My mom is on Medicare, can a doctor's office refuse to see a Medicare patient?

I'm no expert but I think doctors can choose not to accept Medicare patients just as they can choose what insurances they wish to accept. It's sad but a lot of doctors do not feel they get enough reimbursement so they don't participate with Medicare.

Doctors can refuse patients based on the reimbursement including Medicare. Typically they just say that outright. More and more practices are being bought by hospitals, these docs will then take Medicare because they will feed into the hospital which almost always takes Medicare.

It is true that a Dr's office can refuse patients regardless of payer source. As patients switch payer sources, such as the various insurances that the Dr. is not a provider for they will get openings for new patients.

Doctors do not have to see Medicare patients, but it must be an overall policy. That means they can not see some Medicare patients and not others. If they see any Medicare patients, they must see all Medicare patients.

I would try looking for a geriatric specialist or may be a DO (doctor of osteopathy) as they are more likely to see Medicare patients.

I had the same problem. There was not a doctor in our town that accepted new patients on Medicare. We finally found one about 20 minutes away. I'm not sure I blame the docs though. The amount that they receive from Medicare is hardly worth their time. I do believe doctors have to continue to treat their current patients on Medicare, but they do not have to accept any new patients on Medicare ... it's their choice. I kinda liked the fact that I had to search long and hard to find a doc that accepted Medicare because when I finally did, he was so nice and patient with Mom. I think when money is not the only factor for a doc, they are usually so nice with the elderly ... at least that was my experience with her 2 doctors.

Yes MD's do not have to accept Medicare or any other health insurance. The reinbursement rate is so low that in many practices it costs them to have a Medicare patient especially an elderly one that take more time in both physician time as well as staff and having them in & out of the patient care room.

if she has a secondary insurer then often they will take Medicare patient. My mom has Medicare and has a federal Blue Cross and her eye & ortho doc's only would see her because they could bill BCBS.

Deb - the reason that hospitals take Medicare is because if they ever got built using federal funds, which until the last couple of decades that included almost ALL hospitals in the US, then they were built under the Hill Burton Act. Under Hill Burton the hospital was legally required to accept any and all federal health care programs and even more importantly they had to accept patients no matter what their ability to pay. When hospitals when thru the big building phases in the late 1970's and 1980's and were built new they could do a partial Hill Burton
by accepting Medicare and not the poverty ones. They would request a waiver from their regional planning body (the Heath System Agency in the region's Council of Government) because of whatever technology that was "special" they were doing - heart surgery was a biggie back then, then MRI buildings in the 80's.
No one back them ever though heath care would get so expensive in the US!

There are still hospitals out there under total Hill-Burton. You have to google to find out what might be in your area. But for the poor elderly and their caregivers, it is worth it. You cannot be billed if you have no ability to pay. Almost all are teaching hospitals too - which IMHO is the best place to go for care.

A long time ago doctors were willing to take livestock or your fruit/vegetables in exchange for medical care. Those days are long gone. Now its about cold hard cash. Medicare is famous for lots of red tape and a lengthy wait for payment. Doctors don't want to deal with all the crap, so they refuse patients with only medicare for insurance.

I once had a doctor tell me "it" wasn't going to work because I didn't care about my health. She grudginly took me on as a patient. I dumped her as a doctor immediately. Apparently, she only wanted healthy patients... not sick ones. Sick patients don't care about their health, but healthy patients do. What utter garbage! Worthless doctor. But, there are a slew of doctors that share that sentiment. They don't want difficult cases and the aging usually take more time and have more liability I suppose.

Its a show me the money world these days.

Just a little FYI............the amount a doctor receives for a Medicare patient is around $26. And that is for anything from a simple cold to running tests. And in their private practice they can refuse or accept anyone they choose....after all, it is their business.

Sure. I doctor may refuse to see a Medicare patient. If you are on Medicare, and you wish to see this particular physician, ask him (or the office) what would be the fee if you paid privately?.....out of pocket. Don't be surprised if the fee is outrageous.

We are in a transition phase as the massive Medicare cuts mandated by Obamacare kick in. It no longer makes economic sense to see these patients. The doctors are preparing for a future without Medicare by gradually getting rid of these patients.

A doctor has never had to accept Medicare patients (it has absolutely nothing to do with the Affordable Care Act). The only rule is that if they accept one Medicare patient they cannot turn down other patients who are on Medicare if they are still accepting new patients.

My dentist does not participate in the insurance I am enrolled in. I've been paying out of pocket for many years, and have recently decided to switch to a dentist within my plan. This has nothing to do with any legislation, pending or passed. It is a decision my dentist made when he started practice.

A doctor I wanted to see does not participate in Medicare. She is not part of a clinic and cannot afford to take less reimbursement for some patients and average it out over a large patient base.

Larger practices tend to accept all or most insurances, including Medicare or Medicaid. But let's not kid outselves. They still have to meet their expenses (including office staff to handle insurance claims) and pay their doctors and nurses and custodians and cover their rent and equipment ... So what they lose on Medicare they have to make for with higher fees to other patients.

There is no free lunch.

I have called so many physicians to find a Doctor who would accept Medicare...they wont. Seems they want that almight dollar so they can continue to make $200,000 a year or more. I never made that much, but I still cared about human beings.

well maybe states differ on what drs receive from medicare. I just looked at my husbands explanation of benefits. He had two office visit. One wasa $185 and medicare paid $161.54 and blue cross paid the rest. Another visit was $150 and Medicare paid $102.35 and blue cross paid the rest. He had an exam from a eye dr and was charged $150. He could have went to any optical place for the same eye exam for $39. I think medicare and all of us are being ripped off. With fancy offices. 10 on the staft etc etc-somebody has to pay

Here's a new twist on medical. We have a doc that is absolutely magnificent. He charges $55.00 per month to take you on as a patient. We first started with having my parents go to him because their medical issues were complex and they were on medicare with a supplemental insurance plan that picked up the difference on medicare approved procedures, etc. It's hard to mentally accept such a different concept of medical care, essentially that you pay your doctor monthly for the privilege of having him/her available when you have a need. However, this doctor, with the aid of the monthly patient charge, reduces the number of patients he sees. He spends as much time as necessary with his patients. He calls you at home to ask how things are going. It is the closest thing to having a private physician and a friend who cares. I went to see him the other day to talk about my dad's medical situation and he spent an hour with me. Not everyone can afford, or in this changing world, would be willing to consider a physician under this monthly fee basis. I understand that completely. Nevertheless, for us it has been a Godsend. If my dad has a problem, I pick up the phone and call. We can get in that day and my dad gets the best of care. I think that may be happening more in various areas. I'm glad I came across it when my parents came into my care. It has made their medical care 5 star.

I would like to add a small note here....yes, physicians make a good salary overall when they have been in practice for many years. Considering what they do I guess that salary is justified. But the amount these physicians are reimbursed from Medicare is a whopping $26 per patient. Have you ever been in the ER with your loved one and the physician orders a lot of extensive tests and you wonder why.....how else does the facility make the money off a Medicare patient? Those people with insurance and supplemental policies are the ones who pick up the tab after Medicare. Not fair I know, but there's nothing any of us can do.
cattails......I like the concept of what your physician is doing....that might be something that catches on. That's what the air ambulance in my area is doing now...a monthly fee for that "just in case" time since an average air ambulance bill can be as high as $20,000.

Cattails: Way to go. Congratulations on finding a solution to medical care ( not Medicare) with your personal physician. Many people are choosing this option now in exchange for a monthly sum. $55.00 is amazing. Most docs charge much more for this service......mine charges $1,500.00. I declined..... rarely need it with so many docs in my family.

cattails - great concept. Just out of curiosity, is the doc a solo or group practice or part of a larger clinic with many different practices and is the $ 55 for the "system"?

playa - The $ 39 visit was likely from seeing a optician or optometrist or more probably an optometry tech (under the "supervision" of the optometrist)at a business that is about selling eyeglasses, contact lenses, etc. None of these are MD's or true physicians, which is what an Opthalmalogist is, and as such cannot diagnose diseases or write Rx's or do surgery. With the elderly, because of cataracts, glaucoma, macular degeneration being so common & a part of the aging process, it is really important that they been seen by an ophthalmologist. $ 150 is pretty standard, my mom's annual visit is $ 235.

ray - Physicians like NH's can opt out of participating in Medicare or Medicaid. As others have said the reimbursement rate is so low and the time & staffing needed for serving that population is more labor intensive that it doesn't work $ wise. If you are anywhere close to a medical school or teaching hospitals, look to getting into their system for health care. They will take Medicare and Medicaid. It will be well worth it even if you need to drive

this below from Joseph Rago in last weeks WSJ:

"To appreciate what's wrong with the current system, imagine four patients identical in every way except for their insurance coverage. They report to the same doctor for a routine procedure, say, a colonoscopy.

The first patient is on Medicare, which controls prices. The program's fee formula sets prices unilaterally for about 7,000 physician services and pays lump sums for 600 general hospital diagnoses, regardless of the quality of care. Medicare pays TWICE (my emphasis) as much on average for a colonoscopy if it is performed in a hospital outpatient setting rather than in a doctor's office.

Patients two and three are covered by private insurers, but those insurers are likely to reimburse the doctor at different rates—whatever they've negotiated to include him in their networks. The rate will be higher than competitive to make up for Medicare's below-cost fees—the gap between public and private rates is now about 40 percentage points. The rate is also likely to be a proprietary trade secret, or else literally unknowable: The doctor can only generate price information when he codes his services and bills the insurer.

The fourth patient is uninsured. If she seeks treatment, she'll be billed directly from a "chargemaster," a hospital's list of marked-up sticker prices that no one with coverage will ever pay.

So one doctor, four patients, four different prices, multiplied times one-sixth of the economy. Price discrimination, or varied pricing, is common in service industries with high fixed and low marginal costs: airlines, colleges, hotels, telecom. But nowhere else but health care are prices so arbitrary, so disconnected from value. The consensus, on the right and left, is that this fee-for-service jumble is incoherent."

For the advanced elderly trying to deal with the current system is almost impossible. There is no way my 90+ mom could do it. I don't know what the solution is but something universal needs to be done in the US before those of us in our 50's & 60's become a tsunami of health care needs in the next decade or so.

Igloo: He is one of four docs working together. Started out as two docs then added two more over time. Each doc charges his/her patients the same monthly fee.

I am so frustrated and horrified by Medicare. I am 45, and my father is 73 and living in southern Oregon. He is having short-term memory problems, and I'm worried he has Alzheimer's or some other form of degenerative dementia. I started to try to find him a local general practitioner in his town, and could find almost no one taking Medicare patients. Finally found a practice, but they would not see him for FOUR MONTHS. I know he will need a neurological referral, and I can't schedule that until we get a referral from the GP ... then the neurologist will take (I am told) ANOTHER two to three months to schedule. This is ridiculous. Worse, the only doc I could find who WOULD see my Dad as a Medicare patient is from one-star medical school with very little practical experience.

I started looking into what it would cost to buy into a private insurance plan, if not for my Dad (who now presumably has a pre-existing condition), then for myself and my husband when we turn 65. I couldn't find one. But I did stumble across the news of an alarming lawsuit (Sibelius vs. Hall) wherein some fairly well-off Americans (including Dick Army) have said they want to "opt out" of Medicare because they prefer to stick with the private plans they somehow manage to have ... and the government has responded that you CANNOT opt out of Medicare without also giving up ALL social security benefits! And not only future benefits, but the past benefits they already paid to you! INSANITY!

So, as I understand this ... when I turn 65, I will be FORCED to go onto a program that more and more doctors are simply refusing to accept as payment. Since I cannot alternately buy private insurance, my only alternative if I can't find a doctor who will accept Medicare is to pay out of pocket. But as you can see in the article above, the cost to out-of-pocket patients -- which SHOULD by any law of logic and sense be LESS than what is being charged to patients who pay through vast, bureaucratic networks that require enormous amounts of paperwork and additional staff to handle it all -- is VASTLY higher than to Medicare or private-insurance patients. I have seen this in person ... my current medical insurance paid approximately $6,000 for my melanoma surgery, which reimbursement invoices showed me otherwise would have been billed to me at $30,000. Same for my husband's jugular liver biopsy a few years back.

I don't object to paying out of pocket if I have to to get decent care ... but I can't pay astronomical costs like these, which only seem to exist in order to try to "make up" for some of what doctors are losing to Medicare and private insurance.

So this is where we are. By forcing elderly patients onto Medicare, the government is cutting them off from the vast majority of good, qualified doctors ... sentencing them to shoddy care from overstressed, often underqualified doctors ... and not giving them ANY other option whatsoever. And all this at a time in their lives when many people are not intellectually capable of understanding how to advocate for themselves or to research the best in a very limited pool of poor options. I am not a political extremist, but if I don't have private insurance options when I turn 65, I will try to figure out where in the world I can move to maximize my chances of being able to access decent health care. I find this situation really, really scary.

"Health coverage" DOES NOT EQUAL health care.

fivebyfive, I agree with you that something is seriously wrong with a system that inspires so many medical providers to refuse to participate. I agree that the situation is scary.

I don't know how things are in your immediate area, but at least here in Minnesota it is definitely not true that using providers who accept Medicare sentences us "to shoddy care from overstressed, often underqualified doctors." My husband's geriatrician, sleep-disorder psychiatrist, behavioral nuerologist, and cardiologist are all top notch. The Mayo Clinic, which accepts Mediciare, is known Internationally for its quality care.

Medicare, along with the administrative side of health care delivery in general in the country, is definitely in need of serious improvement. In spite of the broken nature of the administrative infrastructure, it is still possible and even likely for us elderly to get high quality care from dedicated, skilled, and compassionate providers.

5X5 - Is there any way you can get your folks seen by the gerontology practice affliated with a medical school? The level of care and umbrella of services will be more co-ordinated and almost always medical school and their teaching hospitals take Medicare, Medicaid and most major insurers. Could part of your MD availability be an issue of demographics? Are you in a rural area? There just isn't enough MD's out there much less in smaller towns so the docs that are there just aren't going to take new Medicare patients or Medicare at all as the reinbursement rate is just so low that it is not cost effective. Or is there a secondary insurer or Medicare supplemental plan in your area affiliated with a health care/hospital group they could join?

I will echo Jeanne's comments on Medicare providers, my mom doc's take Medicare & Medicaid, and they are all multiple board certified and medical school faculty and focused on the reality of health care for the elderly.

When Medicare was first done, it was designed as insurance for hospitalization. This is Medicare Part A and it is a federal entitlement that is tied into SS. You do not have to be "forced" to use Medicare but anyone who works in the US and has SS taken out will pay into Medicare Part A. You pay for it whether you use it or not, just as you do for SS. You have to enroll in order to participate in it. Medicare Part A actually pays pretty good for hospital related services. Now overtime, Medicare added Part B - which pays for medical services, Part C and Part D - the drug/prescription program. It is the low reimbursement Part B that keeps doc's from participating and some people have a Medicare supplemental plan to pay for part of what Medicare Part B doesn't.

Regarding the lawsuit, what was at the heart of their complaint was, I think, was that they are covered by FEHB and therefore don't need Medicare Part A but are in essence paying twice for the same health benefit and want to quit Part A. FEHB is Federal employee health benefit available to all federal retiree's and have the payment for it taken from their retirement. FEHB is not just for the wealthy.My mom was covered by FEHB as my late father was a federal employee and her FEHB was a Texas high option Blue Cross plan. So every month she has about $ 96 a month taken from her SS to pay for Medicare Part A and then she also would have $ taken out from her federal survivor annuity to pay for her FEHB which was through BCBS. FEHB, I think, is proportional so if you have a large federal retirement it can be a pretty big chunk of $$ every month. But if you are on FEHB, you really don't have any co-pays or other costs for your health care as long as you see providers in the FEHB system in your state. How it worked for my mom was that FEHB worked in tandem with Medicare with Medicare as the first payor and then BCBS as a secondary or BCBS as the primary if the provider did not take Medicare. My mom's old opthalmologist did not take Medicare at all ever but would see her because she had federal BCBS which was in essence her Part B payor (but at the much higher & faster BCBS reimbursement rate). I bet that since FEHB works in tandem with Medicare that doomed the lawsuit. My mom is now on Medicaid and her FEHB is "suspended" because Medicaid is now the secondary payor.

The Medicare system certainly has problems, but thank goodness that it's there.

"...ask him (or the office) what would be the fee if you paid privately?.....out of pocket. Don't be surprised if the fee is outrageous."

Fwiw...the average cash cost of a simple office visit at the family physician is about the same cost as one tankful of gas (for a family sedan) or one carton of premium brand cigarettes.

It comes down to what you think is "outrageous" for the $$ paid.

Huh? I don't smoke and don't know the cost of cigarettes, but the most I've paid to fill my 4-door Buick sedan lately is $65. I cannot visit any one of my doctors for less than double that amount.

I am not complaining about the cost of a doctor visit. Generally it is a good value.

BUT let's keep the comparisons honest. A doctor visit is not the same cost as a tank of gas. (And I do think gas prices are outrageous.)

Please forgive the hyperbole, but my intention was to make the point "outrageous" is in the eye of the beholder. Fwiw, my family physician's cash price for a brief OV is $65. Their new patient OV is $120.

What upsets me is the large number of people with Medicare who will find it almost impossible to find a doctor after January 1 because Medicare will cut payments by 26.5% and will be forced to use emergency rooms for care. It only stands to reason many doctors will quit taking it. Heck, who would willingly accept a pay cut like that ?

Yes, a doctor can refuse a Medicare participant.

oneijoe, I don't know where you live, but it sure isn't around here! A brief office visit for under $100? Ha! But good for you.

I agree with your concern about cutting Medicare payments. None of my clinics have notified me of a change in acceptance policies. I hope that holds.

Most doctor's offices will continue taking care of their current patients, I think, especially if you have a continuing problem. It's those without a family doc and those needing surgical and other specialty care which are most at risk.