What good is Medicare if your doctor won't take it?

I received the following question by email from a reader, regarding the previous article What's the good of having health insurance if you can't get a doctor to take it? I welcome you to comment on this article or ask your own questions.

"I read your article on What good does health insurance do if your doctor won't take it.  What about Medicare?  If you are 65 or older and are covered by Medicare (no choice there) and the doctor won't take Medicare, they don't care that you have Blue Cross as well.   Because Medicare is still the primary provider and Blue Cross can't exceed Medicare's reimbursement to doctors.  What's the answer to that one?"

First of all, you do have a choice about whether you have Medicare in the first place, though few make the choice not to take it. Not everyone is eligible for Medicare or chooses to pay the Medicare premium amounts if they are eligible. However, for those that don't have any other given choices from their current or pre-retirement employer, Medicare represents the most typical choice. Since your Blue Cross is written to complement Medicare (and I think we're talking mostly about Medicare Part B here), it does so in only very specific ways. If Medicare continues on the road it is taking perhaps the supplements, such as your Blue Cross, will change their plan to work around this issue. I'm sure that the doctors would be happy to take cash, tell you the list of insurers that they do take (and you could see if you could even buy over 65 health insurance from these insurers).

So in the end, if a doctor chooses not to take Medicare, they are essentially shutting off that group of patients in favor or younger (usually) and better paying customers (it sounds like nobody reimburses for less than Medicare). Your options are cash, changes by the Medicare Administration to the Medicare payout, changes to how your Blue Cross plan works with Medicare, or buying another type of policy from Blue Cross or another insurer that has a different payout to doctors.

This is a business practice by the doctors and administrators who ultimately make the choice by determining if they have enough customers without taking Medicare, and determining how much money they make (or loose) on a typical Medicare patient and comparing that to how they'll do without Medicare patients. Being a doctor also means being in business for a significant number of doctors, and the choice of how to be most profitable can be made by a doctor or an administrator and may include dropping insurers, such as Medicare, that do not help their business. After all, they've got make enough to pay for their health insurance, too!

Your choice is to find another doctor who can take Medicare or to pay cash for a doctor that doesn't take Medicare. These are your choices because of the free market economy for healthcare in the U.S., and some doctors and the Medicare administration are making choices that result in fewer options for patients who do not have the option to pay cash instead of using Medicare. Of course, other doctors will continue to take Medicare, and additional doctors will find a way to run a medical business and take new Medicare patients. The Medicare administration can also adjust their payout levels to increase the number of doctors taking Medicare, but they need to balance these payouts with the available funds. Otherwise additional funding will be needed, such as raising Medicare taxes, and that would be difficult at best.