Doctors dropping Medicare patients

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Candi1

Member
Recently my long time eye doctor told me he is no longer seeing Medicare patients. I had been going to him for 8 years and now he tells me I have to pay out of pocket to see him. I'm in a good Medicare Advantage plan, not straight Medicare. Fortunately, I found an alternate doctors.....a bit further away but affiliated with a good medical group. Has anyone else experienced this?
 

Yes, we are seeing this happening here in Florida too as well as certain parts of Georgia. Those doctors are often specialists and do not feel like Medicare reimburses them enough money for the services rendered.
We recently changed our medicare insurance because we had problems being accepted as new patients when seeing a specialist. We also had to change doctors. We did find good doctors as well.
 
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Candi1 said:
Recently my long time eye doctor told me he is no longer seeing Medicare patients. I had been going to him for 8 years and now he tells me I have to pay out of pocket to see him. I'm in a good Medicare Advantage plan, not straight Medicare. Fortunately, I found an alternate doctors.....a bit further away but affiliated with a good medical group. Has anyone else experienced this?
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Not yet, but I will be on the lookout.
 

I have not run into that problem (yet), but a few decades ago I regularly saw a specialist that didn't take any type of insurance. Even though I had to pay out of pocket, I could manually submit forms and receipts to my health insurer and get out of network level reimbursement made directly to me. I don't know if Medicare would have anything like that, probably not.
 
There seems to be an increasing shortage of young people entering the medical professions.....while many of our doctors and nurses are reaching retirement age. As this "supply and demand" situation continues to increase, doctors will have more incentives to refuse to accept insurance plans. That, coupled with increasing numbers of older folks, needing care, is causing longer wait times just to get an appointment scheduled. I had a series of tests at a major hospital last year, and I noticed that a couple of the doctors involved seemed to have come from India, or somewhere other than here....hospitals may be having to recruit from other nations just to meet the growing demands.
 
There is a difference between Medicare and advantage plans. Regular Medicare is accepted by 99% of medical facilities. Advantage plans are regular health insurance plans that the premium is paid for by Medicare. That way Medicare doesn't pay the bill, the Advantage plan does. Advantage plans negotiate down the fees that are charged by medical professionals.
I hope that I explained it well enough. It is a confusing subject.
 
I agree with Stretch5881. I have Medicare and have no restrictions on which doc I see. I usually stay within the network, but I don't have to. A friend of mine has the Advantage Plan. Sounds great at 1st glance, but if one ever gets sick, then it adds up. He has to pay co-pay each time and a percentage until the $8,000 out of pocket has been reached. He also is limited to which doc he can see. Advantage plans do have more perks at 1st glance, yet I would choose Medicare Traditional instead.
 
Vicky said:
I agree with Stretch5881. I have Medicare and have no restrictions on which doc I see. I usually stay within the network, but I don't have to. A friend of mine has the Advantage Plan. Sounds great at 1st glance, but if one ever gets sick, then it adds up. He has to pay co-pay each time and a percentage until the $8,000 out of pocket has been reached. He also is limited to which doc he can see. Advantage plans do have more perks at 1st glance, yet I would choose Medicare Traditional instead.
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My Medicare Advantage plan has a maximum of $8000 each year on co-payments. Isn't it true that straight Medicare has no such limit on how much a patient will have to pay each year? Also, Medicare doesn't cover prescription drug coverage; you have to buy a separate Medigap (not cheap) plan if you want to be covered for drugs.
 
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It has been my experience that most Eye Drs and Dentists do NOT take Medicare patients - they don't pay enough. Not one Dentist in our area will take it and my Optometrist doesn't either - UNLESS it is "medically related" like cataract surgery. My Advantage plan through Anthem DOES provide Eye Med insurance.
 
Candi1 said:
My Medicare Advantage plan has a maximum of $8000 each year on co-payments. Isn't it true that straight Medicare has no such limit on how much a patient will have to pay each year? Also, Medicare doesn't cover prescription drug coverage; you have to buy a separate Medigap (not cheap) plan if you want to be covered for drugs.
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I don't recall if straight Medicare has limits, that's why I have G supplement.
As far as Part D, there are different plans that you choose for the drugs you are taking. I don't take any drugs so the plan I have is less than $10 a month. It just so happens that Medicare is paying the premium for that one.
As far as expense, I would rather pay the higher premium than loose the farm in the event of a serious illness.
 
I'm brand new to medicare. I took weeks trying to decide what to elect. I elected to go with basic medicare (gov't). I'm happy reading that the advantages plans are not as accommodating as the basic.

Haven't used it yet myself but soon will.
 
I hope that doesn't happen to me, I would be homeless. Medicare and Medicaid ( help for poor seniors ) is covering most everything. I get my premium paid, and it is amazing how much they cover. I hear that it is in trouble. Not enough $$ coming in.? I hope it stays solvent for the next ten years at least, then I won't care, I hope. I am filled with hope this morning. :)
 
Your situation can have other complicating factors. For example if you have retiree health benefits from a previous employer these change once you're on Medicare. You might be offered a choice between a specific MA coverage and another specific set of coverages for the basket of alphabet soup "gap" insurances required when you go on Original Medicare (Parts A & B) instead.

The MA plan might be good no matter where you move within the US, the OM "basket" plan may only be good in your employer's State.

People declaring that "Medicare Advantage is baaad, m'kay?" probably lack a lot of information, and likely don't know your specific situation anyway. They may even be screwing up their own situation and costing themselves more.
 
We have Medicare + Tricare and get all our regular RX from ExpressScripts. we were strongly encouraged to switch from our Kroger pharmacy to that.

We had Tricare for everything when we first moved here right after 9-11. We had so much trouble finding a doctor who would take us. One doc had a flag and a sign saying "we support our troops" in his window, but then said he wouldn't take Tricare because it was too much trouble. I told him he should take those signs down then. Everyone in the waiting room heard me. Heh.
 
We belong to the non-profit Kaiser Permanente HMO (only available in some states, FYI), so our Medicare enrollment seamlessly rolled into a Medicare Advantage plan. Kaiser has a comprehensive, closed system with its own doctors, specialists, hospitals and pharmacies, so as long as you are within reasonable distance from one, it's a good choice that has worked out well for us.

On rare occasions, if there is a someone with a really serious or complex injury/illness, Kaiser will have them transferred to a private specialist or surgeon, but I don't know of anyone who has had that happen. If you have an accident and are unable to give your info to the EMTs, and are taken to a local ER, Kaiser will arrange payment once notified, but all follow-up is, I believe, given at Kaiser after ER discharge.
 
I had not heard of that. I'm not Medicare eligible yet. About 1 1/2 years. I need glasses to function. Might have to plan on out of pocket in the future? I have Covered California right now and it covers most of exam, actual glasses are out of pocket and expensive.

I wonder if this will filter to other MDs.
 
Remy said:
I had not heard of that. I'm not Medicare eligible yet. About 1 1/2 years. I need glasses to function. Might have to plan on out of pocket in the future? I have Covered California right now and it covers most of exam, actual glasses are out of pocket and expensive.

I wonder if this will filter to other MDs.
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My eye exams are out of pocket, but I buy my glasses online. I've bought them online for 15 years without a problem. I'm rough on glasses with my hobbies, so I go through 4 pairs a year. BOGO sales I get 2 pair for $140. Optical center is $650 each.
 
My primary care doctor is a "boutique" type doctor (the doctors hate that expression), who does not accept insurance of any kind. The care I get is excellent, and IMO it's worth the high price I pay every year. Still, if I found an insurance-accepting doctor who was just as good, I'd make the change in a second.

One problem is that we all have to keep paying into Medicare and any supplemental insurance we use, whether we use a "private doctor" or not. That's because we are often referred, or choose to go to a specialist, and most doctors around here do accept insurance plans, especially Medicare. So the fee we pay the primary doctor annually only covers him; we still have to deal with insurance for all the others.

Eye care is a world of its own. When I go for an eye exam, it's all covered by Medicare except for the vision test. I have to pay for that. I can't for the life of me understand why a vision test (where you read the letters on that chart) is not covered, even though the amount is fairly small (about $40-$50). But why?
 
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