If you are receiving Medicare and/or Medicaid, it can often be difficult to find a doctor, be it a general practitioner or specialist, who will accept your insurance. Unfortunately the payment schedules set up by the government have resulted in many doctors opting out of the system because they simply cannot afford the substantially lower payments for Medicaid/Medicare services as well as afford to pay for the substantially greater paperwork involved in taking such patients.
Sadly, government has had a tendency to reduce reimbursement payments, not increase them, and do not seem to be interested in covering the actual cost of providing services.
Not only that, but private insurers are not longer willing to “subsidize” public patients by paying higher rates, so doctors cannot shift the ever-increasing costs to them.
As a result, at a time when more and more doctors are opting out of the system, those doctors who still take Medicare and Medicaid patients generally limit the number they will serve, so finding a doctor who will take your Medicare or Medicaid insurance is not as easy as simply opening the phone book and making a phone call. Indeed, it probably will take some real time and effort on your part.
There is not, and never has been, any requirement that doctors treat patients insured by Medicare or Medicaid. Therefore, people with Medicare or Medicaid are increasingly turning to federally funded clinics, or even to emergency rooms that cannot, by law, turn them away. Sadly, using emergency rooms for non-emergency health care is unbelievably expensive, making the lower reimbursement Medicare/Medicaid rates not financially wise in the long run.
So, how do you find a doctor that will take new Medicare/Medicaid patients?
Well, first of all, do not expect to find a doctor or, should you find one or a clinic taking Medicare/Medicaid patients, do not plan on getting an appointment quickly. Sadly, that will not happen very often. Indeed, if you need quick care, the emergency room is likely to be your only recourse.
To track down Medicare/Medicaid providers, you can contact your local health department or social service agencies to find out more information and there are a number of Medicare and Medicaid doctor directories online. While they cannot guarantee you an appointment, they do have access to information about current providers.
You can also go to the Medicare website at Medicare.gov or call them at 800-633-4227 (TTY 877-486-2048) to find Medicare providers in your area, although there is no guarantee they will be accepting new patients. It is worth a try, though.
Also, managed care is probably a better bet than private practice. HMOs organized by private insurers have a practical interest in having HMO doctors taking government-insured patients, while Prepaid Health Plans (PHPs) are generally run by hospitals or medical schools, and often only accept Medicaid patients.