage, you should present the Medigap coverage information to the provider at the time of service. Medicare will forward the claim information to your Medigap insurer, reducing administrative work on your part.

Depending on the Medigap plan you have, the services that you receive, and the amount you’ve already spent in out-of-pocket costs, the Medigap plan may pay some or all of the out-of-pocket costs that you would otherwise have after Medicare pays its share.

(Note that if you have a type of Medigap plan called Medicare SELECT, you will have to stay within the plan’s network of providers in order to receive benefits. But this is not the case with other Medigap plans.)

After the claim is processed, you’ll be able to see details in your MyMedicare.gov account . Medicare will also send you a Medicare Summary Notice. This is Medicare’s version of an explanation of benefits (EOB) , which is sent out every three months.

If you have a Medigap plan, it should also send you an EOB or something similar, explaining the claim and whether the policy paid any part of it.

What Is Medicare Assignment of Benefits?

For Medicare beneficiaries, assignment of benefits means that the person receiving care agrees to allow a nonparticipating provider to bill Medicare directly (as opposed to having the person receiving care pay the bill up front and seek reimbursement from Medicare). Assignment of benefits is authorized by the person receiving care in Box 13 of Form CMS-1500 .

If the person receiving care refuses to assign benefits, Medicare can only reimburse the person receiving care instead of paying the nonparticipating provider directly.

Things to Consider Before Choosing a Provider

If you’re enrolled in Original Medicare, you have a wide range of options in terms of the providers you can use—far more than most other Americans. In most cases, your preferred doctor and other medical providers will accept assignment with Medicare, keeping your out-of-pocket costs lower than they would otherwise be, and reducing administrative hassle.

There may be circumstances, however, when the best option is a nonparticipating provider or even a provider who has opted out of Medicare altogether. If you choose one of these options, be sure you discuss the details with the provider before proceeding with the treatment.

You’ll want to understand how much is going to be billed and whether the provider will bill Medicare on your behalf if you agree to assign benefits (note that this is not possible if the provider has opted out of Medicare).

If you have supplemental coverage, you’ll also want to check with that plan to see whether it will still pick up some of the cost and, if so, how much you should expect to pay out of your own pocket.

A medical provider who accepts Medicare assignment is considered a participating provider. These providers have agreed to accept Medicare’s fee schedule as payment in full for services they provide to Medicare beneficiaries. Most doctors, hospitals, and other medical providers do accept Medicare assignment.

Nonparticipating providers are those who have not signed an agreement with Medicare to accept Medicare’s rates as payment in full. However, they can agree to accept assignment on a case-by-case basis, as long as they haven’t opted out of Medicare altogether. If they do not accept assignment, they can bill the patient up to 15% more than the Medicare-approved rate.

Providers who opt out of Medicare cannot bill Medicare and Medicare will not pay them or reimburse beneficiaries for their services. But there is no limit on how much they can bill for their services.

A Word From Verywell

It’s in your best interest to choose a provider who accepts Medicare assignment. This will keep your costs as low as possible, streamline the billing and claims process, and ensure that your Medigap plan picks up its share of the costs.

If you feel like you need help navigating the provider options or seeking care from a provider who doesn’t accept assignment, the Medicare State Health Insurance Assistance Program (SHIP) in your state may be able to help.

A doctor who does not accept Medicare assignment has not agreed to accept Medicare’s fee schedule as payment in full for their services. These doctors are considered nonparticipating with Medicare and can bill Medicare beneficiaries up to 15% more than the Medicare-approved amount.

They also have the option to accept assignment (i.e., accept Medicare’s rate as payment in full) on a case-by-case basis.

There are certain circumstances in which a provider is required by law to accept assignment. This includes situations in which the person receiving care has both Medicare and Medicaid. And it also applies to certain medical services, including lab tests, ambulance services, and drugs that are covered under Medicare Part B (as opposed to Part D).

In 2021, 98% of American physicians had participation agreements with Medicare, leaving only about 2% who did not accept assignment (either as a nonparticipating provider, or a provider who had opted out of Medicare altogether).

Accepting assignment is something that the medical provider does, whereas assignment of benefits is something that the patient (the Medicare beneficiary) does. To accept assignment means that the medical provider has agreed to accept Medicare’s approved fee as payment in full for services they provide.

Assignment of benefits means that the person receiving care agrees to allow a medical provider to bill Medicare directly, as opposed to having the person receiving care pay the provider and then seek reimbursement from Medicare.

Centers for Medicare and Medicaid Services. Medicare monthly enrollment .

Centers for Medicare and Medicaid Services. Annual Medicare participation announcement .

Centers for Medicare and Medicaid Services. Lower costs with assignment .

Centers for Medicare and Medicaid Services. Find providers who have opted out of Medicare .

Kaiser Family Foundation. How many physicians have opted-out of the Medicare program ?

Center for Medicare Advocacy. Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) updates .

Centers for Medicare and Medicaid Services. Check the status of a claim .

Centers for Medicare and Medicaid Services. Medicare claims processing manual. Chapter 26 - completing and processing form CMS-1500 data set .

Centers for Medicare and Medicaid Services. Ambulance fee schedule .

Centers for Medicare and Medicaid Services. Prescription drugs (outpatient) .

By Louise Norris Norris is a licensed health insurance agent, book author, and freelance writer. She graduated magna cum laude from Colorado State University.

OMW Health Law

Health Law Blog

ACO: Understanding Beneficiary Assignments

In the final rule, CMS chose to adopt a preliminary prospective assignment methodology with final retrospective reconciliation.  Under this model, CMS will create a list of beneficiaries likely to receive care from the ACO based on primary care utilization during the most recent periods for which adequate dates are available, and provide a copy of the list to the ACO.  During the performance year, CMS will update the list periodically on a rolling basis to allow the ACO to adjust to likely changes in its assigned population.  At the end of each performance year, CMS will reconcile the list to reflect beneficiaries who actually meet the criteria for assignment to the ACO during the performance year.  Determination of shares savings or losses for the ACO will be based on this final, reconciled population.

CMS chose this approach because it believes that it will provide the ACO with adequate information to redesign care processes while also encouraging ACOs to standardize care for all Medicare FFS beneficiaries instead of a subset.  At the same time, CMS believes that the model will provide adequate incentives for each ACO to provide quality care to its beneficiary population.

CMS has also announced a Pioneer ACO Model which will test alternative savings and alignment.  The Pioneer ACO Model will provide CMS with the opportunity to gain experience and evaluate a more prospective hybrid model than the approach explained above.  CMS will study the Pioneer ACO Model and will consider its experiences in the next rulemaking.

Majority vs. Plurality Rule for Beneficiary Assignment

The Act requires that beneficiaries be assigned to “an ACO based on their utilization of primary care services” furnished by an ACO professional who is a physician, but it does not prescribe the methodology for such assignment.  For its methodology, CMS adopted a plurality of primary care services model, defined in terms of allowed charges, as follows:

CMS considered whether to assign beneficiaries to an ACO when they receive a plurality of their primary care services from an ACO, or to adopt a stricter standard under which a beneficiary will be assigned to an ACO only when he or she receives a majority of their primary care services from an ACO.  CMS chose a plurality methodology because it would result in a greater number of beneficiaries being assigned to an ACO, thus promoting statistical stability and a greater incentive for ACOs to redesign care processes.  Additionally, CMS voiced that the plurality methodology promotes ACO accountability for patients that might otherwise fall through the cracks because they would not meet a majority standard.

• No Plurality Threshold:   CMS declined to set a threshold requirement on the plurality of primary care services methodology.  This will maximize the number of patients assigned to an ACO.
• Simple Service Count vs. Accumulated Allowed Charges :   CMS could determine the plurality of services on the basis of a simple service count for each visit or on the basis of the accumulated allowed charges for services delivered.  The method of using a plurality of allowed charges would place greater weight on more complex primary care services in the assignment methodology, while a simple service method count would weigh all primary care encounters equally in determining assignment.  CMS chose to adopt the accumulated allowed charges method count, which put responsibility on the ACO providing the highest complexity and intensity of primary care services.  Additionally, this method results in the assignment of responsibility for containing costs to the provider who generates the most costs.

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Beneficiary Assignment in the Proposed Revised Medicare Shared Savings Program Regulations

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