While Medicare is a nationwide health insurance program, it’s not universally accepted in all healthcare facilities. This could be because of the doctor’s billing preferences or your specific Medicare plan. But even if your doctor refuses treatment, you have options.
Why Would a Doctor Not Accept Medicare?
Medicare is convenient for patients, but not for medical staff. For a doctor, Medicare requires a lot of paperwork – way more than what would come from a traditional insurance plan. Medicare does not give the same level of reimbursement that other insurance plans do. A doctor loses roughly 20% of the reimbursement he or she would have gotten with another insurance policy. For a doctor, Medicare is a tough issue to sort through for very minimal compensation. Some doctors may not accept Medicare, because if they did, their Medical practice would not be economically viable.
If you have Medicare Advantage, which is limited to a network, a doctor can refuse to treat you simply because you’re trying to get treatment out-of-network.
What Can You Do?
Just because a doctor doesn’t accept Medicare doesn’t mean you don’t have options. While it’s true that certain doctors will refuse Medicare, they may offer alternatives such as a slight discount or a payment plan allowing you to make several small payments instead of one large payment. These doctors are known as opt-out providers.
Some doctors can accept Medicare payments on a case-by-case basis. They accept it at times, but they are not in a signed agreement with Medicare. This is known as a non-participating provider. In this situation, your doctor can accept Medicare payment, but you are subject to paying an additional 15% of the Medicare-approved amount, on top of the 20% you pay out-of-pocket.
If you have Medicare Advantage and you’re trying to see a doctor out-of-network, then it is possible to obtain that service for a discount, albeit at a higher cost. This is not a guarantee. An out-of-network doctor who has treated you in the past can refuse to treat you, so there is no telling what can happen. If you find that your Medicare Advantage Plan is too limited, you can opt-out of it in favor of an Original Medicare plan, which will no longer place restrictions on which doctors you can see.
The best approach here is to find out which doctors accept Medicare ahead of time. This is why it is encouraged to call healthcare facilities before going to seek treatment.
What Can We Do?
We can help you find doctors in your area who accept Medicare, and if you choose to enroll in Medicare Advantage, we can help you find providers in your network to get treatment from. And no matter what the circumstances are, we at Turning 65 Solutions will help you find a way as we help you along the way. All it takes is a call at (830) 217-6711. And, if you prefer emailing, you can email us at ron@t65s.com.