Medicare is one of the most widely accepted health insurance policies. However, some doctors won’t accept it. If your doctor doesn’t accept Medicare, you may still be able to negotiate. There are always options with Medicare, and when you put these choices into practice, you can avoid paying excessive costs for your healthcare.
How Are Doctors Classified?
With Medicare, doctors can be divided into three categories – participating, non-participating, and opt-out.
Will A Participating Doctor Refuse Medicare?
Participating providers accept Medicare at all times. When you get a treatment or service from a participating physician, they’ll agree to compensation equal to 80% of what private insurance gives them. You’ll foot the rest of the bill.
What Can I Do When A Non-Participating Provider Refuses Medicare?
Non-participating providers are physicians who generally do not accept Medicare, but can make exceptions. If you have a non-participating doctor, you may be able to get them to make an exception. You won’t get savings to the same extent like you would with a participating provider. Non-participating providers will accept the same amount of pay from Medicare, but will require slightly more from you. These are known as excess charges. But if you have Medigap, you may get coverage for excess charges, so this may have the same outcome as seeing a participating provider.
You may have to pay all costs upfront and be reimbursed later. Your physician may have to file a Medicare claim, or you may have to file a claim yourself via Form CMS-1490S.
What If My Physician Is An Opt-Out Provider?
Opt-out providers don’t accept Medicare whatsoever. Also, physicians aren’t forced to take Medicare for the entirety of their careers, either. A once participating provider can choose to be an opt-out provider at any time. In this case, the best you can do is negotiate costs. All doctors are required to give their costs upfront. If you’re able to get certain costs reduced, you then sign a contract stating that you agree to the terms of the opt-out arrangement.
What If My Doctor Stops Accepting Medicare?
If your doctor becomes an opt-out provider, your only way to get Medicare coverage is to seek treatment elsewhere. Most physicians will be able to refer you to participating providers.
Another alternative is to visit Urgent Care centers, which function as both walk-in and emergency clinics. These will more than likely accept Medicare.
Outside of this, you can browse Medicare’s directory of participating providers on the Medicare website. Once you find a physician you’d like to see, it is a good idea to call the facility they work in and get confirmation that they accept Medicare.
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At Medicare With Jake, your healthcare will always be more affordable. You’re not alone, and we are here to help give you the proper guidance so that you won’t have to worry about high out-of-pocket expenses. Call us today at (833) NOW-JAKE to get started.
