If you are turning 65 and comparing Medicare Supplement or Medigap plans, you will probably ask “do all doctors accept Medigap plans?“. This is one of the most common questions for people turning 65 – it can seem complex, but the answer is actually very straight-forward. Do All Doctors Accept Medigap
Put simply, when it comes to accepting Medigap plans, it all depends on if your doctor accepts Medicare itself. Medigap plans “follow” Medicare. So, if a doctor or hospital takes Medicare, they will accept your Medigap plan. It does not matter which company or plan you have since Medigap plans themselves do NOT have networks. Do All Doctors Accept Medigap
If your doctor is a non-participating provider with Medicare itself (rare), then they will NOT accept your Medigap plan either. If Medicare is not accepted, there is nothing for the Medicare Supplement/Medigap plan to “supplement”.
This is not the case, obviously, with many other types of insurance which rely heavily on network arrangements to determine which doctors you can/can not see. For example, under-65 individual plans, group plans, and Medicare Advantage plans all typically use a PPO or HMO network of providers.
There is a difference in accepting Medicare and accepting Medicare assignment. Medicare “assignment” is the terminology that essentially means whether or not a doctor accepts the Medicare payment as payment in full. Medicare has a pre-defined payment schedule for each service or procedure. This is the amount that they will pay to a provider for a certain service or procedure, and it is based on where you are located (varies by location).
Most providers DO accept Medicare assignment (most estimates show that around 95-96% of doctors do accept assignment nationally). This means they accept the terms and conditions (and amounts) on the Medicare payment schedule.
If a physician does not accept assignment, however, he or she can charge up to 15% above the Medicare payment schedule. This is called a “Part B Excess charge”. This is typically billed to you after the doctor visit. There are a few states that have prohibited the charging of these excess charges, including CT, MA, MN, NY, OH, PA, RI and VT (as of early 2017). In those states, doctors can not charge above the Medicare payment schedule if they are going to accept Medicare patients.
Even when doctors do charge excess charges, many of the standardized Medigap plans cover these Part B Excess charges, including Plans F and G. Plan N is the most common plan among the plans that do not cover Part B excess charges.
We often get this question in January and February of each year. Inevitably, what has happened is the person is in a Medicare Advantage plan that they are mistakenly calling a Medicare Supplement. The Advantage plans all have networks and are typically PPOs or HMOs. Those networks change each year – sometimes even in the middle of a year – and if your doctor is not in network with the specific plan you have, you may have to find a new doctor.
This is one of many reasons why it is crucial to understand the differences in Medigap plans and Medicare Advantage plans.
So in summary, do all doctors accept Medigap plans? The short answer is “No”. However, if a doctor accepts Medicare itself, which is your primary coverage, then they will also accept your Medigap plan, regardless of what company sold you the plan or which Medigap plan you have. The key thing to remember is that Medigap plans “follow” Medicare. Do All Doctors Accept Medigap
Do All Doctors Accept Medigap
Do All Doctors Accept Medigap
Garrett is the founder/President of Secure Medicare Solutions, a leading, independent Medicare insurance agency. Since 2007, Garrett has worked with tens of thousands of people turning 65 or already on Medicare to understand, compare and choose Medicare insurance that fits their specific needs and situation.
His latest project is 65Medicare.org, an online hub for people just starting with Medicare, which is focused on distilling difficult Medicare questions into easy-to-understand resources.
Garrett resides in North Carolina with his lovely wife, Celeste, and three spirited children.View All Articles