An estimated 94% of all primary doctors accept private insurance, and 93% accept Medicare. This means that it is almost certain that your primary physician will accept Medicare.
But how do you know if your doctor will accept Medicare?
The first thing you can do is confirm your coverage by either contacting your Medicare provider or your doctor’s office directly.
I Need to Find a Doctor that Accepts Medicare. How Do I Do That?
Suppose you are looking for a doctor or care provider who accepts Medicare. In that case, you can call 1-800-MEDICARE or visit medicare.gov to find a doctor who will certainly accept your plan. If you are enrolled in a Medicare Advantage plan, your Medicare Advantage plan provider should be able to help you find a doctor through their preferred network (if there is one).
My Doctor Stopped Accepting Medicare, Now What?
If you are an existing patient and your regular doctor stops accepting Medicare, you can either find a new primary doctor who takes Medicare or continue seeing them and pay out-of-pocket. Be sure to speak with your doctor before making a switch to find out how you will be affected by the changes in coverage.
What Are Non-Participating Providers?
Some doctors are considered non-participating. This means that they have not signed a contract to accept assignments for all Medicare services. Assignment is the approved amount that Medicare will pay for a given service. If you have a non-participating provider, they may still be enrolled in a Medicare program, but they accept assignments at their discretion. This means that you may be treated at a higher cost than what Medicare would cover.
While a Medicare participant will not charge more than the Medicare-approved cost for services, a non-participating provider could charge up to 15% more than this amount. Some states have a “limiting charge,” which is about 5% above your regular 20% coinsurance, to help keep these costs in check. Additionally, your doctor will either bill you or require all payment upfront. Note that you have one year to file a claim and be reimbursed for any applicable charges through Medicare.
While it is extremely likely that your doctor will accept Medicare, it is wise to confirm their participation. If you choose to continue seeing a non-participating doctor, ask plenty of questions to know what to expect when the bill arrives.
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