If you’re age 65 or older and have Medicare, working with a doctor who takes Medicare can make a big difference when it comes to your medical bills. In this article, we’ll show you four smart reasons for choosing a doctor who takes Medicare — and what to expect if you don’t.

Doctors who take Medicare…and those who don’t

Are you looking for a doctor who takes Medicare? Some do, some don’t, and some decide based on the type of services they offer and care you need. There are basically three types of relationships health care providers can have with Medicare.

  • Medicare-enrolled providers will only charge the Medicare-approved amount for services that a health plan pays for. These services can often cost less out of pocket than services from doctors who don’t accept Medicare.
  • Non-participating providers have no obligation to accept the Medicare-approved amount. But, they can choose to do so for any service. These doctors can charge up to 15% more than the Medicare-approved amount for their services.
  • Opt-Out Providers do not take Medicare coverage. They will bill you for services in full. They require a private contract between a patient and any person, clinic, pharmacist, or group that gives a member healthcare services. You both agree that neither will get a reimbursement from Medicare for services provided.

4 smart reasons to choose a doctor who takes Medicare

There are at least four reasons why it’s a good idea to visit providers that accept Medicare:

  1. It’s easy to know what you’ll pay. When you use a doctor who takes Medicare, you’ll know exactly what to expect when you pay the bill. An enrolled provider won’t charge more than the Medicare-approved amount for covered services.
  2. You could save money. You may pay less out of pocket with a doctor who takes Medicare than with a non-participating or opt-out provider. That’s because you’re only responsible for your deductible and copayments for covered services.
  3. Your doctor submits Medicare claims. You won’t need to worry about submitting claims to Medicare — your doctor will handle this for you at no charge.
  4. Medicare pays first. Most of the time, providers who accept Medicare will wait for Medicare to make payment on a claim before collecting your part of the bill.

If you don’t choose a doctor who takes Medicare…

Before you go to a provider that doesn’t accept Medicare, there’s a few things to think about:

  • Your cost could be 15% higher than the Medicare approved amount or more. When you see a non-participating provider, you may have to pay the “limiting charge” in addition to your copay. The limiting charge can add up to 15% of the Medicare-approved amount to your bill. If your provider has opted out of Medicare, the limiting charge does not apply, and your provider can bill any amount they choose.
  • You’ll pay out of pocket. If your doctor is non-participating, you’ll usually need to pay out of pocket for all charges. Anything Medicare covers will be reimbursed to you. Opt-out providers will charge you in full for all services. Medicare will not help you pay these bills.
  • You’ll need to submit claims to Medicare. If you work with a doctor who takes Medicare, they’ll submit claims for you. But if your doctor doesn’t accept Medicare, you may be on your own when it comes to submitting a claim.
  • Some healthcare services won’t be covered. If you use a Medicare Supplement plan, your benefits won’t cover any services when your provider has opted out of Medicare. Translation: you’ll be on the hook to pay the entire bill.

Looking for a doctor who takes Medicare?

You’ve got lots of options. Only about 1% of doctors in the U.S. don’t accept Medicare.2 Want some help finding a Medicare plan that works for you and has your preferred doctors? Call a licensed insurance agent today at (800) 488-7621, or find a local agent.

48804-HM-0822

References

1. Lower costs with assignment. (2022). Retrieved from: https://www.medicare.gov/your-medicare-costs/part-a-costs/lower-costs-with-assignment Accessed on July 15, 2022. | 2. How many physicians have opted-out of th the Medicare program? (2020). Retrieved from: https://www.kff.org/medicare/issue-brief/how-many-physicians-have-opted-out-of-the-medicare-program/ Accessed on July 15, 2022.

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