Will Your Doctor Leave Medicare January 1?

December 22, 2011 in Health Insurance, Hospital Bills, Insurance Bills, Medicare, Member Stories

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.

2 responses to Will Your Doctor Leave Medicare January 1?

  1. Hey Dennis – I’m sorry to hear about your cataract. I hope it isn’t too annoying. Where are you having the procedure done and how did you decide where to go?

    Happy Holidays (Solstice or whatever you celebrate).

  2. Martha

    I celebrate them all plus the lunar year!!! The same to you and your family.

    I am a 30-year member of an HMO. I bought into the concept when it was truly an “accountable care organizaton,” doctor-hospital-insurer all legally linked.Luckily I was able to transition over the 30 years from employer sponsored insurance to indivdually purchased insurance to Commonwealth Choice to Medicare without ever having to change doctors or insurers, and while the ACO split into thirds (or fourths or… — see below).

    That means I go where my HMO — the former Fallon Clinic which is now part of Atrius — sends me. For a cataract that is either Saint Vincent’s or an outpatient facility somewhere nearby that seems to have been legally set up as a Fallon Clinic subsidiary rather than actual part of Fallon for some reason.

    The group literally brought me back from blindness years ago after a retinal detachment. All I want this time is to be able to read the box scores on NESN without having to stand three feet from the TV screen.

Leave a reply

You must be logged in to post a comment.