“Do you Accept Medicare?”

“Are doctors still taking Medicare?” This is one of the questions I hear most when working with clients. Recent headlines and talk among seniors suggest fewer and fewer doctors accept Medicare these days. Is this actually true?

When it comes to accepting Medicare, physicians fall into one of three categories:

Participating Providers: Doctors agree to accept “assignment” on all Medicare claims. Beneficiaries seeing a participating provider are only liable for the cost sharing required by Medicare. Most doctors fall into this category.

Non-participating Providers: Providers accept Medicare patients but choose whether to take “assignment” (Medicare’s approved amount) on a claim-by-claim basis. These doctors can “balance bill” you, meaning your portion cannot exceed 15% of the fee-schedule