I’ll never forget Ed. Even in an agency likes ours, which helps thousands of beneficiaries each year, there are certain clients that stand out in your memory for one reason or another. Ed was 67 and owned a small business with 4 employees, including himself and his wife. Because of an article he had read in the newspaper about some doctors no longer taking Medicare, Ed was fearful of rolling off his group health insurance plan onto Medicare, so he was paying over $2100/month for the combined cost of coverage for himself and his wife, and the plan had a high deductible to boot, so he was incurring hundreds of dollars each year in deductible costs.
The look on Ed’s face was priceless when we showed him the costs he would be paying if he opted for Medicare as primary insurance and a supplemental Medigap plan. The savings was around $1400/month, and what’s more, he would have an insurance plan with first-dollar coverage, making his deductible $0. To say he was stunned was an understatement, but what stands out in my mind is that even after he saw these numbers, he wasn’t sure about changing. He took the numbers home and wrestled with them, trying to convince himself that it was worth over $16,000 a year to stay on group insurance and avoid Medicare if possible.
Why was Ed so fearful? Well he had read an article in a newspaper once that talked about the possibility of some doctors no longer taking Medicare. To address his concerns, I had my staff contact all his doctors with him via conference call to let him hear directly from them that yes, they were absolutely accepting Medicare. In the end, he made the switch, and we’ve never heard a single complaint from him about access.
Our agency gets questions nearly every day about doctors taking Medicare. They want to know if doctors are leaving Medicare in droves and whether they will continue to be able to see their favorite physicians once they go on Medicare. What about after Obamacare is fully implemented in January 2014? Will there even be enough doctors taking Medicare for them to feel they have adequate access to providers?
With all the media scrutiny about Medicare’s reimbursement rates to physicians, the good news is that as of this moment, Medicare is still far and away the very largest “network” of healthcare providers in the country. According to the Centers for Medicare and Medicaid Services, around 97% of doctors accept Medicare, which means that for the moment, beneficiaries can feel secure in the knowledge that there are plenty of providers in Medicare’s network.
We are also quite used to networks by the time we retire. Most of our lives we are usually insured by an insurance carrier via our employment and usually these plans are PPO style plans, so as consumers we are already quite used to networks. Though these networks may seem large to us, we have to remember that Medicare is a national federal health insurance program, so the network is not limited to just one city or state or area. There are hundreds of thousands of providers across the U.S.
In fact, the Kaiser Family Foundation reported that recent surveys found less than three percent of seniors reported any problems with finding a physician accepting their insurance. My agents have found this to be largely true. When assisting a client, we routinely help them check with their physicians about which types of insurance related to Medicare is being accepted. Almost always, the provider accepts Original Medicare or participates in a Medicare Advantage plan network, or both. It is very rare for us to be told that the doctor doesn’t accept any form of Medicare.
That being said, we have been able to identify some specific areas where there are limitations and restrictions which make access a bit more difficult, so let’s take a look at what those are.
It is not uncommon for people to relocate after they retire. Often this happens because people want to be nearer to their family members and especially grandchildren. Having family close by gives us some security as we age because we know we may not always be as mobile as we once were. Many people relocate for a better climate as well, or perhaps they hit the road in an RV to spend a few years seeing all the beautiful places in the country that they’ve never had a chance to visit.
Whatever the reason, moving is one of the things that can sometimes create a temporary access problem for people on Medicare. The beneficiary must find a new primary care physician and possibly specialists in certain common health conditions, such as a heart or lung specialist. Though most doctors do accept Medicare, there is no disputing the fact that there are record numbers of Baby Boomers aging into Medicare every day. Since Medicare pays a lower reimbursement rate to physicians than say, a group health insurance company that you were insured with through your former employer, it is common for doctors to limit the total number of patients they see who have Medicare as their primary insurance.
If you have been treating with a doctor for many years, most of the time he will continue to treat you once you roll off of your former insurance and onto Medicare. However, since most physicians make that exception, this makes it more difficult for someone new to an area to find a doctor willing to take them on as a brand new patient. The doctor is trying to keep the overall percentage of Medicare patients in his practice to a certain amount in order to stay profitable and able to provide quality care.
When this happens, a simple calling campaign is all it takes to locate a provider. One can find a list of physicians accepting Medicare online at www.medicare.gov. You can also search for primary care physicians using your Google browser, and make some calls to find out who is accepting new patients with Medicare as their primary insurance. If your Medigap health insurance agent is a thorough one, he or she should also be willing to make these calls for you to help you establish yourself with some good providers in your new city of residence.
Finding Doctors on Medicare Advantage Plans
While traditional Medicare itself has huge numbers of providers, the newer Medicare Advantage plans have just a fraction of that. Advantage plans establish networks of doctors and hospitals that their members can seek for care. This is a competitive insurance market so a good plan will offer several thousand providers in your area. Nonetheless there are always a few Medicare Advantage plans with much smaller networks. If you opt for one of these plans in an effort to lower your overall premiums that you pay for your insurance, you should ask about how many doctors are in their network. If a plan has less than a thousand providers, that is infinitesimally small compared to the tens of thousands of providers accepting Original Medicare.
Before you enroll, you need to carefully think about the reason you are buying Medicare-related health insurance. Remember that getting a copay at the doctor’s office is nice, but what is critical is that if you are diagnosed with cancer or COPD or some other chronic condition, you need access to the very best specialists you can find who treat this. A very small network of doctors might offer you only a handful of specialists in a certain area, and if the network only offers a few of them, these specialists are likely to be fully booked, causing you to wait for an appointment. Don’t make the mistake of compromising your access to care to save a few dollars. Our bodies are the most precious thing that we insure – far more important than auto or homeowners insurance. Spend what it takes for you to feel comfortable that if you are diagnosed with a rare or life threatening disease or illness, you will have great providers to choose from for your care.
Boutique or Concierge Medicine
There is a growing trend across America for fee-based care without insurance. The patient will pay a monthly or annual fee to a doctor and in return that doctor agrees to see that patient whenever he or she needs care. Instead of being covered by insurance, the patient opts to essentially pay cash for care. In theory, this type of practice will allow a doctor to have less patients overall and be able to spend more time with you when you need health care.
Why would a doctor offer this? Well, accepting insurance in and of itself is expensive. The doctor already agrees to treat the patient at the network’s discounted rates, and then he or she has to employ staff to file with the insurance companies. Often they have to wait weeks for payment and occasionally claims are denied by insurance carriers. Collecting from the patient after the care has already been received is not always successful, which leaves the doctor on the hook. All of this costs time and money for the provider, whereas if the doctor collects an annual payment from you for your care, there is much less need for paperwork and staff to handle that paperwork.
There is nothing wrong with purchasing boutique care if you truly feel it’s worth it. However, keep in mind that you are signing away the ability to use your Medicare with this physician. Later on if you develop a very serious illness and need to use your Medicare due to a higher volume of appointments, it may be more difficult to get established all over again with a new primary care provider. You’ll want to also make sure that your concierge doctor is still mindful that you need to use your insurance for things like labwork and hospitalizations. Some patients make the mistake of cancelling their insurance when they begin paying for a concierge doctor, and this can leave you in a world of hurt if you develop a condition needing new specialists and expensive treatments that your family doctor can’t deliver.
With all this said, we should be careful to put in the disclaimer that from the insurance agency side of things, we just aren’t seeing the problems with low numbers of doctors in Medicare yet. That doesn’t mean that this couldn’t change if Congress doesn’t permanently address the insolvency of our nation’s health insurance program for seniors. Doctors accepting Medicare need to fairly compensated for their work, and this is a can that Washington can’t keep kicking down the road forever. The Affordable Care Act includes bonus payments to doctors for primary care services under Medicare, and this is a step in the right direction. Long-term solutions need to be addressed soon to ensure the continued adequate access to providers under Medicare.