If you’ve just signed up for Medicare, you’re probably having some concerns about if your Medicare coverage includes visits to your doctor or primary healthcare provider. This blog will look a little closer at who accepts Medicare, who doesn’t, and why.
Who Is Your Primary Healthcare Provider?
Your primary healthcare provider is the doctor you see for most of your health problems or issues. They’re also the person who will refer you if you do eventually need to see a specialist. Your primary care doctor can be a family physician, general practitioner, or internal medicine specialist. Some seniors opt to use a geriatrician as their primary care doctor since a geriatrician will specialize in treating and preventing diseases that are more common in older adults.
If you’re newly enrolled in a Medicare plan, it’s important to find a primary care doctor who accepts Medicare so that you can manage your out-of-pocket medical costs easier.
To put you at ease, we’re going to start by mentioning that most primary care doctors accept Medicare. According to industry research, around 90% of all primary care doctors accept Medicare.
But let’s discuss why not all primary healthcare providers currently accept Medicare in the next section.
Why Don’t All Primary Care Providers Accept Medicare?
Over the last few years, the prices that private insurers have had to pay have increased dramatically. Because of these higher prices, healthcare costs per individual have also increased, leading to higher premiums and out-of-pocket spending for privately insured people.
Medicare pays physicians and primary care doctors with a fee schedule, while with private insurance, prices are negotiated by payers and providers. This negotiation process means private health insurers usually pay many times more for healthcare services than Medicare.
This sheer difference in prices received by healthcare providers is the main contributing factor towards primary care doctors choosing not to receive new patients on Medicare.
Some people even go as far as to say that taking on patients with Medicare isn’t worth it for the primary care practitioner since Medicare patients receive the exact same kind of medical coverage and services at a much lower price.
Another reason that many primary healthcare providers opt out of working with Medicare patients is the administrative burden that comes with Medicare patients. Because Medicare is a government health insurance program, it’s subject to stringent federal and state oversight. This means far more waiting and paperwork than private medical insurance, as well as more complex reimbursement and billing rules for the primary healthcare doctor.
The extra administrative burden, combined with lower reimbursement rates for their services, is why some primary care doctors choose not to accept new patients with Medicare.
How Can I Find a Primary Care Doctor that Accepts Medicare?
Below is a list of resources you can use to find a healthcare provider that accepts Medicare and learn more about the quality of their services.
- Medicare: To find a provider that accepts Original Medicare, call 1-800-MEDICARE (633-4227) or use Medicare’s Physician Compare tool. If you have a Medicare Advantage Plan, contact your plan for a list of in-network providers.
- American Medical Association (AMA): The AMA offers a search engine on its website to find doctors in your area by specialty. You can also check their training and board certification.
- The American Board of Medical Specialties (ABMS): The American Board of Medical Specialties offers a free service that allows you to look up specific doctor’s credentials or find board-certified doctors in your area. The Official ABMS Directory of Board-Certified Medical Specialists is a book that lists various board-certified doctors. It’s available at hospitals, Socials Security offices, Area Agencies on Aging, senior centers, and local libraries.
- Administrators in Medicine (AIM): You can look up specific doctors on the AIM website. Here you can see the licensing backgrounds of physicians and their practice history.
While some primary healthcare providers are choosing not to work with Medicare patients, the vast majority of them still do, and you will still receive the same high level of medical care when you do need medical services from your primary healthcare doctor.
Based on the information in this blog, you’ll be able to move forward and make an educated decision when picking a primary care provider that suits you best. For more information, be sure to contact Toni Buffington Medicare Solutions today!