- Most primary care doctors accept Medicare.
- It’s a good idea to confirm your coverage before your appointment, especially when seeing a specialist. You can do this by calling the doctor’s office and providing your Medicare information.
- You can also call your Medicare provider to confirm coverage.
The simple answer to this question is yes. Ninety-three percent of non-pediatric primary care physicians say they accept Medicare, comparable to the 94 percent that accept private insurance. But it also depends on what type of Medicare coverage you have, and whether you’re already a current patient.
Read on to learn more about Medicare coverage and how to determine if you’ll be covered.
The Medicare website has a resource called Physician Compare that you can use to search for doctors and facilities enrolled in Medicare. You can also call 800-MEDICARE to speak with a representative.
If you’re enrolled in a Medicare Advantage plan, you can call the plan provider or use their member website to search for a doctor.
For most of these tools, you can usually browse for a medical specialty, a medical condition, a body part, or an organ system. You can also filter your search by:
- location and ZIP code
- hospital affiliation
- doctor’s last name
In addition to online tools or calling your insurance provider, you should also call the doctor or facility to confirm that they take Medicare and are accepting new Medicare patients.
Your doctor may stop accepting Medicare insurance for various reasons. If this happens, you can either pay out of pocket to continue the service or find a different doctor who does accept Medicare.
If your doctors hasn’t signed an agreement to accept assignment for all Medicare-covered services, they are considered a non-participating provider. This means that they are enrolled in a Medicare program but can choose whether or not to accept the assignment, which is the approved amount Medicare will pay for a service.
While participating Medicare providers will not charge you more than the Medicare-approved amount, the same is not true for non-participating doctors. This may mean you have to pay up to 15 percent more than the Medicare-approved rate for a service.
States can limit this rate to a 5 percent upcharge, also called a limiting charge. This is the maximum amount that can be charged to Medicare patients after the 20 percent coinsurance.
Some doctors may require some or all of these payments at the time of your appointment, while others may send a bill afterward. Always confirm your doctor’s payment policies before your appointment so you know what to expect.
You then have 1 years to file a claim with Medicare to be reimbursed for these charges.
Most medical professionals accept Medicare, but it’s always a good idea to confirm whether your doctor is a Medicare provider. If your doctor ever stops taking Medicare, you may want to ask them how it affects your plan and what you can do to make sure you’re financially covered.