Finding Physicians Who Accept Medicare?

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dm200
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Finding Physicians Who Accept Medicare?

Post by dm200 » Mon Nov 09, 2009 5:03 pm

As I approach Medicare age, I am concerned about two conversations I had over the weekend with friends/acquaintences. One person related the difficult search for a phycician (or physicians) who would accept new Medicare patients. They related how sparse that list was.

The next day, someone else mentioned searching for a new physician. Her physician of many, many years has sent notices to his patients that he will no longer accept Medicare, and that she will need to find a new physician.

Any experiences (positive or negative) or succestions to avoid problems like this?

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Re: Finding Physicians Who Accept Medicare?

Post by Mel Lindauer » Mon Nov 09, 2009 5:11 pm

dm200 wrote:As I approach Medicare age, I am concerned about two conversations I had over the weekend with friends/acquaintences. One person related the difficult search for a phycician (or physicians) who would accept new Medicare patients. They related how sparse that list was.

The next day, someone else mentioned searching for a new physician. Her physician of many, many years has sent notices to his patients that he will no longer accept Medicare, and that she will need to find a new physician.

Any experiences (positive or negative) or succestions to avoid problems like this?
Not only do you need to find a doctor who accepts Medicare, you need to make sure they accept "Medicare Assignment" which means you won't have to pay any amount over and above what Medicare says is the amount they'll pay for any particular treatment.
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medgar
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Post by medgar » Mon Nov 09, 2009 5:31 pm

Dm200,

I have been involved in the medical field for 11 years and have seen many things change over the last 3 years.

If it matters to you, make sure you will see the physician not the NP or PA.
Many FP are now directing Medicaid and Medicare patients to their midlevel providers. This does not mean the care will be worse or better.

Interview the physician, as I tell my family, a doctor who finished last in their class is still a doctor. Many of my coworkers who have retired with the choice to buy into the companies' healthcare will continue to stay in to get the doctor they want. They will find a way to use medicare as secondary insurance.

A physicians can opt out or see the minimum patients the need to for medicare so make sure you have a second choice physician in mind.

Good luck with your search,
Medgar

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Post by likegarden » Mon Nov 09, 2009 5:39 pm

You probably checked into the medicare.gov website and found this description which explains what "Medicare" is all about :

"It is important for you to understand that Medicare does not cover everything, and it does not pay the total cost for most services or supplies that are covered. You should talk to your doctor to be sure you are getting the service or supply that best meets your health care needs.

The amount of your coverage is also dependent on whether you have coverage under Medicare Part A, Medicare Part B, or both. Medicare Part A typically pays for your inpatient hospital expenses and Medicare Part B typically covers your outpatient health care expenses including doctor fees."

It seems that Medicare A does not cover doctor visits outside the hospital.

Medicare has several plans. Once you turn 65 you have Medicare A free, which is for in-hospital care and does not cover all costs. Medicare B is for out-hospital doctor visits and cost close to $100/month /person extra. I have additional insurance which pays what Medicare A and B do not cover, handles all the interface to Medicare for me, plus pays most of drug costs. I have no problem finding a doctor, actually am within an HMO for convenience. Optician and Dentist visits are not covered by all of the above.
Good luck!

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Post by neverknow » Mon Nov 09, 2009 6:30 pm

In the small rural town I was in -- all the doctors accepted Medicare, but not all specialties were represented in the community. I was forced to move near a big city for access to medical care.

Of 250 or so listed in one specialty (in the big city) - only one accepted Medicare, and they are taking on no new Medicare patients. The odds of finding a more generalized internist type that accepted Medicare was somewhat better. I have very little regard for what passes for modern medicine these days, so I utilize the Residents (supervised doctors associated with the university). They take all Medicare and Medicaid - and via the associated teaching hospital, all specialties are represented. I find the quality of medical advice greatly varies. The Residents are still learning, so sometimes I know more then they do (but they have Attending doctors to correct their mistakes). But in patient, I have run into the heads of the departments, supervising the residents, and these folks have got to be the best in the country.

This lack of access is what Medicare Advantage pays for - access, to something other then doctors still under supervision. But as I understand it, our politicians want to take this away. I will make no comment on whether this is a good idea or bad idea as that is political.

I think Medicare is every bit as good as any private insurance I ever had. But then again, like I said - I have a very low regard for what passes for modern medicine these days. I don't expect much, and constantly find myself needing to protect myself from koo-koo fadish ideas, that have done me harm in the past. I have refused about 75% of the health care that has been attempted to be sold to me in 2009. I don't need it. They are wrong.
neverknow

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ruralavalon
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Post by ruralavalon » Mon Nov 09, 2009 6:40 pm

Here is a search function that might help-- http://www.medicare.gov/Physician/Searc ... on=default .
"Everything should be as simple as it is, but not simpler." - Albert Einstein | Wiki article link:Getting Started

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Post by fishnskiguy » Mon Nov 09, 2009 7:13 pm

Although I have only been on Medicare a little over a year, my experiences to date have been one hundred percent positive. We were accepted by the first primary care physician we applied to, and have been very happy with him.

I had spinal surgery to fuse two neck vertebrae this spring following a bicycle crash, and later had a very complicated, two part surgery on my left hand to correct a hereditary condition. All three surgeries were done at the world famous Steadman-Hawkins Institute in Vail, all covered by Medicare. I've also been a patient at the main Vail hospital and my wife has had surgery at the hospital in nearby Glenwood Springs. She has been very happy as well.

Not to be a name dropper, but the last time I saw the doc who fixed my hand, he had just come out of unscheduled surgery to fix Kyle Orton's (the starting quarterback for the Denver Broncos) throwing hand.

Chris
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Post by Patchy Groundfog » Mon Nov 09, 2009 8:11 pm

The first practice I called to find a doctor accepting new Medicare patients accepted me. On top of that, I liked the doctor. I had expected a long search, and was prepared to settle for whoever would take me, whether I liked him/her or not.

When my father was new to Medicare, he was treated by a specialist who happened to be his first cousin. Dad was so appalled when he found out how little Medicare had paid that he went out and bought the doctor some kind of flowering tree and planted it in his yard. I think he checked with Mrs. Doctor first - I hope so.
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Post by flowerbuyer » Mon Nov 09, 2009 8:22 pm

I just turned 65, and have been on my employer's plan (HMO). I wanted to find a private physician, but in my area, I cannot find a physician who will accept Medicare, even with the best medicare supplement plan. So my only (non) choice is the HMO. My ex-husband is a state legislator, and when his dad's physician retired, and my ex-husband could not find a physician who will accept him (Medicare).

I wrote our congress-persons about this, and the reply I received was all about their support of the proposed health care plan. No mention at all of the subject of my letter!

This is a serious problem that is much more prevalent in some areas than others.
Last edited by flowerbuyer on Mon Nov 09, 2009 8:24 pm, edited 1 time in total.

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Chas
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Post by Chas » Mon Nov 09, 2009 9:06 pm

mark500 wrote:Medicare generally pays providers less than private insurance. Private insurance subsidizes Medicare.
Without private insurance, some procedures/exams/consults would not be worth what Medicare pays to a provider.
Medicaid reimbursement to providers is very low, and they often refuse to pay unless strict criteria are met.
I have secondary insurance that covers anything medicare doesn't pay. It does not matter, the established general practitioner physicians, at least those in Dallas and Houston area, generally will not accept new medicare patients, secondary insurance or not. I found that I had two choices, either a new doctor just establishing themselves, or one of those that runs patients through like cattle without even requiring an appointment. I have learned to educate myself on my medical conditions and I just use my primary care physician for prescription renewals and periodic blood work. I haven't had a problem with the specialists, at least not so far.
Chas | | The course of true love never did run smooth. Shakespeare

Jack
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Re: Finding Physicians Who Accept Medicare?

Post by Jack » Mon Nov 09, 2009 9:18 pm

HearDoc wrote:And good luck with that when medicare reimbursements are scheduled to be cut by 21% in 2010.
Medicare reimbursement rates are based by law on the 1997 "sustainability growth rate" formula. Each year the formula spits out a negative number and each year congress overrides it with rate increases. Rates are not going to be cut by 21%. It is pretty much like the alternative minimum tax threshold that is annually fixed by congress.

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Post by wshang » Mon Nov 09, 2009 11:25 pm

Patchy Groundfog wrote:When my father was new to Medicare, he was treated by a specialist who happened to be his first cousin. Dad was so appalled when he found out how little Medicare had paid that he went out and bought the doctor some kind of flowering tree and planted it in his yard. I think he checked with Mrs. Doctor first - I hope so.
Your father is a very wise man. That physician will always remember your Dad and you can bet, will go the extra mile for him. Kindness and appreciation are among the two greatest things I hear lacking from their practice - along with how poorly Medicaid pays.

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Post by Lbill » Tue Nov 10, 2009 10:16 am

I've been on Medicare for 3 years and go to the same doctors and health facilities I did when I was on my employer's private health insurance. I was flabbergasted at the small percentage of the billed amounts that Medicare actually approves and pays, compared to what my employer's insurance did. I'm no friend of doctors and hospitals getting rich off sick people, but I frankly can't believe that doctors and hospitals could survive if they had to live off the meager Medicare reimbursements. It concerns me greatly that it will only become more difficult to obtain good medical care with Medicare, except in some instances. I happen to go to a University hospital and I believe (but don't know for certain) that they have to accept Medicare because of Federal funding. Maybe we'll all end up living in University towns to have access to decent medical care at some point.
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Post by semperlux » Tue Nov 10, 2009 1:52 pm

Haven't had a chance to read the entire thread, only the first few posts so forgive me if someone already mentioned this.

I've worked at 3 different university teaching hospitals and I believe in general all internal medicine or family medicine clinics accept medicare because they are teaching hospitals.

I may be wrong, but at least of the institutions I've worked at, this seems to be the case. I would call up your nearest university hospital, ask for their internal medicine or family medicine clinic number and call to find out.

Added bonus is that you will most likely see an MD instead of an NP or PA, not that there's anything wrong with them. But you'll have a better chance if you specifically want to speak to the physician instead of a midlevel provider.

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Post by BlueEars » Tue Nov 10, 2009 3:02 pm

Right now we are retired but not 65 yet and have an employer provider insurance that is going up 26% next year and has gone up at a compounded rate of 24% over the last 5 years ... nice CAGR if it were matched by investment performance :roll:

I'm reading this thread with interest and wondering what we are going to be looking at come 65 in a few years. Currently Medicare would become our primary insurance with the employer insurance as a secondary one. The choices seem quite confusing when I read over the company literature for the over 65 group.

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Post by Alex Frakt » Tue Nov 10, 2009 3:59 pm

I have deleted several posts that had nothing to do with the original question and were in violation of the forum's ban on political and/or economic policy posts.

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Post by mikec » Wed Nov 11, 2009 2:18 pm

I wish poster would specify their location. In Wisconsin, Milwaukee county, I haven't been refused any [medicare advantage] medical service. In the last 4 years, for example, I have a had numerous contacts with a general practitioner a few appointments with my cardiologist and the associated hospital, a surgeon and outpatient facility for hernia surgery, and a few other misc. procedures and contacts.

So far, I've had the best medical care in the world. Judging from the above comments, this may be subject to change. I still have hope that it won't, of course.

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dm200
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Post by dm200 » Wed Nov 11, 2009 3:02 pm

mikec wrote:I wish poster would specify their location. In Wisconsin, Milwaukee county, I haven't been refused any [medicare advantage] medical service. In the last 4 years, for example, I have a had numerous contacts with a general practitioner a few appointments with my cardiologist and the associated hospital, a surgeon and outpatient facility for hernia surgery, and a few other misc. procedures and contacts.

So far, I've had the best medical care in the world. Judging from the above comments, this may be subject to change. I still have hope that it won't, of course.
Washington DC area.

I don't have the problem ... YET. Since I will be eligible for Medicare in 2011, I would like to get any ideas to prevent having a problem.

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Post by flowerbuyer » Wed Nov 11, 2009 4:38 pm

I'm not the OP, but I live in Olympia, Washington and we DO have a real problem with physicians refusing to accept medicare, even with the best medicare supplement insurance. And from what I can learn, there is no way to "pave the way" for physicians to accept us as Medicare patients.

pr
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Post by pr » Wed Nov 11, 2009 4:51 pm

You should try a teaching hospital as someone else suggested. They are not required to take medicare but most do. BTW, I was recently told that the Mayo Clinic-Jacksonville stopped taking new medicare patients. May want to switch now before your local teaching hospital adopts this policy.
Last edited by pr on Wed Nov 11, 2009 4:58 pm, edited 1 time in total.

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Post by pr » Wed Nov 11, 2009 4:56 pm

mikec wrote:I wish poster would specify their location. In Wisconsin, Milwaukee county, I haven't been refused any [medicare advantage] medical service. In the last 4 years, for example, I have a had numerous contacts with a general practitioner a few appointments with my cardiologist and the associated hospital, a surgeon and outpatient facility for hernia surgery, and a few other misc. procedures and contacts.

So far, I've had the best medical care in the world. Judging from the above comments, this may be subject to change. I still have hope that it won't, of course.
If you look at census data, Wisconsin ranks among the top 5 states in pop with private insurance (77%). On the other hand only 57% of people in Texas have private insurance. Therefore it is much easier for a physician in Wisconsin to take a loss on a medicare patient than it is for a doctor in Texas.

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Post by pshonore » Wed Nov 11, 2009 4:59 pm

A friend of mine in Connecticut was "turned away" by her longtime OB/GYN when she reached 65. Since that particular specialty primarily treats younger patients, turning away Medicare patients probably has very little financial impact on revenues compared to say, a Cardiologist.

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Post by mikec » Wed Nov 11, 2009 5:29 pm

Thanks pr.

Everyone knows [or should know] that private insurance patients subsidize medicare patients. So the higher percentage of private patients in Wisconsin explains why there is not problem here getting medicare coverage. Thank God no one is proposing reducing medicare payments further, or retired people like myself could all be in serious trouble.

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Post by bog » Wed Nov 11, 2009 5:39 pm

Life's real problems should be so simple.
The US has a shortage of primary care physicians, so some do not accept new Medicare patients. This is less of a problem among specialists.
If you already have a good relationship with your current primary care physician, ask if he will dump you when you get Medicare. If so, dump him first - you really don't want a doc with such a lack of loyalty and concern for you anyway.
If you need a new doc accepting Medicare and cannot easily find one, look for a gerontologist (a good idea for older people in any case), consider a teaching hospital, or join an HMO.
PS: Doctors are NOT "losing money" or "taking a loss" on Medicare patients, just sometimes they are making less than they could with other patients. Big difference. The idea that regular patients are "subsidizing" Medicare patients is ludicrous. If the doc is really in very high demand, he may even refuse new patients that cannot pay cash for whatever he chooses to bill.

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