by Russell Noga | Updated May 10th, 2023
Many people who are new to Medicare, and even those who have been enrolled for years often as “Can a doctor refuse a Medicare supplement plan if you visit them?” The answer is, possibly.
But as long as you know the basic rules ahead of time, you’ll be left with no surprises when it comes to using your Medicare supplement plan through your doctors.
Doctors must accept Original Medicare
There are doctors that simply refuse to participate in Medicare due to the stringent rules, paperwork, and low reimbursement rates from Medicare.
Medicare usually pays around 80% of what doctors can charge private healthcare insurers for their services. So, it’s unsurprising that some avoid accepting Medicare “assignment” rates.
Doctors state Medicare reimbursements haven’t kept pace with annual inflation increases in recent years, forcing many of them to refuse to accept Medicare rates as payment for services rendered. While this is a fact, the regulations surrounding the healthcare industry keep tightening, and there are stiff penalties for noncompliance.
Using your Medicare Supplement Plan
As long as the provider you are seeing accepts Original Medicare (regardless of if they accept the assigned rates or not), then they will accept your Medigap plan. If they do not accept Medicare, then there is nothing to supplement.
And because Medigap plans work alongside Medicare Parts A and B, and do not replace those parts, then doctors must accept Medicare for you to use your supplemental insurance. There are no exceptions to this.
If a doctor accepts Medicare and Medigap plans, they cannot pick and choose which Medicare supplement companies they wish to accept. Whether it’s an Allstate Medigap plan or a supplement plan from Mutual of Omaha, they must take either one.
There is No Network
Because Medicare is a federal program and is used nationwide, and Medicare supplements follow Medicare, there is no network when it comes to using your Medigap plan.
You may visit any doctor, specialist, or hospital that accepts Medicare and provide them with your Medicare Supplement insurance.
So unless the provider’s office does not accept Medicare patients, or in rare cases, they only accept a certain Medicare Advantage plan, then they cannot refuse to accept your Medicare Supplement plan.
What are Medicare Supplement Plans?
The Federal government standardizes the Part A & B benefits offered in Medigap plans. This regulation ensures consistency in the benefits offered across all providers.
All Medigap plans offer the following benefits.
- Part A coinsurance and hospital costs for up to 365 days after using up Medicare benefits.
- Part A hospice care coinsurance or copayment.
- Part B coinsurance or copayment.
- Blood transfusion costs for the first three pints of blood.
Plans F, G, and N offer additional Medicare Parts A & B benefits.
- Part A deductible.
- Part B excess charges (Plan N doesn’t cover these charges).
- Skilled nursing facility care coinsurance.
- 80% of emergency healthcare costs when traveling outside the US for 60 days. ($250 deductible and $50,000 maximum apply).
- Unlimited coverage for all out-of-pocket costs.
Medigap plans don’t cover the costs of vision, hearing, and dental services. However, some insurers offer discounted rates on these services from providers in their network. Or they may include a separate policy covering these services for a small monthly fee.
Medigap policies also don’t cover the costs of private-duty nursing, stays at long-term nursing homes, or preventative services like foot care, physiotherapy, and chiropractic. Medigap also doesn’t cover the cost of prescriptions – you’ll need Part D for that.
What is Medicare Assignment?
Most doctors accept “Medicare Assignment” rates for their services without an excess charge. However, doctors have the right to charge 15% above the Medicare-nominated rate for consultations and treatments. As a result, you’re responsible for the additional costs to pay out-of-pocket.
Although Medicare Part B excess charges are extremely rare, you can be safe by enrolling in one of the most popular plans such as Medigap Plans F & G. Both of these offer coverage for these Part B excess charges, leaving you with nothing to pay. The rest of the Medigap policies don’t cover Part B excess charges, but these charges are rare and typically very inexpensive.
If you’re on plans other than Plans F & G, such as the very popular Medigap Plan N, you can simply avoid excess charges by using a physician who accepts Medicare Assignment rates. It’s estimated that over 95% of doctors in the United States do not charge Part B excess charges.
How to Find Doctors Who Accept Medicare
Many doctors charge Medicare Assignment rates, and you can locate participating providers close to your using the Medicare Physician Compare Directory.
This comprehensive list of healthcare providers and doctors gives you plenty of options around your local area. After locating a provider, call their office to ensure they still accept Medicare Assignment before booking your appointment.
You can search for Medicare providers in your area by using Medicare’s database here.
Plan N Doesn't Cover Part B Excess Charges
Plan N doesn’t cover the Part B excess charges involved with seeing a doctor charging more than Medicare assignment rates. You’re liable for the additional charges if you see physicians working outside this rate.
These are quite rare, and on average less than 1% of all claims typically include Part B excess charges. If you use a doctor that accepts Medicare assignment, you will not be billed any excess charges.
If a Doctor does not Accept Medicare Assignment
Your doctor may decide that they don’t agree with Medicare’s reimbursement rates but still accept Medicare patients. In this case, they’ll charge their services at a rate 15% above the Medicare-approved amount. These physicians are “non-participating providers.” The extra fees they charge are called “excess charges.”
As mentioned, Plans F & G pay for these additional excess charges. However, the other plans require you to pay the excess out-of-pocket. You’ll also have to pay the doctor’s fee upfront and then get Medicare to reimburse you. Your doctor submits your claim to Medicare on your behalf, or you’ll have to do it yourself using claim Form CMS-1490S.
For instance, your doctor’s bill comes to $300 for your consultation. Medicare pays a rate of $250, leaving you with an excess charge of $50 unless you have Plans F or G (Plan N also requires you to make a $20 copayment).
Ask the Doctor for a Referral
Medicare and Medigap policies don’t institute excess charges or copayments for visits to urgent care facilities across the United States. As a result, many seniors now use the urgent care center for their healthcare evaluations and assessments.
There are over 9,000 urgent care centers across America, and there’s probably one near your home. Many urgent care centers operate as “walk-in” clinics. That means you don’t make an appointment, you arrive, and the team treats you on a “triage” basis, attending to the most critical patients first.
So, you might have to wait a while for your consultation and treatment, but you won’t have any Part B excess charges to pay for these services.
For those who have Medigap Plan N, which typically requires a $50 copay if you visit the emergency room and you’re not admitted, Urgent care centers do not charge this copay.
Medicare And Urgent Care Centers - Avoid the ER Copay
Medigap Plan N doesn’t provide coverage for your prescription medications. However, it does cover pain relief medications in hospices and respite care in skilled nursing facilities, with a $5 copayment. You must take the additional Part D plan if you want drug coverage.
Can a Doctor Refuse a Medicare Supplement Plan? – Key Takeaways
- If you use a doctor accepting Medicare Assignment rates, they won’t charge you more than Medicare-approved rates for covered services.
- Your doctor can be an opt-out, non-participating, or Medicare-enrolled provider.
- Your physician’s Medicare provider status determines how much of the bill Medicare covers and options for finding cheaper providers.
What is Medicare Plan N?
Medicare Plan N is a type of Medicare Supplement Insurance also known as Medigap. It’s designed to cover some of the out-of-pocket costs that aren’t covered by Original Medicare, such as copayments, coinsurance, and deductibles. It also offers coverage for foreign travel emergency care.
What does Medicare Plan N cover?
Medicare Plan N covers several costs including Medicare Part A deductible and hospital costs up to 365 days after Original Medicare benefits are used up, Medicare Part B coinsurance costs, the first three pints of blood used in a medical procedure, and 80% of foreign travel emergency care.
What is not covered by Medicare Plan N?
Unlike some other Medigap plans, Plan N does not cover Medicare Part B deductible or any excess charges, which are the costs that may exceed Medicare-approved amounts for doctors who do not accept Medicare assignment.
How much does Medicare Plan N cost?
The cost of Medicare Plan N can vary based on factors like your location, age, and the insurance company. On average, premiums can range anywhere from $70 to $200 per month. Our FREE quote engine on this page can give you accurate rates for Plan N in your area for your age. Just enter your zip code above
How is Medicare Plan N different from Plan G?
The main difference between Medicare Plan N and Plan G is that Plan G covers Medicare Part B excess charges, while Plan N does not. Plan N may also require a small copayment for certain office visits and emergency room trips.
Is prescription drug coverage included in Medicare Plan N?
No, prescription drug coverage is not included in Medicare Plan N. For prescription drug coverage, you would need to enroll in a separate Medicare Part D plan.
Can I switch from another Medigap plan to Plan N?
Yes, you can switch from one Medigap plan to another, including Plan N, but it’s subject to medical underwriting after the initial enrollment period unless you have guaranteed issue rights.
Does Medicare Plan N cover dental, vision, or hearing services?
No, Medicare Plan N does not cover routine dental, vision, or hearing services. For these types of coverage, you would need additional insurance.
When can I enroll in Medicare Plan N?
The best time to enroll in Medicare Plan N is during your Medigap Open Enrollment Period, which is a six-month period starting the month you’re 65 or older and enrolled in Medicare Part B.
Where can I purchase Medicare Plan N?
Call us today at 1-888-891-0229 to enroll in a Medigap Plan today and get your questions answered. Our service is FREE!
Russell Noga is the CEO of Medisupps.com, an online Medicare Agency and resource center helping Medicare beneficiaries learn about Medicare, Medigap and Part D drug plans, and Medicare Advantage plans since 2009. Russell is licensed in all 50 states and has been featured as a keynote speaker, and author of several publications, along with hosting the very popular Medisupps.com Youtube channel.