Can Doctors Choose Not to Accept Medicare?
Fair Square Medicare

Can Doctors Choose Not to Accept Medicare?

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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.

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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.

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


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