Do All Doctors Accept Medicare Supplement (Medigap) Plans?

January 3, 2019

The short answer is “No.” Not all doctors accept Medicare supplement (Medigap) plans. However, if a doctor accepts Medicare (your primary coverage), they will accept your Medigap plan, regardless of the type of Medigap plan you’re enrolled in.

If you aren’t familiar with what a Medicare supplement plan is, once you turn 65 and sign up for Medicare, you have a choice of any Medicare supplement plan (also called Medigap) your state offers, regardless of your health condition. Medicare supplement insurance covers the remaining costs you are responsible for after original Medicare pays its portion, such as Medicare deductibles, coinsurance costs, skilled nursing facility costs after Medicare runs out and hospital costs after the Medicare-covered days are over.

In other words, you pay your Medicare supplement plan premium and then the policy pays your expenses under Medicare. It “gaps” the differences, so your out-of-pocket expenses are reduced or eliminated.

doctor with patient

Source: Getty

Can I Use Any Doctor with a Medicare Supplement Plan?

When you buy a Medicare supplement insurance policy, you keep your original Medicare and can go to any doctor who accepts Medicare. Your Medicare supplement insurance works in tandem with your Medicare, so if your doctor accepts Medicare, your supplement insurance is accepted as well. Be sure your doctor accepts Medicare when you make your appointment to avoid any denial of payment later on. Studies show that the vast majority of doctors do accept Medicare, though those taking on new patients has dwindled, which has made it more difficult to find a doctor once you are enrolled in Medicare.

Doctor

Source: Getty

By accepting Medicare, and 96 percent do, doctors agree to charge the agreed-upon amount covered and file claims for you. The doctor will not bill you more than your share of the cost, which is the copayment or coinsurance amount ( a percentage of the bill even after you’ve met your deductible) and deductible amount. That portion would then be covered by your Medicare supplement insurance policy, depending on which policy you chose.

Keep in mind that if you use a doctor who does not accept Medicare, that doctor could charge you up to 15 percent more for his or her services, make you pay at the time of service and require you to file your own claim documents. And if you choose a Medicare SELECT policy, you are further limited in the doctors you may use since SELECT policies use a network of preferred providers. Three Medicare supplement plans – Plan F, Plan High-Deductible F, and Plan G – might completely cover these charges but if you have any other plan under Medicare supplement insurance, you may have to pay these costs yourself.

Doctor office

Source: Getty

What to keep in mind for finding a doctor who is accepting new Medicare patients:

  • According to the Urgent Care Association of America, there are more than 7,500 urgent care centers in the United States, and many of these clinics serve as primary care practices for some patients. For typical situations like blood pressure testing, diabetes care, flu and shingles shots and general health purposes, these clinics give Medicare with Medicare supplement plan patients a full range of care options and make an excellent choice for those looking for a new doctor.

  • According to data from the Kaiser Family Foundation/Commonwealth Fund 2015 National Survey of Primary Care Providers, 81 percent of rural primary care physicians report accepting new Medicare patients compared to 72 percent of city providers. This is good news for those who live out in the country or those willing to drive a little to gain the help of a doctor.

  • The Kaiser Fund report also noted that Medicare enrollees without supplement insurance have a harder time finding doctors who accept Medicare, so it may pay to invest in Medicare supplement insurance for these patients.

  • The U.S. Department of Health & Human Services has a physician search tool to help you find a doctor in your area. The continuously updated list can be downloaded for easy viewing. You can search by state or medical condition.

  • If your doctor has opted out of Medicare, ask for a referral to a doctor who is still in the Medicare program. He or she has probably already considered which doctors they’ll send their patients to when the question of Medicare comes up, so don’t be shy about asking.

  • Look to your particular state’s insurance department to find information about physicians in your state who accept Medicare and may be accepting new patients. For example, at the Texas Department of Insurance, you have full explanations of everything you need to know about Medicare. Call your state’s insurance department or visit in person to get the help you need specific to your location.

Doctor Networks and Medicare SELECT Plans

One of the few limits that may arise when it comes to choosing a doctor is if you are enrolled in Medicare SELECT. Insurance companies in some states offer what’s known as Medicare SELECT which is a type of Medigap plan that has its own network of doctors and hospitals. If you enroll in a SELECT plan, you might have some limits on which doctor you can choose. Typically, these networks are for non-emergency care. If you don’t use a Medicare SELECT doctor or hospital, you might be responsible for paying some or all of what Medicare doesn’t pay.

Why Won’t a Doctor Accept a Medicare Supplement Plan?

If a doctor won’t accept a Medicare Supplement Plan, it is most likely due to the person mistakingly referring to their Medicare Advantage plan as a Medicare Supplement plan, according to Medicare.org. Medicare Advantage Plans have their own networks and are usually PPOs or HMOs. These networks change annually, sometimes in the middle of the year. If you’re on a Medicare Advantage plan and your doctor won’t accept it, they might not be in your network anymore.