Do All Doctors Accept Medicare Supplement Plans?

Medicare Supplement plans, also known as Medigap, are private insurance policies that help cover out-of-pocket costs not paid by Original Medicare (Part A and Part B). These costs include deductibles, copayments, and coinsurance. This article clarifies whether all doctors accept these plans.

Understanding Doctor Acceptance of Medicare and Medigap

Not all doctors accept Medicare Supplement plans. A doctor’s acceptance of a Medicare Supplement plan is primarily determined by their acceptance of Original Medicare. Medicare Supplement plans do not establish their own separate networks of doctors; instead, they follow the provider’s relationship with Medicare.

There are three main categories of Medicare providers. Medicare-participating providers agree to accept the Medicare-approved amount as full payment for services, known as “accepting assignment.” These providers must accept your Medicare Supplement plan for Medicare-covered services.

Non-participating providers accept Original Medicare but do not agree to accept assignment for all services. They can charge up to 15% more than the Medicare-approved amount, which are called “excess charges.” Certain Medicare Supplement plans, specifically Plans F and G, cover these excess charges.

A third category includes opt-out providers, who have formally chosen not to participate in Medicare at all. These doctors do not bill Medicare, meaning neither Original Medicare nor any Medicare Supplement plan will pay for their services. Patients seeing an opt-out provider are responsible for the full cost of care, typically through a private contract.

How Medicare Supplement Plans Coordinate Payments

When a doctor accepts Original Medicare and provides a covered service, the billing process for individuals with a Medicare Supplement plan is generally seamless. The medical claim is first submitted to Original Medicare for processing. Medicare then pays its approved share, such as 80% for Part B services after any applicable deductible is met.

After Original Medicare processes the claim, it automatically forwards the remaining balance information directly to your Medicare Supplement plan insurer. The Medicare Supplement plan then pays its portion of the remaining Medicare-approved costs. This portion can include the remaining 20% coinsurance, deductibles, or excess charges, depending on the specific plan purchased.

Patients typically do not need to file separate claims with their Medigap plan for covered services because of this automatic claims crossover system. This coordination occurs smoothly as long as the doctor accepts Medicare and the service is covered by Medicare.

Strategies for Finding Participating Doctors

To ensure your doctor accepts your Medicare Supplement coverage, contact their office before scheduling an appointment. Ask two specific questions: “Do you accept Original Medicare?” and “Do you accept Medicare assignment?”

Another practical approach involves utilizing the official Medicare website. Medicare.gov features a “Physician Compare” tool that allows individuals to search for doctors who accept Medicare. This tool indicates whether a doctor accepts Medicare assignment, which is a key factor for Medigap coverage.

You can also contact your Medicare Supplement plan provider for guidance. While Medigap plans follow Medicare’s acceptance policies, the insurer may offer assistance or provide lists of Medicare-participating providers. Verifying a doctor’s acceptance of Medicare and assignment helps avoid unexpected out-of-pocket costs.