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Medicare Coverage and Doctors (Part 2)

December 26, 2020 by Medicare Coach

There are Different Ways Doctors Accept Medicare

A person looking for a medical service provider must find the one who accepts their type of Medicare program. Doctors who accept Medicare, in general, might not accept Medicare assignments. This is because doctors who accept Medicare assignment can not charge patients balance bills after Medicare reimbursement. They must accept Medicare reimbursement as payment in full. Some of these doctors are labeled non-participating because they will see Medicare patients but reserve the right to send the patient a bill for excess charges of up to 15% more than Medicare pays.


For this reason, many senior citizens opt to sign up for Medicare with Medicare supplement policies that cover all or part of these excess charges. Adding supplemental health insurance eliminates the need to ask every physician if they accept Medicare assignments. There are different Medicare options to choose, including Plan F and Plan G, that cover excess charges, and Plan N, which does not.


If a person chooses Plan N, they will need to ask every doctor if they take assignment or if they will send a bill for excess charges after treatment. Some states do not allow doctors to charge excess fees and, in those states, a Plan N will work like a Plan F or a Plan G concerning excess charges. Then, it is important to ask in advance if doctors take Medicare assignments.

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Medicare Advantage Plans Have Fewer Providers

Basic Medicare has a very large provider network, but the newer Medicare Advantage plans have smaller, more-focused local networks of doctors and hospitals. Good Medicare Advantage plans offer several thousand providers in each geographical area. Since some Medicare Advantage plans have fewer or more providers, enroll in the plan with at least a thousand providers.


Look at the whole plan before enrolling to be sure you get the best care options as well as an affordable plan. Do not limit your provider access to save a few dollars. Get the best Medicare Advantage plan you can afford and that meets your medical needs.

Are Medicare Advantage Plans Accepted By All Doctors?

Since Medicare Advantage plans have their own approved network of doctors, specialists, and hospitals, their members can not go to all doctors. A person must stay within the Medicare HMO network’s providers or end up paying up to 100% of their medical bill with that provider.


There are Medicare HMO-POS or Medicare PPO plans that give members more flexibility. With these plans, the patient can see doctors outside the designated network at a higher cost to them and if the doctor is willing to bill the Medicare Advantage plan.

What If You Decide to Opt For the Newer Boutique or Concierge Medicine?

There is a growing trend throughout the U.S. to use fee-based care with no insurance coverage. A person agrees to pay a monthly or yearly fee to a doctor or clinic. In exchange, the doctor agrees to see the patient whenever they need care. The idea is that, by patients paying cash for care, the doctors or clinics can see fewer patients in total but give better care to those they see.



Doctors like these arrangements because accepting insurance costs them money and they must wait to be reimbursed for care. Sometimes, claims are denied and the clinic must try to collect from the patient after the fact. It is easier to collect money directly from patients with less time and money spent on paperwork.


The downside of boutique care is that the client is signing away their right to use their Medicare with that doctor. If a serious condition develops and Medicare is needed, it may be hard to get established with a Medicare plan and a new primary medical provider.

Solve Medicare and Medical Service Problems With A Good Agent

By choosing Medicare Coach to help with your enrollment, seniors can avoid many problems with getting health care coverage and medical treatment. Agencies are not seeing large problems with Medicare yet. The continued success of the Medicare health insurance program for seniors depends on Congressional action to make the program more solvent. The fair compensation of doctors accepting Medicare must also be addressed.



One step in the right direction has been the Affordable Care Act bonus payments to doctors providing Medicare services. Seniors can help themselves more by enrolling in a Medigap policy through an insurance agency in addition to their Medicare. Our agency can help seniors find the right Medigap plan and the providers you need for medical care.


I hope that this article helped you out.  Learning about how Medicare Coverage works with doctors is very confusing.  If you ever have any questions, please don’t hesitate to phone me. You can also fill out the help form at the top of this page and I will reach out.  

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