Why do some doctors not accept Medicare?

Medicare is the federal health insurance plan offered to certain populations. While many providers accept Medicare, some doctors do not. While this can be very frustrating for patients, there are a number of reasons why some doctors may accept Medicare and others do not. Read on to learn more.

How Reimbursement Works

In order to understand why some doctors do not accept Medicare, you must first understand how Medicare pays doctors. Medicare and doctors come to an agreement for each service. A doctor will be a certain amount for a service, and Medicare will pay them back for that service. When Medicare pays that physician, it is called reimbursement. There are certain rules that doctors must follow in order to be reimbursed.


One of the biggest reasons that doctors do not accept Medicare is that it does make financial sense for them to accept it. Compared to private health insurance companies, Medicare only pays doctors 80% of what private health insurers would regularly pay for different services. It also often takes time to reimburse doctors. Medicare is notorious for its reimbursement delays. For some doctors, especially those who own their own private practice, the combination of delayed reimbursement and decreased reimbursement is too much. Some of these doctors could not operate their businesses if they accepted Medicare.

Overbearing Rules

In order to receive the reimbursement, physicians must abide by a certain set of rules. These rules can require a lot of paperwork and staff to handle that paperwork. They can also be confusing and difficult to follow. Sometimes these rules require that the doctor do certain tests or follow certain protocols even if those tests and protocols do not make sense for that patient. For example, there are different incentive programs to encourage doctors to improve patient outcomes. While this is a good thing in theory, in practice it can be difficult to carry out. It may also be impossible depending on the population of patients that the doctor treats. If doctors do not meet certain targets, they may face penalties. These stringent requirements can take some of the art out of the art of medicine, so some physicians prefer to avoid Medicare altogether. 

Finding a doctor who accepts Medicare is normally easy, but some doctors choose not to participate in the program. To learn more about your options, contact Temmen Insurance today.

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