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Will Your Doctor Keep Accepting Medicare in 2016?

A change to the way doctors are paid may result in fewer choices for Medicare recipients

medicare-in-2016Although a lot of people don’t know it, the federal government has been supplementing the income of primary care doctors who accept Medicare since 2011 to the tune of $664 million per year. The reason? The program, which is open to family practitioners, internal medicine specialists, geriatric specialists, nurse practitioners, and physician’s assistants, was only designed to be a short-term solution to resolving the disparities between reimbursements to primary care providers and higher-paid specialists.

According to a 2014 report, the incentive program disbursed payments to 170,000 practitioners in 2012. Most practitioners used the money to pay for staffing costs associated with complying with the myriad of government regulations associated with providing Medicare-reimbursed services.

A lot of the red tape is attributable to the formation and maintenance of accountable care organizations, which were part of a concept created by the Affordable Care Act (ACA). These organizations designed to coordinate an individual’s care between multiple providers. They were intended to also lower the cost of providing care, but as is often the case with government regulation, they create more overhead. The incentive program reimbursements helped primary care providers with these costs.

What does this mean to Medicare recipients? Experts disagree about the specifics of the impact of the change, however most do acknowledge that without the money the incentive program provided, many primary care providers may find it harder to process Medicare claims. This, in turn, may lead to fewer physicians and practitioners accepting Medicare patients, and subsequently less choice in doctors and availability of appointments for those patients.

According to a national survey by the Commonwealth Fund and the Kaiser Family Foundation, 93% of non-pediatrician practitioners accept Medicare payments. However, only 72% of those accept new Medicare recipients as patients, and if regulations continue to place burdens on primary care practitioners more and more may opt out of taking Medicare patients altogether.

For you, this news highlights the continued importance of always making sure the providers you rely on plan to continue accepting Medicare payments. It’s a good idea to check in with your doctor periodically to verify this.

Wiley Long is founder and president of Medigap Advisors, and is passionate about helping people navigate the confusing waters of Medicare. He is the author of The Medicare Playbook: Designing Your Successful Health Coverage Strategy, a clear and simple explanation so you can make the most of your Medicare coverage. For more information visit www.MediGapAdvisors.com.

 

 
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