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Do All Doctors Accept Medicare?

Do all doctors accept Medicare? over image of doctor seated at desk

Just the Essentials…

  • Do most doctors accept Medicare? While most doctors do accept Medicare coverage, there are certain out-of-pocket costs to consider. In some circumstances, a doctor may not accept assignment for your Original Medicare, Medicare Advantage, or Medigap coverage.

  • Often, a doctor who accepts Medicare Part A & B will also accept the coverage of your Part C Medicare Advantage plan.

  • In order to ensure your coverage is being applied correctly, you should take extra precautions to ensure that your doctor or healthcare provider accepts your plan. MedicareInsurance.com can help.

How do you find out if your doctor accepts Medicare?

When it comes to finding doctors and other healthcare providers who are willing to accept your Medicare coverage, many of those participating doctors also accept Medicare Advantage plans. In fact, some doctors who accept Medicare will accept plans that offer zero out of pocket cost for certain services. Of course, this begs the question, “Do all doctors accept Medicare?”

According to a recent research study, around 93 percent of primary care physicians currently accept Medicare (virtually the same amount that accept private insurance). However, as a Medicare beneficiary, your primary concern when it comes to your healthcare expenses is accessing care that works for you. Sometimes, finding doctors that are open to accepting new Medicare patients is a part of that.

Finding doctors who accept Medicare Advantage or Original Medicare is relatively simple. There are many ways you can go about doing so, such as asking your current doctor, reaching out to friends, family members, and co-workers, and even browsing online directories.

While it’s true that finding a Medicare-approved doctor is usually quite easy, there are some scenarios where you may require care from a doctor who does not accept Medicare or a healthcare provider who does not accept your exact insurance plan.

Do all doctors accept Medicare Advantage?

Common questions that Medicare beneficiaries often ask include, “do all doctors accept Medicare Advantage Plans?, “do most doctors accept Medicare Advantage plans?” Or, “do doctors have to accept Medicare Advantage plans?”, or even, “why do doctors not accept Medicare Advantage plans?”

Medicare Advantage plans are privately offered health insurance plans that are required by law to provide the same level of coverage as Original Medicare, but often include additional coverage like eye care, hearing care, and dental care. 

Medicare Advantage plan benefits and availability also commonly vary by location, so in the event that you move to a new state or regional area, you will likely need to enroll in a new Medicare Advantage plan that utilizes a Medicare Advantage health network of local doctors and healthcare providers.

You will likely be pleased to know that once a doctor or healthcare provider agrees to accept Medicare, they may also choose to participate in many local networks of doctors for your Medicare Advantage plan.

Essentially, this means that once your provider agrees to accept your coverage, they must adhere to the expense rates that have already been negotiated through your Medicare plan. In addition, they are prohibited from adding additional charges that drive up the cost of Medicare-covered services.

When a doctor or healthcare provider agrees to accept your Medicare insurance and charge the rates that have already been negotiated through the program, this is known as “accepting assignment.”

What happens when a doctor accepts assignment?

As stated, the vast majority of doctors do accept assignment. In doing so, these participating providers enter into an agreement with Medicare to accept essentially all Medicare-covered treatments and services.

If your doctor accepts Medicare assignment, the following points are usually true:

  • Your out-of-pocket expenses may be reduced.
  • Your doctor agrees to charge only the Medicare coinsurance and deductible.
  • Your doctor agrees to wait for Medicare to pay its share before billing you, in most cases.
  • Your doctor is required to submit their claim directly to Medicare, and is not permitted to charge patients to file a claim.
  • Medicare is the entity that determines how much your doctor will be paid for health services and treatment supplies.

What happens when a doctor does not accept assignment?

A doctor or provider who does not have an ongoing agreement with Medicare to accept assignment is considered a non-participating provider. However, it is important to note that doctors who are considered to be non-participating providers may still provide emergency services to Medicare patients, with costs following Medicare’s approved fees for those services.

Should you decide to see a doctor who is a non-participating provider, it is likely that you, the patient, will be required to pay for the full cost of your treatment and services out-of-pocket at the time of service. In some cases, you may be able to submit a Medicare claim yourself, using Form CMS-190S, which will then determine whether you are eligible for reimbursement.

If you are enrolled in Medicare and your doctor is willing, however, they may agree to submit a claim directly to Medicare for any Medicare-covered services you receive while under their care. Still, even non-participating providers are prohibited from charging a person for submitting a claim to Medicare.

How do I find the right network of participating providers?

In order to find a doctor or healthcare provider that accepts your Medicare coverage, you can visit resources such as the Medicare Physician Compare website. From there, you can search by location, the doctor’s last name, the group practice name, medicare speciality, body part, and medical condition.

If you eventually find that you may benefit from enrolling in an entirely new Medicare Advantage plan that may provide greater access to more diverse Medicare Advantage health networks, you can always contact the licensed insurance agents at MedicareInsurance.com simply by giving us a toll-free call at (800) 950-0608. We’ll be glad to help you research and compare your available Medicare health insurance options today!

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