Finding a good doctor can be challenging. Many people change doctors over the years until they find one they trust, feel comfortable and confident with. So it’s no surprise that when we start to age into Medicare, we wonder – and worry – if our beloved doctor will accept Medicare.

The truth is, not all doctors do accept Medicare for the patients they see. This can be problematic as it will certainly leave you with higher out-of-pocket costs than you would like. It can also force a tough decision if you need to find a new doctor.

The good news is, according to the Centers for Medicare and Medicaid Services, CMS, most doctors will accept Medicare. To become participating Medicare doctors, according to CMS, they must sign an agreement with Medicare. That means they need to follow the rules for any medical services they provide you with. Simply put, they will:

  • Accept Medicare’s guidelines as the full payment for bills
  • Submit claims to Medicare, meaning you only have to pay your share of the bill

Your costs are generally lowest if you get your services from a Medicare-participating doctor or provider.

Before visiting your doctor, or enrolling into Medicare, you should verify that your desired doctor accepts Medicare.

If they don’t, you still have options.

  1. Pay the difference– Let’s say that after researching, you learn that your doctor is a nonparticipating provider. This means he or she hasn’t signed an agreement to accept assignment for all Medicare-covered services. However, they can still choose to accept assignment for individual patients. In other words, your doctor may take Medicare patients, but doesn’t agree to the program’s reimbursement rates. What does that mean for you? Nonparticipating providers can charge up to 15% over the official Medicare reimbursement amount. Should you elect to stay with your doctor in this instance, you’ll be required to pay the difference between the fees and the Medicare reimbursement. Additionally, you may be required to pay the entire amount of the bill during your office visit. Obviously, this can add up very quickly.
  2. Request for a discount or payment plan– In this example, let’s pretend that you learn your doctor is what’s called an opt-out provider. This means that he or she may still be willing to see Medicare patients, but expects to be paid his or her full fee. In other words, opt-out providers do not accept any Medicare reimbursement, and Medicare doesn’t pay for any portion of the bills they send you. That means you are responsible for paying the full bill out of pocket. However, in certain cases, especially if you have been a long-standing patient, they may offer discounts, payment plans, or extensions on when payment is due. Opt-out doctors are required to give the full amount before your service so you can gauge if it is feasible to pay or not.
  3. Ask your doctor for a referral– If paying out of pocket, at any capacity, is a hard NO for you, talk to your doctor. See who they would recommend you see moving forward.

If you need help finding the best plan, discovering incredible Medicare benefits, or sorting through the options, call us. We are here to help. And yes, it’s completely free.