Will Your Doctor Leave Medicare January 1?
All the recent publicity initiated by Democratic Congressman Hoyer and others, claiming that there is a risk of almost 50,000,000 Medicare patients losing their doctors — and therefore their health care — January 1, 2012 is great political theater. No one’s watching this particular political theater of course because it’s Chanukah, Christmas, Kwanzaa, New Year’s Day in the Julian/Gregorian Calendar (whichever we use these days), Solstice, etc. and we all have better things to do.
But all the controversey is a reminder to Medicare beneficiaries to refresh themselves on the rules about doctors and Medicare. The following is probably not legally perfect but now that I am on Medicare I think there are three kinds of doctors:
- Medicare-participating doctors
- Non-participating Medicare doctors (but Medicare calls them doctors that do not accept assignment)
- Doctors who won’t let you in their office if you have a single grey hair or a wrinkle
Obviously you can’t go anywhere near the third kind (and there aren’t very many of them). But understanding the difference between the first two is important. The Centers for Medicare/Medicaid Services thinks they’ve explained it clearly here. That might be true if you’re a Harvard lawyer but for the rest of us, ask a lot of questions and make sure you understand how much a procedure costs and whose going to pay for it. I’m having a cataract removed next month and if this isn’t settled by January 1, I’m going to light up the phone lines before I go under the knife.
All of these rules also apply to related Medicare providers such as for durable medical equipment.
One thing you might be thinking: if last month I had a procedure where Medicare paid $100 and Medigap paid $25, and next month Medicare will only pay $72.50 (I’m rounding), won’t Medigap now pay the remaining $52.50? The answer is I don’t know for sure but I don’t think so. It’s a good question though.
And fellow Medicare patients, I wouldn’t worry too much about your doctor leaving Medicare January 1. The docs will keep treating us for the same reason Willy Sutton robbed banks.