One of my biggest concerns right now is the current and future availability of physicians who are willing to treat Medicare patients.  According to a recent survey by the American Medical Association, one in three primary care doctors are restricting the number of Medicare patients they accept.  This is likely to get much worse as full implementation of the Affordable Care Act, also known as Obamacare, happens in 2014.
Many of these doctors are actually opting out of the insurance system completely, and setting up cash-only concierge practices.  The Merritt Hawkins company that deals with physician staffing says 9.6 percent of doctors say they want to move into a direct-pay practice within three years.  That’s based on a survey of more than 9,000 doctors that the American Medical Association conducted in 2010.
How Direct-Pay Health Care Works
These direct primary care practices are sometimes known as “medical homes.” In some direct-pay systems, doctors contract with patients to provide primary care for as little as $50 to $150 a month. The cost difference reflects the patient’s age.  Some are much more expensive.
That gets a patient unlimited doctor appointments plus 24-hour access via e-mail.  Of course, you still pay the fee for months when you don’t need medical services.  And you still need insurance, such as Medicare and Medicare supplement coverage, to protect you against the major health problems that could occur.  But you would at least have guaranteed access to a physician.
Instead of paying an insurance company, you would directly pay your health care provider – a doctor or a practice – your medical home. For people who need a lot of health care, the benefit is that they can make a doctor appointment as often as they need.  You can find medical homes in many states at
Should People on Medicare Consider a Direct-Pay Practice?
With so much controversy over Medicare these days, it’s not surprising that there’s already a proposal by Congress as well as Medicare officials to start a pilot program like this.  The program would have a monthly payment to these medical homes for primary care services.  But in the mean time, if you want this kind of Medical care you will have to pay for it.  But it will guarantee you access to a physician, without the hassle and uncertainty that many are likely to face.
If you already have an agreement like this with your main physician, I’d love to hear about it, and how its working out for you.

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