Can my doctor refuse to treat me now that I am on Medicare? In some situations, yes. Your doctor can refuse to treat Medicare patients. If you have a Medicare Advantage plan, your doctor may refuse to see you. If you are being treated for psychiatric conditions, your doctor may treat you but refuse to accept Medicare.
Table of Contents
Can My Doctor Refuse to Treat Medicare Patients
Doctors are not obligated to treat any patients and this is no different if you are on Medicare or Medicaid.
Many doctors limit the number of Medicare patients they will treat. Medicare and Medicaid reimbursements are lower than private insurance so it is not unusual for doctors to prefer private insurance over any of the Medicare options.
Most Medicare Advantage plans have networks. If your doctor does not participate in that plan they may refuse treatment.
Ed had COPD
One of my first Medicare clients was a fellow named Ed. He was a very nice gentleman and when his primary care doctor told him to find another doctor for follow up treatment Ed was upset.
Ed knew me as a result of some advice and counsel I had given his wife a few years earlier. When Ed’s doctor “fired” him Ed called me for advice.
The Medicare Advantage plan Ed chose a few months earlier had a doctor network. Ed bought the Blue Cross Medicare Advantage plan because “all doctors take Blue Cross“.
That’s when he found out that some doctors DON’T take Blue Cross, at least when it comes to Medicare Advantage plans.
Due to Ed’s COPD he could not qualify for a Medicare supplement plan through normal channels and it was too late to switch to another Advantage plan that would include his doctor.
But Ed did qualify for a Medigap plan due to a little known escape hatch in the Medicare laws.
It took some doing, but I was able to get Ed off his Medicare Advantage plan and back into original Medicare and a solid Medicare supplement plan. By returning to original Medicare and a supplement plan, Ed’s doctor would once more agree to treat Ed and help him manage his COPD.
Ed lived another 2 years after that and hardly a month went by without someone calling saying “Ed told me to contact you about Medigap coverage”.
Your doctor may treat you but refuse Medicare
There is another situation where your doctor may agree to treat you but refuse to bill Medicare. In that situation, you are responsible for the full bill.
Many medical practitioners that treat psychiatric conditions have opted out of the Medicare system.
A doctor that refuses to treat Medicare patients is well within their rights if they have opted out of Medicare.
Find out the facts BEFORE you make a mistake. Shop and compare Medicare plans in the comfort of your home.