Not all physicians accept Medicare. To find out if your doctor accepts Medicare, ask the doctor’s office directly or use the Physician Compare tool found at Medicare.gov. Or, for more personal advice, contact Generations Insurance!
Levels of Assignment with Medicare
If a doctor accepts Medicare, it means they accept Medicare assignment. That means they accept Medicare’s payment terms. Accepting Medicare’s payment terms means they agree to accept the Medicare-approved payment for covered services. This is often much lower than what a healthcare provider would normally charge insurance companies.
Participating Providers. Healthcare providers that accept Medicare assignment are known as participating providers. They accept the Medicare-approved amount as payment for their healthcare services. If you see a participating provider for a covered service, the provider will charge Medicare 80% of the cost for the service and charge you the remaining 20%.
Non-participating Providers. Healthcare providers that are non-participating can choose whether or not they want to accept Medicare assignment. That means that if they choose to, these non-participating healthcare providers can charge up to 15% above the Medicare-approved amount for covered services. These additional charges are called Part B excess charges. With these providers, you could end up paying the equivalent of 35% of the Medicare-approved amount for covered services.
Opt-out Providers. Healthcare providers that have chosen to opt out of accepting Medicare assignment are allowed to charge you whatever they want for healthcare services. You would have to pay for the full cost of these potentially exorbitant charges.
How to Find Doctors that Accept Medicare
The Centers for Medicare and Medicaid Services (CMS) has a helpful tool available to assist you in finding physicians who accept Medicare. This tool, which is called the Physician Compare tool, can help you find a Medicare-approved physician based on their medical specialty, geographical area, or by the physician’s name.
How to Find Out if Your Doctor Accepts Medicare
There are two ways you can go about finding out whether or not your doctor accepts Medicare. You can contact your doctor’s office directly by calling the office’s phone number or visiting the office in person. Ask the front desk whether or not your doctor accepts Medicare. If they are a non-participating provider, they may not accept the Medicare-approved amount for covered services, but you would not be responsible for paying more than 35% of the Medicare-approved amount for covered services. If your doctor is an opt out provider, they do not accept Medicare assignment and can charge you whatever amount they wish to.
You could alternatively find out whether or not your doctor accepts Medicare from the comfort of your own home. Use your computer or mobile device to search your physician’s name in the Physician Compare tool, which you can find at Medicare.gov.
For more information about how doctors accept Medicare or finding a doctor that accepts Medicare, contact Generations Insurance.