When I first arrived in our new town, I set out to find Mom a doctor. I got good referrals. Every office I called said that they were not taking new patients. This week I needed to go to the doc and called one of those offices. Suddenly, they are taking new patients.
Can a doctor legally refuse to take Medicare patients? No one has come out and said this, so I'm not sure now.
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.
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.
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.
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.
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 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...
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