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Medicare – Your Doctor, Your Choice

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Medicare annual open enrollment starts soon. Will you be prepared? Will YOUR doctor accept your new plan? Who is in charge of your health care? You, or an insurance company?

Most Doctors Accept Medicare Assignment

The next time you make an appointment with your doctor, will you be turned down? While most doctors accept Medicare assignment, about half do not participate in one or more Medicare Advantage plans.

With original Medicare and a Medicare supplement plan, you get to pick your doctor.

When you have an Advantage plan, the insurance company makes that decision for you and presents you with a list of “acceptable” doctors.

Medicare open enrollment is around the corner and many wonder if they are better off with an Advantage plan or Medigap coverage. The “right” answer is . . . it depends.

The Basics of Georgia Medicare Plans

Original Medicare only covers 52% of your health care costs, so unless you are wealthy, you need additional insurance to help pay your bills. Seniors in Georgia can choose from two types of private health insurance . . . Advantage plans or Medicare supplement plans (also known as Medigap).

Before you can enroll in an Advantage plan or Medicare supplement plan you must have Medicare Part A and Part B. Most do not pay a premium for Part A but will pay the Part B premium via deduction from your Social Security check.

Advantage plans and Medigap plans have monthly premiums that are determined by your age, your gender, where you live and the type of coverage you want.

How Do Medicare Advantage Plans Work?

Most Advantage plans have doctor and hospital networks. Some allow you to use medical providers that are outside their network, some do not. If you have a plan that provides out of network coverage, it only applies if the doctor or hospital agrees to accept the plans terms and conditions of payment.

It is not unusual to find that half the doctors in your county do not participate in Advantage plans or they may currently accept SOME Advantage plans but not others.

Some Advantage plans cover prescription drugs, some do not. For our purposes we are only considering plans that do not include Rx coverage.

Advantage plans have copay’s for doctor visits, outpatient hospital services, ambulance, Emergency Room, durable medical equipment (DME), diabetic supplies, diagnostic X-ray and lab services and so forth.

The copay may be a fixed amount, such as $20, or it may be a percentage of the charge levied by your provider. Typically you are required to pay 20% of the approved charge.

Every time you utilize these medical services you will need to verify that the provider is “in network” or that they agree to accept the terms and conditions of your plans payment schedule.

In short, with a Medicare Advantage plan you use THEIR doctors, not yours.

Medicare Supplement Plan N

If you have original Medicare and Medigap plan N your plan works like this.

You may use any doctor, or any hospital, that accepts Medicare assignment. In your county almost every doctor and hospital participates in Medicare and has no trouble accepting assignment or your Medigap plan.

Your doctor bills Medicare. They review the claim and when it is approved, Medicare bills your supplement plan carrier.

Your doctor never knows, nor do they care, which carrier handles your Medigap coverage. All gap plans with the same letter are identical so you should pick the plan with the lowest premium.

When you pick Medigap plan N you are required to pay your Medicare Part B deductible (currently $162) plus up to $20 for a doctor visit; up to $50 for a visit to the Emergency Room.

With original Medicare and Medigap plan N, you use YOUR doctors, not theirs.

Which makes more sense?

Buying a plan that requires you to use THEIR doctors plus you pay 20% of an unknown amount every time you use the plan, or buying a plan that lets you use YOUR doctors and limits the amount you pay to $20.

You pick.

Georgia Medicare Plans has affordable Medigap plans for GA seniors. Use our GA Medigap Quotes link to find plans, compare rates and decide which plan best fits your needs and budget.

Georgia Medicare Doctors Say No

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Georgia Medicare doctors are saying no to new patients. If you are turning 65 and going on Medicare, you may be shocked to know many Georgia Medicare doctors are not accepting new patients.                      ga-medicare-doctors

A wave of aging baby boomers will soon join the estimated 1.2 million Georgians currently on Medicare, but fewer Georgia Medicare doctors are taking new patients, according the American Medical Association.

“They’re going to find it much harder to find a physician that will accept the low payments that Medicare is giving, because they can’t afford to,” American Medical Association Chair Dr. Robert Wah said.

WSBTV, “Doctors rejecting new Medicare patients”

If Georgia Medicare doctors are not accepting new patients, what is a person to do?

You could purchase a Medicare Advantage plan from an HMO such as Kaiser. The structure of the KP HMO is such that finding  Georgia Medicare doctors is much easier than other MA plans or those with original Medicare and a Medigap plan.

“They’re going to find it much harder to find a physician that will accept the low payments that Medicare is giving, because they can’t afford to,” American Medical Association Chair Dr. Robert Wah said.

The payment formula used to fund Medicare has come up short for the past decade, forcing congress to pass short-term fixes to avoid cutting reimbursements to doctors. But doctors are getting tired of the threat of cuts, so more are choosing not to accept new Medicare patients.
    
“Physicians are dedicated to their patients. They want to take care of their patients, so they’ll probably stay with their current patients, but the new patients will have trouble,” Wah said.

Georgia Medicare doctors cannot afford to lose money on new patients. Don’t expect Congress to do anything until January when they reconvene after the election. The economy and middle east are hot election topics but seniors on Medicare are also keeping a watchful eye on how DC will implement cuts in Medicare funding.

Neither presidential candidate will eliminate Medicare, but Obamacare does gut funding for Medicare. This means fewer Medicare Advantage choices, higher premiums, and higher copay’s.

“We will improve health care only if and only to the extent that the federal government backs away from micromanaging the health care sector,” said the Cato Institute’s Michael Cannon.

The current Medicare fix runs out at the end of February. Unless Congress acts, Georgia doctors will lose an average of $31,000, according to the American Medical Association.

How do you find Georgia Medicare doctors that are approved by Medicare and accepting new patients? Georgia Medicare Plans suggests you FOLLOW THIS LINK to find Georgia Medicare doctors

Medicare Cuts – What Will Your Doctor Do To Survive?

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Planned Medicare cuts mean many doctors, including yours, will take a drastic pay cut in January, 2013. Will your doctor refuse to see you? Will they delay your appointment? Will your doctor limit your number of visits during the year? How will your doctor deal with a 26.5% loss of pay due to Medicare cuts?

Medicare Cuts of 26.5% Will Affect You

What would you do if Congress decided to cut your Social Security check by 26.5% in January? Could you survive? Could you pay all your bills, including Medicare, doctor bills, utility bills, food, prescriptions and Medicare supplement insurance?

If you raised your hand, indicating your life would changed drastically with a 26.5% automatic reduction in your Social Security check then you know exactly how your doctor feels.

What would you eliminate from your budget? Would you stop buying and taking your medication? Would you turn off the heat? Or perhaps you might cut back on the number of times you see your doctor. Or you might postpone or call off needed treatment or surgery.

Now you have an idea of how your doctor might have to deal with upcoming Medicare cuts.

The CMS final calculation of the 2013 SGR cut at 26.5% is slightly lower than its initial projection, but it still is so large that it would negate any increase to a particular specialty from other elements of the fee schedule and further drive down pay for others who are lined up for net rate reductions.

Lawmakers have discussed a temporary delay of the pay reduction as part of an overall package addressing unresolved fiscal issues before Dec. 31. Lawmakers are scheduled to return to Washington on Nov. 13.

AMA, “Medicare finalizes physician pay”

Temporary delay.

This is not the first time. In fact, Congress has done this almost every year  for the last 8 years or so. You would think they would do the job they were hired to do but apparently they feel they can ignore something as important as doctor pay. With almost 50 million citizens on Medicare, you might think this is a big deal.

Well you are right. This IS a big deal.

Will your doctor refuse to see you? Will they delay your appointment? Will your doctor limit your number of visits during the year?

The answers are yes, yes and yes.

Depending on your medical condition(s) and how busy your doctor is, you will probably be pinched in any number of ways.

When this happens your health suffers. All because Congress fails to do their job.

Medicare cuts really suck.

A multiple procedure payment reduction rule was expanded to include more advanced imaging services in the final fee schedule. The policy lowers rates by 25% for interpreting subsequent scans provided to the same patient on the same day — including instances in which two physicians in the same practice interpret images for the same patient during an office visit.

Translation, your doctor will take a pay cut unless they require you to come back to the office on a different day to read your X-ray’s or scans.

Guess what?

Congress doesn’t care if your doctor takes a pay cut for providing a service that is convenient with your schedule.

Medicare cuts WILL happen. You can almost bet on it.

Happy holidays.

Medicare Patients Have Trouble Finding Doctors

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Medicare patients are having trouble finding doctors willing to treat them. Every time the government cut’s doctor reimbursements for Medicare patients, the doctor has to decide if they can afford to continue treating Medicare patients.

If you are on Medicare and need treatment you may run in to Dr. No . . .

Dr No
Dr No

If you just turned 65 you may be in for a surprise. Some doctors, including your family doctor, may not be taking any new Medicare patients . . . including you.

This Madison clinics decision to refuse new Medicare patients may be a trend.

Wertsch, a big guy with a droopy mustache who founded the clinic in 1977 with his wife and another graduate of the University of Wisconsin-Madison’s family practice program, says he and the other 10 doctors who now manage and own the practice can no longer afford to provide that care to additional people on Medicare, who already make up a quarter of the clinic’s caseload and up to 70 percent of the rosters of its older doctors, like him.

Medicare pays only a quarter to a third of every dollar the clinic charges, Wertsch says, often half of what private insurance carriers pay. When you figure that overhead for the clinic — which includes stuff like electricity, staff salaries, and a whopping $700,000 or so for the clinic’s electronic records system — adds up to around 80 cents on the dollar, accepting Medicare is a losing proposition, he says. “I love taking care of Medicare patients,” says Wertsch, 68. “But every time we treat them we have to dig into our wallets. What kind of business model is that?”

Read more: http://host.madison.com/ct/news/local/health_med_fit/madison-clinic-s-decision-to-stop-taking-new-medicare-patients/article_70520894-72c8-11e1-a7d0-0019bb2963f4.html#ixzz1pn2FyZ4y

We see and hear about this more often. Doctors lose money treating Medicare patients and have to make it up somewhere else.

That somewhere else is in the form of seeing fewer Medicare patients and more private insurance patients where the reimbursement for services rendered is considerably higher.

Most doctors accept Medicare asssignment but some are not taking on new Medicare patients. This can be even more challenging if you have a Medicare Advantage plan. Less than half the doctors in Georgia take ANY Medicare Assignment plan and even when you do find a doc willing to take Advantage plans they may not take yours.

Georgia Medicare Plans has affordable Medigap rates for GA seniors. Ask your doctor if they are taking new Medicare patients before making any decisions.

Georgia Medicare From a Doctor’s Perspective

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Doctors in Georgia are having trouble getting paid by government run health insurance plans such as Medicare and Medicaid. This will only get worse under Obamacare.

What is the benefit of having taxpayer funded health insurance if you can’t find a doctor to treat you?

If you are relying on taxpayer funded health insurance such as Medicare or Medicaid, you should be concerned about where you will find a doctor willing to accept you as a patient.

Affordable Medicare Supplemental Insurance in Georgia

Georgia Insurance Shop has a wide array of plans for Georgia seniors. If you have a Medicare Advantage plan that is going away, or are just looking to make a change during open enrollment, ask for a competitive quote. We have low Medigap rates from all the major carriers including AARP, Blue Cross and others.

 

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