Medicare Your Coverage Options

Few doctors opt out of Medicare

If you have traditional Medicare, you have coverage from virtually any doctor or hospital in the US. While not every doctor takes Medicare, the vast majority of doctors do. That said, there are a small number of doctors who opt out of Medicare; they will only see people with Medicare who agree to pay them whatever they charge out of pocket.

According to the Centers for Medicare and Medicaid Services (CMS), 1.3 million health care providers take Medicare. And, less than one percent of health care providers opt out of Medicare. In 2017, only 3,732 doctors opted out of Medicare. These doctors tend to practice in wealthy metropolitan areas, where there is a large pool of patients from whom they can receive higher reimbursements for their services.

If you see a doctor who has opted out of Medicare, Medicare will not reimburse either the doctor or you for any services provided. If doctors who opt out want to provide you with care, they must give you a written document explaining that you must pay privately for the care provided you. And, you must sign this document acknowledging that you understand that Medicare will not cover the service and that you must pay privately for it.

While few doctors opt out of Medicare, some specialty groups have more doctors who opt out of Medicare than others. The three specialties with the largest percentage of physicians who have opted out of Medicare are: Psychiatry, with 38 percent opting out, family medicine, with 16 percent opting out and internal medicine, with nearly ten percent opting out.

Of course, there are doctors who take Medicare but who are not taking new Medicare patients. They have a full load of patients or they want to take a balance of Medicare patients and patients with commercial insurance. Whether they take Medicare or commercial insurance, doctors have the right to decide whether they will treat patients.

Always confirm that the doctors you are seeing take Medicare and, to keep your costs down as much as possible, that they take assignment.  Doctors who take assignment, “participating providers,” agree not to charge more than Medicare’s approved rate for their services. 96 percent of doctors nationwide are participating providers. For a list of doctors and other health care providers who have opted out of Medicare, click here.

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