Do All Doctors Accept Medicare?
The good news is that most healthcare providers do accept Medicare. In October 2020, the Kaiser Family Foundation reported that “the vast majority (97%) of physicians and practitioners billing Medicare are participating providers.” Health care providers can choose to work with Medicare in different ways or not at all, and their choices carry over to how much Medicare beneficiaries can be charged. While not all doctors accept Medicare, it can be fairly easy to find a doctor that does in the area using a few tips.
How to Find a Doctor Who Accepts Medicare
Since you are paying premiums for Part B, it makes sense to use doctors who accept Medicare so that you can receive benefits from the Medicare program.
Here are suggestions to help you find doctors who accept Medicare:
- Medicare offers an online Physician Compare tool to find and compare Medicare doctors based on zip code.
- You can check if your doctor has not registered with Medicare by searching the opt-out database accessible through the Medicare website.
- Contact the physician’s office, and ask to speak to the insurance specialist to confirm if the doctor is a participating provider. Participating providers must accept assignment.
Sometimes, the best recommendations are word-of-mouth. Ask friends and family members for recommendations of doctors who accept Medicare, or use your local neighborhood app. Always check with the doctor’s office when you call to schedule the appointment.
How Much Will Doctors That Accept Medicare Cost?
PAR providers (doctors who accept Medicare assignment) have agreed to provide certain services at a Medicare-approved price. Even though most doctors will accept assignment, make sure you check that your doctor is a PAR provider before seeing them, because if they are not, you may be required to pay immediately.
Why Some Doctors May Not Accept Medicare
A doctor’s decision not to accept a Medicare health plan may be primarily attributed to administrative requirements, the lag between the service date and reimbursement, and Medicare payments reduced according to Medicare’s fee schedule. According to Kaiser Health News (KHN), many primary care physicians argue that Medicare “doesn’t reimburse them adequately and requires too much paperwork to get paid.” As for specialists, Kaiser Family Foundation (KFF) pointed out that the following medical fields had the highest opt-out rates, based on 2020 published data from the Centers for Medicare and Medicaid Services (CMS):
- Psychiatry: 7.2%
- Plastic and reconstructive surgery: 3.6%
- Neurology: 2.8%
What to Do if a Doctor Does Not Accept Medicare
If your doctor has dropped out of the Medicare insurance program, or you found an opt-out doctor you would like to use, you have these options:
- Ask your doctor to work with you on payment terms, and sign a written agreement.
- Don’t be too shy to inquire about a discount because it’s not uncommon for doctors to charge private-pay patients a different amount than patients with private insurance.
- If there are Medicare-participating urgent care centers in your area, consider using their services for non-emergency primary care.
- Work with licensed insurance agents to guide you in your search for qualified Medicare doctors who are accepting new Medicare patients.
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