My mom is on Medicare, can a doctor's office refuse to see a Medicare patient?

Doctors can refuse patients based on the reimbursement including Medicare. Typically they just say that outright. More and more practices are being bought by hospitals, these docs will then take Medicare because they will feed into the hospital which almost always takes Medicare.

I'm no expert but I think doctors can choose not to accept Medicare patients just as they can choose what insurances they wish to accept. It's sad but a lot of doctors do not feel they get enough reimbursement so they don't participate with Medicare.

5X5 - Is there any way you can get your folks seen by the gerontology practice affliated with a medical school? The level of care and umbrella of services will be more co-ordinated and almost always medical school and their teaching hospitals take Medicare, Medicaid and most major insurers. Could part of your MD availability be an issue of demographics? Are you in a rural area? There just isn't enough MD's out there much less in smaller towns so the docs that are there just aren't going to take new Medicare patients or Medicare at all as the reinbursement rate is just so low that it is not cost effective. Or is there a secondary insurer or Medicare supplemental plan in your area affiliated with a health care/hospital group they could join?

I will echo Jeanne's comments on Medicare providers, my mom doc's take Medicare & Medicaid, and they are all multiple board certified and medical school faculty and focused on the reality of health care for the elderly.

When Medicare was first done, it was designed as insurance for hospitalization. This is Medicare Part A and it is a federal entitlement that is tied into SS. You do not have to be "forced" to use Medicare but anyone who works in the US and has SS taken out will pay into Medicare Part A. You pay for it whether you use it or not, just as you do for SS. You have to enroll in order to participate in it. Medicare Part A actually pays pretty good for hospital related services. Now overtime, Medicare added Part B - which pays for medical services, Part C and Part D - the drug/prescription program. It is the low reimbursement Part B that keeps doc's from participating and some people have a Medicare supplemental plan to pay for part of what Medicare Part B doesn't.

Regarding the lawsuit, what was at the heart of their complaint was, I think, was that they are covered by FEHB and therefore don't need Medicare Part A but are in essence paying twice for the same health benefit and want to quit Part A. FEHB is Federal employee health benefit available to all federal retiree's and have the payment for it taken from their retirement. FEHB is not just for the wealthy.My mom was covered by FEHB as my late father was a federal employee and her FEHB was a Texas high option Blue Cross plan. So every month she has about $ 96 a month taken from her SS to pay for Medicare Part A and then she also would have $ taken out from her federal survivor annuity to pay for her FEHB which was through BCBS. FEHB, I think, is proportional so if you have a large federal retirement it can be a pretty big chunk of $$ every month. But if you are on FEHB, you really don't have any co-pays or other costs for your health care as long as you see providers in the FEHB system in your state. How it worked for my mom was that FEHB worked in tandem with Medicare with Medicare as the first payor and then BCBS as a secondary or BCBS as the primary if the provider did not take Medicare. My mom's old opthalmologist did not take Medicare at all ever but would see her because she had federal BCBS which was in essence her Part B payor (but at the much higher & faster BCBS reimbursement rate). I bet that since FEHB works in tandem with Medicare that doomed the lawsuit. My mom is now on Medicaid and her FEHB is "suspended" because Medicaid is now the secondary payor.

The Medicare system certainly has problems, but thank goodness that it's there.

Many years ago I learned that many doctor offices do accept Medicare patients but once that office reaches their quota they can start to refuse new Medicare patients.... but later accept new patients when their regular Medicare patients moved away.

One advantage of living in a large metro area, I never had a problem finding a new doctor for my parents who have been on Medicare for over 25 years. Nor for myself as I am also on Medicare.

There are a lot of myths floating around about Affordable Care Act [ObamaCare]. One myth I wish to break is the rumor about the Federal government cutting funds to Medicare. What is being cut is Medicare fraud, which is a good thing.

The ACA closes the “donut hole” that was causing Seniors not to be able to afford their prescriptions, another good thing.

ACA expands existing coverage for seniors, including preventive care and wellness visits without charging you for the Part B co-insurance or deductible. Seniors will no longer need to put off preventive care and check-ups due to costs. This reform has been active since 2011 and gives seniors better access to cancer screenings, wellness visits, personalized prevention plans, vaccines, flue shots and more.

Yes MD's do not have to accept Medicare or any other health insurance. The reinbursement rate is so low that in many practices it costs them to have a Medicare patient especially an elderly one that take more time in both physician time as well as staff and having them in & out of the patient care room.

if she has a secondary insurer then often they will take Medicare patient. My mom has Medicare and has a federal Blue Cross and her eye & ortho doc's only would see her because they could bill BCBS.

Deb - the reason that hospitals take Medicare is because if they ever got built using federal funds, which until the last couple of decades that included almost ALL hospitals in the US, then they were built under the Hill Burton Act. Under Hill Burton the hospital was legally required to accept any and all federal health care programs and even more importantly they had to accept patients no matter what their ability to pay. When hospitals when thru the big building phases in the late 1970's and 1980's and were built new they could do a partial Hill Burton
by accepting Medicare and not the poverty ones. They would request a waiver from their regional planning body (the Heath System Agency in the region's Council of Government) because of whatever technology that was "special" they were doing - heart surgery was a biggie back then, then MRI buildings in the 80's.
No one back them ever though heath care would get so expensive in the US!

There are still hospitals out there under total Hill-Burton. You have to google to find out what might be in your area. But for the poor elderly and their caregivers, it is worth it. You cannot be billed if you have no ability to pay. Almost all are teaching hospitals too - which IMHO is the best place to go for care.

A long time ago doctors were willing to take livestock or your fruit/vegetables in exchange for medical care. Those days are long gone. Now its about cold hard cash. Medicare is famous for lots of red tape and a lengthy wait for payment. Doctors don't want to deal with all the crap, so they refuse patients with only medicare for insurance.

I once had a doctor tell me "it" wasn't going to work because I didn't care about my health. She grudginly took me on as a patient. I dumped her as a doctor immediately. Apparently, she only wanted healthy patients... not sick ones. Sick patients don't care about their health, but healthy patients do. What utter garbage! Worthless doctor. But, there are a slew of doctors that share that sentiment. They don't want difficult cases and the aging usually take more time and have more liability I suppose.

Its a show me the money world these days.

Just a little FYI............the amount a doctor receives for a Medicare patient is around $26. And that is for anything from a simple cold to running tests. And in their private practice they can refuse or accept anyone they choose....after all, it is their business.

A person can always go to the ER and get care no matter what is their insurance carrier or if they have no insurance.

A hospital won't turn away someone if they can't afford treatment [per a law put into place by President Reagan], but a landlord can turn down a person if that person doesn't meet the income requirements to pay for said apartment and/or has terrible credit.

I am guessing that if doctors refuse patients with Medicare, it is because they do not have a contract with Medicare. Therefore, Medicare is most likely going to have to reimburse the patient for what Medicare would have paid the doctor. In other words, you can see the doctor, pay his price, get a bill and submit it to Medicare. Medicare would then reimburse YOU what they would have given to the doctor.

(First, there is one answer - "5 years ago" - that the problem is massive cuts mandated by Obamacare - sorry, that isn't accurate at all, and has nothing to do with the ongoing and historical situations per Medicare). Currently, yes - doctors can (and do) refuse to accept any Medicare patients because of the low reimbursement rate. I personally really resent this whole system, because Medicare is "the health insurance of the retired" ?!!! I am now on Medicare, with a Medicare Advantage plan through AARP. Medicare isn't free - admittedly, it's much less expensive than "real" health insurance - but there is an automatic deduction from Social Security as well as another premium if you choose to have extra/enhanced coverage through an Advantage (or "gap") plan (you can't have both at the same time). I needed a counselor after a severe and ongoing trauma but couldn't find one for months who would accept Medicare. The first one I finally found that would was a complete idiot (sorry, but he was!), and after I poured my heart out for an hour (and recounted the horror I'd been going through for a year), he looked at me and said "So, do you think this has caused you stress in your life?" - Really? I just told him "you're fired!". I now have a nice counselor who just feels everyone should have access... Interesting fact, though - my "United Health AARP" Medicare Advantage coverage requires a co-pay of $40 for "mental health" visits - twice what they charge for medical Specialists - and in fact, more than the amount they actually pay. Since I'm currently going to my counselor once a week, $160.00 for co-pays is a pretty hefty bill out of my pocket? Mental health care shouldn't cost more than any other care!

I think the denial of Medicare acceptance is discriminatory against an entire segment of the population - the retired/elderly - and there should be some system to ensure coverage is available. Maybe there should be a requirement that doctors or clinics/medical groups, whatever, accept a minimum percent of Medicare patients... If this was spread uniformly across the board, everyone would have to "share the pain"? Non-compliance could carry a penalty at tax time (any incentives or deductions currently available - I don't know? - denied?) Something! I've gotten to the point that if someone does accept Medicare I'm somewhat skeptical why - can't they attract enough "paying" patients and have to take the dregs? This is an issue I'm not seeing debated, or even acknowledged, by the current controversies...