What If My Doctor Doesn’t Accept Medicare?

When the ACA was passed in 2010. the now famous phrase “If you like your health plan, you can keep your doctor” was born. It proved to be false. Life went on, millions more people were able to access health care. As we all saw, however, many physicians wanted no part in the new health care options available as a result of that new health insurance program.

Now we’re being bombarded with new health care proposals: Medicare for All, Medicare for America, and still others that look like parts of each of them with some existing health insurance plan options thrown in. But, as was the case with Obamacare, the question is “Will my doctor accept Medicare?”. If you think the answer will be “Yes” just because everyone will have it, think again.

Not all doctors accept Medicare now. If you choose to stay with a non-participating doctor, you’ll have to pay the difference between the fee and the Medicare reimbursement. Keep in mind that Medicare only pays 80% of what is considered the Medicare standard fee. You’ll likely have to pay the entire amount of the bill at the time of the office visit. In most cases, you will be responsible for submitting a claim to Medicare.

What about Medicare Advantage or Medicare supplemental plans currently available to help defray co-payments and other ancillary fees? First, a doctor has to accept traditional Medicare before anything can be reimbursed by these plans. More importantly, these plans are underwritten by private insurance companies. Some of the proposed Medicare plans call for the elimination of private insurance companies. So what happens to deductibles and co-payments? Will they be gone, too? Under some plans, yes.

The fact is more and more doctors aren’t accepting Medicare. Depending upon where you live, it may be getting difficult to find a doctor you like that accepts any health insurance. Where does this leave Medicare for All and Medicare for America?


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