Medicare Participating Doctors
Information on how Medicare's doctor network works
A big question for many people new to Medicare is "which doctors can I see on Medicare?" Good question and you're probably going to like the answer (if you're new to Medicare). The good news is that most doctors participate with Medicare and even a higher percentage of hospitals (close to all of them) participate in Medicare. What does this mean to say that they participate? Good question. Let's get into the doctor network of Medicare and understand how it even affects which Medicare supplement plan you should choose.
Let's say you've been with your Dr. for years now and are turning age 65. One of the big issues with switching insurance plans is having to make sure your doctor participates in the network (usually PPO or HMO) and if not, who can you choose. Switching to Medicare is slightly different. It functions most closely to a PPO nationwide network or more like an EPO (Exclusive Provider Organization) since there are no benefits with the very small number of doctors that are not in the network. Usually the easiest way to check your existing doctor is just to call the office and ask them if they "accept Medicare". You'll most likely get a "yes".
When a provider "accepts Medicare", it essentially means that they accept the schedule of reimbursement rates that Medicare will pay for various services. On average, Medicare's reimbursement rates are 60% of private carriers but in any given area, there's a larger (and growing) number of Medicare eligible patients so there's a trade off. Similar to any PPO style network, a provider received reduced reimbursement for a large influx of customers/patients. Accepting Medicare basically means that a doctor will accept Medicare's rate of reimbursement for Medicare patients. You are not restricted to a certain area with Medicare and can use any provider in the U.S. that accepts Medicare. This is very important since the plan and the accompanying Medicare supplement plan will travel with you as opposed to many pre-65 health plans that are State specific.
Now there's a little wrinkle that comes into play with providers that participate in Medicare. A provider can choose to charge up to 15% higher than the allowed Medicare reimbursement rate and still be considered as "accepting" Medicare. This additional charge is called "Excess". This is where Medicare supplement plans come into focus. Some of the Medigap plans cover this excess while others don't. Many people new to Medicare are unaware of this excess provision since with most health plans, you're either in or out of network...there's no gray area. This gray area can cost you quite a bit of money so it's very important to make sure you choose a Medicare supplement plan that covers excess. This excess aspect will only continue to become more of an issue going forward since Medicare is under such financial constraints and history shows that doctor reimbursements generally take the brunt of budgetary cuts on Medicare. More and more doctors will be forced to charge this increase amount as the percentage of patients on Medicare increases with the aging of the U.S. population. The F Medicare Supplement plan covers this excess charge which makes it our favorite plan of choice for complete coverage.