“Are doctors still taking Medicare?” This is one of the questions I hear most when working with clients. Recent headlines and talk among seniors suggest fewer and fewer doctors accept Medicare these days. Is this actually true?
When it comes to accepting Medicare, physicians fall into one of three categories:
1) Participating Providers: Doctors agree to accept “assignment” on all Medicare claims. Beneficiaries seeing a participating provider are only liable for the cost sharing required by Medicare. Most doctors fall into this category.
2) Non-Participating Providers: Providers accept Medicare patients but choose whether to take “assignment” (Medicare’s approved amount) on a claim-by-claim basis. These doctors can “balance bill” you, meaning your portion cannot exceed 15% of the fee-schedule amount.
3) Opt-Out: Providers sign an affidavit to “opt-out” of the Medicare program entirely. Any claims you submit to Medicare are denied, and you are considered “cash pay” with these providers.
According to the Center for Medicare and Medicaid Services, only 1.1% of non-pediatric physicians have formally opted-out of the Medicare program. This amounts to about 11,039 physicians across the United States, with the largest specialty being psychiatry. 98.9% of physicians accept Medicare!
Many people question why more physicians don’t “opt-out,” given that Medicare generally pays physicians less than private insurance. The assumption is as our population ages, opting out of Medicare will mean a more substantial loss in revenue for non-participating providers.
Remember, if you have a Medicare Supplement, you can see any doctor in the United States who accepts Medicare. If you are diagnosed with a serious condition, you have the freedom to choose your doctor or use a specialty cancer center, etc. On the other hand, seniors with Medicare Advantage plans generally have a network of doctors they must use. Some PPO Advantage plans let beneficiaries go outside the network, but it’s best to double-check your “Evidence of Coverage” to verify how each plan works.
Our Plan Medigap team would love to help you along your Medicare journey. You never need to guess or go it alone; it’s crucial to get it right! Our service is free to you! You’re welcome to visit us in the office at 2604 Long Prairie Road, Suite 100, in Flower Mound, or simply pick up the phone and call 800-750-2407.
God Bless.
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