Thursday, July 28, 2016

Doctors Who Refuse Medicare Patients

A doctor that doesn't take Medicare? Get out of here! No way. All doctors accept Medicare.

Don't they?

Most do, a few don't.

If you are turning 65 and enrolling in Medicare, there are things you need to know.

Medicare Assignment, No Assignment, Opt-out

Roughly 99% of doctors participate in Medicare and 96% of those accept Medicare assignment. That makes your job a lot easier.

If you have original Medicare.

Not so much if you have a Medicare Advantage plan.

With original Medicare you can use (almost) any doctor anywhere in the United States. No networks. No referrals. No paperwork.

Your job is a bit more complicated with an Advantage plan.

Advantage plans run on a calendar year basis. "Your" doc may participate this year but not next year. That can make it a challenge if you have a medical condition that needs the attention of someone who really knows your history.

And what about that 1% of doctors that opt-out of Medicare.
Opt-out doctors who accept no Medicare reimbursement and put the onus on the patient to foot the entire bill, except for medical emergencies. These physicians are required to tell patients the costs of services up front and have them sign what are known as private contracts, agreeing to the opt-out method. - Next Avenue
Doctors that opt-out of Medicare is generally limited to the psychiatric field. If you need counseling, are turning 65 and enrolling in Medicare you need to ask your therapist if they participate in Medicare

What if Your Doctor Says No?

Don't be too concerned. Remember, most doctors participate in Medicare but some are not taking on new patients.
In 2010 a Texas Medical Association survey found that 18 percent of the state's physicians were restricting the number of Medicare patients they treated, while 16 percent were no longer seeing new Medicare patients. 
Nationally, the number of physicians who still participate in Medicare is unclear. As of 2008 only 58 percent of physicians were willing to see all new Medicare patients, while fully 13.7 percent were no longer willing to see any new Medicare patients, a survey by the Center for Studying Health System Change survey found.4 Both a 2010 American Medical Association (AMA) survey and the 2011 National Ambulatory Medical Care Survey found that about 17 percent of physicians were restricting the number of Medicare patients they treat. - National Center
I am a baby boomer enrolled in Medicare. Moreover, I have over 400 clients in Georgia, all have original Medicare. 

Most had doctors before turning 65, and every one of them were able to keep their doctors. The few that did not have a doctor before 65 had no trouble finding someone to accept them as a new patient.

A few clients moved to Georgia from other states. A few had a serious ongoing medical condition.

One lady was recovering from ovarian cancer but had a relapse shortly after moving here. She had no trouble getting accepted into an Emory Hospital practice that specializes in her type of cancer.

Not only was she able to get the care she needs, but all of her inpatient and outpatient bills have been paid by Medicare and her supplement plan. Her only out of pocket for medical care is the Medicare Part B deductible ($166 in 2016).

Another client had not seen a doctor in years but had been, in his words, "feeling puny" for several months. He was looking forward to turning 65 and getting on Medicare.

Almost immediately after enrolling in Medicare he made an appointment with a doctor for his Welcome to Medicare physical. He had been taking antacid medication for several months for heartburn.

After several tests he was diagnosed with esophageal cancer. Living in south Georgia, was a challenge since there were few doctors nearby that could effectively treat his condition. 

The good news is he was accepted into a specialized treatment program at Mayo Clinic in Jacksonville. His condition has improved considerably thanks to the aggressive treatment at Mayo.

Once again, his only out of pocket for medical treatment has been the Medicare Part B deductible. All of his hospital bills and all of his outpatient medical bills that exceed the Part B deductible are paid in full.

Tomorrow we will address the question, "Does Medicare Cover Cancer Treatment?".

#DoctorsNotTakingMedicare #Turning65

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