Perhaps you’ve been feeling fearful about Medicare and wondering: Are Medicare doctors taking new patients? Fortunately, there are over 800,000 doctors who accept Medicare. In recent years there have been alot of hype about doctors who accept Medicare and/or doctors who accept Medicare assignment. So of course, here at Boomer Benefits, we get many of questions, such as:
- Do all doctors accept Medicare?
- Is there a Medicare doctor shortage?
- Will my doctor drop me when I transition to Medicare?
Let’s put this worry to rest. More than 91% of all primary care physicians in the United States accept Medicare.
A Real-Life “Medicare Doctors Search”
Our agency helps thousands of beneficiaries each year, but there are certain clients that stand out in your memory. Ed was 67 and owned a small business with 4 employees, including himself and his wife. He had read in the newspaper about some doctors no longer taking Medicare.
This made him fearful of leaving his group health insurance plan to roll onto Medicare. As a result, he was paying over $2100/month for the combined cost of coverage for himself and his wife. Even worse, the group health insurance plan had a really high deductible. He was incurring hundreds of dollars each year in deductible costs.
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. 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.
Was it worth over $16,000 a year to stay on group insurance and avoid Medicare? NO WAY.
Don’t Fear the Medicare Doctor Hype
Why was Ed so fearful? He had read an article in a newspaper. An article 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. We wanted to let him hear directly from them that yes, they were absolutely accepting Medicare. In the end, he made the switch. We’ve never heard a single complaint from him about access to Medicare doctors.
Our agency gets questions nearly every day about doctors taking Medicare. People want to know if doctors are leaving Medicare in droves. Will they be able to see their favorite physicians once they go on Medicare?
As of 2018, 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. For the moment, beneficiaries can feel secure that there are plenty of providers in Medicare’s network.
Why Don’t ALL Doctors Accept Medicare?
Often it’s not that they don’t accept Medicare. It’s that their practices are full. Let me explain:
Over the years there have been many scheduled cuts in doctor funding. Each time, Congress steps in at the last minute to kick the can down the road. This is good for our Medicare clients in the short-term, but does nothing to solve the long-term problem that Medicare is paying out more than it brings in. Eventually there will be a point where some President and Congress will need to be honest with Americans about the problems and provide real solutions.
One of the issues complicating the matter is that only about 3% of doctors coming out of med school are going into family practice. The great majority of doctors choose a specialty instead because they can earn nearly twice as high an income by doing so.
This shortage in primary care doctors is occurring at around the same time that the Baby Boomers are entering into Medicare. It has put further strain on an already overworked group of primary care doctors who accept Medicare. They can only see so many patients per day, and since Medicare reimburses them less than what they get for treating other non-Medicare patients, most doctors have to limit their practices to only so many Medicare patients.
So when you call these doctors, their office staff may say they aren’t taking Medicare patients when technically it’s that they aren’t taking any NEW Medicare patients.
The “Medicare Network” Seems Scary but Really Isn’t
Most of our lives we are usually insured by an insurance carrier via our employment. Usually these plans are PPO style plans. These networks may seem large to us, but remember that Medicare is a national health insurance program. It is not limited to just one city or state or area, so it is enormous.
The Kaiser Family Foundation reported that recent surveys found less than three percent of seniors reported any problems with finding a physician. My agents have found this to be largely true. When assisting a client, we routinely help them check with their physicians. We learn 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 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 limitations make access a bit more difficult. Let’s take a look at what those are:
It is not uncommon for people to relocate after they retire. They may want to be nearer to their family members and grandchildren. Having family close by gives us security as we age. Others hit the road in an RV to spend a few years seeing America.
Whatever the reason, moving is one of the things that can create a temporary access problem for people on Medicare. The beneficiary must find a new primary care physician. They might also need specialists for certain health conditions. Though most doctors do accept Medicare, there are record numbers of Baby Boomers aging into Medicare every day.
Medicare pays a lower reimbursement rate to physicians than other insurance. For example, your former employer health insurance pays better than Medicare. Sometimes providers will limit the total number of Medicare patients they see.
Most doctors will continue to treat current patients they roll off of former insurance and onto Medicare. Sometimes their practice just gets full. The doctor is trying to keep the overall percentage of Medicare patients in his practice to a certain amount. He must do this in order to stay profitable and provide quality care.
When this happens, a simple calling campaign is all it takes to locate a provider. You can find a list of physicians accepting Medicare online. You can also search for physicians using your Google browser. Make some calls to find out who is accepting new patients with Medicare. If you work with a good Medigap agent, ask him or her to help with this.
If your Medigap health insurance agent is a thorough one, he’ll be willing to make these calls for you to help you establish yourself with some good providers in your new city of residence.
Doctors Who Accept Medicare Assignment
Sometimes a beneficiary can find doctors who accept Medicare but have trouble locating one that accepts Medicare assignment.
Medicare has doctors who accept Medicare assignment and doctors that don’t. Doctors who accept Medicare assignment can not charge you any balance bills, They accept Medicare’s payment in full. Some doctors are called non-participating. These doctors will see you if you have Medicare, but they reserve the right to send you a bill for an excess charge. This charge can be up to 15% more than Medicare pays.
Certain Medicare supplements will cover the excess charges for you. Then you don’t have to worry about whether the doctor accepts Medicare assignment. For example, Plan F and Plan G do cover excess charges, but Plan N does not. People with Plan N need to ask every provider up front if he or she takes assignment. If not, they might get a bill that comes as a surprise.
There are a few states that do not allow doctors to charge excess charges. If you live in one of these states, a Plan N will function like a Plan F or G on the excess charges.
Finding Doctors on Medicare Advantage Plans
Medicare itself has huge numbers of providers. The newer Medicare Advantage plans have just a fraction of that. Advantage plans establish local networks of doctors and hospitals that their members can see 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. Before you enroll in any plan, ask about how many doctors are in their network. If a plan has less than a thousand providers, be cautious. That is very small compared to the tens of thousands of providers accepting Original Medicare.
Think carefully about the reason you are buying Medicare-related health insurance. Is it important to you to have access to the very best specialists if you develop a health condition? A very small network of doctors might offer you only a handful of specialists in a certain area. If the network only offers a few of them, these specialists are likely to be fully booked.
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 you will have great providers to choose from for your care.
Do all Doctors Accept Medicare Advantage Plans?
No they do not. Each Medicare Advantage plan has it’s own network of doctors and hospitals. If you enroll in a Medicare HMO, you must see doctors in the network except for in emergencies. Going outside the network will generally result in you paying for those services 100% out of pocket unless it was emergency care.
On Medicare HMO-POS or Medicare PPO plans, you have a bit more flexibility. You can see doctors out side the network at a higher cost to you, but first you must ask if that doctor is willing to bill your Medicare Advantage plan. He does not have to .
Boutique or Concierge Medicine Doctors
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. 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, but be able to spend more time with them.
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. Then he has to employ staff to file claims with the insurance companies. Often they have to wait weeks for payment. Occasionally claims are denied by insurance carriers. Collecting from the patient after the care has been received is not always successful, which leaves the doctor on the hook. All of this costs time and money for the provider. It’s easier for the doctor to collect payment from you. There is much less need for paperwork and staff to handle that paperwork.
There is nothing inherently wrong with purchasing boutique care. Just keep in mind that you are signing away the ability to use your Medicare with this physician. What happens if you develop a serious illness and need to use 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.
Make sure that your concierge doctor knows you need to use your insurance for things like labwork. Some patients cancel their insurance when they begin paying for a concierge doctor. This can cause problems if you develop a condition needing expensive treatments that your family doctor can’t deliver.
Solve this Problem with a Good Agent
From the insurance agency side of things, we just aren’t seeing many problems with Medicare yet. That could 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. The Affordable Care Act included bonus payments to doctors for primary care services under Medicare. This is a step in the right direction.
Your own step in the right direction is to enroll in your Medigap policy through an insurance agency like Boomer Benefits. We have a Client Service Team here that assists all of our policyholders with locating providers in their area who are accepting Medicare patients.
Want to have our team available to help you find providers? Enroll in your Medigap plan through our agency, and that service is yours free. Give us a call today!
(This post was updated in 2018.)