Doctors Abandoning Medicare?

The Wall Street Journal reported on July 19, 2013, that 9,539 doctors opted out of Medicare in 2012 according to the Center for Medicare and Medicaid Services.

Should this be a concern to those on Medicare?

Yes and no. Out of a nationwide pool of some 685,000 doctors, 9,539 is about 1.4%, a rather miniscule number. But the trend is scary because it is triple the number of doctors who opted out several years ago and “Baby Boomers” are now aging on to Medicare.

Why are doctors opting out of Medicare?

Medicare payment rates are low and most Medicare services are still paid for on a fee-for-service basis. We’ve been in a vicious downward spiral regarding how Medicare pays most providers for many years. The Affordable Care Act tries to change this pattern which is as follows: The government cuts reimbursement rates. As a result of lowered rates, the incentives for providers are to increase their volume of services and procedures to make up for what they lost in lower rates. This then in turn results in additional costs, which again leads to further cuts in reimbursement rates.

Which doctors are opting out and where?

Generally doctors who have very established practices in primary specialties, located in affluent parts of the country, are those who opt out. But a scary part of the trend is more specialists are opting out, too.

How would I know if my doctor opted out of Medicare?

A doctor who has opted out of Medicare is obligated to provide patients with what is called a private contract. These documents can vary but are usually 2 or 3 pages which indicate:

The doctor can’t submit the claim to Medicare.

The patient can’t submit the claim to Medicare.

The patient acknowledges that he or she is paying cash.

Will my Medicare Supplement or Medicare Advantage Plan cover if my doctor has opted out of Medicare?

No, but it is possible that a retiree medical plan would provide some coverage.

What about Concierge Doctors? What are they and have they opted out of Medicare?

Concierge doctors promote more personalized service. They reduce the total number of patients they see in their practice and those patients pay an additional fee. Some Concierge Doctors have opted out of Medicare and should provide you with a private contract. Others do participate with Medicare but charge an additional fee that pertains to services that Medicare doesn’t cover such as providing you additional access to the doctor through home visits and/or email.

What else should I know?

Some doctors who participate with Medicare have closed their practices to new Medicare patients and/or are maintaining a waiting list.
Clearly, if you have a long standing relationship with a doctor you think may be retiring before too long, you should think about whom you want to see to replace that doctor, and what their status is with respect to Medicare.