Doctors Are Opting Out of Medicare

EARLY this year, Barbara Plumb, a freelance editor and writer in New York who is on Medicare, received a disturbing letter. Her gynecologist informed her that she was opting out of Medicare. When Ms. Plumb asked her primary-care doctor to recommend another gynecologist who took Medicare, the doctor responded that she didn’t know any — and that if Ms. Plumb found one she liked, could she call and tell her the name?

Many people, just as they become eligible for Medicare, discover that the insurance rug has been pulled out from under them. Some doctors — often internists but also gastroenterologists, gynecologists, psychiatrists and other specialists — are no longer accepting Medicare, either because they have opted out of the insurance system or they are not accepting new patients with Medicare coverage. The doctors’ reasons: reimbursement rates are too low and paperwork too much of a hassle.

When shopping for a doctor, ask if he or she is enrolled with Medicare. If the answer is no, that doctor has opted out of the system. Those who are enrolled fall into two categories, participating and nonparticipating. The latter receive a lower reimbursement from Medicare, and the patient has to pick up more of the bill.

Doctors who have opted out of Medicare can charge whatever they want, but they cannot bill Medicare for reimbursement, nor may their patients. Medigap, or supplemental insurance, policies usually do not provide coverage when Medicare doesn’t, so the entire bill is the patient’s responsibility.

The solution to this problem is to find doctors who accept Medicare insurance — and to do it well before reaching age 65. But that is not always easy, especially if you are looking for an internist, a primary care doctor who deals with adults. Of the 93 internists affiliated with New York-Presbyterian Hospital, for example, only 37 accept Medicare, according to the hospital’s Web site.

Two trends are converging: there is a shortage of internists nationally — the American College of Physicians, the organization for internists, estimates that by 2025 there will be 35,000 to 45,000 fewer than the population needs — and internists are increasingly unwilling to accept new Medicare patients.

In a June 2008 report, the Medicare Payment Advisory Commission, an independent federal panel that advises Congress on Medicare, said that 29 percent of the Medicare beneficiaries it surveyed who were looking for a primary care doctor had a problem finding one to treat them, up from 24 percent the year before. And a 2008 survey by the Texas Medical Association found that while 58 percent of the state’s doctors took new Medicare patients, only 38 percent of primary care doctors did.

Meister, you have queried the entire medical profession? Go to, bub.

Medicare is socialism anyway.

Medicare is socialism anyway.

Why didn't cons get rid of Medicare when they were in power? Could it be that they just like to bitch about it?

Why didn't cons get rid of Medicare when they were in power? Could it be that they just like to bitch about it?

It might be that they, like I, believe that a society needs to care for the infirm, the very old and the very young. If that is the case, they would have done something like expanding the drug benefits of medicare.

Oh, Wait! They did that.

Bitching about a problem for decades without doing anything about it is the tac used by the Dems. The best part about the health care that they want to pass without reading it because the need is so great that action must be immediate, is that it won't take effect for 3 years. (?) I suppose to some, "after three years" is immediate.

After the 2010 election, it can probably be either corrected or abolished.

I saw a doc on TV who said cardiac caths cost half as much in his office as they charge in the hospital but Medicare reimburses him 70 percent less. He will no longer offer that service to Medicare patients anymore. So the govt will now pay twice as much. What efficiency!