How Many Doctors Will Still Take Medicare In 2025?

People that are getting ready to go on Medicare ask me all the time, is it difficult to find doctors that take Medicare? Well, the answer is sometimes it is and sometimes it isn't. So as we approach 2025, I'm going to show you in this video how you can make sure your doctor takes Medicare. Now in order to find out whether your doctor takes Medicare or a doctor that your desires to go to takes Medicare, I think it's important to understand that there's actually three different categories or different types of doctors. Doctors can have a different relationship with Medicare. There's three possibilities. So first one would be the most common doc, which is a doctor that we would call a participating provider. That means they have a contract with Medicare. They've enrolled in that contract. And we also call these kind of doctors assignment doctors. All right. And I'll tell you a little bit more about what that means financially to you with a doctor that takes assignment, but that's one option. The second type of doctor would be a doctor that's non-participating, meaning they did not sign the assignment contract. They can still see Medicare patients. They can still build Medicare, but they're under a different type of a contract. Now, just so you know, each of these contracts are renewed on an annual basis around November, December of every year. All right. So that's the second. Then we have a third type of doctor and that's what we call an opt out provider. They did not sign any contract with Medicare other than they said, we're opting out. And that means they're not going to take assignments. So they're not a participating participating provider whatsoever. So they're, they're under contract that says we are not going to receive any money from Medicare and we're not going to build Medicare in any way. So that's truly an opt out provider. And so what I'm going to do is actually want to start with this particular one here, the opt out providers. This would be the least common relationship that docs have, but some have it. So let me explain. Now this chart actually will show you the amount of doctors that are in this kind of relationship to having opted out of the program entirely. And notice it's really, really small. In fact, it's only 1.1% of all the doctors throughout the country that are active physicians that are non-pediatric because a lot of docs that are pediatric docs are certainly not going to take Medicare but non-pediatric physicians, 1.1%. So you can see here and by the way, just so you know, our numbers are all in 2023. Now you're watching this probably in 2025. The 2024 numbers are not out yet as I shoot this video, they usually come out mid year. But again, this is the most accurate up-to-date information when it comes to opting out providers. Right now, 11,039 that say we're not going to bill Medicare, we're not going to take any kind of Medicare from Medicare nor bill Medicare for the services that we give to someone that actually would be eligible for Medicare. Now this next graph was provided by the Kaiser Family Foundation. They put a lot of great information with Medicare really with all kinds of things going on in the health insurance business. But what this does, this actually shows you the type of doctors that have opted out of taking Medicare. Now what you're going to notice that of that 1.1% of that little over 11,000 docs that don't take Medicare, 40% of them are in the psychiatric field, okay, psychiatrists that have opted out. Next would be those that practice family medicine, 21% of that number. Internal medicine, 13%. OBGYN is at 6%. Notice plastic and reconstructive surgery be 3% of that total. And then orthopedic surgery, another 3%. And then other specialties, these would be some dermatologists, endocrinologists, rheumatologists, a variety of doctors collectively that are specialty docs, 14% of those. So again, a great many of physicians are going to take Medicare, but we see there's some that are not going to in any form. All right, so that brings us then to the total, 11,039 docs that are non-pediatric, not taking Medicare. Now in addition to that, I thought this was very interesting as well in my studies, there's 4,229 who also opted out, and these are called just clinical professionals that have a doctorate degree. And so these would be some podiatrists, it would be some optometrists. But what's interesting to me is that 94% of this number right here, these 4,029 are actually oral surgeons. I've had clients call me and say, I have to have oral surgery. Is there anyone that does, you know, takes Medicare for that? And it was almost impossible to find them. And after I did this research, now I know why, because the majority of them have opted out because the Medicare reimbursement rate is so low, they just can't make any money doing that. All right, so of that amount that said we're opting out, so you can see now we're just a little over 15,000 doctors that have decided to opt out of Medicare. So that's the total that we're dealing with in that particular category. Hey, if you found this video helpful and you want to see more Medicare information just like it, then go below, right below the video, and you can give us the thumbs up as well as subscribe to our channel. And every time I put a new video, which is about two every week, you'll be notified of that video and others just like you who need this vital information will get it as well. So what's the likelihood of you trying to see a doctor that has chosen to opt out of Medicare? Well, you actually have this information by state, very low likelihood, of course, across the board, but even lower in Iowa, Minnesota, Mississippi, North Dakota, Nebraska, Ohio, South Dakota, Wisconsin, and West Virginia, there's less than a half a percent chance that you would ever try to go to a doctor that has opted out of the Medicare program. Washington DC, a 2% chance, 2.1% of docs in Idaho have opted out, Wyoming, Colorado, 2.3, Alaska, 3.1. But on average, what you're going to see here is less than 2% of doctors in all the other states have opted out of Medicare. So the likelihood, if you want to see someone, more than likely they're going to be within the Medicare system. Now, doctors that have chosen to opt out, we oftentimes will call those concierge doctors, meaning they don't take insurance. They work on a cash basis. They'll may enter to some kind of an agreement. Now, if you're on Medicare and you see a concierge doctor, you actually have to sign paperwork acknowledging that you know they don't take Medicare, they're not going to bill Medicare, and you're fully going to be responsible for any services that they render for you. Again, that's a concierge doc. So again, less than a 2% chance in most states that'll ever happen to you. All right, so that's the doctors that have opted out completely. Now let's talk about those doctors that are participating doctors, those assignment doctors that we talked about a takes assignment. Number one, you have agreed under contract, again, an annual contract to accept Medicare approved amounts as payment in full, payment in full. So every single service that Medicare covers, we call that fee for service. So every single service they cover, there's already a predetermined, pre-established fee that that doctor knows they're going to get, whether it's a surgeon or anesthesiologist or primary care doctor on a certain office visit or a specialist, they know exactly what they're going to get for Medicare. Medicare sets those rates. And again, when they sign this participating contract, they agree to accept that as payment in full, they're not going to ask for any money beyond that. Okay, so that's part of the contract. The second aspect of the contract is this, they under contract agree to charge only the Part B deductible and the coinsurance. Because again, we're talking about physicians. And so the Part B deductible in 2025 is $257. The patient's responsible for that once a year. If you've already met that deductible, you would not be responsible for that. But again, that's something that they could possibly bill you for. And then you have coinsurance. Remember, Medicare pays 80%, but you're responsible for 20%. So a participating doctor could only bill you in total for that 20% plus the B deductible. Now keep this in mind. If you had a supplemental plan F, all that would be covered. If you had a supplemental plan G, you would have to pay that, but that G plan would cover the full 20%. Okay, so the doc wouldn't bill you anyways. If you had an implant, again, a very popular plan right now, you would have to pay that. And then that doctor could bill you for a $20 copay. They couldn't bill you 20%, just that $20 copay that you're subject to on an implant. But my point is they can never bill you beyond those two items. Now, if you have insurance to cover it, then the insurance company is going to pay that. But if you didn't have any insurance, then that's the most they would bill you. The third thing that contract binds them to, and that's this, that they must submit the claims directly to Medicare. You don't have to file any claims whatsoever. They have to take care of that. That's part of that assignment contract. In addition to that, as they file the claims, they can't charge you for doing so. In the old days, people tried to do that. Cannot do that. It's illegal. So they file the claim to Medicare, no charge to you for making and taking care of that paperwork. And then number five here, they must wait for Medicare payments before they can bill you. In other words, Medicare has to pay this. So we have some of these balances that we talked about here that you're responsible for, because you didn't have insurance to cover that. Then they can bill you only after they receive that money from Medicare. Now, I will tell you this, very interesting. When Medicare pays, they pay quite quickly. And even though doctors are frustrated sometimes by the reimbursement rates, they like Medicare money because it does come very quickly. Usually, I mean, within a couple of weeks, and the supplemental plans usually pay within a week. And so that's why many docs continue to take Medicare, even though they'd like to have more reimbursement rates, they take it because it helps their cashflow in their practice. And just the fact, that's the way it works. Okay. So again, they're going to have to wait to bill you until Medicare pays. And lastly, notice this, they must accept, these assignment doctors, they must accept any Medigap policy, whether you have an F plan, a G plan, N plan, whatever you have, they have to accept it, and they have to accept it from any insurance company. So when you stay in traditional Medicare, and you're dealing with a participating provider, and you have a balance to the bill, and you have a supplemental plan to cover that, or most of that, then that doctor will take that. Now, they don't have to take advantage plans, but under this contract, they have to take your supplemental plan and company of choice. So we know that as a group, the majority of doctors are certainly going to take Medicare. And certainly those that are specialists, why is that? Well, because it's the older population, by the way, I'm part of that older population. And we're the ones that tend to have more illnesses and really serious health issues. And so we're the bulk of where the business is done. However, sometimes primary care physicians have others that are younger than the older population. And so the question is always, can I find a primary care doctor that's going to take Medicare? Certainly most specialists will, but what about primary care docs? So here's the way it stands today. And again, these are the most recent statistics out. They say right now that 93% of all primary care doctors, because we looked at specialists and different people in these different fields of medicine, but primary care doctors, 93% of them are actually taking Medicare. Now what's interesting about that though, only 70% of them are accepting new patients. The other 30% are not probably because they already have enough patients within their book, their group where they're already taking Medicare. And so they may limit how many Medicare patients they actually want to serve, just because again, of those low reimbursement rates. And just so you know, Medicare pays about 80% of what a normal insurance company would pay. Now they pay quicker than what other insurance would pay, but again, about an 80% rate. So a lot of doctors will say, I can limit how many patients I actually can see that are going to be billed through Medicare. So again, 70% that we're still accepting new patients. Now, what we find in our business is that if you have a relationship with a doctor and they're taking your insurance from your group plan or your individual plan, and then it's time for you to go on Medicare, almost always you're just going to stop billing the old insurance company. Now that you're on Medicare, they will remain to be your doctor. Okay. Every now and then we'll see them drop, but usually not. So again, there are plenty that are accepting Medicare and still plenty that are taking new patients. All right. So how can you find out if your doctor takes Medicare? The easiest thing to do is to call them. Now, if you don't have a doctor, you're looking for one, this is a really good tool. You actually can go to medicare.gov on their main site. And they have this system called Care Compare, and you can put your zip code in and it will actually, and you can tell them what kind of provider you're looking for, maybe a dermatologist, an OBGYN doctor, maybe a primary care doctor. And they'll actually pull up the doctors that are participating doctors and actually take assignment. All right. So great tool to go to if you're looking for a doctor. Hey, if you've come to the place where you know, you're gonna have to make some Medicare decision pretty soon, and you want to make the right one, one of the best ways to do this is to go down below and you'll see in the comment section there, the very first pinned comment at the top, you can actually click on the link there and you will book a call. And you'll book a call with one of our Medicare guides, all the guides with our company, I have personally trained them. They're professional, they answer all your questions, and they'll show you your Medicare options so that you'll be confident in your decisions. Let's get back to the video. Now, I think it's very important as we talk about providers to make a distinction between original Medicare and Advantage plans. So let me clarify this because you need to know this because about half of all people today have Advantage plans. And that's a different system. So when we talk about participating providers, we're talking about those that take assignment, those are under that annual contract with Medicare, to follow those rules that I laid out. Okay, now, when we talk about Advantage providers, that is going to be different. Advantage providers now we're talking about, by the way, these are called C plans or Medicare Advantage plans, because all of these have HMO or PPO networks. So you have to find out will your provider take that particular plan if you do enroll into an Advantage plan. So it's not about participating in Medicare, it's about participating in the network provided by that particular Advantage plan, meaning they're under a contract with that Advantage plan. So you can go to that particular provider. So let's see the differences. So when you decide to enroll into an Advantage plan, you're actually going into a network either again, like I said, an HMO or PPO. And so what I want to show you on this chart is this. So when we talk about Medicare doctors, we've already seen that 99% of all doctors take Medicare. We know that 93% of all primary care doctors take Medicare. But what happens if you enroll into one of the Medicare Advantage plans, where you're dealing with an HMO or a PPO plan, you have a 22% chance to have a network that looks like this. These are all doctors that take Medicare, but not necessarily your Advantage plan. So basically what you have with this particular situation with 22% of the Medicare Advantage plans on the market, and right now most markets have about 40 different plans, 40 plans. So we're saying about eight or nine of those plans, this is what your network would look like. Even though most doctors take Medicare, you're going to see they're not going to take Advantage plans. So in this situation, you have 70% of doctors that are in network and 30% of doctors that are going to be out of network. Even though they take original Medicare, this is the way it's going to look. And again, this is going to be 22% of the Advantage plans that are on the market will look just like this. All right, now let me show you another one. Again, same thing. We're talking about Medicare doctors that take that original Medicare system, 99% of them do. But what happens with Advantage plans? Well, in this chart here, notice this. Here we have 70% out of network and only 30% of all the doctors that are available in that area are going to take Advantage plans. And this is what your Advantage plan network is going to look like 35% of the time. So again, if we got 40 plans that are available to us, 35% of them will look just like this. Only 30% of those doctors are taking them. All right, now let's look at another scenario here. Okay, again, you're enrolling into an Advantage plan, HMOs and PPOs, and it's about 50-50. And so what we're seeing, though, all the doctors, 99% take Medicare, now about half are going to be in and half are going to be out of network. So it's about 50% here. And so this type of a situation is going to happen in about 43% of all the Advantage plans in that market, right? So if I have 40 plans available to me, I'm going to have about eight or nine of those plans are going to look like this. And this right here, I have 40 plans are going to be available to me. So if I'm on an Advantage plan, 35% of those plans in my market, which in this example here is going to be anywhere from about 14 to 15 different plans, I'm going to be able to see about 30% of the doctors that are available in that area, very, very few. And then 43% of the plans, which is going to give us anywhere from about 18 to 19 different plan options, we're going to see about half the doctors that would be available will be in my particular network. So then to answer the question, are you going to be able to find Medicare doctors? Well, again, you can see, it just depends on what kind of insurance plan you're going to use. Because if you decide to stay in a traditional original Medicare A and B and get a supplemental plan, 99% of all doctors are going to take Medicare as well as your supplemental plan. But if you choose to take an Advantage plan, that C plan, that replacement plan, it's going to look different. So that's why you got to take the time to make sure that you're picking a plan where you can see the providers that you want to, because some are going to take them and some are not going to. And so here's a very interesting stat. I'll close with this. 50% of all doctors, notice this, will accept some Medicare Advantage plans, certainly not all of them, but some of them. So you have to make sure your doctor takes your plan if you go with an Advantage.