Do All Doctors Take Medicare

Do all doctors take Medicare? The answer may surprise you. Which Medicare plans are widely accepted by Georgia doctors? Can my doctor refuse to take my Medicare plan? What happens then? How do I find physicians that take Medicare?

Do all Georgia Doctors take Medicare?

The short answer is no. A better answer is, most doctors DO accept Medicare patients. But some Georgia medical practices are not currently taking new Medicare patients or may have a waiting list for new patients.

This is especially true if you have a Medicare ADVANTAGE plan.

Do all doctors take Medicare

Finding a Medicare Doctor

Your challenge is even more diverse when you break it down by:

  • Doctors that take Medicare patients
  • Physicians that accept Medicare assignment
  • Doctors that do not participate in Medicare
  • Medical practices that participate in Medicare but not Medicare Advantage

The good news is, most doctors participate in Medicare and do treat Medicare patients. About 96% of physicians that do take Medicare also accept assignment of benefits. Doctors that may opt out of Medicare are usually in the mental health field and some chiropractic doctors.

Most Accept Original Medicare Patients

In Georgia about half the physicians accept Medicare Advantage patients and most of them will only participate in a few plans but not all. The number dwindles down further when you have an Advantage HMO plan.

Doctors can refuse to accept your Medicare Advantage plan if they are not in network. If that happens they are still required to file with original Medicare and then wait on Medicare to pay you. In these situations they are allowed to bill excess charges.

When you have an Advantage plan make sure you understand the rules and how your liability is determined.

Can My Doctor Refuse to Treat Medicare Patients

Medicare participation

Finding physicians that participate in Medicare is relatively easy. If you Google “doctors that take Medicare” you will find an array of choices including other search engines and referral services. My advice is to go direct to the source, Medicare.gov.

The Medicare physician finder is a useful tool for finding doctors, hospitals, DME suppliers and other medical facilities in your area that participate in original Medicare.

When you just use Google you will find doctors that

  • advertise locally on Google
  • are registered with referral services
  • are listed on Medicare plan sites
  • may be reviewed by Yelp or Angies List

While some of those sites may be useful the Medicare physician finder tool has been the most helpful for my clients.

Is Medicare Supplement Expensive?

Medicare supplement plans can be quite affordable and do not require network participation.

We NEVER Sell Your Information

https://www.gamedigaprates.com/

 

New to Georgia

Jean moved from California to Georgia a few months before turning 65. She had Kaiser in California but her plan offered only limited coverage in Georgia where she was considered a “visitor”. Jean had some medical conditions that required a specialist and she wanted freedom of choice when it comes to finding a doctor.

This meant saying no to Medicare Advantage plans with their limited doctor choice, high out of pocket and yearly changes in benefits.

Jean is living on a fixed income and needs a way to budget for her care. Original Medicare and a Medicare supplement plan was exactly what she needed.

No Selling Please

How do you find answers to your Medicare questions WITHOUT getting a SALES PITCH?

Everyone wants to talk. No one wants to listen and answer . . . until you BUY SOMETHING.

Something you don’t want, don’t need and can’t afford.

When Jean contact me she was living with local relatives and didn’t want a bunch of insurance sales people coming to see her. At Georgia Medicare Plans we believe in personal consultation in the privacy of your home. We know that many people do not feel comfortable having strangers in their home and several do not want to travel to see us. I employ a client centered focus and believe in respecting your “space”. That is why all of our clients receive information and advice by phone and email. There is never any pressure to make a decision and you move forward based on your time frame once you are comfortable you understand the Medicare system and can afford the coverage you want.

Find a Medicare Plan Accepted by GA Doctors

I spent several hours on the phone discussing her needs and looking at options. Then I emailed Jean information based on the benefits she needed and plans that fit her budget. I also provided her with details on Medicare Extra Help, a service that can reduce her out of pocket expenses for medication.

After reviewing all her options Jean selected Medicare supplement plan N from a carrier with a long history in covering Medicare clients. While most agents that talked with Jean pushed Medigap plan F she knew that plan was not going to fit her budget.

Blue Cross wanted $176 for plan F and United Health Care (AARP) even more at $180. Plan F with Continental (Aetna) had the lowest premium at $141. But that was still too much.

We talked about the differences in plan F, G and N and how each plan was more affordable due to cost sharing. Plan N coverer her Medicare Part A expenses at 100% but does require her to pay the Part B annual deductible + a $20 copay for doctor visits.

Jean’s premium for plan N was $86 from New Era insurance company. Even with the cost sharing she still cut her premium in half vs. most of the plan F plans.

Finding a Medicare physician

As mentioned above, the Medicare physician finder is the most reliable tool in your arsenal for finding doctors in your area. Once you find some doctors that fit your needs, make some phone calls.

Here is what you need to know.

  • Does the doctor participate in Medicare?
  • Are they taking new patients?
  • If you have an Advantage plan, are they CURRENTLY participating in that plans network?
  • Do they accept Medicare assignment?
  • Does the doctor require up front payment for Medicare patients?

Most doctors DO participate in Medicare and most take assignment. A medical practice that accepts Medicare assignment means

  • you never have to pay up front for Medicare covered services
  • you never have to file claim forms with Medicare
  • Medicare and your supplement plan will pay your doctor direct, not you
  • your doctor can never bill you for excess charges

Doctors that take Medicare is easy. But finding an affordable Medigap plan that meets your needs and budget can be difficult. In some parts of Georgia you may only have half a dozen Advantage plan choices and many of them may not include your doctor or hospital in their network.

However there are more than 170 Medicare supplement plans statewide. Finding a plan with our help is as simple as getting a personalized Medigap quote in the privacy of your home, picking up the phone or sending us an email.

Let us know how we can help.

#DoAllDoctorsTakeMedicare  #GeorgiaMedicareDoctors  #GAMedigapQuotes

Medicare Things You Don’t Know

Medicare things you don’t know (but wish you did). Questions you never asked because no one told you. And you will pay dearly if you are not prepared.

There are things about Medicare that will trip you up when you least expect it. Not so much with Original Medicare, but there are things about Advantage plans no one mentioned. Medicare things you don’t know. Stuff like access to care and prior authorization.

Medicare Stuff About Advantage Plans

You may think you understand Advantage plans but my guess is there are things in this video that will shock you.

Almost everyone LOVES their Advantage plan until they have to use it. I get calls all year long from folks who say they can’t afford their Medicare plan and want a supplement.

Most GA Medicare Advantage premiums are $0. If they can’t afford their plan there’s a good chance they are incurring hundreds or even thousands of dollars out of pocket for claims.

Why Are Medicare Advantage Plans Popular?

I have a friend that has been bragging about his plan ever since he went on Medicare. He thought I was foolish for paying “all that money” every month for a Medigap plan.

A few years ago a cancer diagnosis was a shock. His provider had grant money to pay for his treatment so his out of pocket was minimal.

Now the Cancer is Back

Gary is learning things about Medicare he did not know. Such as prior authorization.

Before he can have a test ordered by his doctor, the carrier must APPROVE the test. It’s all about the money.

His oncologist wants him to have proton therapy but his plan will only pay for a less expensive protocol. Dollars drive many medical decisions when an insurance carrier controls your benefits.

Proton Therapy – It Helps Only a Few at a Wildly Extravagant Cost MedPage Today

All he wants to do is get well but his Advantage plan is running interference. His carrier is interested in saving money. THEIR money. Not his.

It’s all about the dollars. Just another Medicare thing he did not know.

What is Prior Authorization?

According to the Kaiser Foundation “80 percent of Medicare Advantage enrollees are in plans that require prior authorization for at least one Medicare-covered service“.https://www.kff.org/medicare/issue-brief/prior-authorization-in-medicare-advantage-plans-how-often-is-it-used/

Prior authorization is more frequently imposed for HIGHER COST services.

Reading further . . .

A potentially overlooked consideration is access to covered services; specifically, how prior authorization may affect beneficiaries’ access to covered services.

Medicare Advantage plans can require enrollees to get approval from the plan prior to receiving a service, and if approval is not granted, then the plan generally does not cover the cost of the service.

On the other hand, Original Medicare does not require prior authorization for most services.

There are probably many things about Medicare Advantage plans you did not know. Limited access to care because of prior authorization requirements is probably just one of them.

#MedicarePriorAuthorization #MedicareAdvantage #GAMedicareExpert

Why Are Medicare Advantage Plans Popular?

Medicare Advantage plans seem to be popular. But why? What is the appeal? What is so attractive about these managed care plans? Are they really free? GA Medicare expert Bob Vineyard explains.

medicare advantage popular
Why are Medicare Advantage plans popular?

Why are GA Medicare Advantage Plans Popular

Are you turning 65 and confused about the Medicare process? Why is it so difficult? Why do my friends, and many agents as well, want to push me in the direction of an Advantage plan? Low premiums are attractive. So is “free”. Is there really such a thing as a free lunch?

Medicare Advantage plans are like the Hotel California. You can check in but you may never leave.

Some people turn to Advantage plans when they first go on Medicare at age 65. Low premiums, many are $0. Extra benefits like dental, vision and some have gym memberships. Drug plans are often included in the plan. “One stop shopping”.

What’s not to love?

Why do sick people leave Medicare Advantage plans?

Georgia Advantage Plan Traps

Have you ever bought something and later realized you had no idea how it works? Maybe the sales person forgot to mention key details that might have changed your decision.

If something is too good to be true it probably is.

There is nothing inherently wrong with GA Medicare Advantage plans. You just need to understand what you have signed on for. Here are a few questions you need to ask.

Preferably BEFORE you enroll.

  • Is the plan a PPO or HMO?
  • Do I need a referral to see a specialist?
  • Will my doctor take my Medicare Advantage plan?
  • Are there any out of network penalties?
  • Can I change plans at any time?
  • Can I return to original Medicare and a supplement plan if I want?
  • Does the out of pocket limit include prescription medication?
  • What will my health care really cost if I use an out-of-network doctor?
  • Will my claims be paid if I use a non-par provider?

If you ask the right questions and are satisfied with the responses, the Medicare Advantage plan could be just what you need.

When you enroll in a managed care Advantage plan, the insurance carrier, not Medicare, provides your benefits then reviews, adjudicates and pays your claims.

“No premium” plans are not free. You still have to pay for health care and prescription drugs.

There is no free lunch.

Health care is not free. SOMEBODY pays the bill. Either you or the insurance carrier.

But you knew that all along, didn’t you?

This Doesn’t Look Like Kansas Anymore

Managed care plans often have small provider networks. Fewer doctors. Fewer hospitals. The question is, how much smaller?

A Kaiser Foundation survey found that on average “Medicare Advantage plan networks included 46% of all physicians in a county.” Some plans had fewer than 5 thoracic surgeons, fewer than 5 neurosurgeons and fewer than 5 radiation oncologists.

This isn’t JUST about dollars. It is also about access to health CARE.

Each calendar year brings a new list of approved providers. Will your doctors be included or will they disappear into a dark hole?

Are you willing to change doctors to save money or pay more to keep your doctor?

Are claims submitted by non-par providers covered by your plan?

A recent government report says seniors are more likely to LEAVE managed care plans when they get sicker.

Managed care is great when you enjoy good health. But how much will your plan cost when your health changes dramatically? Can you really afford to be sick?

Medicare Advantage Final Exam

Many who enroll in a managed care plan never really understood how the plans work . . . until they had large claims. Don’t be one of them!

Do you like your current doctor(s)? Would you like to keep him or her?

Can my doctor refuse to treat me if I have a Medicare Advantage plan?

Do you want to direct your own health care, pick your own doctors and hospitals, or would you rather let an insurance carrier do that for you?

Is it easier for you to budget $120 per month to cover almost all of your health care costs or are you OK paying for your health care only as needed?

Could you budget $6,000 per year or more for your health care (not including drugs) if you had to?

How long could you afford to pay that much? One year? Two years? Longer?

Would you trade places with Marsha’s husband?

You can change your Advantage plan every year. Same is true for your drug plan. You can also enroll in original Medicare any time you want without answering health questions.

But if you want to change to a Medicare supplement plan you may need to prove you are healthy. Your best shot at getting a Medicare supplement plan is when you first enroll in Medicare Part B. If you wait until you NEED a Medigap plan you may not be able to get one. That is Catch-22.

Many will only have one chance to enroll in a Medigap plan. Will you be one of them?

Shop GA Medicare rates.

Medicare.

You have questions.

We have answers.

$GAMedicareExpert #MedicareAdvantagePlans #FreeMedicarePlans  #MedicareHMO  #MedicarePPO

GA Medicare Advantage

Medicare Advantage Plans in GA are privately run senior health insurance plans that replace traditional Medicare coverage. Most are either an HMO or PPO and require you to use a doctor or other medical provider that has agreed to the terms and pricing structure for the network.

Medicare Advantage Plans = Fewer Choices

Medicare Advantage Plans have more restrictions and fewer choices than original Medicare and a Medigap plan.

  • If you change to a Medicare Advantage Plan you may find that the doctor you have been seeing for years does not participate in your new plan and will only see you on a cash basis.
  • Medicare Advantage Plans typically have low premiums, in some cases $0. The trade off is higher out of pocket when you need it most.
  • Traditional Medicare and a comprehensive Medigap plan F supplement typically means you have $0 out of pocket for hospital and doctor bills when approved by Medicare.
  • When you have a Medicare Advantage Plan, private insurance carriers, not Medicare, decide which claims will be paid and which will be denied.
  • A large hospital bill that is approved by your Medicare Advantage carrier may leave you owing $3,000 or more once the dust settles.
  • When you want to see a specialist you must first have a referral by your PCP (primary care physician) and that referral must be approved by your Advantage carrier.
  • The rules for Medicare Advantage plans change every year

2014 Medicare Disenrollment Medicare Advantage

Medicare Advantage Pluses

To be fair, there are positive things about Medicare Advantage Plans.

  • Advantage plans may include “extra” benefits such as limited vision or dental coverage
  • Advantage plans require copay’s for doctor visits. Something you won’t find with most Medigap plans.
  • Many Advantage plans include prescription drug benefits. Sometimes the “package” covers the medications you need, sometimes not.
  • If you switch from original Medicare to an Advantage plan and you are not satisfied, you may disenroll during the first 12 months of your Special Enrollment Period (SEP) and return to original Medicare.

Types of Medicare Advantage Plans in GA

Most Medicare Advantage plans will fall in to one of the following categories.

  • PPO
  • HMO
  • PFFS
  • SNP

Bob Vineyard, President of Georgia Medicare Plans, has decided to specialize in GA Medigap plans. We believe the flexibility and overall VALUE of original Medicare and a Medicare supplement plan are superior to the Advantage plans currently on the market. We invite you to compare GA Medigap quotes using our instant online quote engine or ask for a free, no obligation consult.

HMO Advantage Plan

Medicare Advantage HMO plans have strict rules for Medicare beneficiaries. You must play by their rules or else your claim is not covered. This is a summary of the HMO rulebook.

  • You can only obtain care from an HMO approved doctor, hospital, lab or other participating medical provider
  • Your Advantage HMO will only pay for a specialist if you have a referral from your HMO PCP (primary care provider)
  • Some medical procedures require prior written approval from the HMO before they will be covered
  • You have limited rights of appeal if your HMO claim is denied

Bob Vineyard and Georgia Medicare Plans does not recommend Advantage HMO plans to our clients. We believe the choice and value from GA Medigap plans is superior to those offered by HMO plans.