Can Doctors Choose Not to Accept Medicare?

Male doctor with his arms crossed stock image

By Daniel Petkevich

Dec 8, 2022

Read this before going to the doctor

Over 90% of doctors nationwide accept Medicare, to match with the 96% of age-eligible Americans receiving Medicare benefits. However, that leaves over 9,000 physicians who have decided to opt out of Medicare, according to KFF. This number may continue to grow in years to come, which could mean an expensive visit for you. Let's talk through which doctors are choosing not to accept Medicare and what you can do to save money.

Stay Up to Date on Medicare!

Header brushstroke decoration.

Join the Fair Square Medicare Newsletter to stay informed on cost savings, changes to Medicare, and other valuable healthcare information.

How do doctors become certified to accept Medicare patients?

Doctors must enroll in Medicare's program to receive reimbursement for services they provide to Medicare beneficiaries. To do this, doctors must apply with a signed agreement stating that they accept the conditions and fees set by Medicare. Once certified, most doctors are obligated to accept all patients with Medicare insurance coverage.

Why do some doctors choose not to accept Medicare patients?

There are several reasons why some doctors choose not to accept Medicare patients. One of the most common reasons is that they do not feel that the reimbursements provided by Medicare cover the costs associated with providing care for these patients. Additionally, some doctors may have concerns about the paperwork or bureaucracy that comes along with treating Medicare patients. Other doctors may simply be overwhelmed with the number of patients they already have and don’t want to take on additional Medicare beneficiaries.

Some of the highest opt-out rates are among psychiatrists. According to KFF, over 40% of the Medicare opt-outs are from the field of psychiatry. This could prove challenging if you are among the growing number of seniors seeking mental health services.

There are some doctors that refuse insurance altogether, preferring to be on-call for private citizens willing to pay a hefty fee. These are known as concierge doctors, and they are becoming more popular in high-income communities.

What are the consequences of doctors refusing to accept Medicare patients?

If a doctor decides not to accept Medicare, then they will no longer be eligible for reimbursements from the program. However, this does not mean that these doctors cannot see Medicare patients. It simply means that the patient will need to pay out-of-pocket for any services they receive from this doctor and then submit a claim to Medicare for reimbursement. In some cases, doctors may also be fined or penalized for refusing to accept Medicare patients.

How can people find a doctor who accepts Medicare patients?

The best way to find a doctor who accepts Medicare is to use the "Find a Doctor" tool on Medicare's website. This tool allows you to search for doctors in your area who accept Medicare and meets other criteria, such as their specialty and language spoken. Additionally, many hospitals and healthcare facilities have lists of doctors who are participating providers with Medicare. You can also call your local Medicare office to get more information about finding a doctor who accepts Medicare.

What if your doctor doesn't accept Medicare?

If your doctor doesn't accept Medicare, you should ask them why they are not participating in the program. Your doctor may be able to offer alternative solutions that would make it possible for you to receive care from them while still receiving reimbursement from Medicare. If you receive care and they have opted-out of Medicare, you could be responsible for the full cost of the treatment out-of-pocket.

You can use the "Find a Doctor" tool on Medicare's website to search for doctors in your area who accept Medicare. You can also contact your local medical society or hospital to find a list of doctors who are participating providers with Medicare. Finally, you can call 1-800-MEDICARE (1-800-633-4227) to speak with a representative and get more information on how to find doctors who accept Medicare.

Conclusion

A growing number of doctors may choose to opt-out of Medicare. For Medicare beneficiaries, it's important to make sure your doctor accepts Medicare. Otherwise, you could pay for your treatment out-of-pocket. For all your Medicare-related questions, talk with an expert at Fair Square Medicare.

Stay Up to Date on Medicare!

Header brushstroke decoration.

Join the Fair Square Medicare Newsletter to stay informed on cost savings, changes to Medicare, and other valuable healthcare information.

Learn More About Medicare


Birthday stock image

What Is the Medicare Birthday Rule in Nevada?

Mar 28, 2023

Ozempic stock image

Does Medicare Cover Ozempic?

Mar 28, 2023

Pre-Existing condition stock image

Can Medicare Advantage Plans Deny Coverage for Pre-Existing Conditions?

Mar 28, 2023

Cover image

What People Don't Realize About Medicare

Mar 27, 2023

woman in a hospital wearing a bandana being shown information by her doctor stock photo

Medicare Advantage Plans for Disabled People Under 65

Mar 24, 2023

senior couple working in a greenhouse stock image

Medicare Supplement Plans for Low-Income Seniors

Mar 23, 2023

Kansas farm stock photo

Medicare Savings Programs in Kansas

Mar 22, 2023

Cover image

How Much Does a Medicare Coach Cost?

Mar 20, 2023

20 Q's with Fair Square

20 Questions to Ask Your Medicare Agent

Mar 17, 2023

Washington DC stock image

14 Best Ways for Seniors to Stay Active in Washington, D.C.

Mar 11, 2023

Nashville city skyline stock image

14 Best Ways for Seniors to Stay Active in Nashville

Mar 10, 2023

Seattle Public Market stock image

14 Best Ways for Seniors to Stay Active in Seattle

Mar 10, 2023

Union Station in Denver stock image

15 Best Ways for Seniors to Stay Active in Denver

Mar 9, 2023

Indianapolis skyline at night stock image

13 Best Ways for Seniors to Stay Active in Indianapolis

Mar 9, 2023

Charlotte skyline stock image

14 Best Ways to Stay Active in Charlotte

Mar 9, 2023

senior couple doing yoga stock image

13 Best Ways for Seniors to Stay Active in Columbus

Mar 8, 2023

Philadelphia skyline at sunset stock image

13 Best Ways for Seniors to Stay Active in Philadelphia

Mar 7, 2023

Arizona desert stock photo

13 Best Ways for Seniors to Stay Active in Phoenix

Mar 6, 2023

Your Medicare One-Stop-Shop

Your guide to Medicare Parts A & B, Medicare Advantage, and Medigap.

100% free.

Fair Square Medicare

LEGAL

Privacy Policy

MORE


Virgil Insurance Agency, LLC (DBA Fair Square Medicare) and www.fairsquaremedicare.com are privately owned and operated by Help Button Inc. Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. This is a solicitation of insurance. A licensed agent/producer may contact you. Medicare Supplement insurance is available to those age 65 and older enrolled in Medicare Parts A and B and, in some states, to those under age 65 eligible for Medicare due to disability or End-Stage Renal disease. Virgil Insurance Agency is a licensed and certified representative of Medicare Advantage HMO, HMO SNP, PPO, PPO SNP and PFFS organizations and stand-alone PDP prescription drug plans. Each of the organizations we represent has a Medicare contract. Enrollment in any plan depends on contract renewal. The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. Plan availability varies by region and state. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. © 2022 Help Button Inc

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

MULTIPLAN_FairSquareMedicare_01062022_M