What if My Doctor Ops Out of Coverage?

It can be unsettling to discover that your doctor has opted out of Medicare coverage. This means they no longer accept Medicare patients, which can leave you wondering about your options. Here’s what you need to know:

Understanding “Opted Out”

• What it means: When a doctor “opts out” of Medicare, they are voluntarily choosing not to participate in the Medicare program.
• Why do they do it? Reasons vary, but may include:
  
  • Focus on private pay patients: Some doctors prefer to focus on patients with private insurance or who pay out-of-pocket.
  • Administrative burden: Dealing with Medicare paperwork can be time-consuming and complex.
  • Reimbursement rates: Some doctors may feel that Medicare reimbursement rates are insufficient.

What Happens if My Doctor Opts Out?

• You can still see them: You can still see your doctor, but you will be responsible for the full cost of their services.
• Medicare will not pay: Medicare will not cover any of the expenses associated with your doctor’s services if they have opted out.
• You may have to pay upfront: You may be required to pay for services upfront and then submit a claim to your secondary insurance (if you have one) for reimbursement.

Finding a New Doctor

• Use Medicare’s Physician Compare tool: This online tool allows you to search for doctors who accept Medicare in your area.
• Contact your local Area Agency on Aging (AAA): They can provide you with a list of doctors who accept Medicare in your community.
• Ask for referrals: Talk to your friends, family, and other healthcare providers for recommendations.

Important Considerations

• Medicare Advantage plans: If you are enrolled in a Medicare Advantage plan, your plan may have a narrower network of doctors.
• Secondary insurance: If you have a secondary insurance policy (such as a Medigap plan), it may help cover some of the costs associated with seeing an out-of-network doctor.

Medicare Insurance Techs Can Help

If you’re confused or concerned about your doctor opting out of Medicare, our team at Medicare Insurance Techs can help. We can answer your questions and explain your options.