- Although many physicians participate in the Medicare program, not all doctors will accept the insurance plan.
- If your physician doesn’t participate in Medicare, you’ll need to decide whether it’s time to switch to a different doctor.
- Some doctors accept Medicare, but can charge you up to 15 percent extra, as well as requiring you to pay the full amount at the time services are rendered.
Medicare is a great program for those who have retired or suffered a qualifying disability. But as with any insurance plan, there are some physicians who will say they don’t accept Medicare. Those physicians are known as non-participating providers.
If your favorite physician doesn’t accept Medicare, you’ll have a few choices to make. You can pay the extra cost, choose a different provider, or use a service like urgent care for your medical needs. Below are some details about those options.
What is Medicare?
You’ll need medical care your entire life, even after you leave the workforce. Medicare was set up to help cover the costs of medical care so that you can retire knowing your healthcare expenses will be manageable. But as you’ve probably learned with other medical plans, not all medical providers accept all insurance policies, and Medicare is no exception.
Before you retire, you’ll need to make sure your healthcare will be covered by Medicare. Fortunately, it’s easy to look up doctors who accept Medicare by searching the Medicare.gov website. If you don’t find your current doctor, you may have to shop for a new one.
What to Do When Your Doctor Doesn't Take Medicare
Do all doctors accept Medicare? Unfortunately, no. Some medical providers simply don’t participate in the program. When that happens, below are a few options:
Pay the Difference
Even if your doctor doesn’t accept Medicare, you may still be able to continue your care with that professional. Medical practitioners who participate in the program have signed documentation to participate under something called a Medicare assignment. Providers who don’t sign the document can continue to care for you as a non-participating provider if they choose.
Before you opt for this, though, it’s important to know what to expect. Doctors who accept Medicare assignment will be able to offer you services at a lower out-of-pocket cost. There is a limit, though. Doctors can charge you more for taking Medicare, but they’re limited to 15 percent over the cost that participating providers would charge. You may, however, be required to pay the full amount at the time of service, then wait for the doctor to submit the forms to Medicare to get your money back.
Request a Discount
There is another scenario where you’re better off looking for doctors in your area that accept Medicare. Some doctors completely opt out of Medicare altogether, which means they’ll require you to sign something called a private contract before they’ll provide services.
If your doctor has opted out, you’ll have a choice. You can choose one of the many doctors that take Medicare or you can pay the full cost out of pocket. If you go the latter route, negotiate a discount with your doctor, who is actually benefiting by not having to go through the Medicare process to get paid. It’s always worth a shot, even if you think your doctor won’t go for it.
Consider Urgent Care Centers
Medicare saves money when you choose urgent care over visiting the emergency room, but urgent care centers can handle more than emergencies. Whether you’re happy or not with your search for doctors that take Medicare near me, urgent care is a good option for non-life-threatening situations like a low-grade fever, allergic reactions, and vaccinations, among many others.
It’s important to weigh the various costs before you use urgent care as an option. If you can find family doctors near me that accept Medicare, you may find you pay less out of pocket. With Medicare, you’ll pay 20 percent of the Medicare-approved amount, as well as your Part B deductible.
Ask Your Doctor for a Referral
If your doctor doesn’t accept Medicare, chances are you can get a good referral. Ask your doctor to suggest a good doctor in the area. It may also help to take a look at the Medicare participating provider list, research some local physicians, and take a list to your doctor to ask if any are recommended.
Use Medicare's Directory
One of your best resources is Medicare.gov/PhysicianCompare. This site lets you track down participating providers in your area. You can use this site not just to find a general practitioner, but also to look for specialists like a gynecologist and neurologist near me that take Medicare.
The CARES Act of 2020
If your illness is related to COVID-19, it’s important to pay close attention to the medical care provisions in the CARES Act of 2020. Patients who have insurance, including Medicare, can’t be charged extra for going to an out-of-network provider. That means even if your COVID-19 visit involved providers other than Medicare physicians, you won’t have to pay more out of pocket than you would for your COVID-related diagnosis and treatment.
Medicare is a great program, but a good doctor is also important. You may find yourself making the tough decision of having your care covered or tracking down another provider. A good Certified Financial Planner® can help you decide the best option for your post-retirement financial health.