Can Doctors Refuse Patients Covered Under Medicare?

By: Thomas Wright
Published: Tuesday, November 20 2018
Last Updated: 25 days ago

Medicare was designed as a sort of healthcare safety net for senior citizens, young people with certain disabilities, and patients with end-stage renal disease (ESRD). While these groups are covered under Medicare, the number of doctors dropping Medicare patients under this form of government-funded health insurance has been rising in recent years. There are many reasons for the falling rate of Medicare-accepting doctors who are looking for other forms of insurance as primary providers.

Doctors Who Don’t Choose To Accept Medicare

Those doctors refusing Medicare patients are described as opting out of the program for various reasons. A small percentage of medical professionals have been looking to not provide services for Medicare patients because of a large amount of paperwork and delays they have been seeing with the program. Some physicians do opt-in with this insurance scheme but do not guarantee the fees recommended by the program for all Medicare patients and are described as non-participating doctors. These physicians have the right to charge up to 15% above recommended service fees but are not actively dropping Medicare patients.

The Percentage Who Don’t

The percentage of doctors refusing Medicare patients has been growing over the course of the 21st-century as paperwork begins to pile up for those not dropping Medicare patients. A study in Texas in 2013 showed around 60% of family physicians were actively accepting patients covered by Medicare, falling from 80% in 2003, The number of doctors refusing Medicare patients continue to grow with reports showing 22,000 physicians nationwide no longer accept Medicare insurance due to the high-pressure demands of the program.

Are Doctors Allowed To Refuse Medicare Patients?

As with all types of insurance, doctors have the right to not accept Medicare patients looking to solely use this insurance as their means of payment. Many doctors are now refusing many forms of private and publicly-funded insurance policies because of the high incidence of burnout among physicians spending more time looking over electronic health records than seeing patients face to face. Medicare patients are guaranteed emergency services from all medical professionals as is the right of all individuals involved in an emergency situation.

There are myriad reasons why a physician would decide to no longer accept patients covered by Medicare insurance, including the long delays experienced between service and payment. The literature regarding Medicare patients explains the shortest time period between service being offered and payment being received is just 14 days, but this has been proven to be something of a misnomer.

What To Do If You’re Denied

This is one of the toughest questions asked by patients who often wish to work with their long-term physician but find they do not accept Medicare payment options. The first step to take when a family doctor explains they no longer accept Medicare is to contact the chosen insurance plan provider and ask for a directory of physicians accepting this form of coverage. Medicare patients are left with the options of paying out of pocket, negotiating a lower rate, asking for a referral or simply finding a new doctor.

Pay Out-Of-Pocket

If a patient switches to a Medicare plan and finds their existing doctor does not accept this insurance they are faced with the very real possibility of paying out of pocket for needed services. Doctors often provide their services on the proviso of payment received at the point of delivery with a set menu of fees published to assist each individual.

Negotiate A Lower Rate

This is often one of the most difficult aspects of working with a physician who is used to working from a set price list for their services with different insurers. Negotiating a lower rate for cash following a medical service is possible but the time and effort may be more difficult than simply seeking out a new doctor.

Ask For a Referral

In the 21st-century, physicians understand the turnover of patients is extremely high due to the demands of insurance companies and will often work with an individual to find a high-quality alternative. A physician opting-out of Medicare coverage will often know of doctors in an area willing to accept coverage from different insurance companies. Referrals can come from different areas including family and friends who are also covered by Medicare.

Find A New Doctor

One can seek the assistance of Medicare when looking for a new doctor as a directory of physicians taking part in these plans can be obtained from Medicare Advantage. Patients can simply call a family doctor and be told if their insurance is accepted by that physician during a short chat with a receptionist.