Is Medicare Running Out of Doctors?

by Nancy Metcalf Health Writer

For decades, Jack Hoadley has made his career in Medicare, first as a government administrator and now as a research professor at Georgetown University in Washington, D.C. For most of this time he has been hearing that, any year now, doctors are going to drop out of Medicare in droves because they are fed up with its red tape and low fees.

So, are they? Not so far, despite what you might have heard from your own doctor. And there are plenty of facts and figures to back this up.

Not quitting yet

In 2015, the most recent year for which figures are available, 581,607 doctors billed Medicare, according to a March report from the Medicare Payment Advisory Commission (MedPAC), of which Hoadley is a member. Only about 9,000 doctors have taken the draconian step of “opting out,” meaning they cannot bill Medicare for any services, and must sign a contract with their patients prohibiting the patients from submitting a Medicare claim on their own.

We did the math: 98.5 percent of doctors take Medicare.

(Interestingly, psychiatrists make up less than 6 percent of physicans but account for about 40 percent of Medicare opt-outs, according to one recent analysis.)

Nevertheless, MedPAC thinks “it’s important to keep looking” for signs that doctors are quitting Medicare, Hoadley says, so every year it commissions a nationwide survey and focus groups comparing access to physicians by Medicare beneficiaries and people between the ages of 50 and 64 on private insurance.

This year, as in the past, Hoadley says that “access for Medicare patients is pretty much identical to that for people with private insurance.” That holds true whether people want routine care, to be seen quickly for an illness or injury, or need to find a new primary care doctor or specialist.

It’s true, as doctors will tell you, that Medicare doesn’t pay as generously as private health insurance—on average, about 80 percent of what private insurance doles out for the same service.

“It doesn’t mean Medicare payments are inadequate,” Hoadley says. “Doctors might have as much or more administrative burden from commercial insurers. The feeling is they don’t lose money by seeing Medicare patients.”

Where the patients are

Moreover, opting out of Medicare means opting out of a significant source of revenue. Only 14 percent of the U.S. population is over 65, but they account for one- third of all health spending. “If you’re in a specialty where the conditions you treat occur in a population 65 and over, that’s where your patients are,” Hoadley says.

Important note: If you get your Medicare coverage through a private Medicare Advantage plan, you probably don’t have access to all the doctors in your area who participate in Medicare.

Advantage plans that are run by private commercial insurance companies, like other commercial plans, only pay the full contracted fee for doctors and other providers who participate in the plan’s network.

To learn more about your Medicare benefits, find the right coverage, or to understand how any existing coverage works with Medicare, contact the National Helpline.

Nancy Metcalf
Meet Our Writer
Nancy Metcalf

Nancy Metcalf is an award-winning independent journalist specializing in health topics. A senior writer and editor for Consumer Reports for more than 25 years, she is a nationally recognized expert on health insurance and health reform.