My mom is on Medicare, can a doctor's office refuse to see a Medicare patient?

Oh, absolutely, doctors can (and many do) legally refuse to accept/treat Medicare patients. They can also refuse to accept/treat Medicaid patients. They can also refuse to accept/treat patients with any or all forms of “insurance” coverage, including any of the coverage now “universally available” under Obamacare.

I think a lot of people are about to learn the hard way, as I have over the last four years, that “health coverage” does NOT equal “health access.”

This extremely unwelcome reality doesn’t ping on the radar for most of us until we are either trying to find a doctor for a loved one on Medicare or until we are forced onto Medicare ourselves and are told by the doctors with whom we’ve had a relationship for years that we need to find a new care provider (which I HAVE heard of happening even in some big-city practices, though not as often in those as in smaller towns).

The “reimbursement rates” set by the government for Medicare services are shockingly low. The bureaucratic reporting requirements are shockingly high. The net result is that in order to have any hope of being profitable, doctors would have to shuffle an enormous number of Medicare patients in and out of their practices very quickly ... and this is particularly ridiculous when you consider that the Medicare patient population is not one that can or should be “shuffled quickly.” Many practices have had to cope with the fiscal realities by other closing their practices entirely to Medicare patients or by capping the number they will carry.

This has been a well-known problem for years. There is constant pressure to raise the reimbursement rates, and Congress constantly drags its feet. (It’s hard to imagine how this won’t get worse with the $750 billion cut from Medicare to help fund Obamacare ... I do realize that a lot of THAT pain is being borne by seniors whose premiums are doubling or tripling and whose out-of-pocket maximums are doubling, but I assume it will also be spread to the provider end of the spectrum?)

Anyway, if you search the Web to try to find out what the current trend is ... are more doctors opting out of Medicare (i.e., refusing to take new Medicare patients, or "firing" their existing Medicare patients, or simply capping the number of Medicare patients they will agree to see), you will find a wealth of conflicting articles. "Yes!" screams The Wall Street Journal. "No!" insists the department of Health and Human Services.

The REAL answer is somewhere in between ... except that it isn't. In my experience, the real answer is pretty much all "yes" or all "no" ... for the individual who is affected.

For Medicare-age people living in or near fairly large metropolitan areas, finding doctors in almost any specialty who will accept new Medicare patients ... and who will see them within a reasonable time frame ... may not be horrifically difficult.

For retirees in rural communities, the picture can be VERY different, and much bleaker. This has been my father’s experience, in rural southern Oregon, and I have read countless similar accounts from people with parents in Colorado, Virginia, and other states.

For people who are retiring now or getting close to retirement, it is ESSENTIAL to be aware of this fact. Often, people dream of retiring to small towns where the pace of life is slower, more relaxed, and pretty. Maybe with wooded areas nearby where there can be fishing, and so on. In the early years of retirement, medical/health issues may be few and far between. As time goes on, the needs increase. If the nearest “big town” is half an hour or 45 minutes away, that may not seem too far to drive when you’re 65 and in good health. But when you’re 67 and fighting breast cancer, the distance quickly becomes an insurmountable obstacle.

As for people aging “in place” in rural communities, it is especially important that when they turn 65 and are forced to go onto Medicare, they – or the adult children or friend or guardian who is caring for and making decisions for them – REALLY understand the difference between traditional Medicare (with or without Medi-gap insurance) and Medicare Advantage (a quasi-governmental government-funded Medicare insurance policy, typically referred to as a “MedAdvantage” policy).

It can be hard enough for a Medicare patient in a rural or underserved area to find a doctor who will accept a new Medicare patient at all (i.e., traditional Medicare). But if the person has selected a MedAdvantage policy, then he or she must find not only a doctor who will accept new Medicare patients, but one who will accept new Medicare patients AND who is ALSO a member of that particular MedAdvantage network. This can narrow an already extremely narrow stream of provider choices down to the barest drip ... or to nothing.

Worse, when a person first turns 65 and is first forced by our system to go onto Medicare, he or she has “guaranteed acceptance” by whatever Medi-gap or MedAdvantage policy he or she selects. BUT he or she may not realize this will never the case again, except under very specific circumstances (for example, unless he or she moves out of the service area of the current policy) . If a person lives in a rural (or otherwise medically underserved) area and chooses a MedAdvantage policy right at the outset, he or she MAY be inadvertently dooming him or herself to many YEARS of access problems ... regardless of the annual Medicare “open enrollment” period in which people are supposed to be allowed to switch policies.

Imagine, for example, that after a year of living with a MedAdvantage policy, a person living in a rural or underserved community discovers (to his or her surprise, because he or she has never had trouble getting in to see a doctor before!) that it is now EXTREMELY difficult for him or her to get access to health care ... and that the reason he or she is given for this is that doctors in that particular MedAdvantage network simply aren’t taking new Medicare patients, or won’t schedule an appointment for four or five months. During Medicare’s annual Open Enrollment Period the following year, the person might think, “Okay, that MedAdvantage policy was clearly a mistake! I’m going to switch back to traditional Medicare and get a Medi-gap policy instead. At least that way, I’ll be able to see ANY doctor who will take new Medicare patients.”

Except that NOW, that person no longer HAS “guaranteed acceptance” into any Medi-gap policy. Now, he or she can be denied for reason of any pre-existing condition the Medi-gap insurance policy may set ... even if they’re limited to the very same conditions he or she had back when he or she first became “eligible” for Medicare and would have had guaranteed acceptance into the same policy.

My father, who lives in southern rural Oregon, was, like many retirees have been, dumped from the employer-sponsored retiree health insurance benefit program he had been promised over 40 years of service and forced instead onto the Medicare rolls. He’d been assured, back when the law changed to make it legal for employers to shuffle retiree health benefits off their own books in this way, that this would never happen ... but it did, just a few years ago. By then, the dementia was already a problem, and he was having a terrible time even reading the newspaper anymore, much less understanding complicated documents.

I knew he was upset, but didn’t understand why. He told me that his company was cancelling his insurance and wanted him to select some new health insurance through Medicare, but that he had decided to decline this “generous offer,” since he didn’t want to see doctors anyway. I panicked and said, “No, you have to have health insurance,” and threw myself into learning as much as I could about Medicare in the few days remaining in that year’s open enrollment period. In the end, I selected a MedAdvantage policy for him, because the directory for the policy made it look as if there were plenty of doctors taking new Medicare patients in his town, and the premiums seemed reasonable.

For a year, nothing happened. We paid premiums. He didn’t a doctor. His memory got worse. I got more worried. By the following year, I knew I needed to get him in to see a doctor about the dementia ... probably a neuropsychologist, but I quickly learned I couldn’t do that without a referral from a GP. So I started looking for a GP in Dad’s town. I pulled out the current physician directory for his MedAdvantage policy and started calling around.

And I rapidly discovered that of the some 24 doctors listed in the directory as accepting new Medicare patients, over half worked for a clinic in town that not only was NOT accepting new Medicare patients, but HAD NOT DONE SO for FOUR YEARS. I asked why they were still listed in the network directory as accepting new patients, and they explained to me – get this – that the fact that they were still seeing Medicare patients they had already had before they decided not to take any new ones allowed the program to list them as “accepting new patients.” ?!?!?

I called the rapidly dwindling list of other doctors in the directory, and in the end found that only TWO were actually taking new Medicare patients. Both had very poor reviews from patients on the Web (e.g., for not listening, for being rude, for being impatient, and for keeping patients waiting very long times). Both had graduated from very low-ranked medical schools. Both were quite elderly themselves; one had retired and returned to work. Both worked for the same clinic in town. (Are you used to researching doctors, or getting recommendations, and making a considered choice? Welcome to Medicare in rural America! Whenever I see the commercials about how “You’re 65! Welcome to Medicare! You’ve EARNED it!” I remember having to choose between these two doctors for my Dad, and I want to cry.)

I called to make an appointment. The earliest appointment the clinic would make “for a new Medicare patient” was nearly FIVE MONTHS out. And they told me they would not even put THAT appointment on the books until my father – who could at that point barely find his way around town to places he already knew how to get to -- had come personally into their office to fill out all of their paperwork (a HUGE amount) and deliver all of his medical records from his previous physician in another town.

I was shocked. I explained that I was concerned that my father was showing increasing signs of dementia, and that I had read that such a condition COULD be due to a treatable vascular or heart condition, but that if that were the case and the condition were not treated promptly, the damage caused in the meantime would be irreversible. Could they not make an exception and get him in earlier?

Did I want the appointment or not?

When we day finally came, we waited an hour and a half to see the doctor, and got literally 7 minutes of his time. He was unfriendly and had a hearing problem. He asked questions and repeated the answers incorrectly. But he gave my Dad a “mini-cog” exam that consisted of about 5 questions and gave us the referral to the neuropsychologist in a larger town, 45 minutes away. (None of the neuropsychologists in town in the directory were taking new Medicare patients.)

And THAT, in a nutshell, describes, REPEATEDLY, my experience with Medicare (at least, from the point of view of a person with MedAdvantage) in rural southern Oregon. At this point, my Dad’s primary care provider is a nurse practitioner, which is not uncommon in rural and underserved areas.

During the very next Medicare Open Enrollment period, I resolved to switch him to traditional Medicare and a Medi-gap policy, which is when I learned that his ability to make such a switch was no longer "guaranteed," and that I would have to find an insurer who was willing to accept him with any pre-existing conditions (which, of course, now included an FTD diagnosis). Fortunately for Dad, he did NOT have any of the other conditions that would have made it impossible for him to be accepted by a Medi-gap insurer (i.e., joint replacement recommendations, kidney issues, and I can’t remember what all else ... there was a list of 8 or 10 coverage-killing conditions). So now he’s on traditional Medicare with a separate Medi-Gap and Part D policy, and his monthly premiums are about triple what they were with the MedAdvantage policy ... but my hope is that if something happens and I need to find him a doctor in some specialty, I will have a better shot at finding one who will take a new Medicare patient without the additional bottleneck of the network filter.

I’ll be keeping an eye on how things develop with Medicare and Obamacare over the coming years. I don’t think things are sustainable as they are, so I don’t really feel as if I can plan for my own retirement assuming that the current rules/situation will still be in place. It’s frightening ... it took me a long time to learn and understand enough to navigate these waters on my father’s behalf. He could have done this easily at my age, and there’s no way he could do it now. What shape will my brain be in by the time I have to do it for myself?

I am sorry that your experience has been so bleak, HaroldSaxon. I have no trouble at all finding doctors who accept Medicare. The one exception has been geriatric psychiatrists in private practice. My husband was on Medicare twenty years; I've been on it three. We have had access to absolutely excellent doctors, including those at Mayo Clinic.As our health conditions have changed we've changed doctors. No problem.

Maybe in some areas there are many more doctors who do not accept Medicare patients. But here it is the rare exception, not the rule.

I was told when you turn 65 your health benefits are lowered to the level of Medicare by law. If you want to move to another area, the chances of getting a doctor to take you on as a new patient are slim to none. We now have a new type of ghetto, the medical ghetto. You can have health insurance as long as you use your current doctor. I may be wrong, but I heard that doctors cannot charge much more than Medicare cost even if the patient is not using Medicare. It seems that there are laws that only allow a low payment to the doctor for those who are 65 and older. I was fortunate in that I did not have to use my health insurance when I was young; that was 35 to 40 yrs of paying health insurance. Now that I am older and with issues, I cannot move to another area and have guaranteed access to a doctor. It seems that the only guaranteed medical care is the ER. Those WITH health insurance will find that they may not have access to the medical care that they are paying for.

can a doctor refuse to see a cash client

can a goctor refuse to see a cash client

You're right, one1joe, ..the fifteen dollars or now ten dollars ( as of 01/01/13) , is the co-pay for an office visit to the PCP. ER co-pay is $65.00 and for specialists, the co-pay is $35.00 I think these are Medicare Advantage co-pays.

N1K2R3,,, Are you sure the charge from your doctor ("$15 to $35) is the entire office visit charge ? That sounds more like the 20% Medicare doesn't cover (which would mean the actual visit charges would be $75 to $175).

Any physician, be he/she a specialist or a PCP, may refuse to treat a patient on Medicare. That is their choice. I have found a wonderful doctor inthe little city whee I live, who charges anywhere from $15.00 to $35.00 for an office visit. This man is an MD and a Ph.d. His wife is a Nurse Practioner and his son is a Pediatrician. He'll spend as much time as you wish with you to discuss any problem. Lab Tests and Hospital Tests are extra, of course.

Most doctor's offices will continue taking care of their current patients, I think, especially if you have a continuing problem. It's those without a family doc and those needing surgical and other specialty care which are most at risk.

oneijoe, I don't know where you live, but it sure isn't around here! A brief office visit for under $100? Ha! But good for you.

I agree with your concern about cutting Medicare payments. None of my clinics have notified me of a change in acceptance policies. I hope that holds.

Yes, a doctor can refuse a Medicare participant.

Please forgive the hyperbole, but my intention was to make the point "outrageous" is in the eye of the beholder. Fwiw, my family physician's cash price for a brief OV is $65. Their new patient OV is $120.

What upsets me is the large number of people with Medicare who will find it almost impossible to find a doctor after January 1 because Medicare will cut payments by 26.5% and will be forced to use emergency rooms for care. It only stands to reason many doctors will quit taking it. Heck, who would willingly accept a pay cut like that ?

Huh? I don't smoke and don't know the cost of cigarettes, but the most I've paid to fill my 4-door Buick sedan lately is $65. I cannot visit any one of my doctors for less than double that amount.

I am not complaining about the cost of a doctor visit. Generally it is a good value.

BUT let's keep the comparisons honest. A doctor visit is not the same cost as a tank of gas. (And I do think gas prices are outrageous.)

"...ask him (or the office) what would be the fee if you paid privately?.....out of pocket. Don't be surprised if the fee is outrageous."

Fwiw...the average cash cost of a simple office visit at the family physician is about the same cost as one tankful of gas (for a family sedan) or one carton of premium brand cigarettes.

It comes down to what you think is "outrageous" for the $$ paid.

5X5 - Is there any way you can get your folks seen by the gerontology practice affliated with a medical school? The level of care and umbrella of services will be more co-ordinated and almost always medical school and their teaching hospitals take Medicare, Medicaid and most major insurers. Could part of your MD availability be an issue of demographics? Are you in a rural area? There just isn't enough MD's out there much less in smaller towns so the docs that are there just aren't going to take new Medicare patients or Medicare at all as the reinbursement rate is just so low that it is not cost effective. Or is there a secondary insurer or Medicare supplemental plan in your area affiliated with a health care/hospital group they could join?

I will echo Jeanne's comments on Medicare providers, my mom doc's take Medicare & Medicaid, and they are all multiple board certified and medical school faculty and focused on the reality of health care for the elderly.

When Medicare was first done, it was designed as insurance for hospitalization. This is Medicare Part A and it is a federal entitlement that is tied into SS. You do not have to be "forced" to use Medicare but anyone who works in the US and has SS taken out will pay into Medicare Part A. You pay for it whether you use it or not, just as you do for SS. You have to enroll in order to participate in it. Medicare Part A actually pays pretty good for hospital related services. Now overtime, Medicare added Part B - which pays for medical services, Part C and Part D - the drug/prescription program. It is the low reimbursement Part B that keeps doc's from participating and some people have a Medicare supplemental plan to pay for part of what Medicare Part B doesn't.

Regarding the lawsuit, what was at the heart of their complaint was, I think, was that they are covered by FEHB and therefore don't need Medicare Part A but are in essence paying twice for the same health benefit and want to quit Part A. FEHB is Federal employee health benefit available to all federal retiree's and have the payment for it taken from their retirement. FEHB is not just for the wealthy.My mom was covered by FEHB as my late father was a federal employee and her FEHB was a Texas high option Blue Cross plan. So every month she has about $ 96 a month taken from her SS to pay for Medicare Part A and then she also would have $ taken out from her federal survivor annuity to pay for her FEHB which was through BCBS. FEHB, I think, is proportional so if you have a large federal retirement it can be a pretty big chunk of $$ every month. But if you are on FEHB, you really don't have any co-pays or other costs for your health care as long as you see providers in the FEHB system in your state. How it worked for my mom was that FEHB worked in tandem with Medicare with Medicare as the first payor and then BCBS as a secondary or BCBS as the primary if the provider did not take Medicare. My mom's old opthalmologist did not take Medicare at all ever but would see her because she had federal BCBS which was in essence her Part B payor (but at the much higher & faster BCBS reimbursement rate). I bet that since FEHB works in tandem with Medicare that doomed the lawsuit. My mom is now on Medicaid and her FEHB is "suspended" because Medicaid is now the secondary payor.

The Medicare system certainly has problems, but thank goodness that it's there.

fivebyfive, I agree with you that something is seriously wrong with a system that inspires so many medical providers to refuse to participate. I agree that the situation is scary.

I don't know how things are in your immediate area, but at least here in Minnesota it is definitely not true that using providers who accept Medicare sentences us "to shoddy care from overstressed, often underqualified doctors." My husband's geriatrician, sleep-disorder psychiatrist, behavioral nuerologist, and cardiologist are all top notch. The Mayo Clinic, which accepts Mediciare, is known Internationally for its quality care.

Medicare, along with the administrative side of health care delivery in general in the country, is definitely in need of serious improvement. In spite of the broken nature of the administrative infrastructure, it is still possible and even likely for us elderly to get high quality care from dedicated, skilled, and compassionate providers.

I am so frustrated and horrified by Medicare. I am 45, and my father is 73 and living in southern Oregon. He is having short-term memory problems, and I'm worried he has Alzheimer's or some other form of degenerative dementia. I started to try to find him a local general practitioner in his town, and could find almost no one taking Medicare patients. Finally found a practice, but they would not see him for FOUR MONTHS. I know he will need a neurological referral, and I can't schedule that until we get a referral from the GP ... then the neurologist will take (I am told) ANOTHER two to three months to schedule. This is ridiculous. Worse, the only doc I could find who WOULD see my Dad as a Medicare patient is from one-star medical school with very little practical experience.

I started looking into what it would cost to buy into a private insurance plan, if not for my Dad (who now presumably has a pre-existing condition), then for myself and my husband when we turn 65. I couldn't find one. But I did stumble across the news of an alarming lawsuit (Sibelius vs. Hall) wherein some fairly well-off Americans (including Dick Army) have said they want to "opt out" of Medicare because they prefer to stick with the private plans they somehow manage to have ... and the government has responded that you CANNOT opt out of Medicare without also giving up ALL social security benefits! And not only future benefits, but the past benefits they already paid to you! INSANITY!

So, as I understand this ... when I turn 65, I will be FORCED to go onto a program that more and more doctors are simply refusing to accept as payment. Since I cannot alternately buy private insurance, my only alternative if I can't find a doctor who will accept Medicare is to pay out of pocket. But as you can see in the article above, the cost to out-of-pocket patients -- which SHOULD by any law of logic and sense be LESS than what is being charged to patients who pay through vast, bureaucratic networks that require enormous amounts of paperwork and additional staff to handle it all -- is VASTLY higher than to Medicare or private-insurance patients. I have seen this in person ... my current medical insurance paid approximately $6,000 for my melanoma surgery, which reimbursement invoices showed me otherwise would have been billed to me at $30,000. Same for my husband's jugular liver biopsy a few years back.

I don't object to paying out of pocket if I have to to get decent care ... but I can't pay astronomical costs like these, which only seem to exist in order to try to "make up" for some of what doctors are losing to Medicare and private insurance.

So this is where we are. By forcing elderly patients onto Medicare, the government is cutting them off from the vast majority of good, qualified doctors ... sentencing them to shoddy care from overstressed, often underqualified doctors ... and not giving them ANY other option whatsoever. And all this at a time in their lives when many people are not intellectually capable of understanding how to advocate for themselves or to research the best in a very limited pool of poor options. I am not a political extremist, but if I don't have private insurance options when I turn 65, I will try to figure out where in the world I can move to maximize my chances of being able to access decent health care. I find this situation really, really scary.

"Health coverage" DOES NOT EQUAL health care.

Igloo: He is one of four docs working together. Started out as two docs then added two more over time. Each doc charges his/her patients the same monthly fee.

this below from Joseph Rago in last weeks WSJ:

"To appreciate what's wrong with the current system, imagine four patients identical in every way except for their insurance coverage. They report to the same doctor for a routine procedure, say, a colonoscopy.

The first patient is on Medicare, which controls prices. The program's fee formula sets prices unilaterally for about 7,000 physician services and pays lump sums for 600 general hospital diagnoses, regardless of the quality of care. Medicare pays TWICE (my emphasis) as much on average for a colonoscopy if it is performed in a hospital outpatient setting rather than in a doctor's office.

Patients two and three are covered by private insurers, but those insurers are likely to reimburse the doctor at different rates—whatever they've negotiated to include him in their networks. The rate will be higher than competitive to make up for Medicare's below-cost fees—the gap between public and private rates is now about 40 percentage points. The rate is also likely to be a proprietary trade secret, or else literally unknowable: The doctor can only generate price information when he codes his services and bills the insurer.

The fourth patient is uninsured. If she seeks treatment, she'll be billed directly from a "chargemaster," a hospital's list of marked-up sticker prices that no one with coverage will ever pay.

So one doctor, four patients, four different prices, multiplied times one-sixth of the economy. Price discrimination, or varied pricing, is common in service industries with high fixed and low marginal costs: airlines, colleges, hotels, telecom. But nowhere else but health care are prices so arbitrary, so disconnected from value. The consensus, on the right and left, is that this fee-for-service jumble is incoherent."

For the advanced elderly trying to deal with the current system is almost impossible. There is no way my 90+ mom could do it. I don't know what the solution is but something universal needs to be done in the US before those of us in our 50's & 60's become a tsunami of health care needs in the next decade or so.

playa - The $ 39 visit was likely from seeing a optician or optometrist or more probably an optometry tech (under the "supervision" of the optometrist)at a business that is about selling eyeglasses, contact lenses, etc. None of these are MD's or true physicians, which is what an Opthalmalogist is, and as such cannot diagnose diseases or write Rx's or do surgery. With the elderly, because of cataracts, glaucoma, macular degeneration being so common & a part of the aging process, it is really important that they been seen by an ophthalmologist. $ 150 is pretty standard, my mom's annual visit is $ 235.

ray - Physicians like NH's can opt out of participating in Medicare or Medicaid. As others have said the reimbursement rate is so low and the time & staffing needed for serving that population is more labor intensive that it doesn't work $ wise. If you are anywhere close to a medical school or teaching hospitals, look to getting into their system for health care. They will take Medicare and Medicaid. It will be well worth it even if you need to drive

cattails - great concept. Just out of curiosity, is the doc a solo or group practice or part of a larger clinic with many different practices and is the $ 55 for the "system"?

Cattails: Way to go. Congratulations on finding a solution to medical care ( not Medicare) with your personal physician. Many people are choosing this option now in exchange for a monthly sum. $55.00 is amazing. Most docs charge much more for this service......mine charges $1,500.00. I declined..... rarely need it with so many docs in my family.

I would like to add a small note here....yes, physicians make a good salary overall when they have been in practice for many years. Considering what they do I guess that salary is justified. But the amount these physicians are reimbursed from Medicare is a whopping $26 per patient. Have you ever been in the ER with your loved one and the physician orders a lot of extensive tests and you wonder why.....how else does the facility make the money off a Medicare patient? Those people with insurance and supplemental policies are the ones who pick up the tab after Medicare. Not fair I know, but there's nothing any of us can do.
cattails......I like the concept of what your physician is doing....that might be something that catches on. That's what the air ambulance in my area is doing now...a monthly fee for that "just in case" time since an average air ambulance bill can be as high as $20,000.

Here's a new twist on medical. We have a doc that is absolutely magnificent. He charges $55.00 per month to take you on as a patient. We first started with having my parents go to him because their medical issues were complex and they were on medicare with a supplemental insurance plan that picked up the difference on medicare approved procedures, etc. It's hard to mentally accept such a different concept of medical care, essentially that you pay your doctor monthly for the privilege of having him/her available when you have a need. However, this doctor, with the aid of the monthly patient charge, reduces the number of patients he sees. He spends as much time as necessary with his patients. He calls you at home to ask how things are going. It is the closest thing to having a private physician and a friend who cares. I went to see him the other day to talk about my dad's medical situation and he spent an hour with me. Not everyone can afford, or in this changing world, would be willing to consider a physician under this monthly fee basis. I understand that completely. Nevertheless, for us it has been a Godsend. If my dad has a problem, I pick up the phone and call. We can get in that day and my dad gets the best of care. I think that may be happening more in various areas. I'm glad I came across it when my parents came into my care. It has made their medical care 5 star.

well maybe states differ on what drs receive from medicare. I just looked at my husbands explanation of benefits. He had two office visit. One wasa $185 and medicare paid $161.54 and blue cross paid the rest. Another visit was $150 and Medicare paid $102.35 and blue cross paid the rest. He had an exam from a eye dr and was charged $150. He could have went to any optical place for the same eye exam for $39. I think medicare and all of us are being ripped off. With fancy offices. 10 on the staft etc etc-somebody has to pay

I have called so many physicians to find a Doctor who would accept Medicare...they wont. Seems they want that almight dollar so they can continue to make $200,000 a year or more. I never made that much, but I still cared about human beings.

My dentist does not participate in the insurance I am enrolled in. I've been paying out of pocket for many years, and have recently decided to switch to a dentist within my plan. This has nothing to do with any legislation, pending or passed. It is a decision my dentist made when he started practice.

A doctor I wanted to see does not participate in Medicare. She is not part of a clinic and cannot afford to take less reimbursement for some patients and average it out over a large patient base.

Larger practices tend to accept all or most insurances, including Medicare or Medicaid. But let's not kid outselves. They still have to meet their expenses (including office staff to handle insurance claims) and pay their doctors and nurses and custodians and cover their rent and equipment ... So what they lose on Medicare they have to make for with higher fees to other patients.

There is no free lunch.

A doctor has never had to accept Medicare patients (it has absolutely nothing to do with the Affordable Care Act). The only rule is that if they accept one Medicare patient they cannot turn down other patients who are on Medicare if they are still accepting new patients.

We are in a transition phase as the massive Medicare cuts mandated by Obamacare kick in. It no longer makes economic sense to see these patients. The doctors are preparing for a future without Medicare by gradually getting rid of these patients.

Sure. I doctor may refuse to see a Medicare patient. If you are on Medicare, and you wish to see this particular physician, ask him (or the office) what would be the fee if you paid privately?.....out of pocket. Don't be surprised if the fee is outrageous.