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Hard to find a Dr who takes Medicare?
Old 07-04-2009, 02:50 PM   #1
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Hard to find a Dr who takes Medicare?

This is not intended to be a political post.

I keep reading stories about how many Doctors will not take Medicare patients - allegedly due to high compliance costs and low reimbursements. Apparently in some high cost parts of the country, for some specialties, this is quite a sizable crisis.

I think it is illegal under Medicare rules for people to pay Doctors outside of "the system", but this does not preclude the existence and use of Medigap policies. Does having a Medigap policy make it easier to find a Doctor? In other words does this "crisis" only apply to those who do not have such policies?
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Old 07-05-2009, 10:37 AM   #2
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Quote:
Originally Posted by FinanceGeek View Post
I think it is illegal under Medicare rules for people to pay Doctors outside of "the system", but this does not preclude the existence and use of Medigap policies. Does having a Medigap policy make it easier to find a Doctor? In other words does this "crisis" only apply to those who do not have such policies?
Nobody else seems to be replying, so here's my take on the situation: I don't think that having a Medigap policy will solve the problem of finding a physician.

As I understand it, a Medigap policy covers the "gap" in Medicare part B. The latter pays 80%, the patient is responsible for the remaining 20%. The 20% is the "gap." Note that the 80% is not 80% of the physician's costs/profit, but 80% of what Medicare thinks is a reasonable cost. Apparently, for a lot of physicians, 100% of not enough is still not enough.

Others may have a better or more accurate explanation.
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Old 07-05-2009, 12:48 PM   #3
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Originally Posted by Dudester View Post
Nobody else seems to be replying, so here's my take on the situation: I don't think that having a Medigap policy will solve the problem of finding a physician.

As I understand it, a Medigap policy covers the "gap" in Medicare part B. The latter pays 80%, the patient is responsible for the remaining 20%. The 20% is the "gap." Note that the 80% is not 80% of the physician's costs/profit, but 80% of what Medicare thinks is a reasonable cost. Apparently, for a lot of physicians, 100% of not enough is still not enough.

Others may have a better or more accurate explanation.
That is the rub. When what medicare pays you doesn't cover costs and overhead, let alone a profit then you have to decide whether to take on medicare patients or not.

DD
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Old 07-05-2009, 04:33 PM   #4
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Here in Anchorage, Alaska, if you are over 65 and need to see a primary care physician, you have to go to the free clinic or the emergency room. Private primary care physicians do not take new medicare patients. Some might continue to see you if you've been their patient for many years, but no one will commit.
This is a modern city of about 350,000 people.
It's been covered in the Anchorage Daily News (local stories), and AARP magazine in the last year. I had a friend taking care of an elderly father here, and there was no legal way for him to get medical care.
If nothing here changes DH and I will have to move before he turns 65.
The doctors say they lose money with every medicare patient. But no one has provided actual numbers. A relative on medicare in Portland Oregon has no problem seeing a doctor whenever she wants to.
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Old 07-05-2009, 05:38 PM   #5
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I have read about primary care doctors not taking on new Medicare patients but I can say that here in the suburbs of Pittsburgh, this is not the case. I believe the proposed new health plan is providing for increases to primary care physicians, and decreases to specialists.
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Old 07-05-2009, 05:43 PM   #6
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My Mother in Law is on Medicare and was treated at the Cleveland Clinic, I have not heard of Medicare being a problem in central Ohio.

Burch
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Old 07-05-2009, 08:07 PM   #7
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My Doctor's office has a sign - No Medicare/Medicaid. Have no idea how prevalent that is.

But it is interesting that we are saying that Doctors don't want to take these cases because the pay is so low, yet, I understand that Medicare/Medicaid is a huge unsustainable cost to the US.

Doesn't sound good at all.

-ERD50
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Old 07-05-2009, 08:29 PM   #8
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I've only heard of one case where Medicare wasn't taken locally (Washington DC area), a friend went to an urgent care clinic and was turned away. They would take cash, but the "cash" doctor wasn't in that day

I've been turned away from Tricare standard by at least one doctor. Next year I'll be Medicare + Tricare for Life, so I wonder how that will work out.
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Old 07-05-2009, 08:37 PM   #9
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I have been on TRICARE for a number of years. TRICARE is similar in many respects to MEDICARE. The rates paid to doctors are the same or very close. The demographic is younger in that TRICARE covers the families of active duty military people as well as retired military and their families up until the point they become MEDICARE eligible; at that point, TRICARE becomes a medigap supplement to MEDICARE.

In two locations, Maryland and Vermont, I have never had any problem with doctors taking TRICARE (and, by logical extension, I believe they take MEDICARE.) Here is one thing I think I have figured out: if you get your care through doctors working for a hospital that receives significant Federal funds (like, for research), I believe they have to accept the Federal programs such as TRICARE/MEDICARE. I used to see doctors at Johns Hopkins in Baltimore and I currently see them at Fletcher Allen in Burlington, VT. In both cases, they are more than happy to accept TRICARE. In both cases, they both receive Federal funds.

So, if you have the opportunity to receive health care at such a place, I believe they will be accepting of MEDICARE,
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