How Does Medicare Influence Patient Access to Care? 

Medicare is the federally run national health insurance system that provides health care coverage for over 65 million beneficiaries in the United States. Most people start getting Medicare when they turn 65, but others get coverage earlier if they have a qualifying disability. If you’re eligible for Medicare, you can enroll in Original Medicare Part A (hospital insurance) and, or Part B (medical insurance). Or you can choose to purchase a Medicare Advantage (Part C) plan, a bundled alternative form of Original Medicare Parts A and B, for your health care benefits. 

To get your benefits if you have coverage through Original Medicare, you must use health care providers, suppliers, and medical facilities (hospitals, nursing homes, clinics, etc.) that accept Medicare assignment. If you are enrolled in a Medicare Advantage plan, you may need to use providers and suppliers that are within a set network of providers determined by your plan provider. 

American beneficiaries didn’t start receiving Medicare health coverage until 1966, at a time when 56 percent of people over 65 didn’t have any form of health insurance. Since then, Medicare has undergone many changes, and the system continues to evolve, however, most recipients find that having Medicare not only increases their access to health care, it also makes that health care more affordable. 

How Medicare can help you get the care you need 

Today in the United States, statistics show that Medicare pays for approximately one out of every four visits to a physician, and according to KFF, 96 percent of all beneficiaries say they have regular access to a doctor’s office or clinic for a primary source of care. Furthermore, 90 percent of Medicare enrollees report that they can schedule appointments for routine or specialty care on a timely basis. 

If you’re eligible for Medicare enrollment, or if you’re already a beneficiary, you probably know that Medicare only covers medically necessary services from health care providers, medical supplies, or care in medical facilities that accept Medicare assignment. So, should you be worried about finding a physician that fits the criteria? Not really, because based on statistics, 93 percent of all primary care physicians in the U.S. accept Medicare. Of course, a certain physician might not be accepting new patients, or you might have certain network restrictions depending on your Medicare plan.

If you’re enrolled in Original Medicare, you can find a health care provider who accepts Medicare by asking your current physician for a referral, asking friends or family members, or checking the official Medicare website. You can also call your local CMS office and ask an agent for help. 

If you’re enrolled in a Medicare Advantage plan that requires you to use network providers, you should have a list included in your policy. You can also contact a provider by phone or visit their official website for more information.  

Health care providers, medical suppliers, and medical facilities that accept Medicare assignment must agree to Medicare rates and can’t charge additional or different fees for your health care services or supplies. For most covered services, Original Medicare Part B pays 80 percent of the final approved cost and you pay the remaining 20 percent after meeting the annual Part B deductible.  

If you visit a physician that participates in Medicare but doesn’t accept assignment, he may charge up to 15 percent more than the final Medicare-approved amount. These surcharges are known as Part B excess charges, and some Medigap plans cover them. However, if you don’t have a Medigap plan, and you don’t want to pay excess, you should only see health care providers that are Medicare approved.